THE

BRITISH

PALAWAN

TRUST

2011

ANNUAL

REPORT

BRITISH PALAWAN TRUST

Aims of the Trust. “ ..to relieve sickness and suffering and preserve and protect the health of the people in Palawan in the Philippines particularly by the establishment and maintenance of an Orthopaedic Project.”

Registered Office:

The Orthopaedic Department,

The Ipswich Hospital,

Heath Road,

Ipswich, Suffolk, IP4 5P

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2011

Mr. Louis Deliss FRCS. Chairman.

Mr. Andrew Gibbs, BSc, FRCS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Mr. Ivan Hudson, FRCS.

Mr. John Powell, FRCS.

Mr. David Sharp, MD, FRCS.

Miss Clare Marx CBE, FRCS.

Mr. Mike Shanahan, FRCS.

Mr R Baxandall, FRCS (Orth).

Mr M Bowditch FRCS (Orth).

Mr J Hopkinson-Woolley FRCS (Orth).

The principle charitable purpose of the Trust is “the advancement of health” by providing medical care for the people of Palawan (population about 700,000) in particular the indigent people. The medical care is specifically for those with orthopaedic conditions, congenital deformities and those affected by musculoskeletal trauma. We also provide for “the relief of those in need by reason of disability” a Community Based Rehabilitation Service. In addition we work for “the advancement of education” through a Training Centre where we teach our methods to other health care workers and doctors.

I described fairly fully the scope of the work carried out in Bahatala, in the hospital and elsewhere in last year’s Annual Report. The past year has been very similar with huge numbers of patients being seen despite the problems. The Bahatala building has new hospital buildings going up on two sides with builders rubble and equipment all round. This means that access is very restricted and the unit is now only approachable on foot. The result is significant difficulty for patients especially individuals with restricted mobility and those in wheelchairs or on stretchers. Fortunately there are usually enough people to help or to even carry such patients.

The part played by out out-reach workers has been consolidated. The unit now works very closely with the Rural Health Workers. These are paid by local government or by the local community and mostly they work from the Rural Health Units. These vary from one room to larger buildings with clinics, treatment areas and offices. They are visited by both government and private doctors some providing specialist services such as X-ray and ultrasound. Many aspects of this collaboration could I believe continue even if BPT ceased to support it although there is no suggestion that this will happen in the near future.

The real excitement during the year has been the purchase of the land which I describe in my visit report below. The wonderful generosity of one donor has meant that we have used very little of our reserves for this. The next stage is building and equipping the new facility. We need to construct the clinic and the therapy areas. The preliminary designs have been discussed and we are approaching a local architect for help. In addition we need a separate building to house the prosthetic and wheelchair workshops with somewhere to make the ADL equipment. This needs to be separate because some of the machines are rather noisy. We hope that the workshop will be fully funded by local donations.

Our original plan was that the Bahatala buildings would only need about half the total area of land and that the rest could be used for income generation. The present thoughts are to put up some simple single story offices to let out. Already a number of other NGOs have expressed an interest in renting these. It would mean raising more money or possibly borrowing from a local bank. It would be better if we did not have to borrow even if it is possible. The alternative suggestion is for a small hotel which the growing tourist traffic could probably support. This will be discussed by the local Bahatala Inc Board of Directors.

The accounts are difficult to compare with previous years. During the year we purchased 4000 square meters of land for our new clinic and workshop. This was largely covered by a single donation from one of our regular donors. Some additional income came from the Chairman’s Special Appeal letter written from UK to all those on our mailing list. The basic income from donors was in line with last year.

Future finances are not quite so clear. We need about 7 million Pesos to build the Clinic and Workshop. A donation from a local politician has provided enough to build the workshop. The Clinic needs about £85,000. We have promises for about a half of this total. We plan to use some of our reserves but will be appealing for extra donations.

In the long term the British Palawan Trust will have to find additional income for the running costs of the new buildings. We hope to offset some costs by donations from those patients who could afford to pay for their medical care, especially those receiving orthoses or wheelchairs.

Full details of the accounts are in the report by our accountants, Beatons, which can be accessed through the Charity Commission web site..

Last year I wrote the following paragraph which unfortunately is still the position. “The AGM held in early 2009 discussed the importance of having at least one other Trustee involved with the detail of the administration of the Trust. Unfortunately none of the existing Trustees were willing or did not have the time for such involvement. This remains the case.”

