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2008 Outstanding Award in Community Empowerment/Service

SOC IS GIVEN SPECIAL AWARD

by THE UNIVERSITY of the PHILIPPINES ALUMINI ASSOCIATION

GARI M. TIONGCO (Chair, UPAA Search & Awards Committee and President, U.P. Alumni Association) wrote to Soc.

Congratulations!  The UPAA Board of Directors has confirmed your award as 2008 UPAA Outstanding Awardee in Community Empowerment/Service.  We are proud to note that you have used your education from the University of the Philippines as a springboard to your total development in your profession.  We recognize your achievements in your particular field, and your leadership in projects which contribute to the welfare of Filipinos and to the larger society.

This is a great honour for Soc.  He and Cecile attended the meeting in Manila during the celebrations.  This year is the 100th anniversary of the founding of the University making the award to Soc very special. 

There are some photos of the event in the Gallery.

Palawan Visit 2008

 (There are some photographs relating to this account in the Gallery)

I have just returned from my annual visit to Palawan.   After a comfortable flight I was met in Manila by Cecile and the next morning we flew to Puerto Princesa.   My usual immediate exposure to work was delayed by a nursing student “sports day” being held on the old basket ball court outside Bahatala.   Instead we went to Bahay Sanay (the Training Centre) where the garden is now well established with a profusion of tropical flowers.    The building itself is still looking good although already has required some re-painting outside. In the afternoon I went to a Valentines Day rally in Medoza Park at which passionate speeches in Tagalog were being made to protest against mining in Palawan.

The next morning was one for work.   Bahatala had the usual early morning queue of patients. These varied from fresh fore-arm fractures to a small baby with severe respiratory distress plus the usual CTEV patients for change of plaster (Ponseti) and a few stroke patients.    The stroke patients have been considerably reduced thanks to the skill and organisational ability of the visiting Canadian VSO Physiotherapist, Angela.      In addition there were a number of amputees being measured or fitted by Romy, Bahatala’s Prosthetist and Orthotist.    Romy was very pleased with the new pneumatic chisel that BPT purchased from Germany with much help from Mr Fuge of OttoBock.

The British Ambassador was due to visit over the week-end but security scares in Manila caused a postponement.   We were hoping that he would visit Bahatala again and possibly open the training course in Bahay Sanay.   He has kindly sponsored some of the training courses.    However we were not idle and the patients continued to stream in, many being brought from the south by Mylene, our hard working contact in Narra.   In addition to the acute injuries and congenital deformities there were conditions that one no longer sees in the UK such as two children with chronic osteomyelitis, one in the lower femur and the other at the level of the lesser trochanter, and two young adults with polio paralysis who came for wheelchair fitting.    Soc received some X-rays by courier from Cebu of a man about 50 years old with chronic renal failure on dialysis.   He had been given one THR (an unusual modular prosthesis) and had been recommended to have the other done with which we agreed as he had quite marked OA changes.   His shoulders also had marked gleno-humeral OA and might have been ideal for Copeland surface replacements.   We spoke to his wife by cell-phone and she seemed reassured.   Whilst we were doing this an interesting family from the indigenous Palawan tribe came round selling farm and jungle produce.

The opportunity of a quiet afternoon on Saturday allowed us to have a meeting of the Board of Directors of Bahatala Inc.    These are all (except me) members of the local community and are of great assistance to Soc and Cecile.    I thanked them for their work and reported on the AGM of the BPT.    They supported my wish that another Trustee of BPT should visit.    They all said that they would make their stay comfortable and memorable, especially Oscar and Susan Evangelista who are retired academics from the Philippines and USA, and have a very nice house on the outskirts of Puerto Princesa.    They felt that Palawan would be very suitable for a family holiday with part of the time in one of the beachside or island resorts.

