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.

Day 3 Iligan Mission

Day 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.

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.

 

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.

Mission 2015!

Hi y’all!

Can’t believe we are a mere 4 weeks away from our next mission trip to the Philippines. Much has happened since my last post.

1. Medical Licenses: for the first time in almost a decade we have been asked to obtain a temporary medical license for our mission trip. All in all a good thing that the community is asking for a vetting process, though challenging since it is not electronic. Pray for us on this one. We would love to see a smoother process around this moving forward.
2. Bovie machines! We received a generous donation from Methodist University Hospital in Memphis which included three very important bovie machines! This is typically a limited resource that we have had to share between surgical teams. Now we have enough for each team! AMEN!
3. New mission family! I am SO excited that three people dear to me are coming with us on this next mission! One is my former medical student, Taylor Walsh, who worked with me when I was in practice in Southwest Virginia. The other is my partner, John Nelson of Resurrection Health, who is an incredible human and grounded surgeon. Can’t wait to get to know them in a different light! Lastly, one of our star nurses from the Church Health Center, Amber-Rose King, is also joining us and I know will be an incredible asset to the team!! (One of the secrets of mission work is that once you do mission work together, you share a special bond. Like band camp but not….more like servethepoorcamp which is much more wonderful)
4. New site: for those of you who participated in the Gofundme campaign, you already know that due to licensing delays and logistics, we had to divert our mission from Iligan to Victorias City in Negros Occidental! This is a community we have served in the past, grounded in sugar cane agriculture and with a beautiful sense of community. We hope to maintain a long-term relationship with Victorias and are so excited about serving there again this year!
5. Lastly, not to be too vague, but we are looking at new potential partnerships, some involving heath care institutions, other with educational institutions. Primarily looking at strategy in long-term sustainable work, and of course wanting to create a stable home and destination for the mission. LOTS of prayers on this please. 🙂

American College of Surgeons, and Friends, and Supporters…and Friends

Forgot to hit publish on this one!!!!: From Last month!

What a conference!!! Just leaving the American College of Surgeons (early, yes, but one can only take in so much) and it is SO exciting to feel and hear the energy of fellow surgeons and their volunteerism! Having an entire tract of the ACS be on international and humanitarian work?!

I am happy to share that much conversation was around the Lancet paper that came out earlier this year. Quite right, the College (which is like a giant “surgery club” for all of the American surgeons to come together to share, learn and network, but is of course open and inclusive of surgeons from around the world) recognizes that many of us in the College already do this work regularly, or intermittently, depending on your involvement. So, we came together to have conversation!!!!! And share experiences, and hear stories. To be frank, we needed more time. To be honest, I was supposed to have time, but we ran out of time. Nevertheless, I met some wonderful people and potential future partners! Either in work, in faith, in mission or all of the above!

I also met our good friends at Scanlan International! These are the kind folks whose beautiful instruments help us do the work well. Their products are instrumental (!) in our thyroidectomies, cleft lip and palate repairs and other facial and plastics procedures. It was like seeing family, as they are used to receiving my reports and emails….and hopefully are reading this blog!!!! I am still learning and remembering to hashtag!!!!

Of course, no visit to the American College would be complete without meeting at least one hero!!!! In this case, it was this guy: Paul Farmer.

natalie best, me, paul farmer!!! bliss!

So where does this leave us? We are still learners, trying our best to find ways to serve, looking for new friends to help us help others and finding kindred spirits. All in all, a great energizer and grounding experience for our upcoming mission!

Go time!

Friends and family!

Mission 2015 is in full effect! All of our medicine orders have been placed and we are in the heat of shipping preparations. Thanks to the support from our crowd funding campaign, we are able to fill in the financial gaps of our recipient town! We otherwise would have had to limit the usual bulk of supplies for the receiving town.

Yesterday we held the first of several packing parties for our upcoming trip. The theme of the day was clinic meds! We are able to purchase large quantities of mission medicines via MAP International and in doing this, provide more than $10,000 worth of medication for the community at a mere fraction. We serve on average between 2000-3000 people in clinic over the course of the week. Any medications left over are endorsed to the local public health authority that we partner with.

Here we are, packing hypertension and diabetes medications!!!

Medicine Packing Party #1!

In case you didn’t notice, this was our first ever crowd funding campaign, so thank you for everyone’s patience as I learned how to fix our broken links, write thank you’s and post blasts on social media. 🙂 We hope not to have to do this very often, but it is nice to have the option!

Many thanks to friends near and far for this success! people from all parts of our lives (india, APQC conference, prior missions, medical school, residency, work, and family!!!!) have contributed! What community!!!!

Lastly, we have received some generous donations of surgical and medical supplies from my alma mater hospital, Santa Barbara Cottage Hospital! They sent us these two lovely boxes of surgical supplies that will most definitely come in handy! We frequently come across children with neurological problems requiring neurosurgery. We now have the capability to be prepared for this particular need, thanks to my friends in Santa Barbara! Humbled by their generosity.

Thanks so much for reading and please keep the prayers and good vibes going! Our mission work is ongoing, both at home and abroad! We invite you to join us! Until next time…

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.