Exploring Bayawan

Bayawan --

Went to a private little spring called “The Source”.  Apparently during WWII, this spring provided water for families in hiding from the Japanese and provided water for the city of Bayawan for many years after.  The land is now privately owned by a prominent family in this area, and they have created a small fresh water swimming area here.  Families can picnic, bring their own food, take a swim in the cool fresh water surrounded by one hundred year old trees.  It was very peaceful.

Swimming hole at "The Source"

"The Source"

We borrowed a motorcycle from a neighbor and along with my cousins and friends visiting us from Bacolod, we drove to a neighboring barangay (town) called Kalumboyan.  This is the location of my mother’s family farm of sugar cane, rice, and mango trees.  This little village is approximately 15km, across a mountain range that was fully equipped with waterfalls, gorgeous scenery, and a nice drop in temperature!  The countryside is too beautiful for words!  I’ve never seen a green like this- so alive, fresh, bright, contrasted with the blue of the sky, and specs of bright pink and red bougennevilla  along the roadside.  The road was cement, clean and smooth all the way. We passed a few other motorcycles carrying entire families,  “carabaw” (water buffalo) being ridden by his owner and hauling a load behind him, or people walking alongside the road while carrying loads of water or a child on his shoulder.  There were plenty of farmers stooped in the fields.

Helmets are for football!

The road to Kalumboyan 

VERY old church in Kalumboyan

Cousin of "Gus" the carabaw 

The houses are built right along the roadway here.  Most are nipa huts that are on stilts.  They are small.  I’m sure one of these simple houses would fit nicely into any of our garages in the US.  They remind me of the little playhouse I played in while growing up- one bedroom, dirt floor, makeshift furniture out of whatever you had around,  tiny play curtains in the windows.  The difference is that an entire family actually lives in there.  There are clothes hanging in the trees and bushes surrounding the homes.  I’m not sure if they have electricity or gas, but I see people cooking over outdoor flames quite a bit so I don’t think these folks need it!  We even passed women and men doing laundry by hand in the river over the rocks.  What amazes me is that people here are so detached from the rest of the world.  They don’t know any other life.  They have no idea who Brad Pitt is, or what Modern Family is, or who Lady Gaga is, or what the Twilight series is.  Do they know who President Obama is?  I would guess they probably know who the local politicians are, as I do see some political signs here and there hanging on the electrical posts.  The world here is all about self-sustenance. People grow or raise what they eat.  They drink from wells or natural springs.  They raise their kids, feed their families.  It’s so simple.  

Farmers at home in Kalumboyan 

Outdoor "dirty" kitchen

Motorcycle repair shop, downtown Bayawan

We Americans seem so wasteful and frivolous by comparison.  We think we need so much more than these people.  Is that bad?  I know that since I have seen with my two eyes what poverty looks like, I feel more conscientious about the way I spend my money and my time. Do I NEED this or do I WANT this?  Is what I’m spending time on important?

Joel says I shouldn’t feel guilty about buying anything.  I work hard too and because of that, I’m given the opportunity to come here and give to others in different ways.  Tonight, we gave P100 to a girl who was serenading customers on the sidewalk outside the bakery.  This is  more than a day’s wage for some and that’s equivalent to $1.50.  I was told that farmers make approximately P200 (almost $3) per day, but they split that between all the laborers that work that day. Could your family live on $1-$2 a day?

Exploring the market with cousins (girls directly in front of Christine)

Shopping for fruit at the market

One of the most touching moments  actually happened in Labo and it was about shoes.  Joel became friends with the security guard of the hospital there.  His name was Mr. Allan.  Before leaving, Joel handed him a plastic bag stating that it was full of hazardous material.  When Mr. Allan opened the bag and realized it was Joel’s pair of Mizumo trail running shoes, he almost cried.  I think Joel just made a ‘pare’ (brother/friend) for life!

Joel's new "pare"

A treasure from a new friend

Here’s the thing though-  giving to others brings more to the person giving than the person receiving. 

The Beauty of the Philippines

Low tide

The beach at "Fun-ta-sea"

Future mission plans

Exhausted today.  We travelled for most of the day, beginning with a 7am departure from Manila, which meant we woke up at 4am to get there in time.  The Nino Aquino International Airport has a little coffee cafe where Joel and I had our first taste of Kaya toast.  Why hasn’t this made it big in the states yet?!  It’s a coconut jam, or as I call it- “yumminess in a jar”.  And they had the best powder Korean coffee!  The barista asked if I wanted condensed milk or evaporated milk, and since I don’t really know the difference, I randomly chose one, and I have to say that coffee beats a Starbuck’s syrup-y coffee any day!  I bought some and will fix it for you if you want to challenge this, along with the Kaya toast.  They have a poster on the wall that says, “If you want a skinny latte, just drink half a cup” and I thought that was a good one!

