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Rising Sun Project:   The Evolution of a Joint Educational Exchange, David Kanuck DPM, John Doolan DPM, Philip Cruz MD             

Political Unrest

As Philippine President Gloria Macapagal Arroyo declared her country, “In a State of Emergency” members of the F.A.M.I. mission organization arrived quietly into the outskirts of Cabanatuan City , located three hours north of the capital city-Manila. With little fanfare and under the cover of darkness the 8th medical/surgical mission chaired under Niles and Leus Perles had begun.

Cabanatuan is a city of nearly 230,000 people located in the province of Nueva Ecija and is considered an economic hub to its neighboring municipalities.  The historical significance of this location is dramatized in the 2005 cinematic release of, “The Great Raid”. The year was 1945, when Army Rangers marched far behind enemy lines to free the remaining 500 survivors of the Bataan Death March. Many American soldiers had spent upwards of three years in prison camp during the Japanese occupation of the Philippines . To this day, it remains one of the most successful raids in U.S. military history.

Upon arrival, volunteers found themselves protected by the contiguous wall of the Acropolis Resort, an amalgamation of erected concrete and steel rods towering above the grounds of the complex.  As base camp was established, security forces guarded precious medications and supplies.  With the site secured, weary travelers retired to their rooms in much anticipation of the days to follow. Many drifted quietly to sleep perhaps not noticing the flickering movement of a gecko as it scurried across the wall curiously investigating its new neighbors.  Although night had fallen, not all had retired for the evening. The blanket of darkness teemed with life, none that could be seen, but all that could be heard just beyond the surrounding walls. Occasionally, a flash of light penetrated the bedroom window, illuminating the darkness as guards performed perimeter searches.  In the distance, indiscernible chatter in local vernacular broke out and deadened the symphony of insects and animals –but only momentarily.

A New Day

The sun effortlessly jockeyed into position at the crack of dawn introducing the heat and haze of this tropical region, while locals tallied to and fro with a renewed determination that often accompanies the optimism associated with a new day and its infinite possibilities. Early that first morning, an anxious busload of volunteers was whisked away as a local driver negotiated streets littered with jeepneys, tricycles, pedestrians and morning activity commonly seen as this giant little city called Cabanatuan awakened.

Ground Zero

 Anticipating our arrival, the sick and needy congregated outside the doors of the first treatment site.  As word spread, lines of people spilled into the streets. We were greeted with that same optimism as toothless smiles and weathered faces of young and old alike shyly glanced into our direction. Emotions were genuinely warm and heartfelt and there seemed to be a sense of hope and relief on the villager’s part upon our arrival. This in turn gently reminded us of our purpose here and why as volunteers we felt so compelled to get involved.

A recreational center was quickly converted into a medical triage and treatment clinic.  An entertainment stage within the complex now doubled as a pharmacy. High above, an abandoned press box was the perfect location for a minor surgical suite and at a site downtown, Lacson General Hospital provided the necessary support and induction capabilities for cases requiring general anesthesia.  Organized under the watchful eyes of Dr. Philip Cruz, Dr. Cephas Swamidoss and their dedicated staff of colleagues, the difficult task of filtering through numerous potential surgical candidates had begun.  It is also at this location, those fortunate to qualify experienced the plastic reconstructive wizardry of Dr. Lloyd Gail or the general surgery prowess of Dr. Dzuy Le and Dr. Adam Fox as they performed vital and life altering surgery such as cleft lip/palate repair, thyroidectomy, mastectomy, paratoid mass resection, and hernia repair.

Major or Minor?

Careful! Patients finding there way into the minor surgical suites were not always simple cases and at times not always minor.  Decisions to operate in this arena were made solely on a clinical basis without MRI confirmation.  An attempt was initiated as long as one had enough confidence to tackle a case and local anesthesia flowed freely. Patients presented with lesions spanning head to toe. The alternative was to decline or defer to major surgery. However, inevitably one soon discovered a fine line existed between limited instrumentation, regional anesthesia, patient comfort and safety. It is in this arena where even the most veteran of surgeons did not emerge unscathed. With each additional day knowledge was gained, efficiency increased and by week’s end an empty room in a half-hours time was transformed into a fully equipped mini-surgical center. Furnishings included surgical tables (desks and gurneys), back table (coffee table), “autoclave”(basins of Cidex and alcohol), and refurbished surgical equipment and instrumentation. Oscillating fans hummed and rattled set on high position providing laminar flow while construction lighting functioned as secondary spot illumination which bought some relief to the work environment.  Eighties metal rock and club music pulsed from a strategically placed IPod rigged with external speakers setting the working rhythm. At full throttle, two to three surgeries were performed simultaneously side by side. Local nursing students served as scrub techs and instrument cleaners while Dr. Michael Ho, the anesthesia fellow assumed responsibility of preoperative        screening,  intra-operative monitoring and  patient  debriefing.  The combined efforts of both medical and non-medical staff produced an impressive number of patient encounters in one week’s time (see figure 1). Figure 1:   Medical Consultation    5500,  Surgical Cases 324,  Major 99 Minor  225 

