this page I intend to put bits of news and information
that I hope will be of interest. The idea is
to supplement the News Letters.
will try and put something new every month or so.
Please feel free to e-mail me with any questions that
you have. Contact.
CAN YOU SEND FEEDBACK by e-mail or on our FaceBook page.
Visit Report 2017
Annual Report 2016.
How to get Soc's books.
Archives. Old special reports and previous visit reports.
Soc died of a heart attack during his usual morning swim
on Sunday 23 September 2012. He
inspired and created the British Palawan Trust and
also inspired all of us who were his friends and
There are many thousands of patients who would have
never received any treatment without the leadership of Soc.
Palawan Visit Report 2019
I visited Palawan from mid-March until the week before Easter.
I stayed in my usual hotel.
Small but comfortable where the staff know me.
I take a tricycle taxi to the Bahatala clinic in
Abanico Road each morning except on those days when we
are doing an out reach clinic.
In Bahatala there are sometimes a patient or two
that the PTs want to discuss.
Often it is because the patient needs an
explanation from a doctor as they tend not to fully
believe the PTs and nurses.
Others need a diagnosis which has to be made on
history and clinical examination.
Occasionally patients have already been X-rayed.
I saw backaches, knee pains, shoulder pains and
short legs due to untreated but healed hip fractures.
One day a young girl came asking for help with her
had been hit by a motorcycle causing a comminuted
fracture of lower tibia and fibula.
She was admitted to the Provincial Hospital in
The attending orthopaedic surgeon said she must
have “stainless” which is the local word for any
fixation device, and that she should find 50,000 pesos
(about£800) for the implant (a locking nail) before any
operation could be planned.
She is from a poor peasant family and cannot
afford this. She
could get it from PhilHealth if she can show she is over
60 and indigent, but she has never had a birth
When if ever she gets recognition from PhilHealth it
will take 1-3 weeks to get final approval and then 3-4
weeks to buy the implant by which time the fracture is
likely to be healed in angulation.
The local orthopaedic surgeons have no real idea
how to treat fractures without stainless.
The surgeon has offered immediate operation in
the private hospital at a cost of 200,000 Pesos (£3500).
We also went on out-reach visits.
These are done in cooperation with the medical
social workers who go around the communities and find
patients for us.
They then gather at a central point such as the
Many are old and some have had strokes so all we
can do is give them walking aids such as sticks or
walking frames, but this if often enough to make their
There were the usual high number of CP children
many of whom need wheelchairs or the specialist Reymon
chairs for which they are measured.
I also saw three children with mildly hypoplastic
legs, which I assume is from in utero infection.
There were also one offs such as severe
syndactyly and many varieties of constriction band
syndrome and some new club feet.
At least the
social workers have learnt not to include
We visited a pair of incredible Siamese twins.
They are now about 4 years old and are joined at
the cranium with basically one brain so inseparable.
They have appeared on Philippine television.
I met up with many old friends and visited some new
Puerto Princesa has grown with the most obvious being
new hotels and eateries.
The traffic is also much worse until you get out
of the capital.
A new menace on the roads are the very large
number of tourist buses.
These hold 10-12 and are mostly driven by
maniacal speed merchants!
The Unit is working well.
We seem to have lost the financial support from
the German charity CBM.
It is not clear why this is but it seems to be
related to a change in attitude to community based
rehabilitation which has now been superseded by the two
in words “inclusion” and “empowerment” neither of which
are well defined nor do they have much practical
application on the ground or the need for rehabilitation
“buzz words” seem to have taken over overseas aid.
Cecile Socrates is very aware that the BPT income
Fortunately, she has been very successful in raising
income from other sources including the Philippine ones.
For this reason, I remain optimistic about the
Louis Deliss, Chairman
Report of Vist March
Palawan from 7th March to 28th
The total flight is about 24 hours, so I pay for
an upgrade to business class which makes it more
bearable for an old man!
I stayed in the same hotel in Puerto Princesa
that I have used for over twenty years.
It is very simple, and I now know many of the
Much has changed
on the island especially in the capital, Puerto
The traffic is now a major problem despite some
The number of tricycle taxis and private cars has
increased beyond recognition.
People many of whom seem much more affluent seem
There are now two huge shopping malls and many
more shops and eateries.
Fast food is unfortunately becoming the norm for
Increasing numbers of people appear affluent.
Abanico Road is much the same and the hard-working staff
have not changed.
I spend most of my time in the clinic seeing some
patients and talking to the staff.
I went on Out-reach Clinic visits which are an
integral part of the unit’s work.
These are arranged with local medical social
The girls visit small towns and individual houses
which means many new patients as well as follow up of
old ones. It
is on these visits that one sees the huge unmet need of
the population for simple health care support.
The disabled (called in the Philippine “Persons
With Disability” or PWDs) are a group that can often be
helped with minor aids and simple physiotherapy.
We all visited
These visits are mainly for “team building” but also for
interest and education.
One place was an organic farm growing turmeric on
a fairly large scale.
