A Picture is Worth a Thousand Words

Sunset in Coron, Palawan 2013

Sunset in Coron, Palawan 2013

We are sharing more photos taken by WSF Volunteer Kui Kanthatham that encapsulate the beauty of the 2013 medical mission trip to Coron District Hospital in Coron, Palawan. Thank you, Kui!

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Days 3 & 4: In the Zone

The team operates like clockwork. A system has been created in the hospital and everyone knows exactly what to do. Doctors and nurses change into scrubs and prep for surgery. Volunteers and hospital staff meet to clarify the patient process for the day. Others create the pre-screening, IV insertion, check-in, and post-op stations. Once in motion, patients flow in quickly one right after the other. The drive to perform at the highest level of patient care is in action.

The conditions are less than ideal, but the experienced team members expect it. It is 101 degrees outside according to my iPhone, yet no one complains. Supplies begin to run low, but volunteers run to find the backup materials. The electricity goes out for a few moments, while everyone continues as if nothing happens to stay on schedule. Equipment malfunctions, and volunteers on standby fix it immediately. As delicious as the lunches are, lunch breaks are short because volunteers are eager to move the long the line of patients waiting outside. Volunteers and hospital staff walk swiftly from room to room to check on patients and team members. Everyone continues to give 100% to each family and patient that walks through the hospital door.

I have heard past participants refer to WSF as a “well-oiled machine” and it is easy to understand why.  There is a 6th sense coming from our highly trained, committed volunteers as a vow to help the local community.

Anesthesiologist Dr. Christopher Chambers, a first-time WSF volunteer, takes the time to explain to me in depth what he does and how he adjusts to the conditions.  With patient care and patient safety as his primary goal, Dr. Chambers works to help surgeons optimize their time with a patient. He also highlights, “We don’t have the monitors that we do back home.” He lists the technical names of the equipment he knows, but doesn’t seem phased at all that they are not here. “We modify our practice to adjust to what we have.” He gives the example that monitors to track patients after surgery are lacking in the post-anesthesia care unit (also referred to as PACU), a 10 X 20 foot room that squeezes up to 5 patient beds – also called the recover room, this is where all patients go after surgery. He does everything he can to assist the doctors overseeing the PACU to ensure quality and safe care, sometimes waiting alongside the patients until they wake up or until he is called for his next case.

The team of surgeons and physicians complete a range of 124 major surgical cases over two days, such as thyroids, cysts, hernias, clefts, and a range of OB/GYN issues. Pediatric surgeon Dr. Domingo Alvear performed surgery on a 16-year old boy with a rare case called severe hypospadias. He, too, was refused by other missions due to lack of specialists. A case found in 1 out of 10,000 births, Dr. Alvear pointed out that he has done this in many of the WSF missions. Plastic surgeon Dr. David Leber did a double left clip revision on a young boy, also a rare case. Both were walk-ins. Dr. Leber says, “We’re going day by day. They come in, we screen, and if we’re open we’ll operate.” There are surprise cases everyday, something very invigorating about this trip.

The day ended with a surprise thank you gift for Dr. Leber from his hemangioma patient: a roasted chicken and a white loaf of loaf of bread! According to hospital staff, it is common for patients to thank the hospital with food, particularly since many cannot afford services. For a team this full of heart, that will definitely do!

Plastic Surgeon Dr. David Leber receives gift of chicken and bread from a patient

Below are some beautiful photos for you to see what is happening here in Coron, Palawan. Thank you to WSF volunteer Kui Kanthatham for capturing these moments.

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Conversations with the Community

Each day, children, parents, spouses, siblings, and friends patiently wait until their names are called. The screening process for walk-ins takes place right outside of the hospital entrance due to lack of hospital space. Some come with having had unsuccessful surgeries in the past, while others have the experience of being turned down by other medical missions because they lacked specialists. Families traveled from far distances  – some by boat – just to be seen by the WSF doctors. Whatever background they have, they all come with one thing in common: today, they are ready for a change.