I visited Palawan in March 2011 for three weeks. I had planned a longer trip than usual because of the number of decisions that needed to be made about our move and the new building. I wrote about the need to move out of the Bahatala house in the Hospital grounds in last year’s report. Much has happened since. Due to the enormous generosity of a single donor we were able to purchase 4000 sq.m. of land in Abanico Road. This is about halfway between the Provincial Hospital and Bahay Sanay (The BPT Training Centre) and near to the main highway to the south. In addition it is quite near the New Market where the buses and Jeepneys have their terminals so not far for patients from outside Puerto Princesa city proper to travel. It is a fairly quiet road but traffic will probably increase a bit as the area is developed. The land is presently covered with scrub and trees. Soc has made a detailed map of the trees which include a number of the beautiful Palawan Cherry, so we can make plans and avoid cutting down too many trees. A lot of the scrub has already been cleared and plans made for perimeter fencing.

Cecile had produced a preliminary plan for the clinic and therapy areas which we showed to a local architect, Mr Quipquip, who is a charming and helpful man. Since I returned they have drawn what I hope will be the final plan. We hope that building can start within the next few months although this depends on getting a building permit (should not be a problem), finding a builder (probably already decided but we are taking advice from the architect) and not least on the amount of rain at the end of the dry season. There is a copy of the basic plan in this report. It sounds as if I had allowed too much time for all this but things move slowly!

Despite the fact that the Bahatala house is surrounded by new building still in progress and the approach is difficult over the builders’ rubble the work continues. There are currently three therapists in addition to the Prosthetist and handyman (who is also assistant prosthetist) as well as the two staff in the office. A nurse has been helping on a voluntary basis but was not there at the time of my visit. We also now have the part-time help of a very nice accountant, Charlie. I anticipate that we may have to slightly increase our staff when we move.

Every day I spent some time in Bahatala seeing patients and talking to the therapists who are always keen to have little tutorials. The range of patients was the same as in other years and I will not list them all. One who stood out was a young boy who had suffered a severe compound fracture of tibia and fibula. He had presented during the week that the German mission of plastic surgeons was visiting. They achieved skin cover so that the fracture could be treated in a windowed cast. This German group comes every year and treat cleft lip & palates as well as some post-burns and others needing expert plastic surgery. There is no cost to BPT as they are sponsored from Germany and bring all their equipment but Cecile has to do a lot of work to facilitate their visit. In fact they leave a lot of drugs and dressings for us. There were two patients who presented at Bahatala with rather advanced cancer, one a bronchus the other possibly gynaecological. Both wanted advice on where to go in Manila which Soc was able to help them with. We also visited a number of patients in their homes in Puerto Princesa. One was a man who had suffered a fracture of the lumbar spine (L1) leaving him para-paretic three months earlier. He had been seen somewhere else and advised to buy from the doctor a small lumbar brace for £150 but had not been advised how to mobilise. We got him sitting and started on Physiotherapy. It was all made more difficult because he came by boat from his village 12 hours away and was living on the boat. At one house we found a very worried lady with a Neer three part (but minimally displaced) humeral fracture. She had been told by one of the other Orthopaedic surgeons to go away and raise enough money for implants and an operation. Soc and I were happy to treat her with a collar and cuff after a couple of hours with a weight on her arm effected a good reduction.

I was lucky to make some interesting trips to remote parts of the island. The first was to the island of CocoLoco where there is a resort in which you stay in individual huts on the beach and eat very good local fish in their restaurant. This was primarily to celebrate the birthdays of Cecile and Jack, a friend who was a Peace Corps worker and settled in Palawan.

We took the opportunity of the trip to visit some patients. One, Angie, about whom I have written about before is a girl crippled by Polio. We had helped her become mobile by providing a wheelchair and she was then able to go to school. During my visit she “graduated” from school. This is a great ceremony at the end of schooling where the pupils all dress in their best “ball gowns” and it was wonderful to see photos of Angie in hers. She is planning to go to university (there are now two in Palawan) to study to become a Social Worker. Social Workers are an important part of the Rural Health Units (RHU) in the countryside.

