Philippines 2007


(Click photos to enlarge)

Blog by Margaret Kolm
Photos by Margaret Kolm


Day 1

We have arrived in Guiuan, East Samar!
Our little caravan of vans and trucks finally rolled into Guiuan (pronounced "ghi," rhymes with "key"-wahn) on a dark, rainy night. It's 6:00 pm Saturday night here in Samar and 5:00 a.m. Saturday morning in Kansas City.

Most of our crew started their journey Thursday morning. It's been a long trip - 48 hours of travel, with a break of only five hours to sleep in a real bed in our Manila hotel. Our transportation has ranged from trans-Pacific jets to vans on dirt roads. Everyone is exhausted. We still have another 45 minutes of bumpy driving to our accommodations.

Nonetheless, as soon as we arrive in Guiuan, the clinicians head to the local hospital to assess the facilities where they will be working for the coming week. Their reactions are mixed; conditions are definitely different from a U.S. hospital! The OR crew is pleased to find stable tables. As the anesthesiologists examine their equipment, I examine a gecko on the wall of the operating room.

I don't know about the gecko, but everyone else here is very excited about our arrival. A welcome banner and a crowd of residents were waiting for us at the hospital. Now we are heading to a dinner hosted by Mayor Kwan, and then (at last!) to bed…

Day 2

We woke this morning to the sun rising over the ocean. Glad of the good weather; we have a busy day ahead. The agenda for today includes unpacking and set up, screening of surgical patients, and an educational session on using native plants to combat malnutrition and vitamin deficiency.

Unpacking and setup is no small job. Over the past months, the team has been hard at work in Kansas City. In our Saturday packing sessions at the MMF warehouse, we collected all the materials for the mission, ranging from surgical supplies and equipment to medicines to toys for the children in pre-op. The volume is astounding! Close to 50 shipping boxes were shipped ahead of time. In addition, every team member carried at least one large bag. Our international flight had a per-bag weight allowance of 70 pounds; many pushed that to the limit!

Needless to say, all of these supplies are costly as well as bulky. MMF is lucky to receive many items as donations. Relying on donated goods means that we don't have a fully-stocked operating room or pharmacy, but the doctors and nurses are very "resourceful" (in the words of Vicky Herrera, R.N.) in treating the patients with the supplies that are available.The 50 boxes were waiting for us at the hospital. When we added the luggage that we carried it made a mountain of supplies to unpack, sort and organize!

Meanwhile, in a tent outside the hospital, the surgical screening team got to work. By the time we arrived, a mob of patients was already waiting. Many had walked for miles, some starting the day before. The need was obvious. One of the first patients into the tent was Jerito, a shy little man with a huge cyst on his neck. Jerito seemed scared – who wouldn't be? – but even more desperate for help.

Meanwhile, in the Mayor's Office, Dr. Tony Racela, Lydia Dr-Ragos, Michelle Messina and Henna Fuller are taking a different approach to health. Dr. Racela has noticed the number of diseases that are caused or aggravated by poor diet and nutrition. He would like to prevent these problems, not treat them. As he tells an attentive audience of townspeople, "it would be even better if we did not need to make these missions." Because most of the patients here are very poor, many living by subsistence farming, Tony's team has researched native resources that are available at no cost. Michelle and Lydia demonstrate the use of leaves from a native tree, the Malunggay, as a dietary supplement. Malunggay is rich in vitamins and minerals.

Back at surgery screening, the number of patients is almost overwhelming. How can we send a patient like Jerito on the long walk home, only to return in a day or two? By mid-morning, the surgeons spring a surprise on everyone. Rather than waiting for the official mission start on Monday morning, they will begin minor surgeries immediately after lunch. Of course, there are a few challenges. Supplies are still being unpacked. Worse, the town is experiencing a "brown out" – no electricity. The hospital has a generator, but it only has the capacity to maintain vital equipment. Luxuries like surgical lights aren't supported.

It's time to be "resourceful." One surgical team sets up by a window to use available daylight. Another drags extension cords through the corridors to power lights, anesthesia and suction machines. Jerito is brought into pre-op. The mission begins!

Day 3

This morning the mission officially started treating patients in all venues.

At the end of our first full day of care, we are up and providing many services. Surgical screening continued, in a tented shed outside our base, the Abrigo Memorial Hospital. Surgery was conducted on seven tables. We got the most out of two anesthesia-equipped operating rooms, running two major surgeries simultaneously in each. Minor procedures were done in the Lions Club Mobile Surgery Unit (literally an operating room on wheels!) and in two other rooms in the hospital. At the end of the day 50 patients had been treated! Fifteen major surgeries including cleft palate repair, thyroidectomy and a hernia repair. Ten patients had cataracts removed and 25 minor procedures, such as removing a cyst, were completed.