I spoke with several patients in the waiting area to better understand what brought them to the WSF mission. Most cited hearing about the medical trip via word of mouth, such as their doctor, a neighbor, and/or a friend. Municipal town meetings from their local government officials, as well as media outlets like a recent TV announcement were also mentioned.  Many came with conditions that they have been living with for 3-19 years – for children, this was all they knew.  They also mentioned their gratitude for the specialists on this medical mission because of their inability to pay for surgery. Marilyn, a 32-year old mother of 2, came to have a goiter removed. She was pre-screened last week so that she could have her surgery done on the first day of the mission. She said, “I can’t afford this surgery on my own, which costs 150,000 pesos according to my doctor. I have two sons, and I just had to pay for my own son’s foot surgery. No money left for me. This mission is my turn.”  Juvila, a 19-year old female born with a singular cleft lip, was contacted by a friend that the mission was coming. A native of the Palawan area, she told us that she was not nervous at all. In fact, she was excited because “it was time.”  She walked in today without being pre-screened, but Dr. David Leber reviewed her case and told her that he could help. It was amazing to see the excitement on her and her mother’s eyes that a lifelong condition was about to change today.  Another patient, Anabelle, a 58-year old mother of 4 children, came for a perotidectomy of the face. Having had the tumor for 15 years, she mentioned that this is her 4th attempt to have it removed. She had been looking for a specialist since she has been living in Palawan for 10 years, one that she could afford.  Like all other patients I met, she repeated how thankful she was to WSF for this opportunity.

I also heard from Fernando, a 39-year old male who traveled a long distance from Busuanga (the other side of the island) to Coron. Fernando learned about the WSF mission from his own doctor, who told him that specialists were coming that could help him with his condition. He had been turned down by other missions in the past, so this was his chance. Fernando was diagnosed with a right inguinal hernia connected to urological issues – a painful condition he has had for 7 years. He, too, conveyed his gratitude to the WSF for this ability to be treated.

From Left to Right: Dr. Richard Bucks, Dr. Jose Prudencio, Fernando, and Dr. Paul Stouffer before surgery

From Left to Right: Dr. Roger Bucs, Dr. Jose Prudencio, Fernando, and Dr. Paul Stauffer before surgery

I later learned that all the patients I had the privilege to speak with went home with successful recoveries. What I saw first-hand today was that the accessibility to quality healthcare that many of us are so used to at home – what may be a phone call, a short drive, or a line at the doctor’s office away – is a rare gift for the lives that WSF touches.

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Day 2: Organized Chaos

Today marked the first official day of surgery. The team arrived to the hospital on schedule at 7:30am. Most of the morning was spent determining the flow of the space, clarifying the roles of WSF volunteers and hospital staff, and confirming the location of supplies. There was a strong sense of focus and excitement from the team, and every single individual jumped in wherever possible to ensure the operation was ready to go!

Thankfully, patients were pre-screened by physicians earlier in the week prior to WSF’s arrival, and this enabled physicians to begin seeing these patients as early as 8:30am. However, many of the patients did not arrive as early as planned since they commuted from far distances.  Specialists are hard to find in this area, and Coron is a municipality of islands, so some people traveled by boat (as much as 4 hours) to make this medical mission. Other pre-screened patients ate food prior to their arrival, which also led to delays since many surgeries require 6-8 hours of fasting beforehand.  Since patients were unaware of how important it was for them to not eat before surgery, many were rescheduled for this afternoon. Regardless, the screening of new patients still continued, so the team was able to take walk-in patients during the day.

Patients waiting outside of the hospital

Patients wait outside of Coron District Hospital to be seen by the WSF mission

The WSF physicians on this trip cover multiple specialties, including general surgery, pediatrics, urology, plastic surgery, obstetrics and gynecology (OB/GYN), and anesthesia.  To allow the range of cases to be seen, Coron District Hospital was transformed into a creatively packed OR facility!  A hospital originally with one room for operations was transformed into three functional rooms and 10 OR stations: four OR stations in one room, two OR stations in another room, and four OR stations in yet another room.  Talk about maximizing space!

4 Stations in OR room 1: general surgery, pediatrics, and plastic surgery cases

4 Stations in one OR: general surgery, pediatrics, and plastic surgery cases

4 stations of general surgery cases

4 stations in another OR: all general surgery cases

The operating schedule commenced at different times by type of case due to delays mentioned earlier. OB/GYN cases started immediately at 8:30am, general surgery followed shortly at 9:30am, and both pediatric cases and plastic surgery cases began at 1:30pm. Even with the ‘organized chaos’ from this morning, there were a few notable observations. First, of all the general surgical and pediatric cases that showed up today, only one case was cancelled because the patient arrived too late – one that was rescheduled for the following day. Second, the team that conducted minor surgical cases under local anesthesia successfully took care of all the 42 patients that showed up to the clinic, leaving no one behind. At the conclusion of the day, the team successfully completed 77 surgeries!

