How Small - AMM Bukidnon Mission

Will (Smith, movie actor) says he felt especially connected to his character (in the movie, "The Pursuit of Happiness") because he's a father himself. "It feels the same way that I felt with Nelson Mandela," Will says. "Like when I met Nelson Mandela and there's this weird thing that washes over you of how small you are. But at the same time, how big you could be."   -- From the "Oprah" show

Just home from an Aloha Medical Mission in Bukidnon, Philippines, my husband, Michael, and I arrive in time to celebrate Thanksgiving with family and friends.  We relax in our friend's home on Long Beach Island overlooking the bay, enjoy a delicious feast, and simply get enveloped in comfort. But just four days ago, we were enveloped by the need, discomfort, and gratefulness of the indigent in Mindanao. 

I was a lay volunteer for this mission.  Eric Wurmser, a plastic surgeon, recruited my husband for his surgical skills as an OB-GYN. Others on the mission include Eric's wife, Teri, a nurse; Robert Arbour, a general surgeon, and his wife, Marie, a nurse; and Nileesh Patel, an anesthesiologist. We are all from New Jersey.  Paul Butler, a general surgeon, and his wife, Janet, joins the mission from New Hampshire.  Shon Magsalin, a nurse, is from Hawaii. Joining us from Manila are anesthesiologists Melissa Young and Liselle (last name), and OR nurse Juong (last name). 

Three flights within 24 hours bring us to the city of golden friendship, Cagayan de Oro, a bustling municipality on the southern Philippine island of Mindanao.  Our workplace for the next week is the Northern Mindanao Medical Center.  Mayor Soccorro Acosta, a little spitfire of a woman, buses her needy constituents from Bukidnon, about 45 minutes away, for a variety of life-altering surgeries.  She makes sure our visit is safe and welcoming. 

At the hospital, we infuse our group into the hospital routine.  The U.S. and Manila entourage is gilded by Gil Soriano, a native of Cagayan de Oro and an internist practicing in Hawaii; Jack Manildi from Las Vegas; and Ruby Caoile from Manila. These three AMM volunteers are available to us in countless ways.  They are helpful answering our questions regarding the local culture.  The docs meet their patients and prepare for Monday's surgeries.

Michael is faced with patients needing operations he has not had to deal with since his residency, which in the U.S. is now handled by gynecologic oncologists and other specialists.  Shon tells him: "You are their only chance." 

Questions race through Michael's head: "Have the patients been screened? Will they understand the pre-op orders?  Will they survive?"

After a few lengthy operations, he realizes the strength of NMMC's OB-GYN residency.  Drug therapies and new surgical technology in the U.S. make most gynecologic surgeries vastly different or unnecessary. Michael is impressed with the resident's surgical skills, diagnostic abilities, and confidence with difficult procedures.  Michael's cases are crowded with resident spectators, listening and learning.  The residents save suture that would typically be discarded in the U.S., so Michael preserves as much as he can so that it can be used later in the same operation.  Lap pads are wrung out and reused.  Unused mission supplies are left behind for future needy patients.

Michael gets a tour of the clinic and its labor, delivery, and post partum areas.  Patients on wards are separated according to their ability to pay.  This sliding scale affords those paying a ward with curtains on the windows and air conditioner.  Up to four moms and babies share one bed at the other end of that scale.  Delivery room tables are lined up, allowing no privacy to laboring patients. Cots line hallways with patients of all ages. The hospital's doctors, nurses and staff carry out a myriad of responsibilities for this mission, adding longer hours to their already busy workload. 

In the Gynecology ward, there are about 20 beds with one bathroom for the patients to share along with family members who are present to take care of their needs.   Unscreened windows provide little ventilation; the heat and humidity is formidable. It feels self-indulgent to roam the operating suites, asking questions, taking pictures, walking the wards, and giving out coloring books and stuffed animals.  Seeing my beloved doing his job that I've vicariously lived with for almost 32 years makes me weep.  His demeanor, calmness, teaching style, and skills shine.  I witness miracles performed by Dr. Wurmser on babies and young children who have their cleft lips repaired.  The children's parents tell me this "is a gift from God."   Goiters and lipomas the size of large grapefruits, hernias, and mastectomies are just a small accounting of what the general surgeons attack.  Their stamina, commitment, and knowing hands are inspiring.  Mindful that a patient's quality of life will change because Aloha Medical Mission is here is nothing short of a miracle.  The experience is emotionally and physically overwhelming. At the end of the week, more than 100 surgeries were completed with about 60 of those major cases.

Here is Michael's top 10 list for this mission: 1) What's easy is hard; what's hard is easy, 2) Trust your skills and knowledge, 3) Hold onto your hat, 4) One can attain rock star status by doing a vag hyst in two hours and close an incision with staples, 5) Massages are cheap, 6) Pork has many disguises and rice has many presentations, 7) If they tell you the fruit "tastes like heaven, smells like hell," see #3, 8) Pearls are cheap in Manila, 9) Make your wife peel the rambutan, and 10) He would do this again.  There are many opportunities this week for Michael to think back to his residency days.  His mentor, Dr. Breen, and the foundation of his training support him throughout.  The memory of making post-op rounds as patients hold his hand and whisper their thanks will sustain him forever.

I am privileged to have made this trip and gain this broad perspective.  I realize how grateful I am for tap water and to be an American living in a country filled with vast opportunities that are missing in third-world countries. I'm not sure how it would have changed me, but I wish I had this grand lesson earlier in life.

How appropriate were Will Smith's words: "How small you are... how big you could be."  This mission's accomplishments in numbers may seem small, but the comfort in the faces of the Filipinos was just about as big as it gets.

Janine Karoly

AMM Volunteer

Bukidnon Mission