2005 MISSION REPORT
12 – 26 February

Tuguegarao City
Cagayan Province, Philippines

Compiled by Mark Sierakowski, Mission Co-ordinator.

The banner announcing our mission at the Hospital entrance.

Getting Ready
With the usual last minute flurry of emails, obtaining equipment and packing suitcases, the Tuguegarao mission got away as planned. Thanks to Lory Rowe and her team at the HCS Inc. Charity Boutique and the fund raising work of all members, this mission was able to become a reality. Bernice McLennan maintained the communication channels with Tuguegarao, usually with Mayor Ting, and a Rotarian, Pichoy, to ensure arrangements were understood and confirmed. All mission members had supplied their details for professional registration with the Dept of Health in Manilla and the information was sent but no reply received before the mission departed (or since, either!). Team members notified DFAT and had their vaccinations updated. Terrace Travel booked the flights and Covermore insurance was obtained for the mission. All our luggage contents (including halothane) were notified to Qantas and received the OK.

The Team
We were fortunate to have two new surgeons, Prof Frank Kimble and Dr Dr Craig Quarmby, from the Royal Hobart Hospital, join the mission this year as none of our previous surgeons were available. Drs Damian Castanelli (Melbourne), and Steve Mitchell (Nambour) provided anaesthetic services. All the nursing staff, including myself, came from the Sunshine Coast, Queensland, with nurses Erin McIntosh, Phil Bartlett, Tracey Madden and Vonnie Burton working in theatre, pre and post operative care was attended by nurses Bernice McLennan, Lisa Torrens and Lyndal Pool. Lyn Neilsen, our non-clinical member, assisted me with screening patients and sorting out emergent problems. We also had Sarah Morgan, a journalist, on the team so that she could gain first hand experience of the mission work for future literary articles and promotion of HCS Inc. So there were 14 members on the Tuguegarao mission and all members performed their duties with competent and compassionate professionalism and worked very well together.

The team on arrival at Manila Airport

Front row; Lisa Torrens, Sarah Morgan, Lyn Neilsen, Mark Sierakowski
Middle row; Vonnie Burton, Tracey Madden, Judge Lore Veneracion, Bernice NcLennan, Frank Kimble, Erin McIntosh
Back row; Lyndal Pool, Damian Castanelli, Phil Bartlett, Craig Quarmby, Steve Mitchell.

Travel Arrangements.
Our friends, Geoff and Maureen at Terrace Travel, Brisbane, made the travel arrangements which had us all converge at Sydney to take the Qantas flight to Manila. Unfortunately our fares were a little more expensive than previous years due to the mission dates which had us traveling earlier than previous missions so we incurred the ‘shoulder’ period fares.

Departing Australia.
The Queensland contingent gathered at Brisbane Domestic terminal at 0730 hrs on Saturday 12 February for a “group book-in”. This was a new concept with Qantas which saw us competing with several busloads of Asian tourists to get into a small glass room with all our luggage – not a easy achievement! After wildly attaching the necessary luggage tags we finally put our 45 suitcases, weighing 780 kgs, through to Manila. Unfortunately our departure from Brisbane was very late and on arrival in Sydney we were immediately rushed through to the international terminal as QF19 was waiting for us. Luckily we met up with Frank and Craig on the terminal bus and Damian was already seated on board.

Arriving Philippines / Getting Set-Up..

Saturday 12 February.
As usual, Supreme Court Judge Lore Veneracion was at Mania airport to meet us and by flashing his credentials he ensured the team had a smooth passage through customs without any baggage being opened.
Unfortunately Frank’s personal luggage did not arrive in Manila and was reported so it could be tracked down. We met with Mayor Ting’s brother, Paul, and one of his clerical staff, Socorro, who escorted us onto a large passenger bus for the trip to Tuguegarao. We reached Cabanatuan, our first night’s stop at 2315, where we met up with Jeremy Simpson and the patients travelling from Olongapo. Jeremy handed over a substantial donation (approx $US8000) to Erin from fund raising activities in Olongapo. We all dined together and retired exhausted after a big day of travel.

