Our mission in Cebu is coming to an end. Today we held our final clinic where we ask our patients to come back in for a check up and a final update of records. I'm told that in most past missions, you're doing well to get 50% coming back for the final clinic. The success we've had here shows when all but three of the sixty plus patients came back to be seen and say goodbye to the team.
It's heart warming to say the least when we see the results of our efforts. The final clinic shows surgical scars already starting to heal. Kids are running and playing and capturing the hearts of our team. All in all, kids and parents expressed their gratitude and we'll miss them very much.
Center top picture, Grace Sang, DDS, our team Dentist
Successful surgery requires a team effort and this team has been exemplary. Our host operating room nurses and OR Techs have been the best trained and most professional with which we've worked. A myriad of people from both the USA and the Philippines worked tirelessly to get all the pieces in place so that we could perform these vital procedures.
Everything seemed right; we had the right surgeons, nurses, doctors and support to make certain that the end result, patient care, was the best you could find anywhere.
We could not have asked for better hosts than the Rotary Club of Cebu Port Center. This club has been sponsoring Rotaplast missions for nine years including our mission. Ove the years more than 1000 patients have been seen and more than 800 surgeries performed. These Rotarians really have taken Service Above Self seriously. The mission for them starts months in advance making certain that every last detail is seen to and all pieces are in place for the arrival of the surgical team. Once we arrived they ensured that we had everything we could have asked for and more. I'm certain that this club has found a special place in the hearts of all our team members. We thank the Rotary Club of Cebu Port Center for their excellent hospitality.
As we prepare to leave Cebu - Queen City of the South - I want to say a personal thank you to our hosts, The Rotary Club of Cebu Port Central, and to the many members of their families, hospital staff and volunteers that made this service to the children of Cebu possible.
This story is about the kids. It’s about making a transformation that improves their lives from now on. This is a story about removing the stigma of cleft lip and palate and restoring self-esteem.
Now this little guy is just one of the happiest kids I have met this trip. He and his mom lit up the waiting room with laughter and giggles.
Surgery is tough on a little guy and this is his picture just minutes out of the OR. Once he got to the recovery ward and had a nap and some food, he was back to his happy self! You can see that the lip has been repaired and it won't be long before the repair isn't noticeable.
I like to spend my time in the pre-op and recovery ward to hear the stories of families and kids. This is truly the reason we're here.
Most everybody likes a good detective story so let's set the stage. Brian, our Mission Director, brought six sets of prosthetic hands with us on the Cebu Mission. These prosthetic hands were donated by the Pleasant Hill California Rotary Club and designed to be a simple and easy to maintain prosthetic. Once in place, the wearer manually closes the jaws of the prosthetic hand around an object which can then be held until manually released. Elegantly simple.
While on our Sunday bus tour of historic sights, David, one of our operating room nurses, spotted a man with a missing hand in a very impoverished part of Cebu City. The man appeared to be an ideal candidate but the tour moved on and no contact was made.
Fast forward three days. David has conferred with Brian (“we should go find this guy cuz that would be really cool”) and there’s no trying to talk him out of finding the man with one arm. David enlisted the help of a local girl, Rachael, to be their guide and with nothing more than a starting point of the Cebu Heritage Site they set off looking for the one armed man.
Typical scene in the poorer neighborhods of Cebu
David had last seen the man going into a small grocery store near the heritage site. Keep in mind that this is not a nice area of town with high poverty, people begging in the streets, and high crime. The man he’d seen wore no shirt or shoes so it was likely he lived nearby. The clerk thought for a bit about the description and then pointed the pair down a dirty street looking for a place that “sold clothes”. The people at the place that sold clothes then directed them up an alleyway where kids were taking showers from buckets of water, up two flights of stairs into a makeshift passage way that led to a room about half the size of our motel rooms.
They found a family of a man and wife with five or six kids all living in the single room. They also found the one armed man. David asked that man if he’d like to try the hand and the man smiled, of course he would and they began fitting the arm.
While fitting the arm, David got a little background on the man. He’s 34 now but when he was sixteen he picked up some fireworks which exploded in his hand. He and his father both said that since then he’s been depressed, has no job and has no girlfriend and drinks too much. He isn’t able to wear long sleeve shirts or nice clothes that people would wear to ask for work. When asked if the hand would help he absolutely beamed. Yes it would help, now he could get a job and get a girlfriend. The only concern the man had was if the hand was actually free, was there a cost? He was assured that it was his to keep.
David told me that when they walked away he felt like a million bucks. He said that it was due to all the Rotarians and their efforts that come together in unexpected ways. He felt that he was just the means of transport and delivery.
Dance is an important aspect to Cebu culture. Cebu is known as the capital of dance for the Philippines. The tradition even extended into the prison where prisoners who’ve been convicted of serious crimes such as murder participate in dance. Video of the Dancing Inmates can be found at http://www.youtube.com/watch?v=CaQczzs2vME
The Cebu team was invited to dinner and enjoyed a performance by the University of Cebu Dancers. The dances commemorate histories and festivals most common and important to Cebuans.