The next trip was a longer one on which we visited Roxas, El Nido, San Vincente and a number of smaller communities in northern Palawan. At each place the local Health Workers had arranged for patients (always an unknown number) to attend the Rural Health Unit (RHU). In the communities we were sponsored by the local Mayor so at each stop we first paid a courtesy visit to the Mayor’s Office. This often involved drinking sweet coffee or a soft drink.

The majority of the patients we saw had chronic problems some of which had been present for many years but they had heard of the visit by Soc and came along. I saw a number but Soc saw more and had to explain our findings in Tagalog as I still only know a few words. We saw a number of babies with Club Feet and usually made arrangements for them to attend Bahatala for Ponsetti casting. Soc was also able to see patients he had treated in the past as they were keen to show off their new ability, especially in the case of the club feet that of wearing normal shoes. There were other congenital conditions and here again we made plans to get them to Bahatala if treatment was indicated. Many men came complaining of back ache that they put down to carrying heavy weights usually because the ground conditions preclude the use of wheelbarrows. They were shown simple exercises by the Therapists who came with us.

Occasionally the local health worker would ask us to make a home visit “nearby” which was sometimes an hour away. We followed as they showed the way riding their motorcycle, the commonest and best form of transport in the remote areas, but our Ford Everest was usually up to it. One man we visited had a severe equinus deformity following a soft tissue injury and we told him to come to Puerto Princesa where we could do a TA lengthening, I am not sure he was convinced and may or may not turn up in time. There were many other patients typical of those I have described in previous reports. On the way back we called on a man with deformities from Osteogenesis Imperfecta who we have tried to help in the past but he has done well on his own and now runs a Sari Sari store (small general shop) however his life could be improved with a proper wheelchair rather than the rather crude and heavy one he made himself. We also visited a very remote Ostrich farm. They are doing well selling eggs, some for food others blown for the tourist trade and also supplying meat.

On the trip the days were long and quite tiring but each time we stayed in comfortable “resorts” sometimes paid for by the sponsoring Mayor. It was a wonderful chance to see more of the countryside and meet more people who were all welcoming and happy. It also made me realise how the effects of the BPT have reached many remote parts of the province.

We had a day trip to Napsan where there is a resort owned by a Filipina who used to work in Switzerland but has now retired to upgrade and run her resort. It is on a wonderful long beach with white sand and coconut palms. Unfortunately the Dap Dap trees did not have their bright red flowers. Mimi the owner has planted even more flowering plants some of which I recognised but others were really exotic. The sea is very warm although the locals were worried if we went too far out due to the currents. We drove back to Puerto Princesa in the dusk so we saw and heard a great many birds which are difficult to see and quiet in the mid-day sun. The noise of the rainforest is incredible and we drove with the windows down to listen and arrived back in the dark.

The next trip was to the south, further south than I had been before. We left early and had lunch with Maylene. She is the local heath worker who a very hard working and a great advocate for the persons with disability (PWDs) as she herself has a high above knee amputation. I had brought with me some new ferrules for her crutches which she wears out very quickly. In turn she presented me with some delicious peanuts that she had fried in garlic and oil. She is a truly remarkable woman who not only looks after the sick and disabled but brings up her adopted son, grows much of her own food and finds time to keep chickens and pigs. She is currently living in a rented house but took us to the plot of land she has bought and on which she plans to build a house. She accompanied us on the rest of the trip. From her home in Narra we went to Quezon visiting some patients on the way.

In Quezon it was the usual set up in the RHU. Unfortunately the health worker there has not really cottoned on to the system yet so initially there were not many patients. We did see some who needed prosthetic legs and Romy, our prosthetist, had come with us and he took casts of their stumps. We also visited some patients in their homes. This is always fascinating to me as one gets to see into the houses. I find it incredible to see the primitive open fire for cooking and a modern TV set almost side by side. The walls have religious images and crucifixes, and always posters of scantily clad girls supplied by Tanduay the local rum makers!

Near Quezon are some famous caves. First we visited the local museum which gave us the history and had many artefacts including remarkable burial urns. The caves were in constant use from 50,000 to 700 years ago. The local Palawans laid out their dead until the bones were clean then put them in large pots and into the caves. To get to the caves involves a trip of about an hour in a “pump boat”, a wooden vessel with outriggers and a noisy diesel engine. The caves are now a national park and one of the rangers showed us round. There are six or seven caves in the limestone cliffs reached by somewhat uneven concrete steps. It was hot (well over 30°) and very humid so quite hard work as in many places the steps were very steep. The guide took us to his favourite cave which involved walking on a trail through the rain forest jungle, fascinating and beautiful. Quezon itself is not really on the tourist route yet so the facilities are simpler than in other places further north.