It is run by a Pilipino entrepreneur who has set
up similar farms on other islands and has several small
shops selling turmeric in various forms.
He may turn out to be of help funding Bahatala.
important in the Philippines and I tried some new
restaurants trying to avoid the fast food outlets.
There is a new one nearly opposite the clinic in
This time I did not eat anything exotic or new as
I have tried most things.
I must pluck up courage to eat Balut, which are
duck eggs left under the mother duck for 28 days and
then hard boiled.
There is a partly formed duck embryo inside.
Overall my visit
inspired me to work harder to get the necessary funds
for the unit to continue and encourage others to do the
I visited out unit in Palawan in
late March 2017.
I was pleased to find that the whole unit is busy
and providing a need especially for the indigent
The Clinic has two Physiotherapists and one
They continue to deliver physiotherapy for CP children,
post-injury patients and stroke patients in the early
phase of recovery.
There are still a small number of acute injuries
and fractures that attend the clinic.
Some have insufficient funds for the “essential
operation” recommended by one of the local Orthopaedic
Why is it that the modern Orthopaedic Surgeon
believes that fractures will not heal unless internally
fixed and have no concept of non-operative management?
The staff make a full assessment and arrange for
X-rays (if not already done) and then often send it all
to me and together we decide on management.
This involves plaster cast or home traction but
if these are not appropriate we try and help them to
raise the necessary funds.
We visited one such patient who had suffered a
per-trochanteric fracture about a month earlier and been
treated with home traction.
Such patients heal very quickly in the home
environment and we took off the traction and started her
addition, the unit hosts the Ponseti Club Foot Clinic
which is attended by Dr Favila one of the new young
He carries out the tenotomies and he will see
other patients that the staff are worried about.
There are about 16-20 new patients a year out of
the theoretical 20-25.
The message about this clinic has yet to spread
to some of the more remote villages especially in the
far south and the smaller islands.
Out-reach clinics have become an important part
of our work.
These are arranged with the local Medical Social
Workers, who compile a list of orthopaedic cases and
persons with disability for the clinic.
The team that goes out usually includes the
Physiotherapists and the Nurse but may take Romy (the
Prosthetist) and Reymon depending on the needs of the
Dr Favila often attends which is a great help
with new patients and we are most grateful for his
I went on one of these clinics in a town 2-3
hours drive north.
We saw about 40 patients and it was a humbling
experience and tested my diagnostic abilities.
Treatment was always based on what is possible
and available, no clever European horrendo-plasties!
The workshop has been revolutionised since Udo
Foerster (the Prosthetist from Australia) spent a year
The prostheses are all made using metal component
parts sourced from China.
This has increased the turnover and reduced the
waiting tome for a leg.
The production of aids for the disabled is also a
busy part of the work.
We make special chairs for CP children and some
We provide wheelchairs (Supplied by the Mormons)
and help train users in maintenance and carry out some
Reymon, the carpenter and metalworker (he also
makes legs) can turn his hand to anything such as making
new furniture for the clinic.
An increasing amount of funding
is coming from with the Philippines and from the
Filipino diaspora in USA.
The Philippine sweepstakes will pay for
artificial limbs for the poor and Norfil in Manila
(supported by a Dutch Charity,
will pay for the treatment of children up to the age of
18. We still
get significant help from
I spent most of my time in the clinic trying to
teach and encourage the staff.
But it was not all work, I have many friends in
Puerto Princesa made since my first visit in 1992.
I therefore attended many parties and dinners.
The whole of the staff went on a “bonding” trip.
This involved going up a river with jungle down
to the water’s edge by boat.
We then walked a short distance to “The Mother
Tree” a huge Dao tree where we had a picnic.
Finally, I must thank our very loyal donors in
the UK without whom we could not continue.
Report of visit March 2016
I have just returned from Palawan and our clinic
I come back more inspired and optimistic than
last twelve months have seen much changed.
An Australian Prosthetist and Orthotist funded by
the Australian Volunteers for International Development
was seconded to us.
Udo Forster and his wife and three lovely
daughters lived in Puerto Princes and I think thoroughly
enjoyed their stay, we certainly did.
Udo’s job description was to modernise the methods and
equipment in the workshop.
We have been making prostheses and other aids for
persons with disabilities for twenty years but were
still using the techniques that we started with.
Mrs Socrates and I had been worried about this
for some time especially as our in-house prosthetist is
nearing retirement age.
Our worries were quickly dispelled by Udo’s
enthusiasm and work ethic.
He soon identified our needs.
He introduced new, modern techniques to the
prosthetist and also involved all the other members of
reorganized the layout of the workshop and requested new
equipment which with our funds and locally raised funds
we were able to purchase.
Now we have three people who have made legs from
start to finish independently.
This is one reason for my optimism and we are
very grateful to Udo and the Australian Government.
The other optimistic development is the change of
emphasis and working methods of the Clinic.
We only have one attending Orthopaedic Surgeon on
one afternoon a week. He
really comes for our thriving Ponseti club foot clinic.
