Participating in a Legacy: An Opportunity to Contribute

by Jeremy Kauffman

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I first had the opportunity to participate in a mission with the World Surgical Foundation in February, 2016 when I was invited by Dr. Alvear to accompany him to the Philippines. I was in my second year of surgical residency at the time and for a number of reasons was thrilled for the opportunity to go. The first reason is that I love to travel and experience new places and meet new friends. The second reason is that I am always excited for the chance to take part in a charitable mission that benefits people who are in need.  And finally, it had once been a goal of mine to become a pediatric surgeon, and I was excited for the opportunity to assist Dr. Alvear and his colleagues in the Philippines with some of the pediatric cases that were planned.  The trip did not disappoint. Not only did I have the opportunity to participate in dozens of surgical procedures on both children and adults, but also was fortunate enough to travel to numerous cities and towns and make many new friends along the way.  Perhaps most significantly, I was inspired to once again consider pursuing a career in pediatric surgery – a dream that for various reasons I had temporarily set aside.

I again had the opportunity to participate with WSF on a mission to La Ceiba, Honduras in October, 2017. This trip had special significance for me because my parents had once lived in La Ceiba and had told me stories about their experiences there. On this trip I again had the opportunity to assist with many surgical procedures performed for patients who many not otherwise have been able to afford medical care.  Moreover, I was again blessed to meet many new friends and reunite with a few whom I had met in the Philippines.  The icing on the cake was the opportunity to meet one of my mother’s former students who had gone on to serve as the minister of health for Honduras.  We concluded the trip with a relaxing day on one of the beautiful islands off the Honduran Coast – a perfect way to conclude an exhausting but incredibly fulfilling week.

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I am grateful to the World Surgical Foundation not only for all that they do to provide healthcare to underserved communities in the Philippines and Honduras, but also for the opportunity the foundation has given me to learn and to grow during my residency training. I am especially grateful to Dr. Alvear, who graciously invited me to participate in the mission and has served as a mentor to me in my desire to become a pediatric surgeon.  As it has been said, there are those who talk about the problems in the world, but do not have the will or wisdom to find a solution. Then there are those who have both the will and wisdom to solve the world’s problems and dedicate their lives to making the world a better place. And finally, there are those who fall into the latter category, but in addition take the time to mentor others along the way, so that their impact is not limited to their own generation but continues on for generations to come. This is the legacy of Dr. Alvear and of the World Surgical Foundation, and I am grateful for the opportunity to have played a part.

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The World Magical Foundation

World Surgical Foundation could be called The World Magical Foundation. On my third mission with ‪#‎WSF‬ and second in Honduras, there are hardly any words to describe what happens here. For example there is an anesthesiologist running two beds at the same time in the same room. And the surgeons coming on these missions are not only donating their time, skills, and supplies, but also paying their way. They are teaching local surgeons new skills and showing them how to use new technologies. It brings tears to my eyes just thinking about the lives saved every day WSF is here at no cost to any suffering man, woman, or child. Suffice it to say this is real magic.

Thursday night Dr. Domingo Alvear and the entire team stayed from 7AM until nearly 10PM because of their compassion and dedication; no-one left Hospital Regional Atlantida before the last case was completed each member pitching in whenever and wherever they could. Whether a patient is on the schedule or a medical emergency that happens to arrive while WSF surgeons are working, everyone is diagnosed and treated with the same care and collaboration the World Surgical Foundation is known for. Since I arrived in La Ceiba, the pure-hearted volunteers and doctors here in Honduras, or when I went to the Philippines, are tirelessly on the job from sunrise to sunset. That still blows my mind.

Veteran members of the 2015 Honduras surgical brigade know missions always come with their share of “issues” from local logistics and supply shortages to machines not functioning at 100%, but the group solves each problem or finds a way to fix or work around faulty equipment to continue changing people’s lives. This mission in La Ceiba was no exception, but the World Surgical brigade performed 21 surgeries on day one and completed more every day after. WSF doctors and volunteers work harder than any foundation I have ever seen, and I am honored to have been a part.