In addition to the work and visits to outlying parts it was wonderful to meet many old friends especially Susan and Oscar Evangelista who are a great support to Soc and Cecile both being on the Board of Bahatala Inc. We had a board meeting whilst I was there when we had frank discussions about the ongoing problems with the medical superintendant of the hospital, Dr G Juan, who is keen to get Bahatala out of the hospital grounds. I was unable to meet him this time as he was away from work having apparently caught a dose of Dengi Fever. He has tried to make a legal case against Bahatala but fortunately the Judge who was adjudicating basically said do not be so silly and sort yourselves out. This will certainly give us enough time to build the new Bahatala. It is however important that Soc continues to have access to the hospital especially the path lab, the x-ray facility and the operating room as well as the BPT Orthopaedic Ward.

Once again my stay in Palawan was rewarding and enjoyable. My thanks go to Soc and Cecile, the staff of Bahatala and my, now many, local friends. I can safely encourage other Trustees to visit and see for themselves the wonderful work being done and enjoy the equally wonderful countryside.

Having been a long-term supporter of BTP, last year I decided to go to look at the work for myself. I was given much support and advice by Louis (the chairman) and Soc and Cecile.

Cecile organised logistics: I was a little worried over safety of stopover in Manila, but Cecile organised all, so there was no hitch. I was met in Manila by driver who took me to hotel (the Tropicana) where I spent the night, was taken to airport for flight to Puerto Princesa where I was met by Cecile and taken to an excellent hotel the Hibiscus (see photo of my own "back garden" above), clean and comfortable with good breakfast (English/American or Filipino - I fell for the dilis -dried anchovies - and had those with rice most mornings), pretty garden with flowers and birds.

Next day I was taken to the hospital where Soc operates, has clinic and where the workshop is sited) and I met the team (physiotherapists, secretaries, workshop technicians and some of the patients.

One was Michael (see newsletter of April 2011) a boy with open fracture tibia/fibula after an older friend on motorbike accidentally drove into him; he was being cared for in the hospital by the friend's mother as his own mother had had a stroke and died some days earlier; although he was in traction(most fractures being dealt with without operation) and daily lavage with water sterilised by sunlight - which is used instead of saline which is of course expensive - he needed reconstructive surgery; another a woman with a sarcoma of leg who had returned, after a year of consideration, for amputation.

In subsequent days I had the privilege of going with Cecile, Angel a physiotherapist, Mayleen (a volunteer on whom a bus had fallen some years earlier and who gets around well on crutches) to outlying villages to take replacement/renovated wheelchairs, sacks of sand (to build ramp to enable access) etc. I met some memorable people:

Christopher, aged 21, another victim of motorbike accident, paraplegic after transection of spinal cord, developed bedsores in hospital and a private doctor wanted £1000 for an operation which would have been useless. His father has to carry him up and down the hill on which his house is (a rail was provided by Bahatala in the house for physio); he had been looking very gloomy but smiled brilliantly when given his wheelchair. Wheels at last! Wheels are very important for machismo in the Philippines, but the roads are terrible.

Jesus, whose spinal cord was transected after he fell out of a tree but who provides for his family by making palm leaf roofs, was brought sand for a ramp for his house.

Dexter, paraplegic from another RTA, was very depressed after his accident but when provided with wheelchair by Bahatala, started to work with it adapted with a cart with which he can earn money by shopping for his village at a local market, met his wife though the internet (Filipinos are very IT savvy) and when I met him had independence, a broad smile, a small son and beautiful wife who was pregnant with his next child.

Angela, a polio victim lives in a house provided by Bahatala and who makes and sells beautiful cane handbags is now able to attend high school (she learned English from copying an English dictionary proved by her mother, herself a teacher).

Alfredo, who fell off a roof, runs a market garden outside his own house from his wheelchair. Fernando is a polio victim who helps in the workshop and lives and works in a tiny shop where he mends all sorts of electrical goods (see photo) and whose mother may come to help with cooking and washing.

