Robin’s Blog…

Thursday, January 21

We gathered at YVR (Vancouver International Airport) around 6:30 PM. Instead of our allotted 2 check-in bags, we had each committed to bring only 1 personal bag plus a box of GO-MED medical supplies for the mission. (While this cut into the personal “stuff” we could bring with us, it would allow us the capacity to bring back an extra bag on the way back, since the medical supplies would be staying there. Great for the souvenir hunters among us!)

Our flight (Philippine Airlines #107 non-stop to Manila) boarded at 10 PM and took off at 10:45 PM. Despite the late hour, most of us stayed awake for the meal and a movie.

Friday, January 22

Friday disappeared. It wasn’t that we were drunk or asleep for a day on the plane…we just crossed the International Dateline!

Saturday, January 23

While being confined to a sitting position in a small space for over 14 hours cannot be considered enjoyable, it was at least bearable, safe and predictable, helped along by an attentive staff of flight attendants. We arrived at MNL (Manila International Airport) about 5:20 am Saturday morning (Manila time), and we gathered for our first group photo of the trip. (See header photo above)

After potty breaks and caffeine breaks (which actually tend to work against each other!) we boarded an air-conditioned chartered bus for the full-day trip to Baguio City. Along the way we stopped at Tarlac (a town) and had lunch at a wonderful restaurant called Isdaan (which means “a place for fish or seafood”). The meal was delicious, and only a few of us made fools of ourselves singing along with the in-house band of troubadours. The “huh?” factor was a wall at the back of the restaurant which had remnants of thousands of broken dishes at its base. This was a place where you could pay a small fee to throw a ceramic dish against a cement wall while thinking of someone you didn’t like. A sign requested that you not verbalize vulgarisms while doing so, but the ‘sounds of silence’ and the mounds of broken dishes said more than any vulgarisms could!

We left the flat plains that lay to the immediate north of Manila and began the gradual climb into the mountainous regions that would take us to Baguio City, the “Summer Capital” of the Philippines. (During the stiflingly hot summer months in Manila, politicians would come here to the cooler climate and then-clean air to ‘serve the people.’) Ha! But if you like winding mountainous roads and homes perched on the sides of cliffs, this is the road trip for you!

Ating Tahanan is the facility in which we would stay. It is a Girl Scout International camp, but is currently being rented out to various groups and hosts many conventions. We occupied two large houses situated in a fenced compound with a 24-hour guard at the gate. There are nicely landscaped grounds to stroll through, all carved out of the steep slopes of the surrounding mountain. The camp is a 5-minute taxi ride from the hospital and about 10 minutes from the SM Mall, a large North American-style shopping mall with a big supermarket next to a food court, and 3 main floors with dozens of stores and hundreds of shoppers. Hip-hop dance competitions seem to occur there on a regular basis.

Sunday, January 24

We immediately began to realize a lack of creativity in the names of our small group. We had 2 Robin’s (Robin Sutmoller and Robin Carr) and 3 Rob’s (Robert Hoskin, Robert Roy and Robert Pinlac). We also had 2 Diane’s (Diane Travis and Diana Villanueva). To make things worse (or at least more confusing) we decided to forego the formal titles (e.g. Dr.) for first names only during this mission. Consequently, we heard many echoes each day (“Good morning, Rob.” “Good morning, Rob.” “Good morning, Rob.”)

Arriving at Baguio General Hospital early in the morning, we were given a tour of the facility and then a Welcome Lunch. While the hospitality and generosity of our hosts were impeccable, many of us decided to forego the “cultural” chicken dish that was served, due to a preparation regimen that we will not discuss here. Cultural relativism always has its limits!

Then it was off to work, with the medical staff meeting tomorrow’s patients and checking the operating rooms and equipment. The support staff began unpacking and organizing the boxes of medical supplies that had taken the place of our extra underwear and shirts on the plane, and the operating slate for Monday was determined.

That evening, back at Ating Tahanan, the family of Shirley Maas donated a terrific buffet dinner for the team. And Dr. Robert Roy provided the best one-line description of the Philippines I have heard: “It’s like Hawaii on steroids. But more edgy!”

Monday, January 25

After the requisite early morning coffees, we gathered at 7 am at the entrance to Ating Tahanan, to wait for the taxis to take us to the hospital. Including the tip, the taxi fare was 40 pesos (less than $1.00 Canadian, usually split 4 ways). Baguio General Hospital was very gracious in providing us free breakfasts and lunches prepared by their nutritionist-dietitian, Julieta M. Calpatura. They were delicious, and they kindly catered ample alternatives for the vegetarians among us.