This means the emphasis of our unit is more on
persons with disability (PWDs) and we have found that
working with the Municipality Medical Social Workers
rather than the Rural Health Units allows us to help
many more patients.
We still help many people with fractures and
other orthopaedic conditions some we can treat others
need finance and appropriate referral.
Unfortunately the cost of healthcare is too high
for the majority and the standard of specialist ability
(all specialties) is generally low with resulting poor
patient confidence making some opt for no treatment or
to attend ‘faith healers’.
The generally low standards coupled with the
total lack of any commitment to post-graduate education
is very concerning for the future.
I have offered to help develop some form of CME
but can’t even get the three or four orthopaedic
surgeons to meet.
They perceive that they are in competition and
are jealous of their income.
(Thank goodness for the NHS).
The recent Lancet Commission has some ideas and
leads as did the GSF Conference at the RCS that I hope
I was not idle whilst there.
I saw many patients and treated some.
Two patients with undisplaced tibial fractures
were initially told there were no doctors in A&E as it
was a ‘holiday’ then that they would need to find over
100,000 pesos (£1700) as a down payment for the
I put the both in POP casts with weight bearing.
The youngest aged 7 was clinically healed before
We also went on “out-reach” clinics to two remote towns.
There we saw between 40 & 90 patients a day.
The spread of diagnoses was truly incredible.
A 30 year old man who had dislocated his knee
twenty years before leaving him with an under developed
leg and a 90 fixed flexion at the knee.
We gave him a pair of crutches.
Many were easier, lots of children with cerebral
palsy needing wheelchairs.
Older patients after stokes needing physio,
walking aids or wheelchairs.
insignificant number of amputees who were waiting for
legs or who did not know how or where to get one.
The national sweepstake funds support the cost of
limbs for indigent patients.
There were many other patients some of whom can
be seen on the British Palawan Trust Facebook page.
There is still a good flow of funds from our loyal
This is supplemented by grants from other European
charities and from donations from the USA. Locally we
get an increasing amount into the donation box in the
clinic, from local donors and Philippine government
Udo Foester is coming
to the end of his time in Bahatala. He has
been an enormous inspiration to everyone and has changed
the clinic and workshop immensely. He will always
be remembered by us all and we are extremely grateful to
him, his family and AVID. we wish him good
luck in the future and hope to see him again in Palawan.
PALAWAN REPORT September 2015
It is three years since we lost Soc. The unit he
founded continues and has established itself in the
health care system in Palawan. The amount of work has
steadily increased since the opening of the new clinic
(The J A Socrates Rehabilitation Centre and Workshop)
and even more since the Ponseti club foot training
course run by Global Clubfoot Initiative.
When I was there in February 2015 another exciting
development occurred. A visiting Prosthetist (Udo),
funded by the Australian government, started a twelve
month posting. Udo arrived with his wife and three
charming children. The first job was to find them
somewhere to live and this was achieved successfully as
a friend of Cecile’s was letting her house.
Udo then had to learn what we do and what our staff
were capable of. Our house prosthetist, Romy, had
been trained some years ago and had not had any update
training. Reymon who does all the manufacturing of
equipment for the disabled had always expressed a desire
to learn how to make artificial limbs especially as he
wears one. Udo spent the next week or two getting to
know everyone and see how the whole unit worked. He
came on some visits to outlying villages so that he
could understand the practical problems of persons with
Since then Udo has trained the two men in the workshop
in more modern techniques including the introduction of
metal lower bits in place of the hand carved wooden
ones. He involved the Physiotherapists from the clinic
in assessment and rehabilitation of amputees. This may
involve us in greater cost but we get most of the
prosthetic costs from the Philippine system. I am sure
that all this retraining will give the workshop a new
spark of life.
Udo also identified the need to develop our brace and
splint making. The local surgeons prescribe braces for
many conditions and there is no facility on the island
at present. The first requirement was a special oven
for thermoplastic heating. Fortunately CBM were
visiting and had some funds for special requests and
have given us enough for the oven. We are requesting
other bits from a Korean aid agency. So we hope to
have brace making in our abilities to provide a full
service for the people of Palawan.
Meanwhile the work in the clinic keeps the two
physiotherapists and one nurse busy. Wednesdays are the
day for club feet. One of the new local Orthopaedic
Surgeons comes to the clinic to perform tenotomies for
club foot and will also see any other patients that the
staff are worried about. Since Steve Mannion taught
our staff the Ponseti technique we have become the club
foot centre for the whole province (now about 800,000
population). In addition post injury patients and
cerebral palsy as well as a few stroke patients keep the
clinic full of activity all day. Cecile arranges
with Rural Health Units to visit villages all over the
province including some of the islands in the north.
These trips enable us to check on old patients and make
arrangements for new patients to come to the clinic for
assessment, treatment or onward referral to appropriate
We are very grateful to Australian Volunteers In
Development as well as our generous regular donors for
the assistance with our work. Please contact me if you
have any questions or would like to join our mailing
list for regular news letters.
