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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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.

Global Surgery, University of Tennessee and an upcoming mission!

We have so much to report on, friends! But, I will keep it brief.

First, we are embarking on our next mission to serve the community of Iligan, Mindanao, Philippines in the coming month! We are so excited to serve this community, who has been waiting for us, as they initially experienced travesty and tragedy in 2011. Frequently, communities require immediate response with emergency type relief after such a disaster.

Check out the news post here: http://www.nbcnews.com/id/45721519/ns/weather/t/nearly-dead-after-philippines-typhoon-disaster-agency-reports/

We help in this disaster relief as much as possible. But as you are aware, our gifts are more of the ongoing variety, with our offered help in the area of surgery and medical care, long-delayed due to economic, social and resource barriers.

The community of Iligan has been preparing for us and others for the past 4 years, rebuilding and creating infrastructure to be able to receive and benefit from our investment of time, resources and care. We are so excited to respond to their stated need, and hope to assist in their long-term vision of care for their community.

Speaking of long term work, for the past year and a half, we (the Zalamea Fam) have been visioning, discussing, collecting ideas and in general, praying and listening, to ways in which we might be able to progress our work, or even focus it, on a single community for the purpose of long-term investment. This could look like many things, but in our minds and hearts, would be a way for us to bring the best of what we have to the table, be it relationships, physical resources, infrastructure, or direct care. The dream would be to bring all of the aforementioned to a single center, developed and built by the mission group, and designed for and with a single community.

Would it be a hospital? Or would it be a surgery center? Would it be a clinic? I think the answer to this is dependent on the needs of the community chosen. It would depend on the immediate needs, as well as the long-term challenges. We know from our public health friends that the ultimate determinants of health are not just biology, genetics and life choices. We know that life CHANCES, shaped by the social circumstances of education, work, social place and setting, as well as physical environment, all play an important role in the ultimate health of a community down to the individual level.

So, if we were to build say, a surgery center, and conduct multiple surgical and medical missions each year, could this recurring theme ultimately influence the long term health of a community? We think it could, and this would be a place to start. But, we wouldn’t want to begin there. We would want to build a facility that would immediately be capable of doing more, and for more people, but begin in a most humble way. Through friendships and agreements, we would want to grow to deliver more comprehensive care as deemed necessary by the community.

We would want to engage in educational partnerships for the benefit of training and inspiring learning surgeons and physicians to ultimately take over and replace us. In fact, this partnership is already beginning. With my work at the University of Tennessee Health Sciences Center, we are launching a Global Surgery Initiative, with the goals of providing infrastructure, mission/vision, and growth opportunities for all within UTHSC to engage in and learn from international work for the underserved. We would match this US-based educational partnership with a Philippines-based partnership as well.

The mission hospital would be a convener of ideas, care, and innovation for the poor. But more importantly, it would be a place where we can serve, stay true to our mission, and bring the best of what the Lord has given us! We would hope that by building such a facility in a place of particular need, we would invite others to join us: industry, technology, education, early childhood development and care, faith communities, etc.

Where do we begin? We begin where we currently stand. We start with the relationships and the communities we have been serving for the past 17 years. We begin by continuing the conversations with our friends from medical device industries, medical and surgical education, civic organizations, faith based friends, volunteers, and most importantly, the communities we have been serving.

Excitedly, and with much anticipation, therefore, we will be doing site visits to 3-4 communities in the Philippines after this next mission. We will present a map of possibilities, which will include every relationship and possibility we have explored and from whom we have received positive feedback and support. We will then listen. We will listen for a common vision and mission. We will listen for mutual respect. We will listen for a community that is committed to solidarity with the poor, with compassion and empathy. We will listen for a place to call the mission home.

Day 3: First OR day!

For the first time really, we learn to process how we will intend to contribute to the health of this community. We had a lovely dinner with the Mayor last night. We were welcomed to the sweet and green city. Sweet describes Victorias in spirit and industry as it is the sugar capital of the Philippines.

The day progressed smoothly as we slowly acclimated to the machines, the noted issues of the machines, the flow, the new teams, the anxiousness of not having familiarity. All went well of course and the result was such that we accomplished two thyroid procedures, two hernias, one cleft palate and one cyst excision from a gentleman’s ear.

Many stories come to mind regarding the people we met today….

We had one gentleman who unfortunately was unable to have surgery today. He came to see me because he wanted his hernia fixed, as it has been causing troubles with pain and discomfort. As we were discussing things however, we noted that he was having daily bleeding from his bowels. On further inquiry he said that the pain was getting worse, and that his primary income came from (admittedly) illegal logging. With all of his work, he didn’t find the time to get his hernia fixed, but he did eventually see a surgeon in a nearby town. They told him that he would have to pay over $600 (over 30K pesos) out of pocket for it to get fixed. This is more than most folks make in a month or two. Because he was noted to be bleeding from his bowels and having back pain and changes in his stools we of course recommended a colonoscopy, which of course costs more than a hernia repair. With that, he took the tylenol and left. We did discuss with the local public health team to see how we can get him his needed colonoscopy and can only pray he will follow-up.