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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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 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.

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.

 

Post Mission Gathering

Been a long time since I’ve posted anything! Much like the rest of the team, we have all scattered amongst our “normal/not normal” lives and are knee-deep in work! We have been gathering mission supplies for the 2015 trip already and 21 boxes have made it overseas already! Woot! And many thanks to the help our local shipping friend Tito Butch Gumban! Tomorrow we have our traditional post-mission party/reunion/download/feedback session/lessons learned get together! This always tends to be the most popular and heart-felt, yet hardest-to-get-to gathering around our mission work. Such an important gathering to process what we have worked towards as a group and reflect on how that work is affecting our daily lives back home! This is my favorite part because we get to relive the experiences, laugh about the funny stuff, cry about the sad bits and thank God as a group for the opportunities we have been given. Today, I will help dad try to figure out how in the world to use our fancy projector to show all of our mission photos on the wall of the living room. Pray for us 🙂 And hope we don’t break anything. We love technology, but such love is not always reciprocated. Want to encourage any and all people related to, in support of (current, past, future) and a part of our mission work to come on out tomorrow afternoon for food, fellowship and chatter! Should be a great time. Hope to see you there.