Texas Mission

Last week we were down in Texas. I did not attend a medical conference. It was not for a vacation or leisure trip either. I was there for some very serious work.

My family and I volunteered to join Your Best Pathway To Health (YBPTH), a non-profit organization that provides a free mobile mega clinic. There were medical, surgical, optical, and dental services offered, all free of charge to patients. There were also mental health, physical therapy, massage therapy, haircuts, financial planning, and lifestyle counseling among other services provided in that event. (See their Facebook page here.)

It was our first time to join this organization’s humanitarian mission, though they have already served in many other cities in the past, like Los Angeles, San Francisco, San Antonio, and Phoenix. This year it was held in Fort Worth, Texas. The free services were offered to people who could not afford medical care or had no medical insurance.

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photo credit: CBS news

In this event, people started lining up outside the building even the night before the clinic opened. I felt bad for the people who lined up for many hours, only to be told that they have to come back the next day as we were already full for the day.

Though if one clinic was full, for example the dental clinic, which appeared to be the service that most people lined up for, then we suggested to them that they go to the medical or vision clinic instead. Yet, there were still some, that sadly to say, we had to turn away completely, for we just could not accommodate them all. The mere number of people who lined up and were willing to wait several hours in line substantiates that there is a great need for these kind of services.

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photo source: YBPTH Facebook

The event was held at the Will Rogers Auditorium in downtown Fort Worth, which was converted into a mini-hospital, complete with operating suites. Minor surgeries and even cataract surgeries were performed here too.

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photo source: YBPTH Facebook

There were dentists, optometrists, ophthalmologists, internists, family practitioners, pediatricians, OB-GYNs, an ENT, orthopedists, podiatrists, a cardiologist, and a GI doctor present. I was the lone pulmonogist in the team. Below is a photo of my own cubicle.

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Since consultation to the Pulmonary Department was not that overwhelming, I assisted also in the Primary Care Clinic, as they were swamped with many patients there. Afterall, I am an Internist still. I probably have done more breast exams (for patients with breast lump complaints) and rectal exams (for patients with rectal bleeding complaints) in that 3 days alone than what I have done in the past 10 years of my practice now as a lung specialist. I declined to do PAP smears though and referred those patients to Women’s Health, as I have not performed that since I was in residency 20 years ago.

At the end of the event, in my estimation, I was able to see 100 to 120 patients. It was tiring to say the least, yet it was fulfilling.

We knew that there would be no monetary payment when we joined this mission. The only thing we got for free was lunch, which by the way was also provided to all the hundreds of patients seen. We even had to pay for our own airfare and hotel, and use our own vacation time to join this event. But the smile, or the simple “thank you” from the patients, and the satisfaction that we helped somebody was enough for our reward.

Yet to say that I did not receive any payment at all would not be true. There was one patient who gave me a large bar of chocolate as a present, and another one gave me a freshly home-baked loaf of bread. Those simple gifts were more valuable than my professional fee.

My wife was assigned in the Vision Department, assisting in the Optical services, and they were even busier than the medical department. My son, who is 15 years old, was in the Patient Assistance and Transport Department, and he probably was the busiest among us three, as he was walking and accompanying patients into the different clinics the entire duration of the event.

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photo source: YBPTH Facebook

The clinic ran for two and a half days, and at the conclusion of the event, the final report was that we had seen a total of 6,805 patients. That was an impressive number of people served.

Many local news media covered this event, so we were instructed on how to answer questions in case we were interviewed. As you know, health care is a hot political issue in this country, and an overzealous reporter might drag us into answering a touchy subject.

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A doctor being interviewed. (Photo source: YBPTH Facebook)

We were directed that we should avoid any political statements, and that when we were asked why we had volunteered and why we were giving all these medical services for free, our answer should be: Because we wanted to be the hands and feet of our Lord Jesus. Nothing else.

In truth, that was really the very reason we volunteered. To God be the glory!

Tumubo Mula Pinatubo

Nataandaan mo pa ba kung nasaan ka nang pumutok ang Mount Pinatubo? Maaring wala ka pang kamuwang-muwang noon, o baka naman wala ka pa at hindi ka pa iniluluwal sa mundong ibabaw nang mga panahong iyon.

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Dalawampu’t limang taon na pala ang lumipas mula nang sumabog ang bulkang ito. Ngunit ang naging sakunang dulot nito ay bakas pa, at malalim pa ring nakaukit sa alaala.