I was also taken to see some patients at home in “greater” Puerto Princesa whose province is extensive covering farming, fishing and jungle regions.     We delivered a new leg to an 18 month old with congenital loss of one lower leg.   He was most reluctant to take his leg off and even his mother could not do so when putting him to bed.     We visited another boy, about 7, who had been born with phocomelia of both legs, this meant that he had to be carried everywhere but he is now walking with a single prosthesis (only one leg being suitable) and crutches.    He is a happy boy with no self-consciousness about his disability.    His twin sister had normal limbs but we found her at home with a grossly infected foot caused by stepping on a shell on the beach.    She was admitted to the BPT Orthopaedic Ward and settled well with incision and drainage plus IV antibiotics.

   We took another young boy home who had fallen from a roof picking fruit and suffered supracondylar and ipsilateral fore-arm fractures.    As is Soc’s practice he was put on modified Dunlop traction at home.   Home in his case was a very small house on wooden stilts built over the water of Puerto Princesa bay.   The approach was along a slippery cat-walk suspended over the water which was hidden by a thick layer of floating garbage.

Monday produced a new crop of patients.   This time in addition to the acute fractures, mainly fore-arms in children, there was a gross tibial dysplasia, a 7 year old scoliosis, a boy with Tb of hip and ankle and a man with upper GI obstruction whom we referred to the General Surgeon.    A number of patients and their families came for reimbursement of their medical expenses.   Cecile is very careful to assess them all and tries to restrict using our funds for those with orthopaedic conditions and the poorest of the indigent patients.

Tuesday and Wednesday were taken up with all day training sessions.   This was part two of basic Orthopaedics for Rural Health Unit (RHU) doctors from all over Palawan, there being about 30% of the total number of such doctors attending the course.   The sessions were for application of POP back-slabs and simple skin traction, with the participants using each other as models.   Angela also taught them how to use crutches and gave a tutorial on back-ache.    The Chief Resident (=SpR) from the Orthopaedic Department of the Philippine General Hospital (Manila) came to assist and observe.    I think that he had his eyes opened to the potential of non-surgical management of trauma.   The junior doctors in Manila, like those in UK, are given grossly inadequate teaching of fracture treatment without complex internal fixation.

On Friday we (soc, Cecile, Angela and I) took off in the Ford Everest for a long week-end.   This was partly to see different parts of the island but mainly to visit patients and the CBR workers and contacts.   We picked up Imee (the Bahatala representative in Roxas and visited the Roxas hospital.   This hospital is being renovated with money raised by BPT.  So far the entrance and most of the rooms have been re-painted, screens fitted to all doors and windows and most importantly an electricity supply connected.   They are now able to use the X-ray machine, the electric microscope, the autoclave, lights and fans.   Still to be completed are the fitting of some air-conditioners, a new fridge and finally the water supply.   A geological survey has shown a usable aquifer near the hospital and we are now attempting to get an extraction permit and install a bore hole and pump.   We arrived late in the day at Taytay where we stayed again at Casa Rosa which is on a hill giving a magnificent view of the bay and the old Spanish fort.     In the morning we went to the local RHU to see patients, many with chronic conditions such as polio, back-ache and healing burns but others with acute trauma or infection.    We also visited some patients at home a few of whom I had seen last year.     Then we drove to El Nido for a late lunch after which the RHU workers had laid on a “clinic” on the town basketball court.   Two of the patients were paraplegics.   The first, a young man, had been injured in a farm accident.  He like many had tried for a cure from the Hilots.  The other was a retired school teacher whose paraplegia was only partial but had no definite cause but he did have a deformed lumbar spine and a barrel chest.   He had been given a THR on one side which, inevitably, had put him off his feet completely.    We took him to his village an hour north of El Nido.    It was clear that he really needed a new better wheelchair and Angela prescribed some hydrotherapy as his house was on the beach.   As usual the village children (huge numbers) found the sight of a tall, pale, white-haired lolo (Tagalog for grandfather) most exciting and they followed me everywhere giggling.

We stayed in Green Views’ new resort (a collection of individual huts with bed and shower plus a central bar/restaurant) which was every bit as good as their branch in Port Barton.    Saturday morning was another clinic this time inside the RHU where in addition to a number of backaches there was a 16 year old girl with a ?hysterical knee problem caused by abuse from a dipsomaniac father, a probable case of Tb in a young woman and a man with poly-arthritis possibly RA.    The basketball court was taken up by a fascinating market where all sorts of fruit and vegetables were being sold.