-Mikaela Lannan

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Final Day of Brigade in San Pedro Sula

It saddens me to arrive at the tail end of the first week WSF is in Honduras. Undoubtedly there were many medical miracles performed in a collaborative effort by this year’s San Pedro Sula brigade in perfect fusion like a symphonic jazz orchestra. International travel is never easy, but one look into the five operating rooms occupied by World Surgical at Hospital Nacional Nor-Occidental Dr. Mario Catarino Rivas, and you’d never know some of the volunteers are here for their first time. The doctors, nurses, and ancillary staff were all calm, cool, and collected.

But it doesn’t take more than a few minutes to settle into the day’s task: to pack up and wrap up everything in the stock rooms and ORs for next week in La Ceiba. Since this is the first time WSF has extended its surgical brigade in Honduras to a second week, everything must go. Limited by the number of volunteers and the amount of luggage allowed by Delta, we cannot afford to donate anything to Catarino Rivas this year. Even the incoming team from the U.S. was not exempt bringing extra luggage containing emergency supplies packed at WSF’s warehouse this week. What World Surgical doctors always leave behind are the techniques, some new and some old, teaching the locals how to do a procedure with limited supplies and in less time. I believe it is safe to say anyone involved in a mission with WSF walks away with at least a few new pearls of wisdom at the end.

Today I got to give a small, 5-year-old angel a teddy bear from the stock of toys and gifts left after a week at the hospital. Her eyes lit up like it was Christmas Morning, and she danced with me in celebration showing her appreciation. It was a wonderful moment, if only it could last forever. So I went back to the stock room and picked the biggest and brightest handmade pediatric gift bag I could find along with whatever personal hygiene products I could fit in for her mother. Did I mention somebody donated coloring books?! How good it feels to give, even if it’s just my time? It’s indescribable. Watching and experiencing the generosity of the other volunteers all week is a life lesson I could not learn anywhere else.

Exhaustion from the red-eye coupled with soaring energy being a part of such an extraordinary group, I am still up and ready for dinner. The food is fantastic in San Pedro, and the people are always so happy; when I was told S.P.S. is the murder capital of the world, I found it hard to believe. Despite the poverty and loose ends in the third world, Hondurans have woven all those ends into a beautiful tapestry or bright family centerpiece. Or at least that’s what I see. Maybe it’s because they are a culture that takes time to appreciate the small stuff, enjoy the food, and siesta in the afternoon.

Just the thought reinvigorates my gratitude to be on a World Surgical Foundation mission. As a life-long volunteer, hands-on volunteerism is in my personal and familial constitution. Sometimes that means signing up at a local soup kitchen in Los Angeles on my day off, but every once in a while, the seed inside that loves to give freely of my time and energy lands me in San Pedro Sula, Honduras to not only observe and write a close-up account, but also to contribute in any way I can possibly changing a life. It’s a gift! One you all can have, too by giving of yourselves at every opportunity. But don’t be surprised at how quickly it comes right back . . .

–Mikeala Lannan

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Philippine Reflections

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I have returned to the States, and once again, I am so amazed by the World Surgical Foundation’s work and commitment. Upon my return I was so wiped out. The jet lag alone was brutal, but WSF doctors, nurses, and volunteers are back to work without complaint. Admiration is an understatement. Surgical missions are exhausting, and I don’t know how they do it. . . . The only conclusion is the passion they have for doing this and really making a difference gives them a superhuman energy.

Reflecting on the three weeks spent in the Philippines, I just can’t express adequately enough the important work done there. Being a part of changing the lives of so many sick and dying patients was beyond beautiful. World Surgical Foundation does so much, all at no cost to the patients. Just the simple fact that over 200 people lives are changed forever makes my heart sing.

The World Surgical Foundation is a real, honest, and generous foundation. What WSF does is unbelievable, and there is so much more to be done around the world. This is why we do not just go in, preform surgeries, and leave; our doctors also teach the local physicians to improve the care patients get when we are gone.

After participating in two missions, I have been inspired to go to nursing school so I can actually help medically in the ORs or PACU. Seeing a young boy get his life back as a result of WSF, being in the operating room, helping any way I could . . . just being there alone was my gift, but I want to do more.

-Mikaela Lannan

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Day Four Talavera

I was once told that the things I take for granted . . . someone is wishing for right now. After all I’ve seen in the last few days, there is no denying this statement. Volunteering on this WSF mission has engrained it even deeper, when I think times are tough . . . it’s nothing compared to what the sick and brave here have to deal with daily. There are even children and adults who craft colostomy bags out of soda bottles and other receptacles or just diapers. If one can’t afford the medical supplies, they must make their own.