ORTHOPAEDICS IN THE HOME AND VILLAGE
Orthopaedic Manual written by Soc before he died is now
available. The book called Orthopaedics in the
Home and Village describes how those with no or minimal
training can care for people with injuries such as
fractures and dislocations. I think that
this book is essential reading for anyone working in or
visiting low or middle income countries. It
is aimed at everyone not just doctors.
asking a minimum donation of £25 to cover costs and
postage. Please contact the
Chairman (Louis Deliss) if you would like a copy.
original book, "Appropriate Orthopaedics" is also
Palawan Report 2015
I visited Palawan for three weeks in
February. This turns out to be a good time to visit
because it was “cold” by their standards which meant
temperatures at 28-30°C, although on some days it felt
somewhat more! At night it was positively chilly at
25°. It was also mostly dry as the wet season was over.
The clinic and workshop were very busy.
The accessibility of the new compound makes it much
easier for patients to attend. Their cars, tricycles
and motorcycles can get to a shallow ramp up to the
clinic. It is amazing how many people a motorcycle can
carry. They usually have mum, dad and at least one
child on each! Tricycle taxis, built for five plus the
driver often have twice that number. Only a few
patients come by car and those that do are usually quite
good at putting something in the donation box which is
Club Foot Clinic
This takes place every Wednesday and the unit is now the
official and only Ponseti treatment centre in the
province. There are between two and eight patients at
various stages of treatment. The local orthopaedic
surgeon, Dr Arnaldo Favila, attends in the afternoon to
assess for the Pirani scoring and to carry out the
Achilles tenotomies. He will also assess other
patients that the Physiotherapists bring up on the
Wednesdays, and has recently started tutorials for the
A number of patients with acute fractures still
attend. Whilst I was there I carried out a Colles
reduction and reduced and cast a child’s forearm
fracture. When I am not there the Physiotherapists
sometimes arrange an X-ray and send it to me by e-mail
for me to suggest treatment. Others are seen by Dr
Favila either in our clinic or in the hospital. There
is still the problem that some patients cannot afford
Another group of patients are those seeking
second opinion. They do this mainly because the
suggested treatment is nearly always open reduction and
internal fixation (ORIF) which they cannot or do not
want to pay for, apart from the fear of anaesthetic and
surgery. They have often seen the failure of ORIF
which has been due to poor post-operative care or due to
infection. The girls either send me the X-ray and
history or show the patient to Dr Favila.
Patients who have been treated elsewhere
come for post-injury physiotherapy and rehabilitation.
There are still far too many children born
with cerebral palsy, an indication of the poor obstetric
care. A number come to Bahatala for assessment and
physiotherapy. Many require aids such as wheelchairs
or Reymon Chairs (see spring News Letter). By making
them more mobile the life of the mothers is often
greatly improved. We also see other children with
congenital deformities or impaired mental abilities.
These have been greatly reduced and rules made about the
length of treatment. A local neurologist has helped
with this and has done some teaching sessions for our
staff. There are usually two or three such patients on
three days a week.
Nearly every week Cecile and two or three members of
staff visit another Municipality. These can be nearby
and done in a day or more distant when they stay
overnight. Dr Favila comes on many of these visits.
The visits, often called a ‘medical
mission’, are arranged with the local health care works,
usually the Medical Social Worker attached to a Rural
Health Unit. The idea is that they gather orthopaedic
patients for assessment. The success of their screening
varies so that some patients have other conditions or
long standing minor aches and pains. When I am there
this can stretch me as I need to remember basic
medicine! Some patients are given a programme of
exercises to do and others asked to attend the clinic.
Some are referred to specialists in Puerto Princesa.
Club foot patients are often picked up on these visits,
as are patients with cleft lips who are scheduled to
attend when the regular visit of the German Plastic
Surgeons takes place usually at about Easter.
We continue to be the only supplier and manufacturer of
artificial limbs, mainly legs, in the province. Romy,
our Prosthetist always has a list of patients he is
dealing with. Unfortunately many amputees are children
and they need new legs as they grow or after they break
their prosthesis playing basket-ball. Romy also helps
in the clinic by removing casts such as those used for
the club foot babies. See more below.
Reymon is equally busy making equipment for the
disabled. His speciality is his design of chairs,
wheelchairs and standing frames for CP children. He
also makes various designs of tricycles; some have foot
pedals others use hand-power depending on the individual
disabilities of the patients. Many of his
projects have been featured in the News Letters. See
Whilst I was in Palawan an Australian
volunteer arrived supported by the Australian government
(AVID). He is a Prosthetist and came with his wife and
three charming daughters. They will be in Palawan for
about a year. His remit is to asses out workshop; help
to up-date our equipment and our techniques. He has
already made good progress. He has identified an urgent
need for a specialist grinder for which we have enough
money from York Vikings Rotary and a donation by the
German Plastic Surgeons. He has also started training
Reymon to manufacture prosthetic legs and splints. He
is also training the Physiotherapists in assessing
patients for and making simple braces such as Ankle Foot
Othosess for drop foot.
