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.

IMG_0960

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.

IMG_0959IMG_0174

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.

IMG_0060.JPG

Advertisements

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.

 

Day 1/2: Set-up

So I completely neglected to write about yesterday’s screening clinic!

It felt like Day 2, but it was still Day 1, or Saturday:)

John and I had our pre-surgery GSurg clinic where we saw all of the folks who had been screened for General Surgery, both medically, and socioeconomically. Our partnerships with the wonderful local public health practitioners is clutch. They help us make sure we are serving the need.

A little background here. Negros Occidental, or the Western half of the island that we are on has endemic thyroid disease, primarily due to iodine deficiency. On my last research, as of 1983, over 70% of the 12 year olds in school were severely iodine deficient! This improved in 1998, which were the last stats I found. But the challenge around thyroid goiters remains.

So not surprisingly, many of our patients needed help with their thyroid goiters. These procedures can be super challenging, due to the vascularity (think lots of blood supply, so higher risk of bleeding) and the sheer size of them. Our record last year was a 15 cm thyroid lobe!

The other patients had primarily challenges with hernias. Many of them have been waiting YEARS for help with their challenges. We even had one patient that had seen us on our last mission in 2010. We did a hemithyroidectomy (removed half of her thyroid gland), but the other side enlarged and was starting to give her trouble. Because these tend to be challenging operations, and because she had not yet tried medication, we recommended that over surgery. If she had the operation, she had the risk of being on lifelong medication. And…if it is a decision she has to make, she would choose food and water over medicine, like all of us would.

I had a special moment in my heart honestly, running this clinic with my friend and colleague John ( I know, go ahead, roll your eyes), but it is a super special thing to be able to serve together. Not every day does this happen!!!!:) And to see Amber Rose and Tina working together tho figure out how to make our operating rooms work….and then to see our instruments from our last mission, organized and labeled by a surgeon that came with us last year, Jig Deneve, another fave of mine!

The local staff had to interpret for us as they spoke a completely different dialect from Tagalog, but good news was that with the little courtesy phrases I knew, they were understood as my attempt to show respect. Hoorah!

Remarkably we finished set-up on Saturday afternoon. We opened our blessed MAP International boxes, cleaned our beautiful Scanlan instruments, organized our Santa Barbara surgical supplies, sorted drains and prep from Johnston Memorial Hospital in Abingdon, and distributed our Ethicon sutures between rooms. And of course all of this was shipped with the funds from our GoFundMe campaign supporters. What a family of support we are!

So much to be grateful for. So blessed to have such a tight mission family. You all are with us. 🙂

Day 1-ish: December 4th, 2015

So…I am finally uploading the blog from mission week. Next trip, I will make sure I have a mobile wifi thingy prior to the trip:) So it’s more in real time! Here goes…

Team Memphis

(John Nelson, Tina Hendrick, Amber Rose-King, James Tatum and myself)

We just arrived in Manila, and were welcomed with that familiar humidity, warmth and smell that always greets your senses as you walk off the plane and onto the gateway. Exhausted physically, but with a slight emotional uplift, and in general a readiness to just get there, we breeze through customs (or lack thereof! 🙂 ) and get to this really bland looking waiting room for the shuttle to take us to Terminal 3!

Herein lies our new home for the next 4 hours. So….I scope out the bathrooms, and Hallelujah, they are SINK SHOWER WORTHY! After sharing news with the team, we get comfy, take over the benches to make makeshift beds, and either take naps, munch on snacks, or charge our devices.

Our flight from Manila to Bacolod doesn’t take off until 550am, so we want to get in as much sleep as we can before we hit our mission site. It is always a bit unpredictable as to what we will do once we get there. We may get a chance to rest, or we may dive right in to mission prep. Need to be ready either way.

James demonstrates his smarts by getting his last burger of the week at the Manila Wendy’s. We get to talking about cows. We don’t have many cows in the Philippines. In fact, on one of our missions, the local people slaughtered their one and only very skinny cow to feed to us on our last day. We didn’t realize until after the fact, but when we did, we bought them a new one! As for the burger, it was good, per James.

I am already falling in love with every member of this team. For some reason, as I get more involved in compassionate work personally and professionally,  my heart becomes more and more sensitive to others, and I feel more intense emotion around these experiences. The highs and the lows. It has been a gradual thing since residency. And to think that one of my greatest fears in training was that I would become an insensitive non emotional surgeon at the end of it all! God is good 🙂 so blessed to have friends family and strangers to help along the way.