At 9 am we participated in what we perceived as a very special event, except that it apparently occurred every Monday morning at that time. It was the Baguio General Hospital Flag Ceremony. To a motley crew of worldly-wise and somewhat cynical Canadians, the ceremony was an impressive display of idealistic patriotism…the national anthem was played, a prayer was said, and a speech was given by the hospital’s Medical Center Chief, Dr. Manuel V. Factora. GO-MED was formally welcomed and our President, Dr. Peter Blair, provided a short description of our team’s purpose. The ceremony lasted approximately half an hour, and then it was on to the business of treating patients.

By the end of the day, GO-MED had provided 7 surgeries:

1 hernia repair, 3 gall bladder removals, 3 gynaecological surgeries.

Back at Ating Tahanan, our day ended with the doctors hosting a buffet dinner for the whole team. It became apparent that none of us would starve on this trip!

Tuesday, January 26

Just when we thought we were getting used to being awoken by dogs barking and roosters crowing (one rooster outside our building seemed to have either faulty biorhythms or a serious mental disorder that caused it to crow intermittently throughout the night) something else happened this morning. From the depths of a not-so-deep sleep, we were greeted by what sounded like a battalion of U.S. marines. While they ran/marched, they chanted “Bahay Kubo…Bahay Kubo” and many other phrases indiscernible to our foggy early-morning brains. We think it was the National Police force who were stationed nearby.

Today GO-MED provided 9 surgeries:

1 hernia repair, 3 gall bladder removals, 5 gynaecological surgeries.

Back at Ating Tahanan, the GO-MED team provided its youngest member with a birthday dinner party. Aidan Bradfield, the 14 year-old daughter of anaesthesiologist Dr. Robin Sutmoller, came with the team as one of its support staff. She turned 15 today!

Wednesday, January 27

Dr. Rob Hoskin presented a lecture on “Anesthesia for Patients with Foreign Bodies in the Airway” to BGH medical staff. The PowerPoint file for this presentation can be found by clicking the link above or by going to the Documents page.

Throughout the week, small groups of team members would squeeze in trips to the local places of interest whenever they could find the time. Perhaps most interesting was the Baguio Public Market (a fascinating maze of narrow passages with vendor stalls lining each side, selling all kinds of souvenirs, food and almost anything else you can think of). If it was incredibly busy in the morning, it was much more so around 5 PM!

Another worthwhile visit was to Burnham Park, where you could take walks, buy food from vendors, or take a boat ride in the man-made lake.

Today GO-MED provided 9 surgeries:

1 hernia repair, 5 gall bladder removals, 3 gynaecological surgeries.

Back at Ating Tahanan that night, we had a short team meeting to discuss how things had been going and to make any recommendations for change.

Thursday, January 28

Today GO-MED provided 9 surgeries:

2 hernia repairs, 2 gall bladder removals, 2 mastectomies, 3 gynaecological surgeries.

Many of the team members went to the SM Mall in the evening, for dinner and/or shopping. Tomorrow would be a shorter day, since we would be leaving in the afternoon for a week-end vacation at an oceanfront resort in Pangasinan, on the western Philippine shore of the South China Sea.

Friday, January 29

Today GO-MED provided 8 surgeries:

5 gall bladder removals, 3 gynaecological surgeries.

We finished only a bit early today, returned to Ating Tahanan to pack, and left separately in two vans and a truck for Shirley’s family-owned ocean-front resort in San Fabian, Pangasinan. The trip took about an hour and a half, and involved some breath-taking scenery from the winding road that snaked its way down from Baguio City to the flat plain that led to the ocean. Along the way we saw lots of evidence of mud-slides and flood damage from the recent typhoon.

An impressive cement wall and open gate led us into the Happy Ripples Resort. Beautifully laid out and recently upgraded, the compound involved a paved road that led halfway down through the property. Vacant land on each side of the road was being kept for future development into condominiums and possible single-family homes. Where the road ended, the current resort began, consisting of two rows of bungalows with common property between them. On one side, the bungalows consisted of side-by-side motel-like units; each about 12 feet by 27 feet and very modern and comfortable. On the other side were the kitchen and various other administrative buildings. And in the middle…a beautiful swimming pool, pagoda-style eating and dancing areas and landscaped lawns with rock pathways.

