I am awakened early by the sound of the bird-life all around me, with dueling roosters on either side of the mat-walled house. As I have risen and started the day with the long list of many cases awaiting, I have set up this laptop with the almost reliable electric source allowing the use of this machine. It turns out that when ever I am moving around, it wakens the attention of two sets of people: the army guards who are supposed to cover me like a blanket, moving around me to assure a safe zone around me as I work. The second is Don Van Weynen, who is eager to visit with his guest and tell stories about WWW II. I try to get a little private time each day to continue this note to you, as well as keep up with the audiotapes and film supply of recorded events, such as the Tboli cultural festival put on for us yesterday. Last night, Vivien told the nurses what I had heard a bit about before, the Tboli people being here at this South Cotabato area, when the Visaya, the dominant language group in the Philippines, were moved down to Mindanao as a resettlement of the kind that has happened world-wide with the over-population of peoples migrating. The New World populated by Europeans, the US now colonized by Latins or Asians—including especially from here, and the dominant economic group overwhelming the indigenous group that may have been able to live in their own environment, when they are no longer adapted given the new element of a superior culture—superior in numbers mobility, aggression and numbers—which was the reason they got started moving around in the first place.
A MORNING STARTING
LINE-UP,
“OUT OF AFRICA”:
FIVE MOUNTAIN MEN, THREE MOUNTAIN WOMEN
AND TWO LOCALS, WITH HUGE GOITERS,
EACH OF WHOM WOULD NOT HAVE THEM BY EVENING
Like “old times;” here I am surrounded by the group of highland mountain folk who have come a long way, each with a sad face, trying to be stoic, but trembling with emotion. They have been brought down by the TLDFI (Tribal Leaders Development Foundation, Inc) truck after they have walked about three days out of the trails in high mountains. They have had hope since seeing the first of the post-op patients from the earlier missions coming back without the goiters they had gone to TECH with and had come back telling about the miracle in which they had been separated from them. No one could tell quite how it happened, but they were wiling to have it done under local or whatever means it took to get rid of it, once they knew that it could be done by someone willing to do it, and by some further miracle not only did it not only cost them anything, but their food, transportation and care for them and their family or accompanying persons were also cared for here by the same people who would be working day and night on them. So, this new group of patients is all lined up, and we pose together for pictures. They hardly dare to look up, and hardly dare to hope—but they see the first one going in to the small room, and emerging a bit later—lying flat with all kinds of tubes and things clustered around them, apparently lifeless, carried over to a common room where there are pallets soon filling up. By noon, the pallets are filled up, but then the people are no longer lying down with the tubes sticking out of their mouths, but are getting up and walking over to the ‘loo”—and giving a toothless smile with thumbs up that they can move their heads back and forth without the big obstructing goiter that had prevented them from swinging their heads around before. They see me, even hidden behind a mask, they know whom it is, since they had glanced furtively at me before when we had posed for the pre-op pictures. Can you believe? They implicitly trust this man help them with white skin, strange clothes, who speaks a language they understand not a single word, and he, they believe, can help them through this process—without having a single clue in the “informed consent” process. TECH, being a charitable undertaking that could be eliminated by one cleverly counseled mishap is now using a sheet of paper—the patient’s entire record. On it, it says, I agree to whatever the staff of TECH has planned for me, and I will hold them harmless for any consequences that befall me! It also is marked with a thumbprint right beneath that statement, giving the foreign surgical staff carte blanche to do whatever their agenda carries them here to do.
We started with several of the men. The goiters were huge, and several had veins as big as my thumb, engorged like stuffed sausages. It is a wonder we did not get into big trouble, and we did get close to it on several occasions, but—and here is the miracle—they all did well, and were up and about when we left, having exhausted the team and the expendable stuff of operating room environments—even the ersatz jury-rigged type. Glory be! It is a good day, having accomplished more than they—and we—could have imagined. .
The team from Bethel Mission Hospital in Malaybalay was the key to our efficiency. Alfred the quick and always ready jack-of-all-trades, is nurse anesthetist, and automatically a fill-in utility player who without even a word, only a rapid glance, knows what is happening, what is needed, and the problem is solved. Don, a very efficient anesthesiologist, is fun to work with, since I know his routine, and at the induction of anesthesia, when the patient is intubated, it always seems that four hands are needed connected to one central nervous system. We could do this with a dance of hands without even realizing whose hand it was that did what.