Hunyo 6 – 15, 1991, nang bumuga ng apoy, lava, at usok ang Mt. Pinatubo. Dito rin umulan ng abo at luha, at naging sanhi ng pagbaha ng lahar at paghihinagpis sa Pilipinas. Sangayon sa mga tagapagtala ng kasaysayan, ang pagputok ng Pinatubo ay ikalawa sa pinakamalakas na pagsabog ng anumang bulkan sa buong mundo noong 20th century.

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Maraming napinsala. Mahigit sa 800 katao ang namatay sa pagputok ng bulkan, may mahigit sa 10,000 mamayan naman ang nawalan ng tirahan, at libu-libo pang mga Pilipino ang nasalanta at natabunan ng paghihirap. Bilyun-bilyung pisong halaga rin ng ari-arian ang nilamon ng epekto ng pagsabog ng Mt. Pinatubo.

Isa sa mga napinsala ng Mt. Pinatubo ay ang base-militar ng Amerika sa Pampanga. Sa katunayan, hindi panukalang batas ng pamahalaan o kongreso, hindi rin ang pagpo-protesta ng mga mamamayan, kundi ang pagsabog ng bulkan ang tunay na nagpalayas sa mga Amerikano mula sa Clark Air Base. Sa aking opinyon, ang Mt. Pinatubo ang siyang naging huling hataw kaya nag-alsa balutan ang mga Amerikano.

Ngunit kamakailan lamang, matapos ang mahabang panahon, at matapos humupa ang lahat ng usok hindi lamang ng bulkan, kundi pati nagbabagang sentimyento laban sa mga Amerikano, ay muling pinaplanong ibalik ang mga base-militar ng US sa Pilipinas ngayon.

Katatapos ko lang ng pag-aaral ng Medisina sa UST, at ako ay isang medical intern sa St. Luke’s Medical Center, nang pumutok ang Mt. Pinatubo. Community service ang aking rotation noon at ako’y nakadestino sa Canlubang, Laguna, sa isang maliit na provincial hospital doon. Kahit hanggang doon sa Canlubang ay umabot ang abo ng Pinatubo.

Umiikot lang sa sarili kong mundo ang buhay ko noon. Hindi ko pa tiyak kung saang landas ako ihahatid ng aking bukas. Hindi ko pa rin alam kung saang lupalop ako ibabalibag ng tadhana. Pangangailangan ko lamang at ang susunod kong kakainin ang akin lang iniintindi. Wala akong masyadong pakialam pa sa mga pangangailan ng ibang tao, kasama na dito ang mga naghihikahos nating mga kababayan.

Ngunit hindi katagalan matapos pumutok ang Pinatubo, isang kakilala ang nag-imbita sa akin na sumama sa isang medical mission sa Pampanga upang tumulong at magbigay lunas sa mga kababayan doon na naapektuhan ng rumaragasang lahar. Bilang isang bagitong duktor, nasabik akong sumama. Wala pa rin naman akong suweldo noon, tapos libre daw ang pakain sa mga volunteers, kaya’t ano pa ang hahanapin ko?

Ito ang una kong pagsama sa isang medical mission. At hindi rin ito naging huli. Nasundan ito nang maraming beses pa ng pagbubuluntaryo ko sa iba’t ibang medical mission noong panahong iyon. Dito ako namulat nang husto sa nakalulungkot na kalagayan ng ating lipunan. Kalagayan na hanggang sa ngayon ay maliit pa rin ang pinagbago.

Mula sa Pinatubo, napunla sa akin ang diwa ng paglilingkod.

Kaya matagal pa bago pa ako sumabak sa mga nasalanta ng bagyong Yolanda (see previous post here), ay nauna muna akong sumabak sa mga nasalanta ng lahar mula sa Mt. Pinatubo.

May isa pang naging bunga ang pagsabog ng bulkan. Dahil sa aking pagsama lagi sa mga medical mission matapos pumutok ang Mt. Pinatubo, ay mayroon akong nakilalang magandang binibini na lagi ring nagbubuluntaryo. Dito sa mga medical mission, akin siyang nakasama at lubusang nakilala.

Sa pagsabog ng bulkang Pinatubo, ay may magandang tumubo, umusbong, at lumago.

Siya’y naging kasama ko hanggang ngayon.

******

(*photos from the web)

Palawan: Photo Haiku

(The following photos were taken during our recent trip to Palawan, and also inspired these haikus, which are short poems, with traditional 17 syllables, in phrases of 5, 7, and 5.)