That evening, a delicious buffet dinner was followed by live music and dancing and yet another birthday celebration – this time for Lisa Bruhm, GO-MED’s Vice-President and resident comedienne.

Saturday, January 30

Most of the team stayed at the resort all day, taking walks north or south on the very long beach, swimming in the resort pool or the even bigger pool outside…the South China Sea. The ocean water was so warm it didn’t even shock you when you first got wet. (They must have a wonderful heating system for this pool!) And almost all treated themselves to hour-long massages from talented masseuses. (It’s embarrassing to see adult professionals drooling in an uber-relaxed stupor!)

Several of the doctors took a half-hour van trip with Miechiel Maas into Dagupan, to have a tour of the
Region 1 National Hospital. The objective was to see if the facility might provide a feasible location for a future mission. While the consensus seemed to agree with the general idea, there were concerns regarding the lack of adequate suction and anaesthetic equipment. We decided to ask Santa Claus for portable equipment for GO-MED next Christmas.

After another delicious buffet dinner, the evening progressed (or should that be degenerated) into karaoke singing and auditions for Canadian Idol. One candidate that wasn’t immediately gonged was Dr. Robin Sutmoller, whose pipes became the admiration of all. (Of course, to the impoverished even a dime looks good!) Dr. Peter Blair fulfilled his role of President by leading the GO-MED wannabe idols in a boisterous sing-along.

Sunday, January 31

More long walks on the beach (Lina and Robin Carr took the resort’s dogs for their outing), more eating and drinking and lying about…well, living in Paradise can be hard work! Robert Hoskin led several of us through a challenging Tai Chi class just to keep us from taking root in the ground. Some took a 1-hour boat ride provided by a local fisherman, but gradually we came to the inevitable realization that all good things must come to an end. Two days had passed by in a flash, and photos and video memories would have to suffice in our old age!

About 4 PM we boarded our vans for the 1.5-hour up-mountain drive to Baguio City and the start of our second week of the mission.

Monday, February 1

The taxis didn’t show up at Ating Tahanan this morning, but a vacant jeepney drove by and our normally peaceful band threatened the driver with testicular excision if he didn’t stop to drive us to the hospital. (Actually, we were quite sweet about it!) Jeepneys are designed for people 4 feet tall or shorter and weighing 50 pounds. Filipinos magically make themselves this dimension to fit in them, and then resume their normal size when exiting. We North Americans have yet to learn that magic!

For many in our group it was their first jeepney ride, but it wouldn’t be their last. We enjoyed the ride so much we asked the driver to come back the same time tomorrow. And we only lost one or two people from swinging off the back of the little bus as it tore around some tight curves!

Today GO-MED provided 9 surgeries:

1 hernia repair, 4 gall bladder removals, 1 mastectomy, 3 gynaecological surgeries.

While the huge majority of GO-MED’s surgeries are likely to have very successful outcomes, it is disheartening to see cases of cancers that should have been treated much earlier, and would have been treated earlier in countries that have easier access by the poor to medical care. Once again, I am convinced that while Canada’s medical system is far from being perfect, it is at least accessible by any Canadian citizen, no matter how poor. That objective should be a priority for any civilized country!

That evening, our webmaster Robin Carr suffered through a slow internet connection to upload 200 photos, taken by some of the deviants in our group, to this website. It’s important to let the families back home see how decadent we’ve become!

Tuesday, February 2

At 10 am today Dr. Laurence Turner, one of our general surgeons from the Royal Columbian Hospital in New Westminster, BC, Canada, gave a lecture to about 30 of the medical staff and residents. Previously presented in BC, Canada, it was titled Multimodal Strategies to Improve Surgical Outcome and it provided an interesting theoretical rationale, and some supportive empirical evidence, for minimizing peri-operative patient stress and reducing post-operative recovery time. Practical strategies included laparoscopic surgical techniques, use of local anaesthetics plus mild sedation rather than general anaesthetics, early resumption of a solid food diet, early mobilization and walking, etc.

Robin Carr, PhD, retired Langara College faculty member and UBC sessional lecturer, followed up with a nutrition presentation titled Getting Rich Can Kill You: a Warning to Developing Countries. It documented the increasing frequency of occurrence of the “diseases of affluence” brought about by sedentary living and an animal-based diet. Research evidence was provided to support a return to a mostly plant-based diet that is better for personal health, environmental health and the more ethical treatment of animals.

The visuals of both of these presentations are included in the documents page of this web site.

Today GO-MED provided 10 surgeries:

6 gall bladder removals, 4 gynaecological surgeries.

