06-JAN-B-7
LAUNCH THE
WEEK OF SURGICAL WORK AT BBH, MALAYBALAY, BUKIDNON, PHILIPPINES WITH MY FOUR
PROTÉGÉS IN BETHEL’S HOSPITAL SETTING NOW THAT THEY HAD STARTED OPERATING WITH
ME IN THE SOMEWHAT MORE PRIMITIVE ENVIRONMENT OF TECH IN SOUTH COTOBATO,
CLIMAXING IN
THE GRAND MMI/BBH
CELEBRATION
EVENING
January 23,
2006
OPENING DAY
AT BBH
Thirteen cases on our opening day at BBH, as we begin our week with a devotional program and a “lovefest” from the staff many of whom recognize me from the multiple return trips. They are rehearsing a “Fellowship Evening” for Thursday night, which they are able to pull off in extravagant performances of excellent choral performances, even theatric dances and pageants of historic and patriotic as well as religious enthusiasm. And, to top it off with a still higher omen of good ambience, the world featherweight championship boxing match was held yesterday in Las Vegas and the Philippino champion, carrying the hopes and pride of the “Pinhyos” worldwide through the Diaspora in which they are scattered, won the title.
Our struggle has been no less heroic if less well paid, since we are trying to do what we can while being overfed and adulated excessively. Yet, a few more rabbits have come out of hats as we have done a bunch of goiters and a thyrotoxic patient, a radical hysterectomy for endometrial carcinoma, a large ovarian cyst, a hemithyroidectomy for cancer, and several other general surgical cases which have exercised the staff and the students I had brought along now in their glory, flexing what they know and what they can do. At one point I was going to present Alan with the printout of the text “Surgery and healing in the Developing World” when I found out that the students who were intent on studying it had “lost” it along the way, so I have not been able to deliver the text I had sat through the entire printout form my computer on the pdf file download. But, as Leslie said, she has learned more in these two weeks than she has in medical school so far, which is when John Sutter added, “that’s why I keep following him into such places, since each trip is worth more than the medical school experience altogether.”
In
between cases and at the lunch breaks I have showed them pictures form each of
the experiences from Somaliland to
SECOND DAY IN OR AT BBH
Breakfast was followed by a personal story of her life and testimony by Alison Froese and preceded the first of a number of goiter thyroidectomies. I did a large and meaty goiter with Monique Hopkinson who had started out “So, this is my goiter for thyroidectomy?” It wrapped around both the esophagus and the trachea so this would not have been an ideal medical student’s first operation, but she is undeterred! I then did one each with each of the other students and launched into a further goiter which I had thought was like the rest, and found it to be a recurrent one after prior thyroidectomy in 2004. So, that was an interesting operation that went well. But then came the piece de resistance—a five year old girl from the high hillsides brought in by a man who identified himself yesterday ad from the New Tribes Mission bringing in a young girl with a burn contracture for operation.
The young girl Angelica is uncomplaining. Her left arm is plastered tightly to her side, and she has a web contracture holding her elbow and forearm to her scarred chest. I could see that she was looking for the first stage in a multi-stage operations series which would have the elbow release by Z-Plasty be one of the easier ones, that cold be done when I am not here. The tough part was a double contracture, both anterior and posterior web contractures of the axilla, which had cemented her arm to her trunk rendering her still good hand functionless. She had been in their hut when the kerosene lamp that had been swinging overhead fell and burst setting fire to her and the hut eighteen months ago. She is still granulating some parts of the denuded area of full thickness burns. I tried to envision the next stages of the operations she would need and avoid compromising those that were to come, so I would raise no flaps or take no skin grafts each of which will have to be done on the next operations. So, I sliced up the posterior web, which I knew I would be able to close primarily, and then started working on freeing the arm up to the shoulder to allow full range of motion there and get primary closure at all but the elbow where there was still granulation and at the upper arm where it did not compromise the axilla. She could then have a later graft to the area of the burn that had never epithelieliazed along with a Z-plasty release of the elbow and another piece of the skin graft to the upper arm, which would not contract as it had in the axilla. It was a challenging creative kind of resolution to the problem of what kinds of problems do I run into in the outback that might forever change someone’s life for trying to intervene, and as the before and after photos will show, that I believe we have launched well.