All these people welcomed Cecile and the team with delight; on our return the van had offloaded its chairs and sand but was full of gifts for the team, plants for the garden outside the Training Centre, many coconuts and live chickens which would be used for the Christmas party.

I also was able to attend a training session given by Cecile (who has degree in rehabilitation) to the local health workers, almost all female, encouraging them to call her directly for help when necessary. There is no NHS as we know it in the Philippines; almost all medicine is private, though the local health workers, mainly midwives carry out immunisations.

I heard of a case where a man with a minor hip fracture, whose leg was opened and stitched from hip to knee without any internal operation who was charged for fixation. Bahatala provides its services free, only asking for contributions from those who can afford it. The mayor of the village with a health centre brought a contributory cheque to Dexter's house.

Also I was lucky enough to be invited for dinner by Susan and Oscar, who are members of the committee, who gave me more background on the Philippines many of whose population are Catholic, so birth control is an issue.

Of course we discussed how to make sure the work of Bahatala continues after the death of its founders, and to improve its cash flow locally (ideas discussed were selling the items produced in workshop, see below (maybe these beds for stroke victims could be sold to hotels as sun loungers?) letting out space in the new Centre to NGOs, accommodation for disabled students at nearby University, etc.

It was not all work; I was taken to watch birds in the local huge open prison (Iwahig penal colony), where one of the warders is an expert, self-taught ornithologist and was finally (on second visit) able to show me the Palawan hornbill, an endemic with white horn and tail.

Although a prison, some areas are open to visitors on some days and families may come to swim and picnic. Soc had worked in the prison in the past so of course has special visiting privileges. He is also a geologist so was able to collect stones on this visit.

There is also a shop where prisoners sell their handmade wares (I bought magazine/newspaper holders, hats etc). By the way the shopping (particularly beautiful hand carved goods made by hill tribes) was good. Also transport by tak-tak (local cab like trishaw but with motorbike) around Puerto Princesa is very cheap; after a few days I felt safe enough to venture on my own.

I was also given a days snorkelling with the orthopaedic team; the fish were wonderful). The fresh fish in the restaurants was also delicious. Other birds I saw were eye-browed thrush (on lawn outside the Training Centre), common iora, common fantail, kingfisher (common and collared), sunbird, herons of various sorts, yellow-breasted leafbird etc etc.

Rain prevented a trip to Sabang with its Underground River, but that means that I need to return.....maybe this year, if not next when the new centre will definitely be up and running.

It was a pleasure and a privilege to visit this beautiful and exotic country with its charming, independent and welcoming people.

We are extremely grateful to Dr Turvill. She has been a loyal supporter for many years and her recent generous donations have allowed us to buy the land and has kick-started the construction of the new buildings.

The financial statements are produced according to The Deeds of Declaration of The Trust. The Income and expenditure accounts are limited to transactions in The United Kingdom. Accounts are monitored in Palawan by Bahatala Inc. The chairman makes regular visits to Palawan to check local accounts and expenditure, and to attend board meetings of Bahatala Inc.

It should be noted that the surplus is maintained for the following agreed purposes,

1. To allow continuation of the Trusts work if donations are insufficient until such time as new funding can be identified.

This Annual Report and the Report and Financial Statement (Beatons) were accepted at The Annual General Meeting of the Trust Board held on 5^th December 2011.

BRITISH PALAWAN TRUST

Registered Office:

The Orthopaedic Department

The Ipswich Hospital,

Heath Road,

Ipswich, Suffolk, IP4 5P

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2010

Mr. Louis Deliss FRCS. Chairman.

Mr. Andrew Gibbs, BSc, FRCS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Mr. Ivan Hudson, FRCS.

Mr. John Powell, FRCS.

Mr. David Sharp, MD, FRCS.

Miss Clare Marx FRCS.

Mr. Mike Shanahan, FRCS.

Mr R Baxandall, FRCS (Orth).

Mr M Bowditch FRCS (Orth).

Mr J Hopkinson-Woolley FRCS (Orth).

The work in Palawan carries on relentlessly. The indigent population of Palawan continue to need and rely on our services. We are however getting an increased amount of funding locally from such resources as the Philippine National Lottery. This lottery provides funds for health care but patients have to apply for it. It does however provide another and welcome source of “sustainability” with local funding supporting our work.

