THE ARRIVAL AND WELCOME CERREMONY AT TECH,
THEN EXAMINE PRE-OP AND FOLLOW-UP PATIENTS,
SOME WITH HUGE GOITERS, AND PREPARE FOR THE SURGICAL
WORKDAY AND WORKWEEK WHICH BEGINS IN THE MORNING
January 12—13, 2003
We landed in GES (GenSan City) on the Airbus 330 “under the command of Captain Culan Culan” and were met by the first of our security contingent, a squad of regular Philippine Army in full battle dress with weapons ready. We were also guarded by the chief of police and his team in purple blue camo fatigues, and two plainclothesmen rode along with us. Despite these large numbers we had tow stops to make on the three hour ride in four vehicles—one a flat bed truck filled with out bags and a group of soldiers—we would be stopping at the fruit stand and the house in Marabel where Bing and Wani’s son Norman was staying with his brother as he went to school to attempt to send an email that we arrived.
THE PINEAPPLE SURGEON
Our first stop was at the fruit stand along the volcanic loam fields harvested (and planted) daily by Dole, with all the bananas, pineapples, jackfruits, and lantanas that I remembered well as emblem of the tropical luxuries of the fruits of the Philippines. We could see the volcanic cone of Mount Matatum behind the fields of perpetually picked pineapples, and I remembered one of the deft women who could carve a pineapple into segments in a few seconds flat. I took pictures of her operating, and told her again that she had a better set of hands than any of the operating surgeons I had worked with. She would cut off the top and bottom of the pineapple, then core it in a flurry of juice, and stick the blade in about one third of the way up the side, and push out the segments while pulling out the core. We did not simply watch here work, but consumed her produce, and sampled all the different fruits we could pick from the piles of fruits on display. All of us together, including the soldiers, eating down great quantities of fruits as I had on my first visit here, came to less than six dollars US
FUTILE EMAILING ATTEMPTS
We pulled up at the home of Wani’s son Norman and the others who looked after him, and he logged on to the Yahoo dot com account and the first two messages by others went smoothly, even if slowly. When it was my turn, the machine reliable crashed, and I had to begin over again. I had typed up everything I had needed to send announcing our arrival and also could send the reports of Florida and Cumberland Island—but only one attachment or at most two could be sent. One message made it out announcing arrival, as the cursor moved on a blank screen as long as ten minutes after I had typed. But, when I tried to send the text files of the trip to Mindanao to this point, the “illegal maneuver” sign came up and the machine crashed---only after all the effort had already been put into the transmission, crashing only after the “Send” button. So the futility of trying to send a message from a remote location in Destination travel—the one set of circumstances when it would be most useful if reliable—proved again, that the email I try to send is a wonderful convenience, failing in its reliability only when it is critically relied upon.
On arrival in Edwards for the remolded and expanded TECH (“Tboli Evangelical Clinic and Hospital”) of TLDF (“Tribal Leaders Development Foundation”) we found lots of patients of the scores already trucked in, and volunteers from TECH and environs ready to help in the start of our “three table operating team.” The group from BBH (“Bethel Baptist Hospital”) in Malaybalay was here, along with Dr. Ragon Espina, who had been brought down from Leyte Gulf last year to operate with me in BBH to get him trained to “stand alone” in Leyte, a clinic of the Alliance Church as an offshoot of the BBH, this year celebrating fifty years in Mindanao. Vivien Forsberg and Don came over for the greeting and the welcome ceremony, and presented me with a calendar celebrating Wycliffe’s fifty years in Philippines, outlining the 93 languages they have translated and written into a text, TO and NT Bibles and dictionaries. This seems to be the fifty year anniversary of many organizations—as I had written the fifty year anniversary editorial for the AGD (”Academy of General Dentistry”), of interest to the oral surgeon John who was with us and for whom I had brought a large amount of the fluoride treatment for cavity prevention of school age children.
