A little boy and his toy cars

Jun (name changed for privacy) is a 3-year-old little boy who lives by the creek and is cared for by various individuals. He was first brought forward to Dr. Homer of the Carmona District Hospital during a patient screening event by his mother. He was found to have bilateral cleft lip and had an active pneumonia. He was prescribed antibiotics and it became readily apparent over his second and third preoperative visit that he had a very unstable home setting.

His mother, who had five children of her own, all with fathers who were not present nor involved, worked most of the day. When she was not able to bring Jun, his grandmother brought him to his appointments, but she had 8 children under her care. The last preoperative visit, he was accompanied by a neighbor, who was unaware of Jun’s recent bout of pneumonia and could not confirm that he had received or completed his treatment. Dr. Homer and his team did a home visit, and it was evident that Jun’s setting was not one in which he could be easily cared for.

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In preparation for his bilateral cleft lip repair, Dr. Homer had Jun admitted to the hospital for hydration, feeding and antibiotics. He then underwent his operation with Dr. Samson Lee of Bellevue, WA on October 2, 2018. His procedure took roughly 2 hours to complete, with extensive pre-incision planning. His team included Aaron Stevens from Florida, CRNA Zohar Levites from Florida, Rebecca Hines RN from California. While in the postoperative ward, various family members and neighbors took turns staying with him, while the nurses and mission team supplied him with toy cars and blocks to help him pass the time.  It was such a joy to see the intense concentration on Jun’s sweet face as he immediately came to the realization that he for the first time in a long while, had all the attention he could handle. Our concern was that it might be overwhelming, but he seemed to enjoy his time and the loving faces around him.

In light of his precarious home and social situation, Dr. Homer and the Mayor’s office of Carmona supported him with a two-week post-operative admission to the hospital for a safe, comfortable, and clean recovery setting. He and his family are being provided weekly food vouchers to ensure he and his family are as stress free as possible during his important recovery time. His postoperative visits are once a week until six weeks, possibly longer.

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Together, with suture provided by Ethicon/JJ partnership, instruments provided by Scanlan International, medicines provided by Americares, Blessings and MAP International, support from the University of Tennessee Department of Surgery, linens, surgical supplies and disposables provided by Methodist Le Bonheur Healthcare and Crosslink Memphis, illumination provided by Precision Surgical, the attention and care of Dr. Homer and Mayor Dahlia and their teams in Carmona, and lastly the heart, leadership and organization of Memphis Mission of Mercy along with the mission family, young Jun is recovering well, gratefully without complication, comfortable and with support from his community. We are blessed to be able to be a small part of Jun’s story, and we hope that it continues to be one of success, joy and recovery. His story is one that we can all see ourselves in, and one in which we are able to witness the power of compassion.

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We. love. our. Board.

What a year it has been thus far. Last year we found ourselves delving into plans that we hope will help sustain our little mission family and work for a long time. We have formed and developed a strong board of amazing folks. We are so grateful for all of them. Here is a little bit about each of them….

Ricky Zalamea, my brother, also a Thoracic Radiologist and logical thinker

Don Guimera, planner extraordinaire and Chair of our Fundraiser Gala Committee

John Shorb a trusted friend a colleague from both the art and non profit sector

Dr Carmelita Teeter, a volunteer from time ago and also a retired Psychiatrist

Dr Connie Babu, a passionate Anesthesiologist and family friend from the days of my childhood

Rob Conley, CRNA, one of our beloved long time volunteers who has been with the family from the beginning

Dr Tom Knipe, similarly has been with us for years, and began with us when he was still in training

Uncle Andy Eugenio, and while we may not be blood related, he is still an Uncle of mine, and is retired as a graphic designer from Fed Ex. He puts together beautiful materials that help us tell our story

Matt Ducklo, has a career in photography and owns Tops Gallery in Memphis, an excellent set of two spaces for various forms of contemporary art. He always has an eye on how we can better present ourselves to the larger community and he is also now my handsome husband!

Dr Van Alstine is a dear long time mission family member who has joined us on mission with his wife, Marcia, as an anesthesiologist. He has one of the most important jobs on the board and serves as our Board Treasurer

Dr Sam Verzosa is an internist here in Memphis who is a supporter of the mission, confidant and continually gives use wise counsel

Jeneba Winfrey-Porter is a dear colleague from the non-profit realm, wise in strategy and disciplined in process. She is our Board Secretary and a valued member of the team.

We have several valued board consultants and advisors as well who have committed to help us along the way:

Mark Crosby, a dear friend, is our counsel and serves as the mission Board attorney

Ken Waxman, a mentor and mission family member since residency in Santa Barbara, is an examiner for international JCAHO and has been our guide in design and build of our mission hospital

James Ferguson is a Certified Public Accountant who has been a friend of the mission from the beginning as well. He has assisted us and continues to assist in all things having to do with our accounting, policies and procedures and tax reporting.