The Cuisine

At day’s end, hungry and parched volunteers quenched their palates with a variety of local and exotic fruits such as fresh mangoes, star apples, baby coconut and lychee.   Others preferred the refreshing bold taste of a cold San Miguel Beer while feasting on suckling pig, barbecued calf or for the truly adventurous-balut (fertilized chick embryo).  The Filipino cuisine, considerably different from its asian neighbors but no less appetizing offers flavors diversely influenced throughout the centuries by its occupants; the Malay, Arab, Chinese, Indian, Spanish and Americans.  However, It was 400 years of Spanish influence and domination initiated by explorer Ferdinand Magellan that left an indelible mark as the country’s greatest culinary influence. This is reflected in a main course dish like Adobo and popular desserts such as Flan and Ensaymada.

Educational Symposium and The Operational Theatre

On March 3^rd, in cooperation with the Philippine Academy of Medical Specialists, De Los Santos Hospital ( Quezon City ) hosted its second post graduate course on the topic of Foot and Ankle Updates.  Drs. Doolan and Kanuck introduced their profession to the department of orthopedics with a day of lectures covering a wide range of elective and reconstructive topics (see figure 2).  Dr. Ericson Zoleta and his colleagues found the discussion on hallux valgus surgery interesting because of its ease of application to the Philippine setting. Attendees were equally impressed with the endoscopic release for plantar fasciitis, a technology not yet locally available while reconstructive experience in the use of external fixation was apparent particularly for its application as a treatment for congenital deformities such as neglected clubfoot.   Figure 2:  External Fixation - Endoscopic Plantar Fasciotomy,  Plastic Reconstruction - Charcot Reconstruction, ESWT/PTTD - Hallux Abducto Valgus

    The second day of the course focused on the practical application of didactic material in the operational theatre.  Orthopedic surgeons scrubbed with podiatric foot and ankle surgeons and monitored approaches were taken to teach in the intra-operative setting.  The combined lecture and live surgical training stimulated a healthy discourse in the treatment of both conservative and surgical care regarding related pathologies.  Differences were explored and debated.  Educational deficiencies and strengths were exposed and a universal interest evolved in exploring how two countries can and should work together to improve upon established treatment protocols and joint educational training.

 Dr. John Doolan reflected on his experience with the local surgeons, “As western practitioners of medicine and surgery we rely heavily on the enormous arsenal of equipment at our disposal that we lose site and possibly basic fundamental skills in executing the task at hand.  What surgeons lack in equipment they’ve compensated for with advanced skill and ingenuity to get the job done.  What first appears as unorthodox and possibly crude makes perfect sense when placed in their working environment.  It is here at this interface between excess and compensation that new ideas evolve, take shape and form. Our goal with “Rising Sun “ is to not only educate and share knowledge but also capture and  foster these moments and try to turn them into something truly special.”  

  “I couldn’t agree more with Dr. Doolan,” added Dr. Kanuck I’ve seen it before in Russia , South America and other countries in South East Asia .  Experiences such as this ground you and force you to approach cases with a new perspective. What I once considered abhorrent work conditions has now become second nature. I believe the diversity and volume of cases has further enhanced technical skills and overall respect for soft tissue and boney pathology.

Representing the Filipino contingent Dr. Philip Cruz remarked, “The recent postgraduate course at the De Los Santos Medical Center was a success in terms of knowledge and experiences shared. The subspecialty of podiatric surgery is not recognized in the Philippines and the practice of foot and ankle surgery is relegated to the orthopedic specialist. Keeping in line with the De Los Santos Medical Center’s vision of health care in the digital generation, the group was privileged to host a course emphasizing updates in foot and ankle surgery. This course not only bridged the gap in specialties but also enlightened the local  surgeons on the development and progression of this subspecialty and the potential for future collaborative projects.