Super Yummy

The flight into Dumaguete was nerve-wracking.  Dumaguete is located right on the coast and the landing strip begins just beyond the water edge.  The plane has to descend to nearly landing on the water before actually touching down literally right at the edge of the pavement just as it rises from the water.   Then the pilot stopped on a dime.  Apparently this is a short runway and recently it was lengthened.  I wanted to cheer.  

We were escorted by a counselor of the city of Bayawan to the hospital for a tour.  This district hospital is like heaven after being in the Labo District Hospital.   It has two functional operating rooms (although never used except by outside missions because they have no anesthesiologist), a labor and delivery room, a lab/xray department, a pediatrics department, a med/surgical department, and even a dentist!  They only have five or six physicians total for a town of almost 500,000.  The hospital is a fifty bed capacity hospital, but we were told that it runs past that capacity at all times.  I believe it- there were patients placed in the hallways, and even in the back patio area with their IV bottles hanging from hooks on the awning.  Beds were not covered with sheets.  

Mission statement of Bayawan District Hospital

Next mission, January 2013...  Who's with us?

Overflow "wing" in Bayawan.  Notice the IV's?

Bayawan District Hospital

Dumaguete is a quiet city, with a very laid-back feeling to it- like in Hawaii, but not expensive or full of tourists. It is surrounded by mountains and is on the southwestern tip of Negros Oriental, and on the shore.  Most people that live here make their living from farming or fishing.  There are people walking, riding tricycles, pedicabs, and motorcycles. Traffic pattern is just as crazy as in Manila, but to a smaller scale.  How do little kids here play in the streets and avoid getting run over?  In the US where there is no traffic, but all the traffic safety rules, kids still get hit by cars!  We should learn from this.

Joel and I went to the market.  I love this place.  After you get used to the mixture of smells from fresh fish, dried fish, fresh pork, fresh fruits and vegetables, and all the spices of course.  I think the market is exciting, and the sights, sounds, and colors are amazing.  I love talking to the farmers and fisherman and learning about their wares.  These fish were caught today.  These vegetables were picked today.  These fruits were picked today.  These people work hard for a living to provide for their families.  It’s admirable.

Produce market.  bags of oil, soy sauce and yummy veggies

Dinner.... Freshly caught, chopped and eaten! (Swordfish)

There is so much beauty that surrounds this sleepy little town.  The beach is pristine, untouched, undeveloped.  Fisherman have simple boats that line the shores.  The sunsets here are picturesque.  It’s lush, green vegetation yields so many fantastic things to eat- mango, papaya, star apples, banana, guava, coconuts- and this is just in our backyard!  We are here during the rice harvest so there are farmers in their fields bent over, bandanas covering their heads, hand-cutting the rice.  The fields are golden yellow when they are ready to  be harvested (I learned this fact today!.  It’s beautiful.

Lovebirds on the beach in Bayawan

Sunset in Bayawan

Coconut trees

For the next medical mission, this location is ideal- plenty of room for our needs.  I can imagine where we would have patients register and wait to be seen.  I can see the operating rooms being used to their capacity by our team.  I can see the people we would be serving and I know they would be grateful to have us here.

Joel's new friends

Possible future patients..  Baluuuuuuuuuuuut!

Medical Mission Day 4

Day 4.

Joel and I left the hospital at noon today.  We are traveling to Naga City which is 90 km southeast of Daet.  Naga is the closest airport to depart, from which we can catch a flight back to Manila so we don’t have to travel by bus for 12 hours again.  We are going to Bayawan via Dumaguete City in Negros Oriental (an island in Central Visayas)  to discuss future  arrangements with the district hospital and local officials there regarding the 2013 Medical Mission.   Yes, it has somehow fallen on my shoulders as the incoming president of the Philippines Medical Society of KC to set this up!  For those of you who don’t know, my mother is originally from this town of Bayawan, and she chose the site for the mission so she could ‘give back’ to the community that helped support her early in her youth.  With dad being too ill to travel, the responsibility landed on Joel and I to make the right connections.