Why the long update? Well, life has been busy, and time has been moving along quickly.  We understand that this group started for a reason, that we were called to serve for a particular purpose, and that this commitment extends past our individual lives and lifetimes. In order to help facilitate the sustainability of our humble organization, and the work and services that we provide, we knew we needed to get organized, defined and delegate responsibility and opportunity.

Even more so now as we head into the next phase of our mission life, we are SO grateful for those of you who are with us. We are grateful for those who were with us in the beginning, in helping us vision, and being by mom and dad as they did the seemingly impossible. That effort has enabled our little mission group to provide over $17.2M worth of free surgical services to the poor in the Philippines since 1999. Their ongoing perspective and wisdom and spirit enables us to get up and do this again every day. We are grateful for those who has more recently joined us, for sharing in our vision and for maybe helping us see things through varying lenses. We hope to be humble, nimble, open and caring in everything that we do in and through our little mission group.

We are honored and excited to be a part of something so special and a group so passionate, and to be looking towards a better surgical future with our partners in the Philippines.

 

 

Comfort

First day in the operating room was a huge success. As always, there is the unexpected challenge, the surprise finicky instrument, the unanticipated difficult case comes up. At the end of the day, around 8pm, the day was done. And we are grateful. We have learning lessons, ideas, thoughts, challenges to bring forward with us. The challenges bring a little bit of the pain of unfamiliarity, the little bit of discomfort, the heat (literally and figuratively so to speak) and a proper detoxifying sweat.

As we move forward with the second day in the operating room, we are hopeful for a smooth progression towards more familiarity, predictability, and flow. It is amazing to realize how important predictability is to our lives. This little bit of discomfort and uncertainty is a small cry from the hard living of our patients and families. It is a small sacrifice compared to the long lines of a life in poverty. It is a fraction of the fear of being turned away, or having a closed door when seeking help.

As we move forward with the busy day ahead, we rest in this….

Psalm 62: 5-7

For God alone my soul waits in silence, for my hope is from him.

He alone is my rock and my salvation, my fortress; I shall not be shaken.

On God rests my deliverance and my honor;

My mighty rock, my refuge is in God.

Day 1.5

The first day is always a bit of a haze, so we can count the first day as 0.5:) The teams are arriving, from all areas of my life, and the US. Santa Barbara, Memphis, Chicago, Abingdon…as always, it is a grand reunion, and such a joy! We have thus far converted an idle shell of a hospital to a facility with 5 operating room beds, a recovery room complete with critical care monitoring, a preoperative holding area, a pharmacy and inpatient medical/surgical ward. With an early core of volunteers, we are now ready to receive the big mission family!!!!

As  always, our hosts are gracious, the local team of volunteers excited and hard working, ready to serve their own. Seeing the Philippines through the eyes of friends who have never been, and through friends who call this part of the world home can be illuminating. It is hard not to learn a lesson from even one day of carefully sorting through precious medications so as not to lose one bottle, or one syringe to waste. We do much with little, serve many with a few. Our “few” is the largest ever, with 41 volunteers on this mission! We look forward to serving many, however, and many hands make light work.

I am so excited for our team, to experience this work in a personal and professional way. I am excited for myself and my family, to continue to grow with and through each other in this work. We are so blessed. And we are so grateful to be here.

Please pray for us, send good vibes, think good thoughts, and maybe check in every once in a while.

Mission and Reunion

Three weeks from now, our team of 42 volunteers from Memphis, California, and Chicago will embark on a journey to Carmona, Cavite Philippines! We are hustling to finish the preparations, last minute changes, etc. Once we land, we know it is game on and time to work! We are so excited.

This year’s mission is marked by a few specific events of note:

  1. We are being invited by one of my mom’s best friends from 1973. Amy Zamora is a nurse from the Philippines, who joined my mom and others on the scary journey to the US to work as an RN in Memphis, TN. They and others quickly became a band of sisters and brothers, helping each other survive physically and emotionally in the City we have since called Home. Auntie Amy helped raise my brother after he was born, so that my dad could go to Nurse Anesthesia school at Charity Hospital in New Orleans. I tell my brother that we kind of owe her our lives. Here we are full circle now, joining back with Auntie Amy and her family, in their town of Carmona, to serve a community marred by the stigma of once being the “town dump” of Manila. Literally. What was once a community of squatters is now a challenged community of over 70K individuals who live too close to Manila to be recipients of much charitable care, and far away enough to have challenge accessing such care. The local government has built a shell of a hospital, but has not yet been able to fully activate the space, due to this stigma. We will play a role in activating that space, and we are honored to do so.
  2. This year we have the biggest team ever, and it happens to be full of people that go way back! My mentor from Santa Barbara, along with a host of others who helped train me, area all coming along. A team of more than 11 folks from SB! The circle of life:) We have our very first mission doctor, John Hodges, joining us to provide expert care for our cleft lip and palate kiddos. And we also have joining us a team of doctors from Manila who have joined us over the years to provide surgical and anesthesia care. Lastly, I have two colleagues from the Department of Surgery here in Memphis at UT, as well as a stellar General Surgery Chief Resident, who we are so blessed to have!
  3. After this mission, we will travel to our permanent mission site in Victorias, Negros Occidental. We will meet with the Mayor, receive a donation of land for the hospital, and receive a survey in preparation for building!
  4. Lastly, we have formed a Board of Directors! We are so blessed to have a wonderful team join us in this work, and we will share stories about each of them over the next few months!

Thanks so much in walking with us on this journey.

About

Day 3 Iligan Mission

img_2182Day 3 and 31 cases in!

We have had plenty of large difficult procedures, all life changing for both the patients, as well as the team. The stories from the families include: a young girl with an encephalocele (this is a birth defect where a person is born with a hole in her skull that allows part of the brain to protrude). She was unable to be cared for by her biological mother, abandoned and was then rescued and raised by her cousin.

Not all of our patients have such dramatic and tragic stories. Most of our folks have quite simply had to make life choices that impeded their ability to attain surgical care. This means we have patients who have been suffering from various problems for 12-25 years! YEARS! No tragedy, just simple life decisions made on life choices. This is the primary need we are filling. We are caring for people who have had to defer their health care due to life chances and choices. We aim to help them get back on their feet and to they walk of life. So far so good. We pray that we continue to do the work we are called to do, with the quality we aim to provide, and with the compassion and love we are commanded to share.

Mission Iligan Philippines

Working in missions is humbling in so many ways. Just today, we noted on the aspects of daily life that we absolutely take for granted moment to moment. The predictability of presence of things like water, a trash can, an easy restroom to use, and even warm bath water. These things are not absolute givens.

We all take for granted the very things other people consider pure luxury. In life, this may show itself as uncertainty of the time of a meal, the time of a ride home, or maybe even whether or not we will have a meal. When doing surgery in a context different from our daily lives, the little things are all opportunities for stress. They are all variables. Even the person who is responsible for handing you instruments is new and unfamiliar.

All things on mission trips are uncertainties, new experiences, unknowns even. Imagine dancing with a stranger. The first steps or even the first whole dance is a challenge, awkward even, as you struggle to anticipate, or maybe even match your partner’s movements. This is the same in many ways. The anticipation of another’s movements, of their needs, and their thoughts on where we are heading are all real.

In talking with one of our residents today, I asked her what she learned. She learned today that she is not as flexible, or versatile as she thought. She realized that she was much more fixed, and more needy around certain aspects of her work, than anticipated. Such an incredible lesson to learn in the field. There is a reason that fast food chains work. We are all creatures of comfortable habit. Meaning, habits or patterns of behavior, create a façade of familiarity. They create an environment or context with which we are familiar. All of this lowers the levels of stress and anxiety.

The term “preference card” is a misnomer.(A preference card is a wish list of items and supplies that a surgeon puts together for surgical teams to prepare for each surgery.) Many of us might rather call them “absolute or all or nothing cards” because we hold them so close to our minds and hearts. How we work is typically how we were taught, or evolved over time to work. Neither of these things are easily changed. They are kept as a pattern for a reason. We find what works best for us and our patients alike.

This undergirth of stress and unfamiliarity and dare I say instability, is something not altogether different from what people in poverty experience every single day. It has been termed “toxic stress. The uncertainty around finances, food, shelter, safety from violence and maybe even the possibility of employment, all contribute to create a context of multiple stressors for an individual or family. This toxic stress is so powerful that it has been shown to lead to negative health outcomes around infection, hypertension, atherosclerosis and central obesity. Toxic stress in a mother even affects a growing fetus as it is developing in utero.

We reflect on the stress that we experienced today, with a little different set of instruments, with new staff, with unfamiliar operating rooms, beds and equipment, and with patients that look different than our usual Memphians/ Chicagoans/Seattle-ites/Sacramentoans. Now think how this little bit of stress affected how we felt at work today. This work stress is a mere fraction of what our brothers and sisters in poverty experience every single day. These are things we will never understand even just at surface level unless we seek to find out. Maybe this is our lesson of the day: Seek the lessons that teach us to be more sensitive, and increase our ability to recognize, or maybe even anticipate, the stressors the people around us might be experiencing.