Post Mission Reward

Having completed a successful mission, many missionaries rewarded themselves with a well deserved excursion to the exotic islands of Boracay, Palawan, and Cebu . These gems of nature located in the Southern Philippines are home to some of the most pristine beaches in the world. Until next year- Maligaya at Ligtas na Paglalakbay!

Recognition/Thanks

As physicians we are empowered through education and training the valuable skills needed to diagnose, treat, and heal. Volunteering your services to help those less fortunate is not only noble but rewarding. The mission” experience” produces a timeless collection of images, memories, and fresh perspectives that every physician should experience once in a lifetime. We salute the following contributors.

Players:

Ericson Zoleta MD, Adam Fox DPM DO, Finnie Lau PhD, PT, Dr. Joseph Disabato, DPM, Dr. Gary Jolly, DPM, Dr. Juan Garbalosa, PhD, PT, Dr. Shushil Dhawan, DPM MD, Samir Bondojki DPM, Cephas Swamidoss MD. Lloyd Gail MD, Michael Ho MD, Lyzel Madelo RN, and the numerous additional nursing and non-medical support staff.

Institutions:

The F.A.M.I. Organization, Virginia Foot and Ankle Surgical Associates, Gramery Park Podiatry, St. Lukes Hospital, Lacson Foundation College Hospital at San Leonardo, Crescencia Shamsoddin Hospital,  De Los Santos Medical Center, Cabrini Medical Center, The Hospital of Special Surgery.

Corporate: Osteomed, Wright Medical, KCI, Smith and Nephew, and EBI.

Authors: David Kanuck DPM, Private Practice, Virginia Foot and Ankle Surgical Associates, Charlottesville , VA,  drdamikan@yahoo.com

John Doolan DPM, Private Practice, Gramercy Park Podiatry, New York , NY, johnjdoolan@yahoo.com

Philip Cruz MD, General Pediatrician, Manila , Philippines, Philipcruzfiles@yahoo.com

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On route, we observed smoke rising from small, smoldering roadside fires that littered the surrounding area. The smell of charred ambers wafted and lingered in the air.  Each breath was a gentle reminder that we were in a far away land. The weather was hot and balmy but not oppressive.  The equatorial sun flexed its strength daily, providing  little  relief until nightfall.

There was no need to set an alarm. Each morning, one was awakened by the piercing cock-a-doodle-doo of the roosters that in turn agitated the local dog community into a frenzied state. The result was a competition for loudest, most obnoxious animal sound.  Showtime began punctually each day at 4:30 am.

The rural city called Urdaneta boosts a population upwards of 120,000 and was the first of 2 locations to be the recipient of both medical supplies and patient care provided by the Filipino/American Medical Incorporated ( F.A.M.I). This non-profit organization, chaired by Niles Perlas, was embarking on its 7th annual mission pilgrimage to both urban and rural areas in the Philippines.  It is here that volunteers from the United States were joined by volunteers from the Philippines to jointly diagnose and treat a multitude of pathological conditions, rendering care to the impoverished and underserved people of this province.

Discussions about effectively addressing the “poverty problem” struck a chord with the local physicians.  Dr Philip Cruz, a pediatrician and staunch advocate for patient care equality, offered a sobering reminder to many volunteers.  He remarked, “a large dichotomy in economic classes often defines third world countries, and the Philippines is no exception - unfortunately, it is always the people who suffer most”. The end result is a lethal combination of both poverty and inaccessibility to proper health care.  Medical doctors and staff are faced daily with the intellectual skills and training to properly treat patients but the lack of proper equipment and supplies. In addition, inadequate funds to replenish and provide a satisfactory level of continued care further contributed to this complicated problem. It is these same medical professionals who stare into the collected eyes, and perhaps souls of entire families and watch helplessly as prescriptions for important medicine go unfilled or vital surgery not performed because funding is unavailable.  Others are forced to contemplate the reuse of needles and the sharing of ventilators, a stark contrast to the current practices observed in most of the western hemisphere. 

This mission’s aim was to provide much needed relief to those who sought care and needed it most. This was accomplished one person at a time, even if only for the short term those that made the journey to Urdaneta City would at the very least be heard, and in most cases treated.