Tinnikling is considered the national folkdance with a pair of dancers hopping between two bamboo poles held just above the ground and struck together in time to music. Originated in Leyte Province, this dance is in fact a mimic movement of “tikling birds” hopping over trees, grass stems or over bamboo traps set by farmers. Dancers perform this dance with remarkable grace and speed jumping between bamboo poles.(1)
It's hot and humid, probably one of the hottest locations in the hospital. It's noisy. It's on the street level and all the comings and goings in the hospital complex go past the open front. It’s a place of anxiety, boredom, pain and joy. It’s not a very comfortable place to be yet it’s the place where the results of our efforts are most readily seen.
It’s the pre-op and recovery ward run by Michelle, our Ward Coordinator. All our patients pass through here during their surgical stays. The Ward is in one very large room in an older section of the hospital aptly named, Children’s Survival. In addition to hosting our ward, the single large room also hosts mother and child exams for the regular hospital patrons. All this activity adds to the noise and confusion that Michelle sorts through daily.
Once patients check in with the hospital they are sent to the pre-op ward where they’ll stay until called upstairs for surgery. Michelle assigns them a cot, writes their name on one arm and their patient number on the other. This helps speed them through the process of getting them ready for surgery.
Keeping kids and parents occupied is a tough task in a crowded, noisy, hot environment. Rotaplast members brought toys, coloring books, crayons, markers and puzzles to help ease both the boredom and the anxiety. Through the day a bond forms between the staff and the patients, and a camaraderie forms between the patients. Simple activities such as coloring breach the language barrier. Lisa from medical records got a game of balloon volleyball going to help burn off nervous energy among kids and staff alike.
Sheila Mackell, MD, Lead Pediatritian makes the morning rounds of the recovery ward
After surgery, patients return to the recovery portion of the ward where they mostly rest over night under the watchful eyes of the Cebu Rotaplast staff. Physicians and nurses take turns being on-call and checking the patient’s progress. Some patients whose surgery was more involved stay longer in post-op but most of the simpler cases leave on the morning after their procedure.
David Sparks, RN, OR Nurse follows up with one of his patients in recovery. This boy had extensive work done on both the palate and lip, and is recovering well.
The first day of surgery can often be tense. Just like everything so far on our trip, the opening day of surgery went very smoothly. In spite of having very small operating rooms, things worked exceptionally well from the very beginning. Our first patient went to sleep at 8AM and the second one fifteen minutes later.
Waiting for surgery to begin, our moms and little patients relax in the pre-operation waiting area.
Today’s surgery concentrated on patients under one year of age with soft tissue procedures only. The team uses the standard of 10,10,10 where the patient is ten months old, 10 hemoglobin, and a weight of ten pounds to determine the safety of anesthesia and surgery. Adhering to these standards reduces risk to the patient but may require us to turn away those who may not meet the standards. At times there are steps that can be taken such as putting the patient on antibiotics for a few days to eliminate an infection. Sometimes this is just not possible, so the team begins paperwork and starts building a file that may be used in the future. This is the ninth mission and next year’s mission is already scheduled so the chances are that they’ll be seen in the future.
Even with the restrictions of small spaces and the tropical heat, we're able to treat 3 to 4 patients per table per day, with extra care and teamwork.
Patient transport brings the patients up to surgery from the ward which is three floors down and two buildings away. The patients wait in the hallway until their turn comes. Once in the OR, the anesthesiologists get the patient asleep and prepped for the surgeon. The surgeons and the surgical nurses then perform the procedure whether it’s for cleft lip or cleft palate. Dentists work on necessary extractions and the whole surgical team works under the watchful eye of the medical director and head nurse.
Once the procedure is complete, the patient is moved to PACU (post anesthetic care unit) and watched closely till they wake up. Waking from surgery can be traumatic, especially for our youngest patients who don’t understand what’s happening, they only know they hurt and feel bad. Once the PACU nurses determine that the patient is progressing well, the family is brought in and reunited. After another half hour or so, patient transport goes back into action and moves the family to the recovery ward.
The look of joy on the faces of the mothers as they are brought in and see their little ones for the first time post surgery makes all the effort worthwhile.
Project Wrap-a -Smile: Each child is given a blanket handmade and donated by Rotary District 5080. As patients come through pre-op they’re presented with a blanket that follows them and is theirs to keep. The blankets are used to cover them during surgery and comfort them during post-op and recovery. So many of those we treat come from extreme poverty and the quilts and blankets become prized possessions.
The talent of the surgeons and the transformations made in just a day is astonishing. Many of these babies start nursing immediately after waking, truly a tribute to the skill of the surgeon and the talent and professionalism of the team.
Today’s blog is short because we were busy meeting patients! Intake clinic processes and prioritizes patients for the surgical schedule. The process requires all members of the team to be actively involved all day.