After surviving one of the biggest natural disasters in history, the Philippines is a country rebuilding itself, stick by stick. And the people are as well. I am frequently shocked by how willing and strong they are, rebuilding their shanty homes and doing all of this with an air of gratitude and happiness.

World Surgical Foundation has preformed over 70 major surgeries in three days. Dr. Domingo T. Alvear didn’t stop there. At noon on Wednesday a group of us went to the main hospital down the road, and Dr. Alvear spoke to surgeons about appendicitis and lowering the cost of an appendectomy. He lectured once the appendix is ruptured all that is needed are antibiotics and pain medicine as the organ will break up and dissolve internally.

His lecture was followed by Dr. Rolando Mindiola to share his knowledge of minimally invasive surgery and the importance of laparoscopic surgical techniques. The goal here is not only to preform operations, but also to teach the local medical professionals how to do modern, quick, cost-efficient surgeries with a low loss of blood and minimal scarring.

Being a part of this mission is not just a blessing, an honor and a privilege, but the beginning of a career path I never would have been exposed to as well. Since I was a child, I did community service on my own volition. When I see a family come into the hospital with a child or other family member in total crisis and the next day leave with smiles of relief, I am flooded with indescribable gratitude. I know I’ve helped in making a difference in the quality of this person or child’s life. After seeing what WSF does, I will without doubt be picking up my service at home and abroad.

-Mikaela Lannan

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Day Three Talavera

With each passing day here things are running smoother and smoother. The coming ins and going outs are like clockwork. Dr. Lester Suntay is the coordinator of this mission locally and the Filipino contact on this side of the earth for the World Surgical Foundation. He is an admirable man to say the least and cool as can be under pressure.  He has a dry erase board that’s a perfect daily schedule. I asked him today why he does what he does, and his response was simple, “It’s for the patients . . . . It’s my calling.” I totally understood that. With six operable beds remaining full and post-op patients shuffled down for recovery the day keeps moving along.

Today was an emotional day for me. I didn’t come down here with the expectation that working in a run down hospital, in a country ravaged with devastation from Yolanda, and in living conditions less than sanitary, was going to be easy to digest. Every time I walk out of the operating theater and see the families of the patients on the ramp, with huge eyes looking at me for some sort of indication on the progress of their loved one . . . so many emotions flood. First off, I want to hug everyone and tell them in a language I don’t speak that it’s all going to be okay now. But I can’t, because sometimes everything is not going to be okay. We are all doing the best we can every moment, using every supply donated for it’s need, and that’s fantastic. Again, I am beyond impressed by WSF, not just for doing this, but for doing it so vigilantly. Every minute scheduled with the obvious willingness to do anything needed at any moment. I don’t doubt if a trauma case came into the ER, WSF would work it in at no cost and ten times the quality of care. It’s just awesome.

I feel lucky to be a part of what is happening here. Deciding to volunteer on this mission, my second with WSF, was a “no-brainer”. I have an application in to go back to school and start my way into the medical field. My goal is to be a key participant in WSF operating rooms and take on the unaffordable health care in third world countries.

-Mikaela Lannan

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Day One Talavera

After experiencing Tacloban, I was somewhat prepared for the larger planned mission in Talavera. But once again, I am moved and amazed. The first day of the mission is called a “screening” day where people come en masse to get assessed, and the surgeons diagnose, schedule, and decide if they are going to be blessed with free medical care from World Surgical Foundation. When I arrived at the screening there was an unprecedented number of people at least 300. And my bleeding heart wants every single patient to be seen and receive the care they so desperately need. We anticipate 150 major operations and 50 to 100 minor procedures. Needless to say this week is going to be hectic and busy, but WSF comes to do as much as possible, and we will.

As the nurses and volunteers were setting up the stock room I stumbled upon something I couldn’t resist writing about. WSF team member, Dr. Chambers, has a daughter who took it upon herself to start a toy drive for the children in Talavera. I was so moved as he told the story to me.  Three days before the mission supplies were to be sent in boxes to the hospital, his 10 year old daughter took it upon herself to start a toy drive for the pediatric patients her dad will be working with. This little angel and her friends sent over three large boxes of toys.