The medical and surgical entourage who provided the patient care was diversified.  Specialists in the disciplines of internal medicine, infectious disease, cardiology, and pediatrics worked side by side often consulting each other to provide the patients with complete and thorough care through their individual expertise.  Nearby, at Don Amadeo J. Perez, Sr. Memorial General Hospital, the surgical team, consisting of general surgeons, plastic surgeons, foot and ankle surgeons, anesthesiologists, ob/gyn and physician assistants worked methodically and diligently in an assembly line format.  Surgical procedures were divided into major and minor based on severity or whether they could be performed under local anesthesia. Prospective patients filled the halls adjacent to the surgical suites in the hopes they would be chosen as a candidate.  They lined up in formation and we walked up and down indicating to them with a “yes or no” whether we would or could perform the procedure. Those fortunate to qualify were often brave and stoic, never complaining and grateful for our assistance. We often wondered how we achieved such “pain-free anesthetic blocks” repeatedly.   

Unfortunately, there was never a lack of candidates, only limited time and resources. The on-site supplies and poorly equipped facilities made way for a challenging operational theatre.  Large drapes and split sheets normally used to adequately maintain a sterile field,were substituted with a limited number of towels and gauze. These were strategically placed about the local surgical site. Hemostasis was maintained with epinephrine and suture ligation because there were no tourniquets, gel foam, or topical thrombin. The adjacent area to the surgical site served as a back table and for the most part one worked independently without retractors.  When bandage supplies dwindled down to none, the knives (#15 blades clamped with a hemostat-no blade handle) were put to rest and surgery was no more. Occasionally, assistance was attempted by a rouge fly or insect that precariously perched itself next to the surgical field. 

In the early mornings, people filled the auditorium of the Cultural Center of Urdaneta for registration.  Here, census information, vital signs and chief complaints were recorded and patients were triaged appropriately.  A make-shift pharmacy was constructed where nursing and additional non-medical staff worked.  It served as a hub of activity and a  fresh change of scenery when a much needed brake was in order. Personnel dispensed medications and filled prescriptions as patients filtered back from their clinical evaluations.  Intermittently, lists were updated and generated to the physicians keeping them abreast of the medications available and the volume remaining. 

The medical and surgical environments were both richly populated with diverse  pathology. Most striking were conditions such as goiter in the young and old alike, and cleft palate which are not as prevalently seen in the United States. The foot and ankle was not immune from disease either.  Soft tissue tumors such as lipomas, sebaceous cysts, fibromas, angiomas, and bone tumors were abundant and large. This pathology provided unique surgical and reconstructive challenges in an already compromised work environment.  Congenital deformity such as clubfoot, was also observed in its severe and neglected state.

Each passing day produced countless stories that were often eagerly shared between volunteers.  Some retold tales of hardship and despair, while others sort comfort in stories of hope and those that exemplified the human spirit.  One such story tested the fragile balance between life and death and forced all who were witness to ask the proverbial question, Why? Tragically, in a cruel twist of fate, a mother accompanying her child for cleft palate repair was pulled aside during her son’s surgery and was told her husband had been struck and killed in an automobile accident. Ironically, the husband’s body was bought to the very same hospital and lay in a neighboring room. 

 As one learned rather quickly, the life of a missionary can be both an exhausting and humbling experience.  The frenetic pace of mission life slowly chips away at one’s strength and energy, physically as well as mentally.  At times, as waiting patients piled up in lines three to four deep, we had to remind ourselves why we volunteered for such an event. However, a certain level of electricity and excitement often surrounds these “events” and seems to generate the added adrenaline needed to continue.

The 2005 FAMI mission delivered an impressive number of medical and surgical consultations and procedures. This can be attributed to the concerted efforts of many individuals.   ( see graph A). 

________________________________________________________________________

Graph A ( Patient Census)

Medical consultation                                         8000

Surgery                                                           296

                        Major                                                              116

In addition to the established volunteers, the success of this mission would not have been possible if not for the excellent assistance provided by nursing students from City College of Urdaneta. They functioned in multiple roles which included initial patient triage, language interpretation, and patient transport.  This in turn, not only streamlined the number of consultations but also improved the quality of each encounter. 2005 also marked the third year anniversary podiatric surgeons became actively involved  with the F.A.M.I. Organization.  Through the diligent work of Dr.John Doolan, this profession has secured a vital role contributing to both the medical and surgical treatment of patients above and beyond foot and ankle pathology.  His proven effort has allowed the development of this subspecialty, the respect of his medical colleagues, and a future limited only by the skills, training, and vision of the organization .