We all do what we can. Out in front of the hospital this morning as I went along creaking my way to the OR like a very old man because of the stiffness in my lower extremity muscles from the climb up Mt Kitanglad two days ago, I saw a “tuck tuck” parked in front of the hospital. It had several decals of daffy Duck and Spiderman and other icons, and beneath that a sign which said Rev. Arcadia, Operator. So, a rickshaw drive preacher and an operating anthropologist and a group here in the middle of Mindanao rehearsing their special numbers for the Fellowship Program in honor of the MMI visit are all amateurs doing well what they like to try to do.
I will have to try to pop a few Motrin and get over the stiffness and disability inflicted upon me by the all straight up steep Mt Kitanglad, where no one had ever yet heard of the switchback, since it is a long straight uphill plane to the top. So, besides having had a birthday in the course of this trip, I am moving around as if I had aged a decade, since my quads and all muscles below the waist are warm tense and stiff, so that I can stand in one place such as in the OR, but can barely move up or down on stairs or even a slight slope. So, it is good that I have a couple of days recovery before going out to do any kind of exploring—even so far as to try to cross the street to see if I can get to the Internet Café to send these messages.
THE FORESHORTENED DAY ON WEDNESDAY
1/25/’06
We have had
a chance to make a few plans for our withdrawal here on Friday after the big
“Fellowship Night” program on Thursday night.
John Sutter is keen to go scuba diving so a special arrangement is being
made for him to leave form Cagayan de Oro on a van and a boat to get to the
reefs. Lindsay and Lesley are eager to
get back sooner rather than to walk off the pane like zombies and go directly
to class, so that they would have a better chance to get back to GW, and they
are moving it up for a change fee for both PAL and the
The
arrangements that were made to change their flights for two of the students
came through an email to Lindsay Eisler’s parents who are currently in
Wednesday is usually a half day at BBH, and if I can move my stiffened sore lower extremities I will see if I can make a brief excursion into the Forest Province’s rainforest across streams and off to a freshwater pond. I will get back to moving about slowly with a bit of Motrin.
THYROIDECTOMIES AFTER THYROIDECTOMIES:
ASSIST EACH GWU STUDENT WITH A FULL
DRESS
THYROIDECTOMY FOR GOITER OR GRAVE’S
DISEASE
1/25/06
I started
the day typing up a letter to the Eisler family about their daughter Lindsay
and the special “private patient” Evangelica she will be following. Lindsay suggested I write and accept the
invitation to visit them this summer in mid-July when I might be traveling through
I scrambled
to the front entrance to set up for a posed picture for the group of the MMI which,
of course, as always was four students short, so we have to do it over again
tomorrow. But the one good thing I was
able to do was to open the computer with its limited access to the internet to
see if I could receive, review and delete a few of my emails in the account
since I have been away. I learned that
there were two drop outs who had got to this point before deciding to scrap the
ALL DAY OPERATING WITH A THRYODIECTOMY
FOR EACH OF MY PROTEGES AND INTERESTING FOLLOW-UP ON POST-OP PATIENTS WHO ARE
ALL DOING WELL
Each of my students joined me today in goiter operations: Monique early and bold, having to be restrained, but technically ahead of the others, Lindsay doing a swift hemithyroidectomy for a goiter before a luxurious lunch climaxed by green mandarin “oranges” and then a large goiter thyroidectomy with John Sutter for a climax for him. Lindsay managed to get the letter to the Eisler family through the email and we will correspond later. I also had the “Mexican Fire Drill” of the MMI Group Photo repeated from yesterday, where we finally got everyone together but then had to alternate photographers and photographed behind a banner. Now we await the extravaganza of the Fellowship Program tonight than the staff has been rehearsing for us for weeks.
