Highest honour for the Australian doctor David David who changed the face of surgery

When Professor David David met Xu Fei, the girl had a vast cleft in the middle of her face.

Professor David David has been awarded the Tessier Medal. Picture: Morgan Sette

When professor David David first met Xu Fei, the little Chinese girl had a vast cleft in the middle of her face that meant her eyes were splayed out towards her ears.

The nine-year-old had a condition called Cohens Syndrome, and even the best Chinese surgeons were unsure how to correct it.

So, in 1983, Xu became one of the first Chinese citizens permitted by Beijing to fly abroad for surgery, travelling to Adelaide for the first of two operations at the Australian Craniofacial Unit, founded by Professor David in 1975.

Xu Fei before the operation.

Xu Fei after the operation.

As with all his work, this wasn’t some self-promotional exercise by a big-name surgeon, but a serious learning experience for the Chinese, who sent their own team to South Australia from Shanghai’s 9th People’s Hospital headed by legendary Chinese surgeon Ti-Sien Chang to watch Professor David and his fellow medicos in action.

“I have always abhorred the idea of dashing off somewhere to operate on the natives. It is patronising in the extreme,” Professor David told The Australian. “It is about sharing knowledge and helping other countries develop the skills to which they aspire.”

The operation on Xu had to be conducted in two stages, 12 years apart. The first operation in 1983 brought Xu’s eye sockets together; the second in the mid-90s moved her face forward and rebuilt her nose when she was mature and had stopped growing.

Xu was one of the thousands of patients on whom Professor David operated in the course of a five-decade career.

Now 78, Professor David has retired from surgery — “I don’t cut people up anymore,” he says ­drolly — but he has just registered the highest honour of has career, being awarded the Tessier Medal for his international contribution to crania-facial surgery.

The honour is especially poignant as it is named after the late Frenchman Paul Tessier, the ­father of modern craniofacial surgery, under whom Professor David trained in the 1970s.

“It was frontier stuff back then,” Professor David tells The Australian. “Some of these ­patients died. But it was vital that a new way was found, because up until then these poor children were being consigned to mad houses on account of their malformations.

“I had just graduated from the University of Adelaide and was in the UK and Tessier was doing amazing work in France. He was the talk of the day. We would get telegrams saying he would be ­operating in two weeks’ time and I would head on over. He didn’t take the slightest bit of notice of me. He was single-minded and wholly focused on his work.

“The most important thing Tessier did was that at a time when people were saying: ‘How do you do this?’, he came along and said you do it with team work. He ­assembled a team. It was hugely important because up until then there would even be actual fights in the operating theatre between brain surgeons, eye surgeons and plastic surgeons. It was one big ­demarcation dispute.

“Tessier said it had to be about collaboration. He would say: ‘We can’t operate unless we push the brain back a bit.’ The brain surgeon would say: ‘Can we do that?’ And Tessier would reply: ‘Pourquoi pas. Why not.’ That’s our logo. Why not. That’s where we all started.” Despite hanging up his scalpel, Professor David continues to serve as chairman of Craniofacial Australia, is a consulting professor and runs his own medico-legal business.

He laments the fact that there are only two cities in the world, Adelaide and Dallas, with fully dedicated craniofacial units that focus exclusively on these operations, as opposed to what he calls “boobs and bums” surgeons who predominantly perform cosmetic surgery and do crania-facial surgery on the side.

Aside from campaigning for a national cranio-facial unit in Australia, Professor David regrets the fact that the bottom-line pressures of public health are undermining whole-of-patient care.

“The bureaucrats want to turn our work into a Medicare number and say, here’s the line item, we will slot you in there. That’s not the way it works when it comes to complex issues like this.

“When Tessier was doing his pioneering work, he was shifting this surgery away from being all about technique, to being all about understanding pathologies. In World War I, when you got your face blown off, fixing that was a technique.

“But when you have these serious cranio-facial malformations, it’s not just a question of going in and fixing them. You have to have a team of people that works ­together on every aspect of the condition.

“If you look at something like a cleft, it has a microcosm of all the issues in it. It is a bony abnormality that goes right through to the base of your skull. You are missing teeth. Your upper jaw is small. The base of your nose is twisted. You can’t speak properly. And then ­because you can’t clear your auditory tubes you are often deaf. So you have all these other issues requiring all sorts of experts. It’s not just a magical operation.”