Medical missions offer a unique and individualized experience to anyone who accepts the challenge and adventure.  Each volunteer comes away with new insights, and for some it is a reality check. Others recall the unparalleled appreciation demonstrated by patients who spent what little money they had on transportation to the mission site. Some mission goers reveled in the opportunity to hone their medical and surgical skills.  Whatever one’s motivation, there was something for everyone.

However, unmistakably, the most gratifying feeling one takes away from an experience such as this is knowing that you have made a difference in somebody’s life.  This difference is small and fleeting for some and for others profound and life-lasting. The countless hours of preparation and sacrifice sometimes come down to a child’s smile, or a mothers endearing hug followed by a simple, thank you.  These are truly the special moments that resonate and remain forever in our memories.

Special thanks to the sponsors that supported this humanitarian effort and dared to make a difference: Gary Jolly DPM , Osteomed, Novartis, New Britain General Hospital/staff, Smith and Nephew,        R & R Medical, Stryker

  Authors:

     *David Kanuck,   DPM

         Revision and Reconstructive Fellow

                                 The Center for Reconstructive Foot Surgery, PC, Plainville CT

     **John Doolan,   DPM AACFAS

                                Private Practice New York NY

                                Podiatric Clinical Supervisor Gramercy Park Surgical Center

                                Cabrini Wound Healing Center

     ***Phillip Cruz,  MD

                                General Pediatrician & Data Base Manager

                                Ostrea Study Group on Enviornmental Health

                                National Institute of Health, Manila, Philippines

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The two doctors were among those who joined a contingent of New York-based Filipino doctors who conducted a medical mission in the second congressional district of Negros Occidental. Later, the team also attended to indigent patients in Marinduque and Manila. Organized by the New York-based Filipino-American Medical Inc. (Fami), the mission treated hundreds of indigent patients and distributed medicines.

Doctors, nurses and other medical workers from New York, assisted by several local health people, held consultations for three-days in Bago City, one day in Marinduque and two days in Manila.

In Negros Occidental, a surgical team from the Makati Medical Center operated for free on hernia, goiter, boil and even did one or two hysterectomies (surgical removal of a woman's uterus). The Philippine Association of Ophthalmologists (Western Visayas chapter) removed cataract and implanted corrective lenses, also for free.

Fami brought the medicines and medical supplies, provided by four to five sponsors, from New York.

Milestone

Now on its sixth year, Fami was started by couple Meneleus and Niles Perlas, administrator and chair, respectively, of the organization. Niles, a surgical nurse in New York, said she decided in 1999 to mark a milestone, her 50th birthday, by doing something different and significant-try to help Filipinos back home. Her husband, a businessman, helped her set up Fami, which drew the enthusiastic support of their kababayan in New York.

During the first two years, the missions were purely surgical. The medical aspect -consultation and diagnosis-started four years ago.

Niles said Fami had over 300 members. A board decided where in the Philippines to send a mission based on requests, which had poured in after the group started its project. The choice is made on a first-come, first-served basis, she said. However, since surgeries needed even the most basic of medical facilities, the chosen destination had to have a hospital where volunteers could operate. In Bago City, the mission had the use of the brand-new and still-to-be completed hospital.

Volunteers were recruited by word of mouth. In the six years Fami had been going on medical missions, several had participated at least twice. Meneleus said for the volunteers, joining the mission entailed some sacrifice, as they had to give up their vacations and work in places with only the most basic-and hardly up-to-date-equipment. Doctors from both Manila and the beneficiary city or province beefed up the contingent.

Coordinating the mission was Marietta Santos in Manila and, in Negros Occidental, Marilou Arroyo, sister of President Macapagal Arroyo's husband, Mike.

Both Drs. Sitafalwalla and Doolan were with the mission for the second time. Were they not worried that language might have gotten in the way of accurate diagnosis? Dr. Sitafalwalla said translation was fairly good (the doctors were assisted by Health Aid students of the Bago City College as part of their practical training) and they were experienced enough as doctors to read telltale signs of medical problems.

Frustration

But occasionally, their patience was tried. Dr. Doolan's voice rose an octave in frustration as he explained that he could only give a 75-year-old woman, who had not walked for a year because it pained her to move her limbs, medication to ease her pain but not to regain the use of her legs and feet. He suspected a hip fracture probably from a fall but without an X-ray, he could not be sure.