We also conducted a general medical clinic for adults and children. The clinic was originally to be hosted at the Rural Health Clinic, also in Guiuan. When the crowd of patients turned out to be too large for that facility, the clinic was moved to the community center. The doctors saw conditions of all kinds, from asthma to tuberculosis. Over 250 patients were treated in clinic. Eyeglasses were distributed from the Lions Club Sight and Hearing Mobile Clinic on the hospital grounds.

The team from Candon, Philippines did vision testing and distributed reading glasses to over 750 patients. Operating from a tent outside the mobile clinic, EENT consults and minor surgeries were going on inside the van.

What was the day like? Exhausting, but exciting. In every location, crowds of patients seeking care greeted us. Whether they were waiting patiently or noisily asking for help, they created a pervading sense of urgency. I was impressed at how the clinicians handled the situation. They really pushed themselves to treat as many as possible, but without compromising the quality of care. Cora Zamora R.N., in surgery, confided her biggest worry for the day - whether she would be able to give each patient the best possible care and attention. From what I saw, she did, and every team member matched her high standards.

Of course, we had some challenges. Heat - I don't know whether it was worse to be sitting in the sun at the eyeglass clinic, or swathed in gowns in the operating room. It was hot, wherever you were. Electricity - Father Adz, our local coordinator, reflected, "Ah yes, electricity. Our challenge here in Samar." Luckily, the surgery staff was given a few minutes of advanced warning before a couple of blackouts that briefly plunged the operating room into complete darkness!

With so many different services in so many locations, we in the non-clinical support crew were kept busy running communications, patients and charts. We're lucky to have a great quartet of drivers/support staff (organized by Father Adz) who shuttle us around and are extremely resourceful about tracking down what we need. After acquiring every available bottle of bottled drinking water in town, they organized a run across the island for more. The operating room celebrated when Schubert obtained some ice and a tub from his own home, so they could cool their drinking water. One thing that didn't seem to be a challenge at all, was integrating a diverse team. Volunteers from the US, Manila, elsewhere in the Philippines and the local East Samar community all worked together enthusiastically. Each newly assembled team had to be "resourceful" in figuring out how to manage workflow. By the end of the day, all the locations were running smoothly.

I think we all feel pretty good about today. We're looking forward to tomorrow.

Day 5

Arlene is a beautiful young woman, and intelligent, too. She just completed college in a neighboring province, majoring in computer science. Unfortunately, at the age of 23, Arlene's neck is disfigured by a huge goiter. She is so sensitive about this condition that when she was offered a job in the municipal office after graduation, she turned it down.

"People stare at my goiter," she explained. "I am too embarrassed to work in a public office."

Dr. Ben Tumanut explained why goiter is so common here. The very poor cannot afford to buy rice, the national staple of every meal. In its place, they dig cassava root, which grows easily in the area. "Cassava root is poison to the thyroid," Dr. Ben says. Combined with poor nutrition, this creates a high incidence of goiter, especially among women of childbearing age and beyond. Arlene's goiter is unusual, even in this community, for its size and for her young age.

"If it were caught early, Arlene's goiter could have been treated with a six-month course of medicine," Dr. Tumanut noted. At this point, however, the thyroid is so enlarged that there is no option but surgery. Dr. Arnel Tolentino, general surgeon and mission volunteer from Manila, told me that a thyroid operation costs over a thousand dollars. Even a working-class family that can raise the money would make tremendous sacrifices. "If a family pays for a goiter operation, one of the children cannot be educated," he said. Arlene and her parents were near the head of the line of waiting patients when we arrived on Sunday. On Monday, Dr. Tumanut performed a total
thyroidectomy. As Arlene was taken from surgery to the wards after the operation, her new, slender neck was already visible. For the past few days, Arlene has been recuperating in the hospital, getting stronger every day. Her parents stay in the ward with her, as do the families of the other six patients in her room. (It was intended as a five-patient room, based on the number of name slots by the door, but now houses seven.) The relatives camp on cots or improvise sleeping pads on the floor from cardboard or palm leaves.Arlene's parents take turns fanning her face. It must provide a little relief from the stifling heat in the room. For the first couple of days after surgery, Arlene could only smile when we checked on her. By today, she can whisper.

"Thank you," is what she says, again and again.