After lunch we took some time off and hired a boat with an amusing boatman.  He took us to his favourite areas on some of the islands.   The islands of El Nido bay have magnificent limestone cliffs rising straight out of the water capped by rainforest.   These cliffs are home to the swift whose nest is made into soup, hence the name of the town.    We swam into hidden lagoons and over wonderful coral reefs.  We were very luck with the weather – clear blue skies; the previous few days had been cloudy with tropical downpours.   We arrived back at Green Views as the sun set behind the islands giving a romantic vision of pink sky and tropical islands.

The journey back started by being taken to some small villages by the local RHU worker, known simply as “Pastor” because in addition to his RHU work he is a Pastor of a “Born Again” church.   He preceded us along small rough roads on his motorcycle which he manages well despite a leg paralysed by polio.   

The first village was (relatively) prosperous due to good local farming and fishing.    We saw many patients, some in the compound of a woman who grew cocoa and coffee.  The coffee was in flower and had the most wonderful, heady scent.   The patients included a polio paraplegic, a Caisson disease with partial paraplegia, a giant cell tumour of index finger and a number of healed fractures.   In the next village we found a young woman with abdominal pain and swelling who had started vomiting and then developed a (?pure) motor paralysis of her legs.   Her husband had sold their cow and carabao (water buffalo) to pay for medical expenses.   They had spent two days in the private hospital (a ‘charity’ run by the Seventh Day Adventists but too expensive for most Palaweños) however they did not have enough to get a full diagnosis or any treatment so had come home.   Soc arranged for her to come to the Provincial Hospital (at BPT’s expense) to have a more careful work-up and be referred as necessary.

We dropped Imee at her family home in Roxas where we met her father who had recently suffered a stroke.   This caused the postponement of Imee’s wedding, a disappointment as I had been invited and brought my best barong (formal Pilipino shirt) – but I was able to wear it the next day for Marichell’s birthday causing much amusement amongst Bahatala staff.

Monday, my last day in Palawan, was spent in Bahatala seeing the many patients, both new and follow-up.  On Tuesday we all flew to Manila as Soc and Cecile were going on to Bohol for a short break with Soc’s brother from USA.    The time between arriving and my flight was spent visiting VSO Philippines.    VSO is withdrawing from the Philippines because of lack of (UK) Government funding.   This will be a loss to many projects and something that I had not heard about in the UK.

A journey on the Manila Metro and a taxi ride in a very ancient cab with a driver who talked politics all the way, took me to the airport.   The flight home brought me back to reality with a drop in temperature from over 90 to under 50!   As always I had been most impressed by the wonderful work being done by Soc and Cecile and for the need for BPT to continue.

Louis Deliss

                     Chairman

Notice to all donors

1. Thank you to all our loyal donors.  I am well aware that many of you make donations on a regular basis often more than once a year for which we are extremely grateful.  I apologise that I do not acknowledge all the donations but I feel that this is really a waste of our resources,  If you do require a receipt let me know.

2. The work in Palawan is still increasing.  Not only do Soc and Cecile have to care for an increasing number of patients but the new training centre (Bahay Sanay) creates even more work - and of course needs even more money.

3. The latest Annual Report is now available.

4. We are about to send out a News Letter to doctors who are not on our Mailing List.   Please encourage others to support us and let me have the names and addresses of any colleagues who might be interested in our work.  Addresses on the Contacts page.

5. It would help me enormously if donors who have previously signed a Gift Aid Form could let me know when they sent donations.

Louis Deliss

ARCHIVES

Sasakawa Health Prize

I am delighted to report that in Mayoc attended the World Health Organisation (WHO) Sixtieth World Health Assembly at the Palais des Nations in Geneva. He was there to receive the Sasakawa Health Prize for 2007.   The prize is given for outstanding innovative work in healthcare development.  this is a wonderful achievement and recognition of Soc's work in developing appropriate Orthopaedic and Rehabilitation in Palawan that is applicable in many parts of the world.

Photos of the award ceremony can be seen in the Gallery.