Pediatrician Dr. Philip Cruz found out that for mothers, every respiratory distress in their children was asthma. Although he told most mothers with "asthmatic" children that the problem would disappear even without medication, he did see some cases of pneumonia, primary complex (the beginnings of tuberculosis) and a couple of congenital heart problems.

At least two people were found to have blood sugar levels so high they no longer registered in the test kits brought by the team of medical technician Romeo Reyes. The machines only registered levels up to 400. Reyes said he was surprised the two were still up and about when their sugar levels should have kept them in bed.

Local volunteer Dr. Antonio Protacio found himself coping with more than a medical problem. A woman did not need professional attention but was looking for help in putting behind bars the rapist of her teenage daughter.

Many of the people the Fami medical mission saw did not really have any specific health problems in need of attention. They simply wanted to take advantage of the chance to see a medical professional that included even specialists like Dr. Lestrino Baquiran, a leading heart specialist in New York. Several of them confessed they found it inconvenient and time-consuming to visit even government health centers and so simply ignored aches and pains.

Others were simply there to get the free vitamins and basic medicines the mission brought.

Whatever their reason, the visit was a fulfilling experience for Fami volunteers and their friends, one that they were willing to repeat whenever they could.
  ©2004 www.inq7.net all rights reserved

Health News November 17, 2003 By Rhia A. Diomampo

FAMI holds 4^th Medical Mission

A mission that began in New York among Filipinos medical practitioners

and otherwise—has now become a yearly service to poor Filipinos in their home country.

            The Filipino American Medical Incorporated (FAMI) came to the Philippines in 1999 for its first medical mission full of enthusiasm and eagerness to bring medical service to Filipinos, especially the poor and the marginalized.  What they experienced during that first visit in 1999, when they performed surgeries and treated patients at the Perpetual Help Medical Center in Las Pifias and the Rizal Medical Center in Pasig City was enough to make them come back every year thereafter.Visiting the country in February for their fourth medical mission, FAMI served the sick in Makati City, Laoag, Ilocos Norte and several areas in Metro Manila.

           Doctors and medicines -Its team of more than 30 physicians, surgcons and mcdical specialists performed 20 surgeries and attended to over 8,000 patients during their one-week stay. FAMI Board Member Leus Perlas says this year, they brought over $600,000 worth of medicines and medical supplies.

            The group served thousands of poor patients at the newly built Makati Hospital. John Doolan, MD, one of FAMI's physicians observed that most of the patients he saw suffered from high blood pressure and stomach problems.

            "The case is very similar with that in the United States," he notes. "High blood pressure is also one of the under-treated conditions in our country. But here it might be an issue of not affording the medications over an issue of not taking care of themselves there in the U.S.,, A few were diagnosed with diabetes.The medical mission was a first of its kind experience fur Doolan, who couldn't help but warmly express his gratitude and joy at being part of the project. "I'm so happy to be here. It feels really good. Wish we could do more. But we only have so much time and so many medicines."Host of this year's FAMI Medical Mission, Meldy Cojuanco (second fromleft) with FAMI chair Dr. Niles Perlas, Dr. David Lee, Jesusa Calanog,

Marietta Santos and Susana Sarangaya. Giving out prescriptions and medicines to patients (from left): Dr.Violet Reyes, Nancy San Pedro, Susa Calanog and Ignacia Ocampo. Dr. Perlas sees a patient after an operation with nurses Betty Piracha and Pomphie Qulazon.

           Medical lectures - In its last three medical missions, FAMI performed

more than 100 surgeries and provided medications to 6,500 patients. Last year, the group served patients in Marinduquc, Pampanga and Quezon City. On their second year, they performed 30 surgeries and provided medicines to some 260 patients in San Fernando, La Union and Pasig City. Aside from giving medical assistance, it Is also FAMI's goal to share medical knowlege and techniques with local doctors. Thus a part of irs acriviries in the country are lectures and workshops on latest medical innovations. This year, FAMI conducted a lecture for the resident physicians and medical specialists of Makati Hospital.FAMI's lecturers were Dr. Antonio Calanog, a gyn oncologist practicing at Lenox Hill Hospital who talked on ovarian cancer (See related story) Dr. Michael Castellano, a clinical professor of Surgery at Mount Sinai-Cabrini Medical Center on "Screening and Early Detection of Breast Cancer Metastasis"; Dr. David Lee of Cornell Medical Center on "Epidural Hematoma—Prevention and Managemen t"; Dr. Cephas Swamidossof Cornell Medical School on "Geriatric Anesthesia" and Di. Lestrino Baquiran of New York Central ParkWest on "Updates on Cardiology."