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Dalampasigan

Dalampasigan,

Hawak ko iyong kamay,

At ‘tong tsinelas.

(Shadow selfie with wifey at a beach in Sabang)

*******

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Katig

Hindi tataob,

Alon ma’y maligalig,

‘Pagkat may katig.

(In the sea of life, we also need “katig.”Photo taken at Honda Bay, in Puerto Princesa.)

*******

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Lulubog Lilitaw

Dito sa Luli,

Sa Lulubog-lilitaw,

Phone, nagtampisaw.

(The island was named so, as it will appear and disappear depending  on the tide. The water here was so inviting that even my cellphone tried to swim. It drowned.)

*******

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Bayawak

Mga bayawak,

Mayro’n sa gubat, at sa

Gobyerno’t syudad.

(Bayawak or monitor lizards are “cold-blooded animals” that prey on smaller creatures and their eggs, or their balikbayan box.)

*******

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Dagat at Gubat

Dagat at gubat,

Ng lupang pinagpala,

Ba’t ginahasa.

(Acres of virgin forest in Palawan are being ravaged due to mining.)

*******

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Kulang

Likas na yaman,

Ngunit paraiso man,

Ay mayro’ng kulang.

(Part of our trip was a medical and dental mission in Narra. Here I observed the lack of health care for the people in this paradise island, especially the natives, known as “natibo.”)

*******

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Boatman

Hindi si Batman,

Ang nakita sa kuweba,

Kun’di si Boatman.

(That is what our bangkero called himself, when we explored the Underground River, which is named one of the New 7 Wonders of the Natural World.)

*******

A backpack, bedbugs and toilet paper

(This is a story of my trip to Tacloban, albeit more lighthearted than my previous post, “Tour of Duty.” It is not my intention though, to discredit the seriousness of the situation there.)

While watching CNN (Anderson Cooper 360) from the comforts of my home in Iowa, with live coverage of the effects of super typhoon Haiyan in the Philippines, somehow the strong winds jumped across the Pacific and reached me. It agitated me into action.

I was literally in front of a computer searching for how I can volunteer, when I received a phone call. It was from someone whom I have not seen for more than 10 years as he now resides in Virginia. He told me that a certain organization *(ACTS/GR3) called him and he in turn invited me to join them. I believe that was the heaven-sent sign I was seeking for.

After arranging my schedule in our clinic, soon I was airborne for the Philippines. From Des Moines, I made a connecting flight to Atlanta, where I was joined by four more people in our medical team. From Atlanta our next layover was in Seoul, where another doctor (from California) joined us there. Our next stop then was already Cebu, Philippines. Two more doctors (who flew from Colorado) were waiting for us there.

I traveled light for the trip and packed just the bare essentials. I was able to fit all my things in a medium-size backpack. But when I read the notice from the organization that each one should bring at least 3 days worth of food (as they cannot guarantee our food), so I also brought a small duffel bag with cereals, power bars, chocolates (survival essentials!), apples and water. In fact, nothing was guaranteed for us, food, lodging, nor security. The only thing guaranteed was that there was a lot of work for us.

I did not even notify my mother who was in Manila that I was going to Tacloban. First of all, there was no chance of seeing her anyway as we were flying directly in and out of Cebu. Another reason was, as the situation in Tacloban was dire, and there was even reports of rebels and insurgents taking advantage of the chaos, I did not want her to worry about me. I just called her over the phone after I already returned back to the US.

When we arrived in the Philippines, as a returning expat, the custom officer looked at me in disbelief, as I was just lugging a backpack. Perhaps he was looking for the typical large balikbayan boxes that any returning Filipino carry. But nothing of this trip was typical.

From Cebu, we caught a commercial plane flight to our final destination. Flying on a C-130 would have been more dramatic, but it did not happen. After 32 hours of travel (that’s my own time, I don’t know exactly how long were the other’s), which includes flight time plus layovers, we finally landed in Tacloban.

The short bus ride from Tacloban airport to the place where we stayed was one of the most heart-gripping experiences I had. I saw with my own eyes the desolation of the place we came to. Street after street, block after block, were piles of debris, brokenness, and misery. The stench from decomposing unretrieved bodies was overwhelming. One of the American doctors tapped me in the shoulder and sincerely said, “I am so sorry for your country.”

