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.

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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. 🙂

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.

Tagum Mission Journal

Day One

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This morning, after arriving in Davao, we were quickly whisked off to join the Bishop in Tagum who will be hosting the majority of us at his house. We had a lovely breakfast with the priests and I had a chance to have some conversation about the work they were engaged in in Tagum. One particular priest, Father Tom, has been here for over 11 years. He grew up in Tagum, and since the founding of the community by an American Bishop, Bishop Regan, he has known that he wanted to be a priest.

After covering some of this background, Father told me that Tagum is a city of around 210,000, but the diocese covers about 1.5 million and totals 40 parishes. On their latest survey “the Church” was still the most trusted public entity for over 70% of the population locally. This foundation as well as the extremely organized infrastructure across their community is what allows them to be so efficient and effective at their outreach, Father Tom said.

For example, on December 4, 2012, Typhoon Pablo struck the community of Tagum and the surrounding small towns including Compostela, Nabunturan, and New Bataan. The majority of the people affected by the typhoon were banana plantation workers. These plantations were rented by Dole, and after the banana plants were destroyed, they too left with destruction and hardship in their wake.

Within hours of the storm, the community of priests in this same area began to respond with relief efforts by partnering with outside national and international agencies. This is initially how we came to be in touch with this community. The priests also began their own longer term planning for their parishioners. The community of priests I speak of includes clergy with backgrounds in engineering, architecture, business, etc all on the foundation of theology and service. Naturally, in extension of the support of their local communities they immediately planned for a response to the economic and structural hardships that were to come.

The architect priests drafted simple house designs while others taught the others how to make hollow blocks out of sand and still others, how to install electricity. In this way they were able to quickly devise, share and pass on plans to their communities much faster than any outside or governmental assistance. To date they have built 500 homes and provided skill-set training and thus jobs for their community in the past year.

It is this same community that we are serving during this mission.

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Patient screening today happened without troubles. Most of my patients today are banana farmers or work elsewhere on the plantations within other capacities. One of my ladies in particular shaved the bananas before they go to the dehydration plant to become dried banana chips.

They all traveled approximately 2-3 hours to see us for their final screening today. Majority of them have massive thyroid goiters and have been waiting, symptomatic, for at least 7 years. They have oftentimes been seen by a surgeon but have not been operated on due to lack of funds. (hmph, heard that one before…)

One patient of mine has actually had symptoms for 20 years! Another has had a massive growing posterior auricular hemangioma for 7 years. A 20 year old has had a papillary carcinoma of the thyroid for 2 years, all while awaiting for funding. One little boy of 6 years told me today he was getting beaten up at school and showed me a round scar on his forehead. His mom told me a boy hit him hard with the eraser end of a pencil that had long lost its eraser. He was teased and bullied because of his cleft lip. In the FIRST GRADE.

Another was a 20 year old young woman who finished high school but was afraid to go to college because of the speech barriers her cleft palate generated. Therefore she stayed at home near the plantations and helped her parents with their work. As we were discussing surgery, we chimed in that she would definitely need some speech therapy (or speech exercises as they call it here). I have never seen someone SO happy to hear the words “speech therapy!”

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Here is a selfie with just a part of the team that helped my dad and I see and schedule 47 patients today!

We look forward to the rest of the team arriving tomorrow, morning mass at 530 (we are staying at the Bishop’s house) and the last wave of patient screening in the morning. THEN….we get to set up the operating room! My favorite part! Aside from the actual operating 🙂

Reflecting on how all of this is happening (as it often does in this work) as a result of a community of faith responding to the specific health and social challenges of their community. This is much like our work at the Church Health Center. In fact, I talked with Father Tom about our work at CHC, and how in a way, what they do for their community is much like what we do for ours back home. He replied quite simply with “that is what it should be” and he is right.

Day 2

Today is the first day our entire team is complete! It is 7pm and all of us Westerners are crashing from the jet lag. In total our team of 28 folks represents the cities of Seattle, Fresno, Sacramento, Memphis, and Phoenix. We also welcome friends from other areas of the Philippines! Such a relief to have had the entire afternoon to set up our four OR tables for tomorrow.

This morning we conducted a free medical clinic for the poor in our immediate surrounding area of Tagum.

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On my interviews, I became aware of the fact that many of them were food cart owners, some of them banana plantation farmers and the like; still very much in our targeted clientele. It is evident that the local community health workers worked hard to ensure we would meet our target audience.

Most came to us with complaints of cough and fevers. Not surprising considering that they persistently breathe in the fumes of burning trash, burning diesel and on occasion burning nicotine. Some of our most pressing patients were malnourished families of a mother of three, and a large deforming probable squamous cell carcinoma on the forehead of a 20 year old girl.

We are conducting our surgical part of the mission at the Diocesan hospital called Bishop Regan Hospital. Here it is below!

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They have an amazing and skilled staff and much more infrastructure than we are used to! It was founded by an American Bishop years ago as a charity hospital. While our surgical team stays here at Bishop Regan, our clinic reaches out to the smaller communities directly, as the majority of our patients are plantation workers. The clinic is therefore a mobile entity.

Day 3

Our first day in the OR proved to be a smooth steady effort! Each team performed 6 procedures, and to date it was the first day that I did 4 thyroidectomies in a single day. Dr Deneve and I ended our day around 10:30pm I think. All of our patients were so gracious, and in the spirit of sharing their story, more than willing to be a part of our mission, our sharing of our mission and stories!