THE LONG-PLANNED AND WELL-EXECUTED
PRODUCTION
OF THE BBH-MMI “Fellowship NIGHT”
AN EVENING OF SINGING, PERFORMING AND
CULTURAL DANCING AS A FAREWELL TO OUR TEAM AND A HOMECOMING FOR VIVIEN AND DON
The
production was a major feat of choreography, song and special events to thank
the MMI team, and we were feted well with a lechon de leche and all the
fixings. Don and Vivien Van Wynen were
here who go after 52 years of service by Vivien, the one who had first written
to me and invited me twenty years ago to come well over a decade ago. They will be going to a retirement complex
in
The carefully orchestrated program consisted of contributions form each of the BBH teams in full costume. We, the MMI team sang a song and also put on a slide show in Power Point that Poppy Casino showed with his newly learned tricks of the Power Point. At his age of 72, he was convinced when he saw my laptop about eight years ago that he should try to do the same in learning than technique, then got into digital photography, and we have been hazing each other about this advance into a new millennium ever since. He is also trying to learn the guitar—so who knows what is next for me? He also has made a foundation, the American Foundation to Aid the Poor, which continues to make contributions to the well-being of this area, as MMI gave an anesthesia machine a new OR light, a new OR table and an X-ray machine for Tiboli. Good things are happening, and their own young surgeon Bon is learning to do the cleft lips and palates with the instruments that they are donating for the purpose.
But each of us were invited to say a few words, and even my students contributed in kind when they had seen the whole Mindanao historic pageant and sung the songs and got the warming reception of the BBH staff. It was a very genuine series of exchanges in which all were edified and we still have another operating day to go! We will be packing up and leaving for Cagayan de Oro after the last of cases tomorrow, which will get us into the return mode of travel which is the conclusion of our stay here.
LAST OR DAY IN BBH, AS WE PACK UP AND
LEAVE FOR CAGAYAN DE ORO, WAYPOINT FOR OUR ONWARD JOURNEY TO MANILA AND THE LONG RETURN HOME
1/27/’06
The evening’s events, a grand climax for a year of planning, did not mean we were not going to have to try to accomplish a shortened list of final cases this morning.
Even after the big production
number last night in which every one of the BBH staff had been involved, we got
up this morning and proceeded to do seven final cases to be finished by noon for
yet another extravagant lunch. The first
case was, of course, a thyroidectomy for goiter, which may have marked my third
or fourth dozen of these in this mission.
I had also done the first of two “broken wing” girls, each with a web
contracture of their upper extremities to their thorax in tight burn
contractures. Angelica –my little
angel—was so sweet and happy, we were all eager to see what could be done for
her. I had one final case to do before
her and that was a very instructive fistula in ano, in which the sphincters
could be seen and the fistula probed with the internal crypt abscess identified
and a fistulotomy carried out for immediate relief of the patient’s
problem. We then turned our attention to
Angelica to see what could be done to address her elbow contracture since I had
released the upper arm to mobilize the shoulder after it had been frozen in
place for the last eighteen months. The
result of the prior procedure was really quite good, but the extent of the burn
was such that we could not get good triangular bases for the two flaps that
would constitute the “Z-Plasty” release and reconstruction. So, we debrided her granulation from the
areas of the burn and also cleaned up all other areas that would be grafted
later and made for a higher probability of success of the next stage when she
is returned in five days for split thickness grafting to the burn sites and a
Z-plasty through better vascularized skin flaps. This was our “climax case” in BBH and brought
to 107 the major surgical cases we had done on this mission in addition to the
732 teeth extracted from 406 patients.
Without dwelling on numbers, that is a lot of lives touched and poor
people helped, and by even conservative numbers in multipliers means about a
third of a million dollars of free surgical care (with no estimate whatsoever
as to the value of the dental care delivered) from this very efficient
mission. We would have our final review
of the experience form each participant later tonight, but we first had to have
yet one more extravagant lunch with good food and lots of it. We are at high risk in
PACKING OUT AND TRAVEL TO CAGAYAN DE ORO
WITH THREE STOPS FOR SCENIC SIGHTS,
BEFORE ARRIVAL IN THE MARCO RESORT
1/27/PM/06
This
concludes the surgical extravaganza of our two weeks of intensive activity, a
week in the Tiboli area and now a week in Malaybalay. We will see what comes of the plans for next
year in which we may schedule back to back missions involving my being here
five weeks with two teams rotating through, with the first two weeks being the
repeat experiences just done in Tiboli and Malaybalay and then a brief break
centered in Manila and a forward to Leyte and Atlan, with or without the Palowan
mission that has been planned if I can arrange some of the fuel and funding on
my layover in Manila forthcoming. In the
two days at