Our surgical teams seem to have ramped up their efforts, doing what they’re trained to do with both skill and efficiency. As one of the non-medical administrative support staff, I continue to be awed by their ability to care passionately about their patients yet still manage to maintain the “dispassionate distance” required for taking people’s lives in their hands. Memories of the old television show “M.A.S.H.” come to mind!

Wednesday, February 3

Today GO-MED provided 10 surgeries:

1 hernia repair, 5 gall bladder removals, 4 gynaecological surgeries.

Ten more necessary surgeries today. Our team is HOT! (In the professional sense, of course.)

While this blog is starting to look like the statistical record of the innings of a baseball game, it should be pointed out here that this mission is not about setting records for numbers of surgeries, or for providing intensive “practice” for our surgical teams. All of GO-MED’s surgical patients on this mission have been pre-screened by the local hospital physicians and recommended for surgery, and they have been again screened by our own doctors before being slated for their operations. In a few cases, non-surgical treatments were happily recommended by our surgeons.

At the request of the BGH Department of Anesthesiology, Dr. Rob Hoskin, an anesthesiologist from the Royal Columbian Hospital in New Westminster, provided two demonstrations of ultrasound-guided nerve blocks. Using ultrasound imaging allows one to see the nerve that must be blocked, to see a needle being directed toward the nerve of interest, and to see local anesthetic bathing the nerve if the needle is properly located.  This gives a higher success rate for the nerve block and reduces complications caused by damaging adjacent structures with the needle or injecting local anaesthetic in the wrong place.  This technique has only emerged within the last 10 years and is still evolving rapidly. Dr. Hoskin successfully used this technique on two of the hospital’s patients to provide anesthesia for their surgeries.


Above: Dr. Rob Hoskin uses ultrasound-guided nerve blocks for surgery on a BGH patient.

That night Ruben Pinlac, one of our wonderful Filipino benefactors who hails from Chicago but spends time each year in the Philippines, hosted a fabulous dinner at Camp John Hay, tucked in amongst the pine trees in the hills above Baguio City. Surrounded by a golf course and buildings formed by stone, glass and gleaming wood, it was reminiscent of Whistler Mountain resorts in BC and would have been considered 5-star dining in any country of the world. It was a terrific meal and a wonderful experience for all of us, and I’m sure most of us were almost able to forget the poverty that has led to this country needing our services.

Thursday, February 4

Today GO-MED provided 7 surgeries:

5 gall bladder removals, 2 gynaecological surgeries.

This was the last day of GO-MED’s surgeries and it seemed to be the culmination of something that had begun slowly at the end of last week and had been growing each day since. An intermittent, informal procession of warm, smiling faces…Filipino faces…had been periodically walking up the stairs of the old hospital building and down its dark hallway to the small but frenetic stock-room that had become GO-MED’s office during this mission.

Walking unaided, looking healthy and happy, these were the patients that had been operated on several days earlier. They had come back to the hospital to thank the doctors who had given them relief, to give them small gifts, often just a letter or card expressing their gratitude. (These have been scanned and uploaded as a third photo album, Patient Thankyou’s, on this web site.) Sometimes they would ask to have their photo taken with the surgeon who operated on them. (These can be seen along with many others in Photo Album Week 2.) If any of us ever had fleeting doubts about this mission being able to make a difference, those doubts were now put to rest forever.

In the evening, in the Cobalt Hall above Baguio General Hospital’s Cancer Centre, we were given a gracious farewell via a Recognition Dinner hosted by Dr. Manuel V. Factora, the Medical Center Chief. We were entertained by superb performances from Baguio City National High School’s Special Program for the Arts including the Young Minstrels Choir and the Dance Troupe & Rondalla. During our meal, a message from the City Mayor of Baguio, the Honourable Reinaldo A. Bautista, Jr., provided a personal thankyou to our group. He expressed his hope that we would return to Baguio again to provide our aid.

Friday, February 5

No surgeries today. The doctors did their rounds seeing yesterday’s patients, while the rest of us boarded buses to various places. Some returned to Manila to fly home the next day. Some went to Batangas and then to Puerto Galera in the Province of Oriental Mindoro, for snorkelling and SCUBA diving, and two (Rizalina and I) went to their vacation home in San Pablo City, Laguna.