Below is Dr Jig Deneve (right side, surgical oncologist at UTHSC), Rob Conley CRNA (center, formerly at Methodist LeBonheur, now Kaiser Permanente) and Chad a local OR tech (left) as we start our third thyroidectomy of the day :

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Above is Monette RN from Seattle (left), Cora Padua CRNA (Center, Regional One , Memphis TN) and my dad! (right, CRNA) They are inducing anesthesia in preparation for surgery. Behind them is our army-grade anesthesia machines, trusted companions on many many trips for us.

This is Mr Sasi, a banana plantation worker.

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When I asked him if he would mind me sharing his story with the world, he heartily agreed and said thank you. If he had internet or a computer he would love to see. He has had a hernia in his left groin for over 12 years. He has been unable to get it fixed due to finances and inability to leave work. At his age, he worries about his job going to someone younger and more spry.

Our thyroidectomies here in the Philippines are much more advanced than those we see in the states. Below is one of our “smaller” specimens. Mind you, this is just one side. 🙂

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In total we performed 12 procedures today, ending our day with our last patient in recovery room around 10 pm. Exhausted yet pleased with the progress of the day, we are happy!!! Our patients are safe, happy, comfortable and Christmas-level-excited about receiving surgical care that they have been seeking and waiting for for years….

The majority of our patients are Christians, but we also have a significant number of Muslim patients. Regardless, they are interested and happy to pray prior to and in preparation for surgery. The spirit is viably important to the most of them, especially in light of the fact that they have a tremendous amount of trust and respect for the church here. Without that established relationship, our outreach in these communities would be near impossible.

Day 4

Today proved to be a fruitful one, full of very challenging but safe and fulfilling cases! Truly a practice of patience and trust for our patients. We began the morning with a wonderful reflection on yesterday’s long hard day, how we respond to and recover from, and even grow and garner energy from such an experience. In this type of work, one expects a fair amount of suffering, naturally.

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bananas!

In fact, if there is no suffering, whether personally or as a whole, it doesn’t really feel like a mission. I found myself talking to Father Em today (Em short for Emerson!) and he told me his story of how he entered the religious life. We reflected on how as young people, we often think of our paths as straight, a paved road to follow, maybe even with yellow bricks! (do people still watch the wizard of oz, or am i dating myself?!)

But in times of calling or being called as it were, we sometimes find ourselves with getting doors slammed in our face. It feels harsh, hateful even, and it feels like we are being persecuted for going after our dreams. In fact what it likely is in reality, is us being guided towards the right corridors. If we were to walk through those doors (reminds me of Monsters Inc!) it would put us in rooms/places we are not meant to be.

Father Em said that this is how he entered, left and then re-entered the priesthood. He thought he was destined for a different life , but God had other better plans, yet to be manifested. How exciting! It is like choose your adventure, only not at all like choose your own adventure! It is like let God choose your own adventure!

Today’s procedures/surgeries were much like this story. Time and again,we are presented with people in need, with perceived expectations from the patient perspective. Similarly we have our own expectations as surgeons. Regardless of either, at a certain point we all realize that there is a higher power at play: the planes of dissection are pointing in a certain direction/order, the case progress is fast/slow, there are areas of lull or slowness dictated by a higher sequence of things over which we have no control.

We often call these things “Murphy’s law” or fate or even “poor protoplasm” as oftentimes they lead to humbling changes in management for the safety of the patient. For example, we had planned to perform a total thyroidectomy on a certain patient this afternoon. After removing one lobe, however, we found that physiologically and anatomically, it would be more conservative and appropriate to forego removing her other lobe. Safety first, and do no harm are some of our mantras. In fact, we say these things as if we are in fact the ones choosing the path we are taking. My fellow surgeon and I in this particular case remarked on the fact that “someone” was telling us to stay away from her right side. We quickly remarked that it was God telling us to do the right thing:)

Day 5

What a day! After a total of 9 cases for us today, we noted that we were able to be home before 9pm! An accomplishment for sure. As it were, it was a medically challenging day. Our oldest patient was 63 years old and her surgery was hard. I plan to monitor her closely overnight. She has no diagnosed medical problems, but as is often the case, this is likely due to the fact that she is not able to go to the doctor for regular visits.

My second most difficult case of the day was a large 6 cm hemangioma behind the left ear of a 17 year old girl. Beautiful young lady, but made self conscious and ashamed due to the large deforming mass visible from almost all directions. It was in this moment that I am so grateful to have a reconstructive plastic surgeon here! Dr Samson Lee helped me plan my incisions and in fact helped assist in the operation. A wonderful cosmetic result followed.

For the first time, this young lady smiled at me! Though she is young, she has already had a rough life. Her father passed away when she was very young, and her mother abandoned her a few years ago because she was unable to support her and her older sisters. She now lives with her older sister but is under guardianship of her school teacher. Her teacher mentioned that she had been abused as a child, as there were various men in and out of her mother’s life before she was abandoned. She has difficulty looking up and speaking as a result. Every move she has ever made has been a nidus for punishment in the past.

Day 6

A busy day. Don’t remember much else aside from our four hernia procedures and two thyroidectomies. Dr Deneve repaired an interesting scrotal hernia which contained omentum and transverse colon! That would be a first for me! The patient stated he had the hernia for a couple of months, though based on the extent, we suspect decades.

For now…sleep…