This week he and Cecile have identified a young man who
might take on much of Reymon’s work. He is an amputee
we have known for some time and attends regularly for
new legs. Currently he is working in the workshop to
be assessed as to his ability and suitability. If this
is a success it will go a long way to solving the
problem of the long term successor for Romy.
The development of the ability to make braces is
important. The local doctors prescribe a lot of braces
and we will be able to make them and charge for them as
well as enhancing the treatments available to patients.
The other improvement is the increasing co-operation
with the local doctors which again will be very helpful
to the long term of Bahatala. All these advancements
make me even more optimistic for the long term.
Report of Chairman's visit in 2014
Towards the end of our financial year I paid my annual
visit to Palawan. I chose this time of year because it
is the “Dry Season” which whilst rather hot (35C “feels
like” 40+ with humidity over 85%) I like it and road
travel is possible. During the rainy season many
inches of rain can fall in a few hours.
It was wonderful to see the new clinic and workshop both
working well with many patients. Most days were spent
in the clinic either teaching or seeing patients.
Every Wednesday there were between two and eight club
feet. Some were new cases and others for re-casting,
fitting braces or just for check-up. I saw a number of
fractures. Some were “fresh” having had no treatment,
except by the Hilots (lock traditional healers) but may
have happened some days before. The delay was either
due to the distance they had travelled and some because
they did not like the suggestion of surgery with its
high costs. If the fracture was simple and minimally
displaced we put them into casts or in a few cases set
up home traction for hip fractures or femoral fractures
We went on a “Medical Mission” to the north. We took
the two Physios and Naldz Favila came with us. We saw
the usual mixture of diseases. Many were
musculoskeletal pain requiring simple physio,
reassurance and simple analgesics. Paracetamol is
easily bought over the counter although some local
doctors prescribe the more expensive NSAIDs and such as
Tramadol. Antibiotics are always recommended for all
injuries even if there is no wound. We stayed in some
resorts (hotels) with amazing views over the limestone
islands in the South China Sea. We went by “pump
boat”, wooden boats with two out-riggers and very noisy
engines, to visit the Italians on their remote island.
One of the Italian ladies was stung by a Sting Ray which
became infected, I advised that they fly home for which
they were grateful.
I also met up with friends in Puerto Princesa and we
went for dinner with the Evangalistas. Susan and
Oscar, see previous reports, are great supporters of
Bahatala and are on our Board. I am a member of the
Board representing BPT but had to stand down as Chairman
because I do not have a BIR (Inland Revenue) number.
Puerto Princesa, the capital of Palawan, has changed
over the years. There are many private cars, mainly
large 4x4s and housing estates are being built. There
is a new huge shopping mall with all the normal
international small shops in the enormous air
On the way back Cecile and I spent a day in Manila.
Manila is not a city I would recommend spending too much
time in but it does have some interesting places to
visit. We went to see the local representative of the
Cambodia Trust (now called Exceed International) to talk
about the changes in prosthetic manufacture and
materials. I was pleased to find that the methods
that Romy has used for many years does not need to be
changed in a hurry.
I came away full of confidence for the future of our
have put in some new internet links
as some were out of date. There are some links to
the Typhoon below. Jan 2014.
STOP PRESS TYPHOON NEWS
Fortunately Puerto Princesa (the capital
of Palawan) has only been hit by very heavy rain (up to one
inch per hour) but not by the severe winds. The
North of Palawan (Basuanga island and other - See
my report below) have been hit badly. It
was the Pacific coasts that suffered the most.
we expect that there will be an increase in injured
patients needing our services. They will start
arriving at our unit when the roads
are passable again.
I now have a full report from the Palawan
branch of the Red Cross. there was quite extensive
damage in the north especially on the islands.
there were about 125,000 people affected with 90% on the
islands with 98 injured and 19 dead (so far as some
still missing or in areas not yet reached.)
There were 18,000 houses damaged or destroyed.
For those asking how the typhoon affected
Palawan go to
Kat Jack has put her photos.
Chairman’s Visits 2012 and 2013
was unfortunately unable to be in Palawan for Soc’s
funeral but went a month later in October 2012. This
was a very sad time. I hope I was able to support
Cecile and the Bahatala staff a bit. It was wonderful
how many local people and ex-patients came to tell us
how they admired Soc and how they hoped his work will
The work was indeed continuing. I saw many patients
both in the clinic and in their homes. As always this
was a humbling experience. So many are truly indigent
and live a subsistence life. This means that something
like a fracture is so devastating. There are now four
young Orthopaedic Surgeons in Puerto Princesa, but they
like all doctors work privately. The patients are told
at the first consultation how much money they need to
raise in order to be treated. The amounts, from £200
to £1000 for a limb fracture, are completely out of
reach for the families of patients. Sometimes they
pawn their means of livelihood such as land or a fishing
boat to raise the money. Some can get help from the
Philippine Lottery but this can take weeks to arrange,
not much help with an acute fracture. The other
problem, that I fear is now world-wide, is that the
young Orthopaedic Surgeons seem to believe that
fractures will not heal without implants and that these
must be made of expensive titanium! I did do some
manipulations, without anaesthetic which they all
accepted, for simple fractures, and taught the
Physiotherapists how to do it. Fractures that are only
minimally displaced we put in POP casts.