It is really incredible that this child did all of this on her own. Having been on a WSF mission before I know what an impact these donations have on the patients going in and coming out of surgery. Because WSF does not bring back the unused supplies and donations. The amount of toys sent will most definitely outnumber the patients, so they will distributed long after we leave. I can’t say with enough emphasis that this 10-year-old girl with a heart of gold collected so many toys we won’t be able to get rid of them all. I believe she will be coming on missions herself very soon.

As far as the next five days go, we are going to provide as much service as 12 hour days will allow. This hospital has been retrofitted for WSF. Three operating rooms were divided into two operating rooms with two beds a piece and one room with three beds. Additionally there are five stations set up for the minor procedures. This gives us a possibility of performing up to 12 surgeries at one time, and with this team I trust we will surpass our expectations.

It is such a blessing to be a part of this mission.  I can’t thank Drs. Domingo and Veneranda Alvear enough for creating World Surgical Foundation. Not only for providing medical care in third world countries and donating equipment and supplies, but also teaching local surgeons and anesthesiologists while they work, giving the gift of skills learned over 50 years of medical practice.

-Mikaela Lannan

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The Accidental Mission

I am presently in the Philippines visiting Tacloban City Hospital with the World Surgical Foundation. We are here to check on the progress of the hospital rebuilding and determine what else WSF can do to help. This was supposed to be a simple visit with no major operations scheduled, but there is a young girl here today in need of an operation immediately to remove a choledochal cyst in her bile duct. Since this surgery was not planned, Dr. Alvear does not have all the equipment he would normally use like a harmonic scalpel or GIA staples. He will be doing it, “the old fashioned way” and expects to be operating for three hours.

As I watched her going under anesthesia, I got chills knowing this life is going to be saved or changed. Her pain and difficulties gone. I am going to watch her surgery because it is all just so incredible to see. Words cannot describe seeing this little body under the blanket with her tiny arm poking out. I have to hold back the urge to hold it. But it is soothing knowing that everything will be better for this little angel. I really understand now that having good health and good health care is such a blessing. I have to mention we arrived the day Pope Francis was leaving, and I believe this was no mistake. I say this because this first of three missions in the Philippines is already mind blowing, just the beginning of the magic. The World Surgical Foundation is making a difference one person at a time. This little girl will have a life she couldn’t have imagined before without cost. Not a even penny, because the hearts of WSF are ready to go.

The second case that hit me in the heart like a bomb is a sweet young mother with her baby boy who has an inguinal hernia. The procedure itself only took a half hour, but this woman, her brother, and child were displaced by Yolanda and live under a bridge. Homeless as can be, she works doing laundry for pesos. I could not let them leave here without giving them something. I was not going to let them just go back under the bridge. So I changed out of my scrubs and walked to a store to find some kind of useful gift before he was discharged. I remembered seeing a store on the way to the hospital that sold children’s bedding and bought a small mattress pad for her baby so he would not have to sleep on the ground.

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A city completely leveled by the devastation of Typhoon Yolanda, Tacloban is really picking itself up and moving on. I took a tour around town and was actually shocked at how the survivors here are generally happy, grateful, and amazing people. I have completely reassessed my views on what really matters. I am so grateful to be here. So grateful of the Alvear family for creating this movement. Because that’s what it is a movement. With all the tragedy around the world today, I believe people are finally starting to reach for something greater. And WSF makes it easy for volunteers to get there.

Next stop? Manila and then a long bus ride to Talavera on Saturday for a week-long, multi-specialty mission.

-Mikaela Lannan

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Surgical Day 5: “There’s always one.”

“There’s always one.” Sister Martin said looking back at me this afternoon as we hurried through the hallways of General Santos City Hospital, jumping from the OR to the PACU. We were walking fast and going through doctor’s notes, trying to figure out the discharge instructions of a post-op patient who had a total hysterectomy 2 days before. “The one” Sister Martin was referring to was baby Cyril, the little girl I will always remember. Cyril is one of the many young WSF patients that has been operated on during this mission and staying in the Pediatric PACU. Cyril, now 16 months old and her mother Marysol, traveled over 2 hours from Sarangani Province to have her unilateral complete cleft lip repaired. Cleft lip and palate repairs are usually simple procedures and are given a couple weeks after birth however in developing countries like the Philippines the cost of surgery is impossible for many. Cyril’s surgery was successfully completed on Monday evening (day 1 of surgeries) however due to a high fever she has been staying in the pediatric PACU a little longer than expected.