Having observed the physicians and nurses work late into the evening to operate on all admitted cases without a hint of hesitation, I can say that my perspective of commitment to one’s craft was redefined. Congratulations to our volunteers for a successful day 1 of surgery.

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Inaugurating the Adopted Hospital

The first day at the hospital concluded with an inaugural welcome from some of the key organizers of this trip.  It began with a visit from Governor Abraham Kahlil B. Mitra of Palawan. Governor Mitra highlighted that healthcare is important here because in addition to serving thousands of its citizens, Coron is the leading municipality for tourism in Palawan – and tourists also look for hospitals here in case of emergencies. He gave a warm speech that conveyed his gratitude to WSF for the adoption of the Coron District Hospital that includes donating essential medical equipment to sustain the hospital long after the mission leaves. While healthcare in Palawan has always been a priority, Governor Mitra said, “There is still a lot more to do and a lot more to accomplish, especially in heath, and this mission is a very big step towards attaining that goal. Of course, you will be operating on about 200-250 patients for the next few days, but the equipment that you brought today will be of help and assistance to us for our lifetime. I don’t know how I can express our gratitude, but in Tagalog, it’s ‘Maraming salamat po.’ Thank you very much!”

Governor Mitra of Palawan Province gives inaugural speech on first day

Governor Mitra of Palawan Province gives inaugural speech on first day

Dr. Alvear and Dr. Espineda give a tour of the hospital with the newly donated equipment and supplies

Governor Mitra tours the hospital to see the newly donated equipment and supplies

WSF founder Dr. Domingo Alvear emphasized the exclusivity of this medical mission trip.  In his speech he says, “This is the first time that you are going to find a collaboration among the Philippine and the American surgeons, physicians and nurses in equal number.” Today, the nurses and doctors from Manila will be arriving to Palawan to assist with this mission trip. Dr. Beda Espineda, a pediatric surgeon from Manila and former liaison for medical missions with the Philippine College of Surgeons, said, “Many times, we go to provinces and rural areas to perform surgical missions. But there comes a point in your life when you want to serve people in a more people in a more sustainable way…not come and go.” Through this adopted hospital model with a fully functioning OR facility, along with support from entities including all branches of the Philippine government, the Philippine College of Surgeons, Philippine Anesthesia Association and the Philippine OR Nurses Association, a channel is being created to bring Philippine surgeon specialists from big cities to the Coron area on a regular basis. It is the hope that collaborating with local medical professionals will support a longer-term sustainable healthcare through this model.

Gov. Mitra group photo

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Day 1: Operation Unpack and Unload

The first day of the medical mission was critical: this was the first trip to the hospital site where all equipment and supplies must be organized to support WSF team’s ability to efficiently care for the hundreds of patients they will see over the next 5 days. Because WSF donated a 40-foot container of essential medical equipment and supplies and had it shipped directly to the Coron District Hospital, today was the day that the packages were allocated to their appropriate storage room. “It is essential to know where everything is located before we start the mission to run a smooth operation,” said WSF Travel Coordinator Gilda Cabarlo, who helped with organizing the packages. Witnessing the volunteers quickly unload, move, and account for the 200+ boxes conveyed that this is indeed the case, given that they had to do all of this in the blistering hot Philippine weather! It was exciting to witness this newly adopted hospital receive so many essential supplies donated by WSF that could be used for long-term, quality care for their patients.

Snapshot of 200+ boxes of donated supplies in storage

Snapshot of 200+ boxes of donated supplies in storage

WSF Volunteers unload donated supplies from storage to the hospital

WSF Volunteers unload donated supplies from storage to the hospital

Throughout the day, crates of heavy medical equipment arrived that carried items such as two anesthesia machines, an electrosurgical generator, a pulse oximeter, and infant bassinets. Volunteers and hospital staff worked tirelessly to unpack and unload these items.