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destruction in Tacloban (photo credit: ACTS website)

Barely 3 hours after we landed, even though we were all travel-weary, jet-lagged, tired, and hungry, we started working. We relieved a team of doctors who were already working in Tacloban for a week. On my first day, our group was divided into 4 teams and we treated a few hundred people in our mobile clinics. And we saw even more every succeeding days. (It was reported that on the 2 weeks of medical mission, ACTS/GR3 has seen more than 6000 patients in Tacloban and its surrounding towns.)

We stayed in Romualdez hospital, which was not operational at that time due to damage from the storm, yet it provided lodging for us. On our first night, 7 of us slept in 1 room, mostly on the floor. There was scarcity of beddings in the room for us – maybe 2 hospital mattresses, a couch, a mat, and cardboards. Being the only Filipino in our team initially, I thought that I should give the mattresses to our foreign visitors, so I slept on the cardboard. Being hospitable whatever the circumstances, is one of our Filipino traits you know. Besides I am used to sleeping on a hard surface anyway.

When we woke up the next morning, I was sorry to learn that the one doctor who slept on a mattress, got bitten all over his body by bedbugs. Who would think that sleeping on a cardboard was better, as at least it has no bedbugs? Many members of our team, were also feasted upon by mosquitoes. I brought a mosquito net but I let somebody else use it. I jokingly told them that even Filipino insects practice colonialism as they were specially attracted to Americans.

Many of the doctors I was with were unsettled with one trivial fact: that there was no toilet paper in the restroom. I explained to them that most Filipino household don’t use toilet paper. We use soap and water instead.That’s what the ubiquitous tabo (dipper) is for, which is indispensable to our culture.

But since they were so culture shock with this, and we did not bring toilet paper, we went for “operation toilet paper.” Me and another commando went to the camp of the Taiwanese doctors who were lodging in the far end of the hospital and hijacked some toilet paper. OK, OK, we did not really stole them, we just took some rolls they left behind.

The following day, a group of doctors from Harvard and another group from Abu Dhabi arrived and joined our team. The Abu Dhabi group initially asked if there was a hotel they can stay, perhaps after seeing the meager accommodation we had. But after learning that the nearest hotel was probably about 3 hours away, they decided to stay. It was amazing that the next day, we have to wake their group up as they slept so good despite the “meager” accommodations.

On my third day, another Filipino doctor (from Baguio) arrived and joined the team. Being the only two Filipino doctors in our team, we believe we had the advantage. First of all, though we don’t speak Waray ( the dialect in Tacloban), yet we speak Tagalog, and thus we did not need an interpreter. Most of the foreign doctors required an interpreter.  We also understand the culture better so we can connect with them easier. Though some patients may have preferred seeing the American doctors, due to our ingrained colonial mentality, viewing them as superior. Yet working hand in hand with them we earned their respect.

For me, as a Filipino, it is quite understandable why I volunteered: for this is my country, and this is my people. For the other doctors, it is for no other reason than the goodness of their hearts and their sense of humanitarian mission. They sacrificed their time, effort, and not to mention resources, as nothing was paid, not even our airfare, and we were all volunteers. (All donations to ACTS/GR3 was used for medicines and medical supplies.)

After a few days of working with these highly trained and yet very compassionate doctors, and after undergoing a unique experience together, we have formed a bond. A bond more than bedbug-infested-mattresses and mosquito bites. Beyond toilet paper-less bathrooms and cold pail-and-tabo showers. Even beyond being medical professionals, foreign or otherwise.

For one special time (despite of the calamity), we were one race – the human race. Working together. Sharing a common goal. We were a team.

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*ACTS (Active Communities That Serve) / GR3 (Global Rapid Rescue Relief). Learn more of their work and their mission, and how to help at actswr.org

** After returning home, I left my backpack in the garage for a month, where it was freezingly cold, to make sure I don’t bring in any chance-passenger bedbugs to our home. 

Tour of Duty

I am sitting in an airport terminal in Seoul, waiting for my connecting flight back to the US. I have more than four hours of layover here – plenty of time to reflect on the things I have witnessed and places I have been in the past few days.

As I look around on this beautiful airport in South Korea, its sturdy structure, its opulent stores, the distant city skyscrapers glistening in the morning sun, I noted that all these provide stark contrast to the place I have just come from. It is a place where there was utter destruction everywhere I looked; what was left was a ghostly reminder of a once thriving city.

The place I went to was Tacloban.