I met the British ex-pat community at a
meeting with the British Vice-Consul. I was
allowed to address them and asked that they consider
raising some money. A few were very
enthusiastic but buy the end of the financial year no
funds had appeared. I will try again.
I also talked to some of the local people about raising
money. I am not too hopeful because the idea
of charity donation, apart from to their church, is not
in the culture.
Cecile and I went to visit the new Prosthetic &
Orthotic School in one of the teaching hospitals in
Manila. This is a new venture being supported by the
Cambodia Trust, which has spread their work beyond
Cambodia. The unit is run by Helen Cochrane of
Cambodia Trust and Dr Penny Bundoc a rehabilitation
physician. I hope that they will be able to help and
support us. We already arranged for Romy to go there
for some extra training. They will also help us up
date our methods to come into line with the
specifications that will be supported by local funds.
I came back however with a feeling of great optimism
for the future of Bahatala and the BPT.
I visited again at the usual time of year in March
2013. I like to go in the spring when it is the “dry”
season making travel easier. This visit was much busier
as the work at Bahatala had settled a bit.
Much of my time was spent helping Cecile oversee the
builders and make decisions about what bits to buy at
the local builders merchants. There seemed to be new
decisions every day so it was all very hectic. We
spent many hours discussing how we wanted the unit to
develop. Then we had to prepare for the Blessing by
Bishop Arigo. Bishop Arigo has always been a supporter
of and admirer of Soc and his work. It was he who gave
us the land for our Training Centre. There is a full
report of this on the web site with photographs on the
BPT Facebook page.
I saw many patients in the clinic. One memorable
one was a 14 year old girl with severe
She is wheelchair bound but was going to school.
She came because of discomfort sitting for a full day.
We came to the conclusion that the only thing we could
do is give her a new larger wheelchair. This
needed to be ordered and I hope will be with her now.
I had to see a 10 year old boy with a fresh forearm
fracture. This was minimally displaced and
so as I put on a cast I pushed it straight.
The local people all seem to tolerate this possibly
because they know that the village Hilot will cause much more pain. I did this
without any x-rays. His arm was thin enough to make
the full diagnosis clinically.
We also visited a number of patients at home. This was
mainly follow-up of elderly with proximal femoral
fractures. They had nearly all been treated on
traction at home and we were there to advise on
mobilisation. We visited the 21 year old gardener from
Bahatala. He had come off his motorcycle when racing
with friends. A cervical fracture had left him with a
fairly profound quadriplegia. He was lying in his
mother house on a bed which as usual had no mattress on
the bamboo slats. He was doubly incontinent and had a
urinary catheter. The inevitable result was a huge
sacral pressure sore. I could not give an optimistic
One patient illustrated the problems seen in Palawan.
A small boy (2 or 3) had been involved in a RTA when
riding on his father’s motorcycle. He was said to have
had a head injury but was never unconscious and a
fracture of the mid shaft of his femur. He had been
admitted to the private hospital where he had a CT head
scan and a double spica cast applied. They had been
told that they should return for a further scan and
x-ray. The parents were not keen on this as the
initial bill was £500 and they had pawned some
possessions to raise the money. In addition the girls
from Bahatala were convinced that the fracture was being
treated wrongly because Soc would have used home
traction. Whilst I agreed that traction would be
satisfactory and possibly quicker I had to
that the spica cast was an entirely acceptable way to
manage this injury. It had the side benefit that the
family could all return to Taytay, a four hour bus ride
north, rather than stay in Puerto Princesa until union
on traction. Soc had been rather naughty when he
openly criticised other surgeons for using a method he
did not like and now I have the job of showing the staff
that other methods may be acceptable and successful.
There were as always a number of club foot patients who
came for casting or re-casting. Fortunately the girls
are quite competent at this. I must arrange a Ponseti
course in Palawan when I return. (I did achieve this and
will report on it next year)
The last few days were spent in the remote north of
Palawan on an island called Cuyo. This used to house
the Philippine leper colony. We were there at the
invitation of the local Rural Health Unit workers.
They said they would get a lot of patients but only
managed about 50. They came with all sorts of
conditions. Some we could help there and others needed
to come to Puerto Princesa for full assessment and
usually provision of ADL equipment such as wheelchairs.
We took the opportunity to see the area. This was a
boat trip to some of the other islands. One had a
number of fresh water lakes. These have cold clear
water with unique fish in them. We stopped at a
Marine Park, an area of sea where fishing is banned.
The reefs had corals somewhat different to those near
the mainland and many types and colours of fish.
The visit showed clearly that we need to develop access
to the surgeons working privately in Palawan. This
will be hard work for many reasons. I did get to meet
a General Surgeon who agreed to help with
amputations. I also met the newest Orthopaedic
Surgeon who trained in Manila. I hope we can develop a
working relationship with him.