Mission Accountability

GO-MED’s objectives, as listed in our Constitution, are shown again below. Under each objective is an accounting of how we achieved those objectives on this mission:

  1. Specified free medical and surgical procedures performed by qualified medical personnel;
    The GO-MED medical team provided a total of 78 surgeries, which included
    7 hernia repairs, 38 gall bladder removals, 3 mastectomies, and 30 gynaecological surgeries.
    In addition, GO-MED paid the medical expenses for 13 thyroid surgeries conducted by BGH surgeons.
    GO-MED also provided pre- and post-operative medical expenses for all our surgical patients.
  2. Training of appropriate local medical personnel in the techniques of the surgeries and procedures being used, and in related pain management and cost-effective decision-making;
    GO-MED provided the following formal training sessions:
    “Anesthesia for Patients with Foreign Bodies in the Airway” by Dr. Rob Hoskin;
    “Multimodal Strategies to Improve Surgical Outcome” by Dr. Laurence Turner;
    Two demonstrations (during surgeries) of ultrasound-guided nerve blocks by Dr. Rob Hoskin.
    In addition, Dr. Peter Blair and Dr. Laurence Turner, two leaders in the growing area of laparoscopic surgery, mentored several of the BGH surgeons in this expanding methodology, while Dr. William Young and
    Dr. Rob Roy worked closely with BGH gynaecologists.
  3. Educational information focused on prevention and positive health behaviours;
    GO-MED provided a lecture summarizing the scientific evidence that supports a plant-based diet, in
    “Getting Rich Can Kill You: a Warning to Developing Countries” by Robin Carr, PhD.
  4. Used and donated medical equipment and supplies.
    GO-MED was pleased to donate, on behalf of one of our benefactors (Louis Bortolazzo) a new suction machine for the BGH operating rooms.

Personal Review of Baguio 2010 Mission

In looking back over the last two weeks, several impressions stood out for me from the myriad thoughts and senses that this experience had provided:

  1. How warm and gracious our hosts at the Baguio General Hospital had been!
    On a personal level, as a vegetarian, I had worried about not getting enough to eat in a country where meat is used to flavour almost every dish. But I need not have worried, as the hospital nutritionist-dietitian, Julieta M. Calpatura, provided vegetarian options at every meal.
    But her consideration was not alone. The generosity and kindness afforded us was felt everywhere, even from the Virtual Library manager who showed me a place where I could upload photo files long after the library had closed. At every turn, from the local nurses who staffed the wards and the local physicians who conferred with ours regarding their patients, to the hospital staff who endlessly mopped the floors and always smiled as we passed them, we were greeted with generosity from our hosts.
  2. How the GO-MED team really was a team!
    It was quite amazing how a team of individuals, many of whom had not met each other prior to this trip, managed to come together and function as a cohesive unit, and bonded almost as if they had been childhood friends. This was in large part due to the leadership of Dr. Peter Blair, GO-MED President and general surgeon who, from the very beginning, emphasized the egalitarian spirit that effused this mission and who insisted (even though we all really knew differently) that we were all equally important to the mission. From the outset we called each other by first names only, omitting any reference to professional or academic titles that can often separate people. The example Peter set was exemplary. Also, Shirley Maas, Mission Coordinator, and her “jack-of-all-trades” husband Michael Maas, Equipment Manager and “fixer”, deserve heaps of credit for pulling off a large, complicated effort without a serious hitch. Amazing, since this was the first mission they’ve organized!
    Wars were even put on hold so GO-MED could fulfill its mission. The forth-coming ice hockey Olympic Gold Medal wars (for both women and men) will certainly have Canada and the U.S.A. among the favourites. But during this mission, there was only the occasional cross-checking and interference calls between the American and Canadian members. All-out war was averted…at least for these two weeks.
    On Thursday afternoon we packed away the supplies and removed our equipment, boxes and bags. Shortly afterwards (Doctor) Rob Hoskin, one of our anaesthesiologists, noted how the stock-room, which had become the frenetic, energized heart of our two-week existence, suddenly was emptied of life. Experiences, like life itself, are fleeting.
  • How GO-MED made a difference!
    In the scope of what is needed, GO-MED’s contribution to the planet’s impoverished is a hardly noticeable speck in an ocean of need. But to the few dozen patients who were given the help they desperately needed, GO-MED was a life-boat in that ocean. We must not focus on all that cannot be done. We must take heart at what can be accomplished. That’s what will motivate us for the next time!

If there are any serious errors or omissions to this blog, you can blame GO-MED’s Secretary, Robin Carr. He won’t accept any responsibility, but you can blame him anyway if it makes you feel better!

Robin Carr, PhD