JAN-C-4
FOLLOWING A PRE-DAWN RUN AROUND THE
RAINFOREST,
THE FIRST FULL DAY OPERATING AT BBH IN
MALAYBALAY
BEGINS WITH A VISIT TO THE MAYOR’S OFFICE
AND A GIFT FROM THE CITY OF 130,000
CITIZENS OF THE BUKIDNON CAPITAL,
THEN ONE GOITER AFTER ANOTHER UNTIL WE
COMPLETE THE OR LISTS
FOR THE DAY WITH JOSEPHINE TANO’S
RECONSTRUCTION INCLUDED
January 20, 2003
I got up at five AM and put on the shorts once again for the run down the deserted main street of Malaybalay to arrive at the Kamulaon Park in the dark. The birdsong was just beginning in full chorus in the canopy overhead as I got half through the rainforest newly bulldozed road and circled back to return for our early breakfast, assuming an early start-up for our cases. But we had a mayoral summons, and you can’t fight city hall! So, I changed out of the scrub suit and into the street clothes for the reception by “Baby Doc” Mayor Flores. I had met him last year at that BBH/MMI celebration and pageant in song and dance of the origins of Bukidnon and its peoples. He was the administrator of BBH when Dr. Nelson, its founder fifty years ago was still active, and he shared the administrative duties with “Dr. Ruth” who is now the chief administrator of the hospital. So, BBH was and is the centerpiece spark plug of thief development in this formerly remote and isolated town and now marks a special spot in the mountain regions of Mindanao.
After we had talked with him and accepted his thanks on behalf of the people of the region, we had our “photo op” and only after the others had been on their way back to the small Philippine bus with two bench seats in back did I receive his special token, a Malaybalay keychain souvenir.
The small vehicles are a specialty here, with a number of pickup trucks and “AUV’s” (=”Asian Utility Vehicle”) which is smaller than an SUV and of a variety of brand names unknown to us since they are not allowed into the US because of the ire size. They are taxed on the size of their engines and a standard SUV would be a luxury vehicle that would have to pay very high tax, whereas the smaller “Cute Utes” get (translating km to miles and liters to gallons) over forty miles per gallon.. Mitsubishi and Isuzu are major suppliers of these vehicles along with a few manufacturers from the Seven Tigers of Southeast Asia I had not been familiar with before. We squeezed into one of these and made our way back to the hospital to begin our list of today’s cases
TEACHING CASES AND LEARNING CASES
Last year I had operated with Ragon Espina from Leyte Baptist Hospital, one of the four sister institutions of this primary one at Bethel Baptist Hospital. He had taken his exams in April of 2002 and now a new young female surgeon is being recruited to be the surgeon at one of the hospitals in this system—it is hoped it might be BBH, since Alan lives in Cagayan de Oro to preach in the starting churches there and commutes sown to Malaybalay by bus in order to operate two days a week. Janet, the young woman resident at BBH who is now a qualified surgeon and with whom I had operated in Tboli and BBH over the past two years was the full time resident surgeon here until last months when she left to go abroad for a three year contract in ---of all places—Bahrain. She had gone there to learn laparoscopic surgery techniques and also to make more money than shed could in the Philippines, but, again, it is hoped she might return to BBH, especially since Alan is tending less to a career as a surgeon, and more to the ministry, just as his wife Blessie, a qualified veterinarian is giving that up, in going up the phylogenetic scale, into nursing!
Janet had carried with her my Study of Surgery and other board review books to take her exams, so Alan had emailed me to carry a new set of these books with me for this trip, so that both Ragon could study them in Leyte, and now the new younger female doctor Jovi could also get prepped for her April 30 exams in Manila. The first time Janette emailed Dr. Ruth back from Bahrain, she exclaimed: “You will not believe who is well-known and highly regarded here in Bahrain---Dr. Geelhoed!”
The Suleiman University is headed by my former colleague whom I had visited the last time I was in Saudi Arabia and then the last time I was in the Middle East including Bahrain, Dr. Abdul Wahab, formerly a fellow for a short period under Tim Harrison in Hershey, PA. The new American University of the Middle East in Bahrain is headed by Dr. George Abouna, and Iraqi originally, but a long-term resident of the US and transplanter whose applications for Kuwaiti grant support I had once vetted. He and I were also the external examiners for the Kuwait University in 1996. I hope the person she is speaking well of is Abdul Wahab, and not the Iraqi heavy handed power-craving Abouna.
The plastic surgeon from Sebu City, Dr. Morella Majares, who last year had come down by ferry overnight to Cagayan de Oro and then by road to Malaybalay to operate on the four patients we had carried up by ambulance from Tboli was coming today to operate on them in their next stages of reconstruction. Also coming by air from Manila and then by road courtesy of a drug rep, would be Dr. Jovi, to come to operate with this team.
But, by the time the first goiter came to the OR, there was no one around to be trained, since Ragon was next door to operate on the large hydrocele that a patient from Tboli area had tried to reach us to have fixed, and had arrived too late, so he was willing to hop into the ambulance and ride up to Malaybalay, an eight hour ordeal over “roads” not worthy of the name—and even more importantly, is willing to ride back the same way, post-op being jounced around. So, I simply DID the thyroidectomy on the goiter, assisted by OR nurse Wilma, also known as Wing. “Have you ever wanted to do a thyroidectomy, Wilma?” I asked. “I am a nurse, Doctor.” So, I did a thyroidectomy in less time than the emergence from the anesthetic post-op. I consider this fun enough, but a waste of a teaching opportunity, so that the immediate patient benefit is present, but not with any lasting effect beyond this patient—so the next goiters were all done by my assisting Jovi doing them.
Also done were an ovarian cystectomy, a prostatectomy and Vesical stone, and two cleft lips and Josephine. Josephine had had her first stage last year, and was now here to have a nose constructed in a first stage of what will be a multi-stage series. So, we have finished a number of cases today, which will look almost identical to tomorrow, with goiters and special plastic reconstructions alternating in the OR with a large number of miscellany patients who have waited for our arrival. But, I now have a pair of surgical trainees, so that I can teach thyroidectomy thoroughly as well as the variety of cases that may come through the door. I was introduced by Alan as the “ OR Mentor and Tormentor of each of the surgeons who will be trained in our trip—by the greatest Surgical teacher of any Professor he has met” in the introductory session with the BBH staff this morning before we were whisked off to the mayor’s office.
So, I hope I have a hand in passing along some expertise in perpetuity, to make the surgical care here sustainable. At least, I have improved the quality of thyroidectomy in Bahrain!