I came away still optimistic but realised that there is
much to do to settle the unit into its new roles.
Dr Jose A Socrates
1948 - 2012
Jose Antonio Socrates (Doc Soc) was born in 1948 in Ubay,
Bohol and grew up in the University of the Philippines
campus in Diliman where his parents were Faculty
members. He and his eight siblings spent their
happy childhood years inside the prestigious UP campus
in a humble, Spartan home made of “sawali” (woven split
bamboo.) Despite their poor and simple life, their
hardworking parents instilled in them the value of sound
work ethic and the importance of diligence and
discipline in their studies. All nine children
successfully completed their college education with
careers ranging from education to medical and
originally graduated from the University of the
Philippines as a Geologist. It was in the field as a
geologist when he met an impoverished and ailing old man
from a local village tribe in Isabela (province in
northern Luzon) who had insisted he was a doctor because
he wore spectacles, that he started to wonder if he too
(for his brother was already on the way to becoming one)
could be a doctor. He returned to Manila and graduated
from the U.P. College of Medicine in 1974. Whilst at
Medical School he met and married Cecile who was
studying psychology. An early post was as Prison
Medical Officer in Iwahig the huge open prison in
Palawan. Then he left the country to join the United
Nations as a UN Volunteer in 1977 and was posted in
did not return to the Philippines until 15 years later,
during which time he had acquired a medical license and
trained in the United States. Then he explored what the
United Kingdom's health service had to offer working in
Bangor, Cambridge and lastly Ipswich. He ended up
specialising in Orthopaedics and earning his Fellowship
of the Royal College of Surgeons of Edinburgh. It was
in Ipswich that he was shown the non-operative methods
of fracture care that he put into practice later. His
hospital consultants in Ipswich were so impressed with
his work ethic, dedication and resolve to return to his
country that they all decided to help him. They formed
the British Palawan Trust (a charity registered in the
UK) in 1990 whose main objective was to provide health
services for the people of Palawan, in particular
orthopaedics and rehabilitation, and especially to those
who could not otherwise afford them. Soc worked
tirelessly writing appeal letters to doctors in the UK
raising sufficient funds to set up his unit.
arrived in Puerto Princesa in Palawan (the third largest
island of the Philippines) in 1992. He rapidly became
known to the people of Palawan especially the poor. He
never charged at all for his services and all expenses
were met by the British Palawan Trust. Within a short
time he became the Provincial Heath Officer and was head
of the Public Health department and medical
superintendant of the Provincial Hospital. He changed
many practices in the hospital and built an Orthopaedic
ward extension, again funded by the British Palawan
Trust. He made himself available for patients every
day and all day. For many years he was the only doctor
with orthopaedic training on the island so was
incredibly busy. He treated thousands of patients who
would otherwise have no treatment because it was not
available or they could not afford it.
found that the equipment and facilities were very
limited so he developed his method of fracture
management without surgery which he called Appropriate
Orthopaedics that is outlined in his book of the same
name. This is still available from the British Palawan
non-operative methods and giving his services for free
did antagonise some other doctors especially those who
came with a special interest in orthopaedics. Soc
never let this worry him and in fact he rather relished
being different but it was often a worry for those
acquired the use of an old building in the hospital
grounds that was originally the house for the Medical
Superintendant but was not being used. This became
Bahatala from Bahay Hawak Tayo Lakad which is
Tagalog for "house to hold, to stand, to walk”. This
remains the headquarters of all the work supported by
the British Palawan Trust. In the last year of his
life he was working hard to develop a new building on
Abanico Road that the whole unit could move to. Soc
never saw it completed but it will open in 2013. He
obtained funds with the help of Handicap International
(a French charity) and Tahanang Walang Hagdanan (The
House without Stairs) in Metro Manila, to train
technicians and build a workshop which is the only
supplier of artificial limbs and braces in the
province. A second technician was trained to repair
and modify wheelchairs and manufacture aids for the
Throughout his work he was very ably helped by his
wife, Cecile. She gained a degree in Community Based
Rehabilitation in Developing Countries from London
University. This led to the full development of the
rehabilitation services both in Bahatala and in the
community. They made a wonderful team despite their
occasional differences, as Soc was not always the
easiest person to work with.
has gained many honours. In 1999 the UP College of
Medicine awarded him an Outstanding Alumnus Award and
recognized the fact that he was a "brain gain" in the
face of the exodus of health professionals from the
country. In 2005 the International Committee of
World Orthopaedic Concern gave him the Arthur Eyre-Brook
Medal. In 2007, in
recognition of his work in orthopaedics for the
community, the World Health Organisation awarded him the
prestigious Sasakawa Health Prize. In 2008 the
University Of The Philippines ' Centennial Celebrations
awarded him an Outstanding Alumnus Award for his work,
in particular for services to those who can least afford
never forgot that he was a geologist and called himself
a DOG, being a doctor of orthopaedics and geology. It
was always a pleasure to go for a walk with him because
he could give full details of the geology of the area
and of every stone he picked up. His hobby was
collecting stones with which he built rock gardens
wherever he was at the time. He became geological
advisor to the Provincial Government and became very
involved in the Philippine claim to the mineral wealth
around the Spratly Islands on the Palawan Shelf. He
helped to set up the St Paul National Park which has
recently become one of the New Seven Wonders of the
was a humble man with very simple needs, a wonderful
companion in all his activities. I was very
privileged to know him. We will all miss Soc and will
remember his enthusiasm, energy and inspiring
leadership. The people of Palawan will always be very
grateful for what he achieved. We must continue his
Soc is survived by his
wife, Cecile, his daughter, April and his Grandson,
Ethan. We extend our sincere condolences to them and
all his siblings.
