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.

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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.

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. 🙂