Patient # 1 from Olongapo Mark Joseph with his grandmother. Mark had a palate repair and lip revision.

Sunday 13 February.
This morning in Cabanatuan we met with Vicky Gaetos, a Rotarian and local business woman (Nissan dealership) who is very interested in organizing a mission in 2006. We also met with Helen Bagasao, the Director of Social Work with the local health service who supported the need for our work within the area. We were unable to visit the Hospital but scheduled it for the return journey to Manila. We left Cabanatuan on the bus at 0915 and headed north. After a few ‘food & water’ stops we arrived in Tuguegarao at 1730 and unloaded at the Roma Hotel, which was about 100 metres from the People’s Emergency Hospital where we were to work. We then attended a dinner with Mayor Randolph Ting and his wife, Nancy and other councillors. It was great to meet up with our Queensland mates holidaying in Tuguegarao, Tony and Lillia Frost (Sunshine Coast), Gloria Mayon (Brisbane) ,along with Hilda and Ferdie de Leon (Gold Coast). It was Hilda and Ferdie who initiated this mission as they were Tuguegarao residents before coming to Australia.

Ferdie and Hilda DeLeon – our Aussie mates from the Gold Coast

The Mayor’s brother, Councillor Mike Ting, became our official minder to help us with any local issues. Mike was an excellent ambassador for Tuguegarao showing us all the hot nightspots for a nightcap! Mayor Ting was an exceptional host. He is a middle aged family man who firmly believes that helping the younger citizens of the city with education and health issues will lead to a better future for the people of the city. He took over the Mayoral reins from his father and is now in his second term as a highly respected and very popular leader.

(left) The mission sponsor Mayor Randolph S. Ting

The medical staff on the way to work – Drs Frank Kimble, Craig Quarmby,
Damian, Castanelli, Steve Mitchell.

Monday 14 February

With the nearby church bells tolling at around 0430 to gather the congregation, we later met at breakfast, then headed to the Hospital for a tour with the Medical Chief of Hospital, Dr Ray Duhig. Then our work started in earnest - the task of organizing our clinical supplies and starting to screen all the
patients. The Hospital staff were most accommodating and very helpful. The theatre nurse manager, Candi, was an absolute gem. The Hospital cancelled surgery for the duration of our stay and we set up two operating tables very cosily in a small theatre. The other theatre held all our stock. We had a room outside the theatres which just fitted two beds as the recovery room. Upstairs, a student lecture room was where we set up for screening. Along from the screening room were two wards, each holding about 10 beds, one of these wards was given to us for HCS patients. All beds had mattresses and a green sheet cover. And we even had IV poles! However transporting the post anaesthetic patients up the stairs to the ward was interesting. Patients were carried on a stretcher by the wardsmen as there was no lift. Generally the Hospital was clean and spacious with polished concrete floors. In the first day of screening 52 patients were seen and the surgery schedule started to take shape. That evening the Mayor organised for the team to attend a St Valentine’s Day celebration at a local Christian association where Damian won a cheval mirror which he generously donated to the Hospital.

The ‘cosy’ working conditions in the operating theatre.

Days of Surgery

Tuesday 15 February to Wednesday 23 February

The surgical workday started at 0800 and most times went smoothly. Occasionally a patient may not have fasted properly and the surgery schedule was adjusted. Only two patients scheduled for surgery did not return as planned. Screening continued as more patients came to the Hospital throughout the week. We were most fortunate that the Medical Chief had an excellent computer set up in his office which he allowed us to use. Maynard, a young man from the Mayor’s Office, assisted Lyn in managing the patient photo records.

Each morning the previous day’s patients were checked and their wounds treated prior to discharge and the recovery staff ensured they were adequately hydrated and understood their post-op instructions. Some clinical resource issues arose such as the Clements suction unit leaking oil, unable to buy aqueous chlorhexidine, exhausting our supply of 5/0 sutures and searching for more supplies eventually getting some locally, and also getting some sent from Manila courtesy of Johnson & Johnson. Thank you, J&J!