Already I saw goiters. One woman came to me before the singing even had started with about two kilograms of very solid mass in her neck, extending around to lymph nodes in the posterior. The repeatedly confirmed story was that this mass had not been there ten months before—a sign that this is not a goiter, but a rapidly growing anaplastic carcinoma, for which there is no treatment---in Mindanao or in Washington DC. There is nothing we can do for her, here, or there, and we will have to see what comfort she can get during the rest of her short life. A score of large goiters treated with a couple of injections of Lipiodal which we brought from Manila (where we met the oldest son of Bing and Wani when he delivered it from his apartment across from the Tropicana Hotel where we stayed, as he is studying medicine, as the other two kids are also hoping to do. After the welcome celebration and the introduction of each member of the team, we went to the clinic in front of the now remodeled “OR’s” (these warehouse rooms now actually have curtains instead of paper surgical gowns taped over the windows! And real anesthesia machines and patient beds trucked down in a container since our last visit!) I saw scores of new patients and a half dozen returning patients here for follow-up from last year’s operations. All of the latter looked good the former looked intimidating!
There were about thirty goiter patients for whom we had selected twenty to go into a triage for the first days operating, shrunk down by about a third after two Lipiodal injections and firmer with less blood flow. A few were still soft and could benefit from medical treatment first. We had said we would not run an exhausting schedule as we have every time so far, and try to start at eight in the morning but finish at six each afternoon. Right! With the unlimited supply of patients who would line up for free care, I do not see the leisurely schedule happening, now or any time soon! We saw a young man with undescended testes, a woman with a UVF (“Urethral Vesical Fistula” after a very traumatic childbirth) and a couple of general surgical procedures, and their were a dozen patients selected from youth to adulthood for cleft lip and palate repair. So, the first several full time days’ work will be a dozen goiters and clefts.
Wednesday, we will try to stop at noon, and go up to Lake Cebu, the center of the Tboli crafts where the woman lives who is featured in the video on “Dream Weavers” the one designated a “National Treasure of the Philippines” who had already produced for me the tapestry of the abaca fibers weaving when I had met her up there last two years ago. By special arrangement, she will be seen by us and will show us how she works, even though she does not like having her picture taken, will assent to this as a “Photo Op.” This will make each of the recipients of her classic work that I have accumulated over each visit very much tuned in on the source of her handiwork. After the evening “devotions” which followed dinner, and tonight consisted mainly of lengthy introductions of each to each by a self-testimonial, my recently purchased video of the “Dream Weavers” was played of our group on Bing and Wani’s VCR.
A SHOTGUN CUTS SHORT MY (LAST OF THE
GROUP’S) SELF-INTRODUCTIONS
The group was asked to say something about themselves in about five minutes each, and each took about four to five times that long. Several were Mennonites or Missionary Alliance—the one being Helen, born of Dutch parents in Russia when the Mennonites were thrown out of England and Holland and invited by Catherine the Great to Russia, until the revolution when they fled to Canada. Several of the members have been on previous MMI missions, but none had traveled as widely nor as often as I, including a few who were paid as staff on several missions. When it came time for my presentation (and Jennifer and Ragon had each said that I was the reason they were here) Ragon and I went to the clinic to see a mother and child, suffering, of all things, a shotgun wound. So, I briefly stated that I had started doing medical missions in the Dominican Republic as long ago as 1965 and had simply never quit.
The mother was holding the child apparently when the shotgun discharged, and had multiple pellets in here right knee. But the child had a soft tissue loss that was quite extensive, with a blast injury that took the skin and soft tissue down to the gastrocnemius muscle on the left for about six by eight inches. This needed debriefing like any war wound—an odd thing for a four year old to have to suffer. So, the first case of our trip was an emergency gun shot wound suffered by a child—an odd injury to have after the headlines were blaring that Mindanao was a dangerous and violent place. Vivien and Don had come over to say that my usual place had been all cleaned up and new screens put on it, but for security purposes the chief of police who came by to make my introduction had said he wanted the whole team inside a defense perimeter. Wani and Bing had remodeled their house to accommodate us all in bunk style dorm rooms, so we will be close to our work, eating and sleeping our surgical project here, until Friday when the Malaybalay team and an ambulance-load of referred patients goes up to BBH in convoy, and we will operate here with our reduced and all expat staff. We will then work in BBH for a week, and then Ragon Espina proudly escorts “his Professor” (who has brought a number of Board Preparation books for his study) up to his home town in an adventure across the water by rapid hydrofoil to his clinic to do a number of cases set up in advance for us, and then we sightsee around Macarthur’s landing site, before going on to Tacloban to takeoff for Manila and our return.
Hold on to your surgical scrub cap, we are on our way!