Crates of WSF donations arrive throughout the day

Crates of WSF donations arrived throughout the day

Volunteers unload donated anesthesia machine

Volunteers unload donated anesthesia machine

In addition to the reviewing the supplies that were shipped directly, volunteers also had to account for the bags of supplies that were checked-in via plane by each traveling volunteer. To provide some background, each member of the volunteer team (including myself) was tasked with carrying a bag of donated medical supplies from the U.S. to the Philippines that we had all received by the WSF organizers prior to departure. These 50-pound bags held critical supplies – such as vials of medicine and sutures – for the physicians and nurses. Yesterday, we were stopped at our domestic flight checkpoint from Manila to Coron because the baggage weight limit exceeded the flight we were about to board. Despite an unanticipated fee that had to be shouldered as well as the fact that we were separated from 20 of our bags for 24 hours, our bags arrived safely today and were greeted with enthusiasm!

WSF luggages of donated supplies safely arrives 24 hours later

WSF luggages of donated supplies safely arrives 24 hours later

With only four hours into our first day onsite, I was struck by the creativity of our volunteers to help with the setup of the hospital facility. For example, Dr. Jason Marone, a fourth-year general surgery resident from Enola, PA, and a first-time WSF volunteer, built a cabinet from the leftover wood from crates to create storage for the newly donated supplies. Dr. Marone cited his previous training with family stonemasons and artisans that taught him these skills. Thank you, Dr. Marone!

WSF Volunteer Jason Morone designs cabinet from leftover crates

WSF Volunteer Dr. Jason Marone designs cabinet from leftover crates

Philippine OR nurses and doctors from Manila arrived in Coron to assist with this medical mission. Most veterans have been participating in the mission for the last several years, while some nurses were brand new to the mission. Reunions and introductions were made in preparation for tomorrow.

WSF Mission veteran surgeons Dr. Roger Bucks  from Pennsylvania and Dr. Beda Espineda from Manila

WSF Mission physicians Dr. Roger Bucs from Pennsylvania and Dr. Beda Espineda from Manila

Check back for the next post as the WSF team will begin the official first day of surgery!

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Voices on the Ground: An Introduction

Hello! Welcome to the official blog of the World Surgical Foundation (WSF) 2013 Medical Mission Trip to Coron, Palawan, Philippines. My name is Jennifer, a first-time volunteer of the WSF 16-year operation. A Filipino-American native of Central Pennsylvania where WSF was founded, I have only heard of the impact that WSF has made all over the world – an organization with a mission so unique to that of its counterparts – that I had to come and see it for myself. I invite you to join me on this journey to uncover what truly makes WSF so unique at what they do, why the dedicated volunteer staff and medical professionals keep coming back, and what impact WSF has on the community it serves. Over the next 6 days, we will discover the narrative stories of the patients being cared for and the volunteers selflessly devoting their energy and expertise to those in need, all in an effort to further the WSF mission of providing high quality, sustainable healthcare to the community of Coron, Palawan, Philippines.

Coron District Hospital

Through an in depth discussion with the founder, pediatric surgeon Dr. Domingo Alvear, I quickly came to learn that the mission of WSF is very distinct among other medical missions through its two-fold focus on quality and sustainable healthcare. How? Visiting physicians from the U.S. work with local physicians from the area to share best practices, knowledge, and techniques over the course of the week. The foundation also donates essential supplies and equipment not only to conduct intricate surgeries while they are here, but also to give the hospitals the means to continue providing high quality healthcare long after WSF leaves the mission site. As Dr. Alvear emphasized, “Collaboration with the local community is key for WSF.”

Dr. Alvear also shared with me that this particular mission trip to Coron marks a unique point of history for WSF and the community it will serve. Today, a two-year vision to formalize the WSF mission into a sustainable healthcare institution becomes realized in Coron. Our on-site location, the Coron District Hospital, has been approved for a Memorandum of Agreement (MOA) to become the first officially adopted hospital by a foreign surgical mission – as sanctioned by the national government of the the Philippines, the Province of Palawan, and the local government that this hospital will serve. This is a collaboration not only among all government branches and WSF, but also the Philippine College of Surgeons, the Philippine Anesthesia Association and the Philippine Operation Room (OR) Nurses Association. It will enable Coron District Hospital to become a central hub for performing surgical procedures to the Coron community and surrounding islands of Palawan.

With an upcoming visit from Governor Mitra of Palawan tomorrow, come visit my subsequent posts to learn about the breadth of impact that this medical mission will have for the Municipality of Coron and the Province of Palawan.

WSF Mission Advertisement at Coron District Hospital

WSF Mission Advertisement at Coron District Hospital

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