Traveling in the Philippines is not easy.  This country is made up of 7000+ islands, not all connected with roadway, or interstate, or cellular phones, or airlines, or rental car services.  If you can figure out what the main cities are on the island you are traveling to, then the next step is to see whether there is a plane or a boat that can take you there.  In our particular situation, there are no direct flights to Bayawan as this is a small town.  There are no direct flights to Dumaguete.  We are back-tracking back to Manila on the last departing flight of only TWO flights leaving Naga, to fly to Manila THEN Dumaguete, THEN find a ride to Bayawan which is another 2-3 hours drive south.  Follow it on a map.  AND because there are only THREE flights leaving from Manila to Dumagute, we were forced to spend the night in Manila and take the first flight the following day.

Our travel route...... so far!

There are 12 people on this pedicab!!!! (no, this was NOT our mode of transportation)

Can you tell I’m a little frustrated?  This is because it forced me to leave the mission one day early.  I can’t just get in the car after we are finished on Friday and drive to our next destination within a couple of hours.  I felt horrible leaving the mission early.  When we left, there were still hundreds of patients waiting to be seen.  I left only 2 physicians and 1 nurse practitioner in the outpatient clinic to see these people and triage them.  With me there through the week, we were already seeing close to 100 each per day.  How many more patients can one person see in a day?  I know the mission team will all be staying late tonight to accommodate them all.

Today, the number of patients has grown.  Again it is a sunny day.  Temperature is probably in the lower 80F range.  People are okay with waiting.  They will wait all day.  We move them from the street into the tented area on the front lawn of the hospital, then to the front waiting area in the hospital for registration, then to the final waiting area where vital signs and their list of concerns are taken.  It’s amazing how incredibly patient everyone is.  No complaining about the heat.  No questioning on how much longer it will be.  No bickering and  demands to quicken the pace.  We buy ice cream for the kids, give out candy, toys, and make balloon animals to help keep the mood up, although honestly, I saw only smiles on those faces waiting to see me.  

Step one... Wait at outside waiting area

Step two... Wait at first indoor waiting area

Step three... Wait to be seen (finally) at second indoor waiting area

  

I saw a sweet woman today with her husband and daughter.  She looked completely emaciated.  She was only in her 40s, but looked in her 80s.  She complained to me about hoarseness and abdominal pain and vomiting with every attempt to eat.  She was so weak that her husband had to practically carry her in.  Without anything but my clinical eye, I would say she likely has an end-stage GI malignancy with metastasis to her lungs (they sounded wet with fluid), and that the tumor in her abdomen was causing some obstructive symptoms to eating.  When she asked me what her diagnosis was, I told the family I suspected she had terrible GERD.  I gave her what acid-reducing medications we had, pain medications, vitamins, and some medications to improve her appetite.   They were very satisfied and grateful for my advice when they left.  I don’t know how much longer she will be alive, but I hope I made her a little bit more comfortable in her last days.

There was also this 5 yo boy who came in with his mother with a “bump on the knee”.  It had been there for over a year.  Mom thought he had fallen initially, but the bump never resolve.  It only grew, caused pain, and for most of the year, he had not been able to walk due to pain and inability to straighten his leg.  This “bump”  was a baseball size bony mass just above his left knee.  His calf and thigh muscles were atrophied from not using this leg.  I’m sure he will be diagnosed with osteosarcoma, which is a bone cancer that can affect children this age.  I could only advise the mom to seek a specialist’s advice at the Provencial Hospital, give him pain medications, and treat some spots of impetigo that covered his scalp and other knee.  Mom never asked me what I thought the diagnosis was, but she was tearful.  In reality, they will likely not have the money to travel the distance to this hospital, nor get the appropriate testing to make a diagnosis, much less treatment.  It broke my heart.

Worried mom

"Bump" on the knee

I was able to help one child- a 18 month old little girl named Princess who had a “bump” on her neck.  It began as a bug bite and slowly grew over three weeks.  She came in with a fever of 103.9F.  This “bump” was  an abscess the size of a cutie orange just under her jaw.  I gave her a shot of antibiotics, set her up for I&D (incision and drainage), and gave her plenty of antibiotics to continue at home after surgery.  She will likely spend the night for observation  after surgery with her entire family sitting on the bed right there beside her and a ward full of patients and their families.  Mom was very grateful for this treatment.

Abscess

And then there were the unknowns-  

Rashes that I did not recognize... I will post the picture and maybe my Dermatology and Infectious Disease friends can help me on that.

Unknown rash - Any guesses?

Now onto planning for next year....  Who's with us???