John Nelson’s main event on the flight to Bacolod: the baked buns with chicken asado (chicken that has been cooked in soy, garlic and a little vinegar, uber tasty) inside. Trump that, Delta peanuts!!!!

My main event was the time from landing in Bacolod to arriving at the doorstep of Immaculate Conception Health Center in Victorias.

https://www.google.com/maps/dir/”/Victorias+City,+Negros+Occidental,+Philippines/data=!4m5!4m4!1m0!1m2!1m1!1s0x33af2cd43109a0f9:0xcc3dc51b2a3b46f4?sa=X&ved=0ahUKEwjJu6Ta7dzJAhVHspQKHQ7HCNoQiBMIEDAA

Just in case you ever need to visit 🙂

I have been here several times in my learning and attending life. This is only the second time I am doing mission here since finishing residency. And I am SO excited to be working with new colleagues from Memphis, and old friends from prior missions, and MY FAVE former medical student now SURG RESIDENT ever, Taylor Walsh. Hoping he doesn’t see this, because I don’t want him to get all big-headed and whatnot 🙂 jk.

Seeing the water buffalo, smelling the open fires, the sugar cane fields, the tricycles, the big trucks with piles of sugar cane and the epic (but unsafe) crazy feats of MacGyverness that are the houses, clotheslines, power lines, etc that make me proud to be Filipino. They make it happen with what is available.

Like a bright eyed child, I watched and listened and took it all in. And of course got super-emo. It is always like coming home. Both to the work and the place. So blessed to be here.

 

 

 

Love in the moment!

Travel and being with people with a common mission really sets you up nicely to contemplate the “things” of life. As a natural introvert, I tend to go that direction anyways, but here are some thoughts about what is happening right now. The team has made it to Manila and we are just waiting for our last flight to Bacolod! So joyful to be together in service…

December 3, day of embarkation. News of the recent shooting in San Bernadino, ISIS, Obama and climate change, Paris, Pope Francis in Africa, Advent and preparation, repenting of our sins, and Christmas approaching.

Advent began two days ago. It is a time of preparation, and reminds us that we are always to be prepared. Not for a journey like the one we are on now, or for some singular experience that will be “one and done.” But more of a preparedness to live and love daily to serve Christ. And more to not just live in the moment, but to love in the moment. We know not the hour nor the day, nor would I want to know! There is something freeing in knowing that Christ has a plan for me, and you and all of us. And that His power and might is bigger than ISIS, and typhoons, and drought and hunger, and corruption and injustice and climate change, and illness and death and sin.

Christ is healer, the great physician, the nutrition, the water of life, the justice, the peace that we seek here on Earth. Why would I or we look for answers elsewhere? In order for Christ and Peace to be with us, me and you and all of us have to open our hearts and lives and let Him take over, to use us for His purpose and to help each other in this. At one point in time, a reallllly long time ago Christ had hands and feet here on earth. And we drove nails into them. Really big and likely rusty ones. And we made them bleed. And we didn’t use any anesthesia and we made Him suffer. But this physical suffering is no match for the suffering He endured to save us from our sins. No match for the sorrow He feels when any one of us goes astray. And along with those nails, He nailed our sins and sorrows and fears to the cross, to be done with them. And by His dying, we now have life. God is good. He no longer just has one pair of hands and one pair of feet, He has legions, and we must live according to His instructions and do His great work with great love.

Advent reminds me to not wait to love my neighbor. Not to wait for Sunday for the homeless man on the street. Not wait until it is more convenient, or when I am less stressed. And not to wait because I know that I need Christ’s love just as much as anyone else I meet on the street, at work, at home…..Love em RIGHT NOW. You may not have a second chance.

Sometimes when I hear “live in the moment” I think of the hedonistic self-serving lifestyle that tells us to live for ourselves, with as much pleasure and joy in this life, at whatever the cost. The reality is that there is no greater pleasure and joy than that of our friendship with Jesus Christ. No earthly treasure, or experience or relationship could come close. He is our friend and our Dad. So “live in the moment” isn’t meaning living in the moment for ourselves but live in the moment for the Kingdom and for our relationship with Christ. Seize the day, and night, and morning and every day that we are blessed to wake up. Don’t wait to love. Live in the moment and love in the moment. There is no timeline for Christ and our relationship with Him. It is long term and everlasting. What joy and security we can have in this! I want to make every sweet second count.That’s what this mission trip is all about. 🙂 Thank you for being with us.