medical mission: 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.