Labo Medical Mission Day 3

Day 3.
Today we were greeted by a front lawn filled with patients waiting for us to arrive.  I can guarantee that most of these people have come from afar and have already waited in line since dawn to ensure a visit with us.  Our team now functions like a well-oiled wheel.  Everyone moves into their department and begins working.  I am amazed at how well we all adapted to our meager surroundings and have just made it work.  "Make do."  That's the motto here.
It's sunny today.  I think this drew out more people.  I know it made our little Outpatient Clinic room stifling hot and humid.

I wish everyone back home could see how different this world is here.  The hospital has no running water.  Now I realize this sounds ridiculous for a hospital.  When the water does run, it's important to keep the buckets full.  This way you know there is always a reserve of water somewhere.  The basic needs such as running water and electricity are not always met.  One of our team members bought a battery for a generator that was not functional and hadn't been functional for quite some time, but he couldn't let our plastic surgeon operate on anyone without that.  There are 'brown-outs' during the day and any interruption of electricity when a patient is under general anesthesia would obviously be a disaster.  In one room, another one of the team members bought an air-conditioner for the OR so the surgeons didn't have to operate with sweat dripping off their brows onto a sterile field. There's not really a way for us to improve the water system without digging up the entire city.  As of now, the only source of water entering the hospital is through one pipe the size of a water hose.

HOSPITAL water source!!!!!!

Lots of interesting patients came through the clinic today.  A 54 yo. man came in today with large deformities on his joints.  He reported that he had gout, but no medications for treatment.  These were the largest tophi I have seen in person.  It's what I have only seen in textbooks.

Gout tophi

We also had 2 kids and 1 adult with chicken pox, and at least 2 kids with measles.  Immunizations are not routine here, nor are they required for school.  I'm glad I am updated on my shots.  These kids  were ill.  There's not much we could do for them other than educate them on preventing spread of infection to the rest of their family as well as their entire community.  The secondary infections following these illnesses usually cause more problems more than the initial illness- dehydration from diarrhea, malnutrition...

I saw a 6yo boy who had wrecked his bike YESTERDAY and had a deep gaping wound on his lower leg.  He walked into the clinic with his mother, removed the dirty scarf tied around his leg, let us evaluate him, then tied it back on.  He went to OR for wound debridement and closure.  They would not have seen a doctor for treatment had we not been there.  They travelled from quite a distance.   He did not cry a single tear.

Needs to learn to ride a bike better!

A man was rushed into the hospital mid-afternoon.  He was unconscious.  The local hospital staff nurses performed chest compressions for a few minutes, then stopped.  He died right there in front of dozens of patients watching.  No code was called.  No epinephrine.  No heart monitor.  No mad dashing...  I heard he had a stroke while at work in the fields.  Several of us from our team gave his family some pesos to help with funeral expenses.   Personally, Joel and I gave P500 which is equivalent to $12 and that was a significant amount for the family.  His body lay on that gurney in the hall uncovered for 2-3 hours with his widow standing over him before being moved into the family's home.

God bless this man and his family

I saw quite a number of children with extensive scabies head to toe, with secondary bacterial infection; one infant had cellulitis and fever of over 104F for 5 days before coming in!  Mom cried.  Normally this child would've gone into the pediatric ICU, Infectious Disease consult, IV antibiotics, etc... all i could do is one injection and oral antibiotics plus educate the family.

Scabies

The surgeons removed a number of very large tumors today-  I wonder how such small malnourished people can grow such large tumors.  One older man had a growth on his neck that was almost as large as his head.  Another patient had a growth on her back the size of a grapefruit.  The reason for this I suspect is that there is no money to get evaluated, much the less, have surgery.

Wow!

The last of our team arrived back to the hotel at almost 10pm- that's a 15 hour day!  We all just work until the work is done.  There are so many people to serve.

Grand totals:  Inguinal hernia repairs-3; emergency cesarean delivery for surprise twins- 1; major gyne surgeries- 3; tumor/cysts/lumps excised- 40; pairs of reading glasses provided- 150; patients seen in outpatient department- over 400;  Rx written/OTC meds dispensed- hundreds;  Largest tumor 'delivered' 7.5 lb ovarian cyst.

I'd say that's another productive day.

Happy to be here

Christine seeing yet another patient

These people are waiting to see any one of three docs

Dr. "Gamy" writing notes after a surgery

Ambulance, meet chicken... Chicken, meet ambulance

So cute!  Waiting to see Doctor!

Emergency C-Section for twins