The work in Palawan can now be seen in a number of different fields which in many ways are separate but interdependent. They all complement each other but some could manage as “stand alone” organisations if the need were to arise. These activities can be summarised as,

3. Training. We continue to use the separate purpose built Training Centre. Here Soc and the Bahatala staff train doctors, nurses and village health workers in the principals of Appropriate Orthopaedics. (See Soc’s book for details. This can be obtained from the Chairman)

This list also illustrates the enormous amount of work that Soc and Cecile undertake or supervise. It does not however quantify the huge number of patients who benefit both directly and indirectly from the work of the British Palawan Trust. I can testify the numbers and the variety of patients treated as could any visitor.

The list also shows how much goes on in the Bahatala building. This building was appropriated by Soc about 12 years ago for use by BPT. The house was originally designed as a residence for the Medical Administrator of the hospital to live in but it had not been used for many years. It is now showing its age and the termites have added to the decay. It is getting too small to house all the activities of the British Palawan Trust and of Bahatala Inc. In addition the hospital has plans to build a new wing on the site housing modern operating theatres. We have therefore been looking at ways of moving to an independent site which would free us from the ever changing government plans and the inevitable political involvement. We think that we have identified a site in an ideal position, near the BPT Training Centre and near the bus routes for patients. It is not far from the Provincial Hospital and most importantly is being sold at a reasonable price. (The price of building land in Puerto Princesa has shot up to ridiculous figures.) This exciting development will mean much more work for Soc and Cecile and I am looking to all our UK supporters for backing and of course money.

The finances which are summarised at the end of this Report and covered more fully in the Report by Beatons, are in a fairly healthy state. There was slight drop in donations during the year which was disappointing but the large payment from HMRC of Gift Aid covering more than one year made up for the shortfall. We were hoping that the new mailing list would increase the donations but it seems that the “credit crunch” may have had an effect. It all means that the fundraising effort must be increased especially in view of the proposed acquisition of a site and the building a new Bahatala.

The reserves look large but we are in the process of purchasing some land on which we propose to build replacements for the current old Bahatala clinic, office and workshops.

The AGM held in early 2009 discussed the importance of having at least one other Trustee involved with the detail of the administration of the Trust. Unfortunately none of the existing Trustees were willing or did not have the time for such involvement. This remains the case.

I have just returned (written in June 2010) from another wonderful trip to see the work of the British Palawan Trust and to see more of the province of Palawan. I flew via Dubai and was met in Manila by Soc. The next morning we visited a very active convent, La Consolacion, where the nuns run schools for all ages. We were asked to see a number of the nuns with various aches and pains mainly related to their great age. Then we flew to Puerto Princesa.

The whole of the Philippines is suffering from a severe drought that is also affecting most of East Asia, and is caused by El Niño. This meant that it was fairly hot, usually over 35° C in the shade at midday but still very humid. The fields especially the paddies were parched and mainly unproductive. In addition the inshore fishermen were not catching the usual numbers as the fish had gone to deeper, colder water. One island that we visited had caught no fish for two months which meant no income at all and little food. They were understandably rather fed up!

I stayed as usual in the simple but very pleasant little hotel, Casa Linda. It has all one wants and is well situated being a short walk from Soc’s house and from the hospital, although I always took a tricycle taxi. The price of a room has not gone up much although the weak UK pound has caused a slight rise over the last two years. The staff, who remain the same happy bunch, now recognize me which adds to the pleasure of my stay.

The week-days are all similar. I start by arriving at Bahatala at about nine. Soc is usually there as is the staff. This includes the Therapists, the Prosthetist, the office girls and the odd job man who makes things and repairs them, things such as seating for children with Cerebral Palsy and also wheelchairs. There are always a number of new and follow up patients being seen or treated. We also visit the BPT ward. This is now in general use, as there are currently two other doctors who treat trauma patients. Soc usually has three or more of his own patients. Unfortunately because we no longer have control of the ward it has deteriorated with dirt and loss of the pictures on the walls.

During my stay the ward patients included two fractured tibiae and four fractured femora. One tibia was mid shaft the other upper involving the tibial plateau. The shaft fracture was treated by skin traction and then put into a cast. The upper tibial injury was taken home to be on traction there for about four weeks. The femora were at all levels; supra-condylar with extension into the knee, one mid-shaft, one sub-trochanteric and one per-trochanteric. These were all treated with traction through a Denham pin, the first in 90/90, the second by classical Perkins traction followed by a thigh brace, the upper one in abduction and flexion and the NOF by traction and transfer to her home before early mobilisation.