Further details can be found on the following links.

http://www.who.int/gb/ebwha/pdf_files/EB120/B120_DIV3-en.pdf  See notes on page 4.

http://www.nippon-foundation.or.jp/eng/brief_dtl/20070528HealthPrize.html

http://information-hub.ofw-connect.com/OFW_Articles/?q=Palawan_Doctor_to_receive_WHO_Award

Photos on  http://www.who.int/mediacentre/multimedia/2007/wha60/en/index2.html

Report of visit to Palawan August 2007

My annual visit to the Philippines started with two days in Manila.  Soc had arranged meetings with various, hopefully, influential people.   These were both in government and at the University of the Philippines.    Some would be helpful with Soc’s medical activities and some for his geological work as he still advises the Provincial Government on geology.   I was also scheduled to give a talk to the Orthopaedic Department of the Philippine General Hospital.   The PGH is the main hospital and medical school in Manila.   It was interesting to be shown around by the Chief Resident (SpR).   I lectured on Appropriate Orthopaedics as I see it, concentration on the need to question the excessive use of internal fixation.   The senior Consultants agreed but the juniors had more difficulty!

Then we flew to Palawan.   There are not many changes but a steady increase in the signs of affluence.   There are more cars and tricycle taxis on the road and more smart shops and restaurants as well as many new buildings.  The other measure is the tripling of scheduled flights from Manila.   I stayed as usual in a fairly simple wooden hotel near the centre where they are extremely welcoming.

Soc and Cecile were also most welcoming but got me down to work straight away.   Off we went to the Bahatala building to meet the staff including Angela a Canadian VSO Physio.   Then we went to see patients both in the clinic and in the ward.   There are the usual large numbers of Club Feet, many Constriction Bands, skeletal trauma and infection.    The first patient in the ward had a nice cold abscess with muscle wasting and osteoporosis making the diagnosis of Tb easy.   There were also the large numbers of forearm fractures in children and some in adults.   These fractures vary from fresh to a few weeks old, some even hoping for correction years later.  The fresh ones are treated by either manipulation under haematoma block or a few days on skin traction, often at home, before casting.    Fractured "NOF" are as usual not treated surgically and do very well, as do the femoral shaft fractures.   The sub-capital fractures often do not come in but are given a few days rest and then mobilised with sticks or crutches. The per-trochanteric are mobilised the same way after 1-3 weeks on traction.   Femoral fractures are treated by traction, skeletal in adults, on a Perkins’s bed for 4-6 weeks and then put in a thigh brace and mobilised.

We had a trip out as always.   This was to follow up some patients and to see new ones.   We went to Taytay which is the old Spanish capital of Palawan north of Puerto Princesa.   It was particularly nice to see “Lee” (see under “gallery” on the web site) who was at school and came running across in normal trainers.  We also saw new patients that had been “found” by Aimee, the local CBR worked attached to Bahatala.   These varied from simple trauma to complex difficult cases some probably infective and the usual congenital problems and CP.   Whilst there I unfortunate caught the local ‘flu and found a fever in temperatures of 95+ quite difficult.  But at least it was not Malaria!

The last week of my visit coincided with a two day course for doctors.  They came from most of the municipalities of Palawan to learn some Orthopaedics.   They are often the only doctor for many miles and have to be “multi-skilled”, performing Caesareans and treating the two common diseases of childhood, gastroenteritis and Malaria, but must be ready for anything including trauma.    I was able to present Soc with the Eyre Brooke Medal awarded by World Orthopaedic Concern International at the opening ceremony.  I then gave opening and closing talks, Soc did the most and short talks were given by the VSO Physio and by Cecile.   Everyone seemed very keen and to enjoy themselves.   The meeting was held on the BPT Training Centre (Bahay Sanay.   This building is in constant use for meetings and training courses.  It is definitely showing its worth.