We arrived in Tacloban 2 weeks after super typhoon Haiyan (local name Yolanda) basically wiped out the city. After seeing the horrific news of the calamity day after day on TV and internet, I felt compelled to do something. Something more than financial donations. So I volunteered to go.

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I came as a member of ACTS World Relief team. Our group was composed of international physicians, nurses, paramedics and rescue volunteers. Among the doctors that I worked with were several Disaster Medicine specialists from Harvard, an Emergency Room physician trained in Mayo Clinic, an experienced orthopedic surgeon from Colorado, an anesthesiologist from Tennessee, and an Urgent Care physician from Loma Linda Hospital. There was a team of doctors from Abu Dhabi, and a surgeon from Baguio in our team as well. I  am proud to work hand in hand with these highly trained and compassionate people.

Even after watching it in the news, witnessing the state of devastation in person was surreal. It was heart-gripping. The stench was gut-wrenching. On my first day there, even if it was already entering the third week after the disaster, our search and rescue team had recovered 9 more bodies. You can just imagine the state of those cadavers. They even found 13 more, but they ran out of bodybags, so they left them to be picked up the next day. On my second day, when we posed for a group photo, we saw a decomposing body of a child in the middle of the street a few feet away from us. It was harrowing.

Our team made Romualdez hospital our command base. The hospital though was damaged from the typhoon and was not operational. Still, the hospital became the “hotel” for several teams. The amenities may be meager, but we have a roof over our heads, toilets (just don’t ask how clean), and cement floor with mats and cardboards for beds (though some were lucky to scavenge foam beds). Those (in)conveniences were still much better condition than what people in Tacloban had. Aside from our group that stayed in the hospital, there were the team from Sweden, a big party (more than 60-doctors strong) from Taiwan, and a squad from Colorado with their rescue dogs.

Instead of hospital setting, everyday our team will be divided to smaller groups and were deployed, with coordination with local leaders, to set-up different mobile clinics. One day my team erected a clinic in a street in the inner city, in the midst of debris and mud. There were teams that went on helicopter mission to reach distant towns, and I was fortunate to join the flight mission (twice!). Some areas we went to were so remote that the terrain can only be reached by a truck. In one particular area, our bus cannot go through any further, so we all hopped on the convoy truck carrying our medicines. We fit 25 people in the back of that flat-bed truck. It was a trip that could rival the thrill of the helicopter ride.

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The condition in Tacloban was horrendous. Yet people try to cope to the situation the best they can. I saw vendors of eggs and vegetables on the side of the street. People taking a bath and doing their laundry next to piles of wreckage. Children playing in the street littered with refuse. Somehow they tried to bring back normalcy. But it was far from being normal!

Now the foreign media has gone, and the local press has pursued some other fancies, like the spat between senator Enrile and Santiago. Tacloban and its relief efforts is not hugging the headlines anymore. Yet hopefully these people will not be forgotten, for they still badly need our attention – with or without coverage of the press.

Despite of the calamity, the people in Tacloban were strong and resilient. When I saw patients in our mobile clinics and I asked them how they were they told me: “OK lang doc, buhay pa” (I’m OK doc, I’m still alive). They said this with a smile. But I always eventually found out that they had a relative or a friend who had died. It was story after story of tragedy.

I remember one woman whom I saw on my first day in Tacloban, in one of our clinics. She told me that she lost her husband, and two children during the typhoon as they were washed away by the storm surge. Yet she kept a positive outlook in life. Where she was getting her strength was a marvel to me. The foreign doctors I worked with were really amazed with the spirit of the Filipinos. Yes, typhoon Haiyan was strong, but the Filipino spirit is stronger.

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I may be feeling exhausted, sleep-deprived, and emotionally drawn-out after my 5 days tour of duty in Tacloban. But I know that tomorrow night, I will be eating a home-cooked meal, sleeping in my comfortable bed, embracing my wife and hugging my kids. For the people of Tacloban, it will be another day of struggle wondering where will they get their next meal. They will continue to sleep under make-shift shelters from the rubble. And many will cry themselves to sleep, mourning the lost of their loved ones.

The task is so enormous that sometimes we wonder if our little efforts even matter as they are just lost in the sea of need. Coming to Tacloban, I just hope that I can make a difference and make a little change.

Well, it did. It changed me.

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(*photos taken with my iPhone)

You can visit ACTS World Relief Facebook page for more photos of their mission.

(**Post Note: the above article was eventually published on Manila Standard Today, Dec 2, 2013.)