Patients arrive at the clinic held in an area that belongs to the Tian Sian Buddhist Temple, about thirty minutes from the hospital where we'll be working. The heat and humidity is oppressive in the buildings but even worse for those waiting outside. Rotarians from Cebu arranged for and placed tents in the parking area for patients and families to wait in an area as shaded as possible.
Emotions run pretty high during the intake clinic. Parents are apprehensive. There are language barriers to overcome. The staff is scrambling trying to make sure that the flow is smooth and efficient. The response from the kids ranges from being scared of absolutely everything - from the ink markers to stethoscopes - to one little boy who was so excited to be "made handsome" that he sang us all a song.
The first stop in the process is medical records where Lisa (assisted by Kem, a local nursing graduate) collects all essential demographic and patient identification information and assigns unique patient identification. Patients are then photographed and the picture is attached to the records to provide identification as well as a base line for the before/after photos. Patients are then seen by pediatricians, surgeons, anesthesiologists, and the dentist to ensure that there are no underlying conditions that may complicate or prevent surgery.
It can be a smooth, efficient process but it takes a tremendous amount of effort and the cooperation from the parents. Luckily, they are exceedingly patient and polite. Some of these families have been waiting a year or more to have their kids seen and evaluated for surgery. The stigma that these kids face is unbelievable yet the attitudes that we saw would warm the heart.
One mother was asked why she had waited so long to get her child seen. She said that while her husband was alive it was impossible. The husband felt that the child had been born that way for a reason and saw no need to make any changes.
The priority for surgery is cleft lips for kids under age one, then cleft palate for kids under age 6, and then cleft palate/lip for those older than age six. All the potential patients are screened for anything which may raise the level of risk during surgery or recovery such as infections and reactions to medications. Because of the level of detail and the number of stations each patient has to navigate, most all the patients and families spent the entire day at the clinic waiting for word on if and when their child would have surgery. By the end of the day, we had established the initial surgical schedule and admitted the first set of patients to the hospital for surgery the next morning.
Besides repairing cleft lips and palates, the purpose of missions such as Rotaplast's is to foster goodwill, peace and understanding around the globe. The Rotarians of District 3860 provided the Rotaplast team several opportunities to experience the culture of the Philippines and the Province of Cebu in particular. Several of the team members met with the Cebu Provincial Governor, Gwendolyn Garcia who expressed her support for Rotaplast and explained the history and outlook of Cebu. Governor Garcia is the first female governor of Cebu province.
Food can define a culture and it’s one of the easiest things to share. Rotarians here make sure that the team gets to sample many kinds of local foods. One of the most popular items is the locally grown mango which we have during our breaks in surgery. We’ve been doing our part to try some of everything. When Brian told us to be flexible in his emails prior to our trip I never thought it would refer to a flexible waistband.
Later in the week, Governor Gwen Garcia invited the Rotaplast Team and their Rotary Club of Cebu Port Central hosts to a dinner at the Governor’s Mansion. Getting off the bus we climbed a beautiful staircase to the dining area flanked on both sides by the University of Cebu Dancers. Each group represented a part of life in Cebu, its history and festivals. The most important festival happens in January in Cebu City to honor the Santo Niño, or the child Jesus, who used to be the patron saint of the whole province of Cebu (since in the Catholic faith Jesus is not a saint, but God).
The knowledge of local history is important here. Everybody seems to know the oral traditions and throughout the area there are reminders of those important moments in the history of the island and the community. Cebu is very old and is home to the University of San Carlos (1595) which actually predates Harvard University.
Ferdinand Magellan discovered the Philippines when looking for the Spice Island on behalf of the King of Spain. Of course being “discovered” came as a bit of a surprise to those who already lived here, the native Cebuano’s. For centuries Cebu was a center of trade. The tales are told of how Magellan brought Christianity to Cebu and as the stories begin to tell how he met his end, it occurred to me that they resemble the story of an American, that of Colonel Custer.
Our team toured the historical sites, the churches, the cross of Magellan, the museums, and the site where Magellan met his fate at the hands of Lapu Lapu in the year 1521. The people of Cebu revere both Magellan and Lapu Lapu, the one for bringing Christianity, and the other for resisting foreign invasion.
Modern Cebu continues to grow. One of its most important industries is information technology. Cebu is home to a multitude of call centers and IT manufacturers. These jobs are raising the standard of living for thousands who call Cebu home. On the down side, many informal settlers flock to Cebu looking for jobs which contributes to the poverty. It is estimated that there is an influx of 200 informal settlers each week without jobs to support them. This tends to stress the social support system as witnessed by people begging in the streets. As the team looked around, it appears that many of our patients come from this group.
Our Rotarian hosts pointed out the many actions the government of Cebu has in place to alleviate this situation and is aided by the many programs supported by Rotary District 3860.Our Rotaplast mission is just one cog in the plan to help out those most in need in Cebu.