            FAMI was founded in 1999 in New York City by Niles Perlas. CRNA, Maria Mamawal and friends. Its membership includes a cross section of Filipino—Americans and Americans. Most of its volunteer medical personnel are professional practitioners in the city of New York. Filipino gyn oncologist expert in US: 'Staging crucial in ovarian cancer  Dr. Antonio Calanog, a gyn oncologist practicing at Lenox

            Hill Hospital in New York City, emphasized the importance of"staging" when it comes to dealing with ovarian cancer, at his lecture to doctors at the Makati Hospital. The activity was part of the medical mission of the Filipino American Medical Incorporated (FAMI), a group of Filipino and American medical personnel and volunteers in New York. "The important thing in ovarian cancer is the staging because prognosis depends on the staging," Calanog explains. Staging is determining the severity of the cancer in a patient's body. "The most important operative procedure is the first (operation) because at that time, you make the diagnosis, you stage the patient, you treat the patient and you remove as much (tumors) as you can.

            According to Dr. Calanog, who is an acknowledged expert in his field, there is greater chance for survival if no tumor is left during the initial operation of the patient. "If you remove (tumors) and you render the patient with no tumor, let's say, at stage 3 (of the cancer) where the survival is only 20 percent, you can make it up to 60 to 70 percent if you don't leave any tumor. Obviously, if you leave a tumor behind, their chance for survival is close to zero," he notes.

            He also advises doctors to be extra cautious about the symptoms that their patients complain about, especially in the cases of post-menopausal women (ages 50 and above), where the ailment mostly afflicts. "If you're a gynecologist, always think about, 'why is this patient complaining of something that is so vague?"' Meanwhile, Calanog recommends that women around the post-menopausal period have regular check up’s particularly Pap Smear since there is no way of actually preventing the disease. "If you have symptoms, make sure your doctors are aware of them," he states.There are no statistics about the incidence of ovarian cancer in the Philippines but the fact  that it is detected mostly in its later stages accounts for its high mortality rate.

—R. A. D.

By Angelica Cecilia Cu, RN, PACU

Editor's Note: Angelica Cu, RN (EPS Lab) and Tina Johnson (Bed Coordinator for Cardiac Service Line) recently completed a medical mission to the Philippines. Ms. Maggie Smith, RN, volunteered her services by packing medicine and supplies for the trip. The trip is described in the article that follows.

February 10 11: "The adventure begins..." At the airport we were met by FAMI's Philippine Coordinator, Ms. Marietta Santos. We drove to our hotel for a short rest and later boarded a bus carrying boxes of medicine destined for the north. In the middle of the night we arrived at our destination nestled in the northern remnant of Cordillera Mountains. Another 20-minute drive brought us to the city of Vigan in the province of Ilocos Sur. Vigan, the oldest surviving Spanish colonial city in the country, was a vital stop on the old Silk Route that connected Asia, the Middle East and Europe. Gabriela Siland General Hospital was our first mission site, a mere 10 minutes from the compound where we stayed. After observing the customary formality with our hosts, we quickly transformed the hospital's front open space into a triage area (for admissions and blood sugar testing), a waiting area, a clinic, and a pharmacy. How can I describe that first day? All around us stood people of all ages, waiting to be seen. Crucial to the strength of teamwork lies the continual assessment and reassessment of the need to put a sense of order to seemingly impossible tasks. Yet by 4 pm, we had seen 1028 patients.

February 11th: It was a clear, fresh, cool morning. Despite our efforts to set up the clinic earlier than usual, 45 patients had already arrived before us! How our doctors managed to see 910 patients by 12 noon is beyond me. The changing voices of the volunteers (growing more and more hoarse as the day progressed) became a source of fun. Scarcely had we finished our lunch break when another sea of people materialized. We were invigorated by an afternoon walk and after dinner we honored our local hosts and volunteers. We left Vigan at 9 pm that night to return to Manila.

February 12th: "A Time of Refreshing" We arrived in Manila at 4:30 am, and the streets were already alive with people. Today was more carefree and we had a social dinner with our local sponsors.

February 13th 14th: Our mission site was St. Martin de Porres Charity Hospital. Building relationships with the local medical professionals was an integral part of our mission. More than 116 volunteer nurses, nursing students,