Saturday, March 21, 2015

189. Dagupan Day 3

A light day, as the team learns to work with each other, and with local staff and equipment. I do just one vaginal hysterectomy for a fibroid associated with heavy bleeding. She was pre-screened as an abdominal hystectomy, but I changed that to a vaginal hyst, which went well. She went home in two days (would have been one day in the states, but here both patients and the local staff prefer longer stays.

In Baguio, the residents were eager to assist with vaginal hysterectomies, since they are not allowed to to vaginal hysterectomies for fibroids (only for uterine prolapse). But here interest is minimal; I don't know why the difference.perhaps because they are busier. Later in the week I asked one resident what her call was like the night before (she was assisting me on surgery the day after a 24-hr call): two ectopics, two CS, and 9 vaginal births, including two breech extractions. Whew). As with Baguio, all ob-gyn residents are women.


Thursday, March 19, 2015

188. Dagupan Day 2

Sunday, more unpacking, meeting patients who were scheduled for the next day.  Like last year, local residents had screened patients. There are three waiting for us.  I'm working with a recently retired German-born, Canadian-trained ob-gyn.  I will do one case, she the other two, but we cancel one who probably has metastatic cancer and we'd like to talk with a local oncologist before accepting her has a patient.  A local oncologic surgeon, a luxury most of these trips don't have.

When I first heard that another ob-gyn had signed on, I felt some regret, knowing that would cut my productivity by half--I know, sounds like I'm trying to build up points for the platinum trophy. But really, I'm just trying to make best use of my time.  Having two of us in Cambodia worked well, one of us operating, the other screening, but here screening is already done

My new partner expects we will be working together.  In her home practice, she assisted her partners and vice versa.  I explain that we have residents to assist here and she appears to be okay with that.  In the end I'm happy she's here.  We consult with each other and can be around for difficult cases.

Tuesday, March 17, 2015

187. Dagupan Day 1

Most of the team left Vancouver around midnight, arriving in Manila Saturday morning around 0730, then for Dagupan by chartered bus.  With a different starting point, I couldn't get there that early, so came the day before, planning to just take a taxi to the the airport to meet the team at the bus departure point.
Hospital Main Entrance

But I got my days mixed up (multiple time zones, international date line, what can I say); they had actually arrived on Friday, so when I showed up Saturday, no one was there.  A quick look at the departure screen confirmed my fears since there was no arrival from Vancouver.  Two choices: taxi to bus terminal, assuming I could find a public bus to Dagupan. With no phone or internet access, this carried some risk (the 100lb of medical supplies was another factor).  Or, take a taxi, which with some bargaining could be done for about $115.

I chose the latter; which turned out okay, even though busses would have been an option, because just as the taxi arrived at the hospital, some team members, having spent the day unpacking, were about to leave for our lodgings about 30 minutes away.  Had I missed them (likely if Ihad used the public bus option), it would have been difficult to catch up with them.

All's well that ends well; I did get to spend a worthwhile day in Manila, and I didn't miss anything by arriving in Dagupan a day late.

Sunday, March 15, 2015

186. Dagupan Prep

Last year I joined Vancouver-based GO-MED for a two week surgical mission to the Philippine mountain city Baguio; this year's trip was planned for the provincial hospital in Dagupan, a 4-5 hr drive up the coast from Manila.


About a week before leaving I received a call from the mission coodinator asking if I could obtain some more sterile gowns. My hospital uses standard sterile packs (containing instruments, a gown, and drapes) for vaginal deliveries that are opened as delivery nears. If a cesarean happens instead, the disposable drapes and gowns can't be reused, the hospital figuring that it is cheaper to buy new than re-sterilize. But my own clinic will take discarded but otherwise clean and unused supplies and re-sterilize them for me. I come up with ten more gowns.

When I finish packing, I have two 50 pound bags with these supplies, plus surgical instruments, medications, scrubs, and non-sterile supplies.


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