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
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