Cyril on day  waiting to be screened by WSFCyril getting ready for surgery

I’ve noticed that Cyril and her mother are usually by themselves unlike the other patients who always have an entourage of family members by their side. Due to the lack of resources and funding, GSCH does not have the same patient accommodations that we would expect to see in the United States. This makes the presence of family members vital to the patient’s well-being before surgery and recovery afterwards. During our 12 hour shifts together in the PACU I’ve heard Sister Martin, a highly experienced ER nurse, say repeatedly, “Now remember, you are the nurse now”, to family members who agree by nodding their heads as they listen closely to her instruction. The hospital does not offer meals so the patient’s relatives are responsible for providing breakfast, lunch, dinner, and water. There’s a water pump and makeshift wood stove outside next to the hospital building that families can use to wash dishes and cook food. In a small room filled with over a dozen other families, they share a bed with their loved one who is either waiting for surgery or who is recovering from it. They even bring sheets and pillows from home so their loved ones do not have to rest on a bare and dingy, thin mattress after surgery. The patients that the WSF serve are financially poor but they are rich in family however it seems to me that maybe Marysol and Cyril have neither a large network of family or money. Yesterday I witnessed a little girl run over to Marysol and kindly give her a mango to snack on. Marysol quietly whispered, “thank you”. The little girl who gave her the mango was the sister of another young WSF patient waiting to have her cleft palate repaired. At 6 years old, her mother had to pull her out of school because she was being constantly teased by her school mates for “talking funny”. Children with cleft lips and palates can not eat, drink, or speak properly, but they also face a social stigma that can sometimes result in staying home from school and isolation. Despite how hard each one of these families have it, physically and socially, they are still willing to help one another out. That is absolutely amazing to me.

Cyril after surgeryTrying to keep Cyril's fever down with a cool washcloth.

From screening day until now, day 5 of surgeries, I’ve been visiting Cyril every morning, afternoon, and before we leave the hospital for the evening. Usually when I visit, Cyril is either sleeping or very fussy. Every time I try to talk to her she starts crying, clings on tightly and hides her face behind her mother’s shoulder, making sure that our eyes never meet. I don’t know what it is but I do not think she likes me! I still love visiting her.  And I love visiting all of the children in the pediatric PACU but there’s something about Cyril that pulls on my heart strings. She reminds me of my daughter Sophia who is thousands of miles away from me right now. When Sophia, now 7, was Cyril’s age she was that same little girl who held her mommy tightly and wouldn’t dare give anyone else the time of day. Cyril has a head full of dark hair, big brown eyes and olive skin just like Sophia and they both have mothers who love them dearly. On Sunday during screening, I remember seeing Marysol holding Cyril in the crowded registration area. You could tell she was nervous about whether or not Cyril would be scheduled for surgery by the WSF team. When I introduced myself, she replied back quietly and had the sweetest smile. After Cyril’s surgery, I visited her immediately and exclaimed to Marysol how beautiful Cyril was. Marysol said in her soft-spoken voice “it’s true”. But the way she said it I wasn’t sure if she was agreeing with my compliment or if she was asking if it was true that Cyril is beautiful.

The most important and life–changing parts of this mission are the operations the surgeons of WSF perform but there’s definitely something gratifying about volunteering in the PACU as well. We get to know the patients and their family. We talk to them, we comfort them, we identify with them in some kind of way. Today being our last day at General Santos City Hospital, we got to leave earlier than usual and say our good-byes to the wonderful staff members and nursing students of GSCH. I made my way over to the pediatric PACU. Cyril was still there. Her mother said they would be leaving tomorrow and Cyril was not running anymore fevers and eating much better. I wished her good luck and to take care. I tried to hold Cyril for one last picture but she didn’t want anything to do with pictures or me and of course she cried… something Sophia would have done. I will miss all of the patients and will always remember my experience at GSCH but most of all I will miss Cyril. Sister Martin was right… there’s always one.

Last picture with CyrilA thank you note that Cyril's mother wrote

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General Santos City Mission PACU

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