Dr Kimble about to operate on a patient’s cleft lip.

Unfortunately we also had two serious clinical crises. On Wednesday, a 1 year old boy, Christian, developed a severely low pulse following intubation, so the surgery was cancelled and he was actively resuscitated. He regained alertness some 10 hours later! Then on Friday, a 13 year old boy, Wifredo, developed a life threatening cardiac rhythm anomaly following intubation which required defibrillation. Unfortunately the Hospital didn’t have a defibrillator so Dr Duhig rushed to another Hospital to get one. The theatre staff applied life support measures to Wilfredo for 20 minutes awaiting the defibrillator. Incredibly when the machine arrived, Wilfredo spontaneously reverted to a normal cardiac rhythm, and the antiquated machine was not used. We must ensure we take a defibrillator on all future missions to treat this rare but fatal medical crisis. Inevitably Wilfredo’s surgery was also cancelled which made him most upset once he regained consciousness but he was very luck to survive!. We promised him and his mother that we would help him, so we arranged for a local dentist to fit an obturator to cover his palate defect. HCS Inc. met the cost of this (P7,000) and the dentist promised to fit another obturator in six months time as Wilfredo grows bigger.

Our lucky patients, left is Christian and right is Wilfredo with his mother.

We certainly appreciated the Mayor providing daily lunches at the Hospital consisting of sandwiches, snacks, fruit and beverages. Socorro and Mike visited frequently to assist with any problems. Lilia, Hilda, Gloria and Ferdie were excellent in facilitating translation with patients and their families. Most of the Hospital staff spoke good English and also readily helped when needed. The working day finished about 1800 and after checking the patients, we met in the evening to dine together at a local restaurant. We had varied cuisines and of course, plenty of San Miguel to stay hydrated in the humid weather. The ‘tempura vegetables’ were especially enjoyed by the two vegetarians in the group and had others seriously considering a lifestyle change. We celebrated Lisa’s birthday in style with a huge ‘Barbie-doll’ cake in our little tea room at the Hospital. Later in the evening, some of team still had excess energy to burn so they headed to the disco to mix it with the locals!

On the Saturday evening, the team were hosted by Hilda’s father”, Max, who had a neighbourhood party to celebrate his new residence and his great grandson’s christening. We had lechon and many other Philippino delicacies. It was a night of good fun – the team certainly gave rousing renditions of the karoke tune “Like a Surgeon”( akin to Madonna’s “Like a Virgin”).

On Sunday, we had a day off, so after checking on the patients we set off in a convoy to visit the Callao Caves – a most impressive series of vast caverns, one of which holds a chapel. It was a pity to see extensive grafitti and damage done to huge stalactites. We had a picnic lunch and then took a ride along the Pinacanauan River in long slender canoes and met with some Aeta people from a nearby village. A very relaxing day spent seeing the countryside and also the opportunity for some shopping at the market.

Surgical Outcomes

A total of 92 patients were screened with 61 receiving surgery. Of those who did not receive surgery the commonest reason was that the child was too young. Several children presented with chest infections and were given antibiotic therapy but were not suitable for a general anaesthetic. The youngest patient to receive reconstructive cleft surgery was eight months old and the oldest patient with a cleft repair was 47 years. The oldest patient to receive surgery was 72 years. Other anomalies presenting outside our scope of practice included encephalocoeles, nasal polyps, hygromas and very wide cleft palates, as well as one very happy toddler, John Philip, with a bilateral facial cleft. The surgeons are hoping to get some of these patients treated in Australia.

Despite a front page article in the local press “The Northern FORUM – Harbinger of Truth”, the number of cleft children presenting for surgery waned after the first few days. Unfortunately it seems that the mission was not promoted to people in the surrounding villages as well as it could have been. Consequently we had surgical spaces for other candidates. So some adults had lipomas removed and tongue releases attended. All patients truly appreciated the opportunity for the free surgery.