I spent much time with Soc and Cecile talking about future developments and inevitably about finance.   The exchange rate has fallen a bit after the spectacular climb from 43 peso to the pound to 110.  It has now settled at about 90.   This means that the inflation proofing effect of the exchange rate has stopped and slightly reversed.   In addition the costs inevitable increase and the Training Centre will have revenue consequences.   Below is a table I will put into the 2007 Annual Report.  It shows the additional funding that Cecile skilfully and successfully arranges.  The small but increasing local contribution is very reassuring for our long term sustainability.   All the funds in Palawan go through the NGO we set up, Bahatala Inc.  There are in addition some other local donations for the supply of wheelchairs.

             I hope that we will be able to increase our income by completing the revision of our mailing list.   This has already gone up by about 15% but we need to increase further to cover increased costs.  Please consider us when making charity donations and pass on the news about our work to your colleagues

Chairman British Palawan Trust

www.britishpalawantrust.org.uk

2 September 2007

Report of 2006 visit by Trust Chairman

My annual visit in 2006 took place over Easter.  Being there over this devoutly observed religious holiday is a mixed blessing.  The whole island is in holiday mood with small shrines in each street and the Stations of the Cross at Calvary, a hill on the outskirts of Puerto Princesa which is part pilgrimage and part fiesta.  On the other hand the work stops and it is really to see the work being done that I visit, although the enjoyable holiday is another good reason.   I was greeted by Soc and Cecile at the airport and after dumping my things at the hotel it was straight to work.  

I saw very many patients with both traumatic and orthopaedic problems.   I spent time in the Bahatala building and with the staff we employ.   I even saw some new patients on my own when Soc was off doing other things.  It all brings home the excessive reliance on high technology that is the fashion in the west! 

I was also able to spend a great deal of time talking to Soc and Cecile.  Sometimes I talked to them both at other times I was able to talk to them separately.  The result was that I learned much and began to understand what the real problems had been over the last year.   It is now, I am pleased to report, all irrelevant as Soc is now reinstated with full admitting rights in the hospital.   The week after I left he had two operating lists and has had more since.   He is also once again using the BPT ward that we built as an extension of the hospital.   However one must remember that the majority of his patients do not require in-patient care

The new training centre, now called Bahay Sanay the Tagalog for Training (and exercise) House, is a really wonderful facility.   We must be very grateful to the Bishop of Palawan for most generously giving us the land.   The building, funded by an oil company, is in the grounds of a seminary close to the Bishops Palace.   This means that it is totally free from “political” interference.     The centre will be use for training courses.   The first is on 6^th & 7^th June and aimed at the School Nurses.  It will also be used for training village health workers.   At the opening I invited the Palawan Medical Association to use it for their meetings and I hope they will take up the offer.  I have suggested to Soc that training sessions for local doctors should start as soon as possible.

The cost of building the new training centre was all met by an oil company but there will be an ongoing cost for courses, upkeep and electricity.   In addition the number of patients increases each year.   Cecile has been very successful in obtaining additional funds from partner charities such as CBM (Christoffel Blindenmission), Stitchting Lilliane Fonds and others but the British Palawan Trust will have to find more money.  To this end I have been working with Soc on the mailing lists and NewsLetters.  I will also try to find companies to give donations and look to others to do the same. 

In summary the work of the Trust is still needed and appreciated by the Palaweños.  The numbers of patients and of the disabled who benefit is enormous and growing please keep supporting us. 

WOC International Eyre-Brook Medal Award

Soc received this letter from Mr K Tuson F.R.C.S. in 2005.

Dear Dr Socrates,

I am delighted to be able to tell you that I was able to announce to the International Committee of World Orthopaedic Concern that your nomination by WOC UK for the receipt of the Arthur Eyre-Brook Medal has been approved. As you know, the Arthur Eyre-Brook Medal is named after one of the founders of World Orthopaedic Concern and designed to recognise the efforts and input of surgeons like yourself who spent many years working in areas of great need. Many congratulations. I hope that Dr Rajasekaran, who is visiting the Philippines shortly, will be able to make contact with you to present you with this medal.

P.P.S.  I presented the Medal to Soc at the opening ceremony of the Doctors Training Course in August 2007.  I had been asked to do this by WOC.  The Medal now hangs in a frame with the certificate in the Bahatala staff room.  LD.