The out-patients varied from simple closed fractures of the arm to more difficult cases. The arm fractures were most often in children. Distal radius, fore-arm bones and supra-condylar fractures made up the majority. There was a case of tibial osteomyelitis in a teenage boy requiring sequestrectomy. I was asked to see two cases of pseudo-winging of the scapular producing muscular pain and both caused by mild mid-thoracic scoliosis in young women. There were two cases of fractured clavicle plus a fracture of the glenoid neck. One had minimal displacement but the other had an upper brachial plexus lesion with a Horner’s syndrome. All the fractures are treated without any internal fixation.

We saw one case of carpal tunnel syndrome and one bilateral ulnar palsy from elbow pressure whilst in hospital. A young man presented with osteoarthritis of the hip secondary to either an impacted subcapital fracture or possibly a slipped epiphysis. There were the usual number of babies (Soc seems to have dealt with the older untreated club feet) coming for change of plaster using the Ponsetti method, and also patients with the puzzlingly common constriction band syndrome. There are usually a small number of elderly patients who appear to have “burnt out” or quiescent Rheumatoid but I have never felt any evidence of synovitis.

I am sure that I have left out many patients but I do know that any visitor would see a vast and wide variety of both orthopaedic and other specialty pathology. It is often a test of one’s retention of basic medical school training!

Two days were spent in Bahay Sanay our purpose built Training Centre. The programme was to teach doctors from the, often remote, Rural Health Units. Some are recently qualified and are sent to the more remote parts on a Government scheme. They were shown how to apply bandages and slings, how to set up upper and lower limb skin traction and how to apply POP back-slabs. They were very enthusiastic and keen to go back and try out their new skills. On their return they started sending photos by text taken on their mobile phones for advice about management.

Some of the most interesting days are spent visiting patients in their homes. We went south principally to measure a number of patients, paraplegics, amputees and cerebral palsy children for wheelchairs. We now get the wheel chairs from a factory set up in the Philippines by Handicap International. These chairs are of a very high standard and are able to cope with the local conditions. The rough ground and the humidity wears out less well made chairs very quickly.

We made three visits to the north of Puerto Princesa to follow up patients. These included a young woman confined to a wheelchair because of Polio with major social problems. Another was an 89 year old spinster who farmed in a very remote part of the country. Four months earlier she had fallen (pushed by a bad spirit she said) and fractured the mid-shaft of her femur. She came to hospital which must have been a difficult and painful journey in a bus where she was treated with traction followed by a thigh brace. She was delightful and because I was the first white man to visit her we had to go upstairs for a cup of coffee.

The trips to the outlying barangays (villages) are not always pure work. Once we stayed on a small island on a reef, CocoLoco. This resort is quiet and remote with the most marvellous coral and fishes just a meter or two down. Another time we stayed in a new very comfortable resort (the local name for hotels with the rooms in individual huts or buildings) on a beach near the St Paul’s Park, a World Heritage site. The sea water is always as warm as a bath and crystal clear, the beaches white coral sand and almost empty.

I spent a great deal of time in discussion with Soc and Cecile. The Bahatala building in the hospital grounds is beginning to show its age and we have been talking about plans to replace it for some years. The generous offer of a significant gift from one of our loyal donors just before I left UK was the stimulus we needed. We put the word out that we might be interested in purchasing land and in this were helped by the other NGOs working in Palawan. A plot of land was identified and we visited it. The land is near the main highway, useful for patient access and near the BPT Training Centre and importantly was at a price we felt reasonable. Negotiations were started and a small deposit paid. There are some legal matters to be tidied up before we can take possession which should be towards the end of 2010. The next task would of course be designing and building the new clinic, therapy area, office space, workshops and staff facilities. I hope that Soc and Cecile will be able to undertake this enormous workload in addition to the regular help for indigent patients. It is however very exciting and we will put more details in forthcoming News Letters and on the web site as things develop. There are some more details in the Trust Report above.

I would like to thank all the people who made my visit so enjoyable - the Staff of Bahatala and the many friends in Palawan especially Oscar and Susan, and special thanks as always to Soc & Cecile.