Post operative photo of our youngest patient, Mary Grace, with her parents.

Summary of Surgical Procedures.
(NB – 15 patients had 2 procedures)

Post operative photos of lip operations on
5 year old Mirasol (left) and Richard (right)
47 years.

Finances.
Most team members paid cash for their contribution towards the travel insurance. This money was converted to pesos and used to pay meal and accommodation costs. We also received a P50,000 donation from the parents of one of the patients and Frank donated his compensation of P3,400 when his lost luggage was returned via Korea. There was only one withdrawal from the ATM of P30,000 before we obtained the Olongapo donation which we utilized to pay meal and accommodation costs. The Hospital did not charge the mission for any pathology, radiology or pharmacy supplies which we have paid on previous missions. The cash we took from Australia was returned intact and deposited back into the HCS Inc. account. We also used the $US 455.00 to pay for the diathermy machines servicing by Zenith Medical in Manila.

Budget Expended

Airfares :

A$17,520.00
(11 pax ex Brisbane, 1pax ex Melb., 2 pax ex Hobart)

Accommodation :

P 212,586.00 / A$ 5,185.00
(14 pax X 14 nights)

Meals

P 63,070.00 / A$ 1,538.30
(allowance of A$20 per person per day = A$3,920.00)

Transport

( luggage & people to airport) P 2,700.00 / A$ 65.85

Incidentals

P 22,811.30 / A$ 556.37
( includes phone calls, sutures, drugs, Wilfredo’s obturator)

Departure Tax

P 7,700.00 / A$ 187.80

GRAND TOTAL A$ 24,994.32

The final checkup and farewell to Tuguegarao.

Heading Home.

Thursday 24 February

This morning was our last ward round and discharge of patients. Patients from the previous week returned for a final check-up then later in the morning most patients who resided nearby gathered at the Hospital for a final farewell. It was wonderful occasion to see the results of our work and receive the heartfelt gratitude of patients and their parents. Lots of photos were taken and addresses exchanged as friendships were made. Then it was into the ordeal of sorting and packing up all our equipment. A lot of the disposable gear we had in excess we donated to the Hospital along with surplus medicines. The Mayor requested our attendance at the local gymnasium that evening for a cultural exhibition of song and dance performed by secondary school students. The Mayor then presented each team member with a plaque of gratitude and HCS Inc. with a large framed plaque signed by all the patients along with their photo. It was a tremendous production and afterwards all the cast of about 100 students and ourselves attended a buffet banquet in the Mayor’s office! It was certainly a grand finale!

Cultural evening and presentations at the Tuguegarao gymnasium.

Friday 25 February

We headed south from Tuguegarao at 0500 next morning in our big bus to Manila. We stopped in Solano for breakfast and then for a lunch hosted by Vicky at Cabanatuan. Erin, Bernice and Damian went to the local Hospital for a site visit for the 2006 mission and came back with a glowing report about the facility. We arrived in Manila at 1830 and after unloading our luggage headed to Starbucks for a decent coffee then a Japanese restaurant for dinner. It was a big day of road travel which was certainly tiring despite the sing-a-longs and DVD movies on the bus.

Saturday 26 February

Well, the shopaholics hit Robinson’s Shopping Centre with gusto in the morning! As half of the team was going to Boracay for 5 nights after lunch and the others were heading back to Australia that evening, it was a sad time for the team to disband around noon. We were a very successful team and felt privileged that we had the opportunity to make such a positive difference to many young Philippino lives with the support of Helping Children Smile Inc.

Congratulations to all the team members, you all did a marvelous job and it was a real pleasure working with you. And a special thanks to all the HCS Inc. members in Australia who enable these surgical missions to happen. Be assured that your efforts are truly appreciated by the patients and their families.

The Tuguegarao team at the Hotel Roma.