There will be changes but we owe it to
his memory to continue his work.
On a personal basis I am very grateful
that he opened my eyes to the needs of the people of
Palawan. I and his family will miss him
Chairman of the British
Blessing by Bishop Arigo of the building,
the staff and the patients.
The First Phase of Opening the New Clinic
I was privileged to be on Puerto Princesa for the first
phase of the move to the new Bahatala clinic. On 13th
April the Bishop of Palawan, Bishop Arigo, led a simple
service to bless the buildings and those who will be
treated there as well as those who work in the unit.
Following the Blessing there were a few speeches by
Cecile Socrates, myself, Angela Loonen (a Canadian
visiting physiotherapist) and Soc’s sister (Luchie)
before the traditional merienda food. We were
serenaded by Dempto Anda on the guitar. Many people
were present including the Board of Bahatala, local
doctors, staff and helpers, patients who had been helped
and a large group of supporters including some from
The building is beautiful thanks to the work of Mr
Quipquip (the architect) and supervision by Mrs
Socrates. It has high ceilings and is basically open
plan. This makes it remarkably cool helped by the
ceiling fans. The workshop where artificial limbs and
aids for the disabled will be made and wheelchairs
repaired and modified is a separate building.
The new unit is to be called Bahatala at the Dr J A
Socrates Rehabilitation Clinic and Workshop. Soc was
the inspiration and driving force and it is fitting that
we remember him this way.
There are a few finishing touches before the unit moves
all its work there. We hope that the final move will
be completed before June. Then I anticipate a
significant increase in the number of patients because
of the improved access and the publicity.
We will put more details in the next News Letter.
Meanwhile please continue your support as there are very
many people here needing help.
See gallery and the BPT
Facebook page for photos
Report from Palawan October 2013
I have just returned from visiting
Palawan. I return in an optimistic mood. Mrs
Socrates (Cecile), the staff of Bahatala and the Board
of Directors of Bahatala Inc are all very keen that the
work started by Soc should continue. The patients too
hope that we will still provide free services for the
The old clinic, Bahatala, in the
Provincial Hospital compound is still open to patients.
The Physiotherapists continue to provide rehabilitation
and therapy for post injury patients, stroke patients
and cerebral palsy children. In addition they have
learned how to apply serial casts to club feet. The
Orthotist is very busy and has a waiting list for new
artificial limbs and many people come for repairs. The
technician is carrying on his work repairing and
modifying wheelchairs and making equipment for the
disabled. He has many cerebral palsy children needing
his “Reymon Chair” (see last News Letter).
Cecile as well as managing the
whole enterprise is very busy arranging patients for the
Cleft Mission. This is a group of German surgeons who
come every year to treat the patients with cleft palates
and hare lips as well as others needing plastic surgical
expertise. Patients with ophthalmic problems come to
the clinic and we are very lucky to work with an
excellent local eye surgeon.
Whilst in Palawan we went on an
outreach clinic visit to Brookes Point, named after a
British naval captain who established a base here. We
saw over 50 patients over two days. They came with
many complaints some of which required explanation and
to be given exercises by the physiotherapists. Some
needed more and we arranged for these to attend Bahatala
the next week. We reimburse their fares and any other
expenses. There was a boy with a dysplastic hip for
whom the local facilities could really do nothing as
embarking on pelvic and upper femoral osteotomy would be
unwise. Another needs to be referred to the Orthopaedic
Hospital in Manila after his tibial fracture had been
treated in a cast for one week three months earlier,
which was of course unsuccessful.
I also saw patients in Bahatala
every day. Many were old patients who were attending
for Physiotherapy. There were a couple of fresh
fractures with minimal displacement that I could
cast. One boy came with an external fixator on his
tibia that had been there since January. Some healing
had started so it was easy to remove the fixators and
apply a cast which saved him the £900 that the surgeon
requested. There were many other memorable patients
making my visit both enjoyable and productive.
Cecile and I spent two days in
Manila. We visited the Vice-principal of the Philippine
Orthopaedic Centre who was a most enthusiastic
Anglophile having trained at Stanmore. I am very
hopeful that he can arrange for a senior orthopaedic
trainee to visit Bahatala on a regular basis. This
would give a reference point for any difficult problem
patients and also give training to the Bahatala staff.
I also think it would be good experience for the
residents (registrars). We also had a meeting with
the Under-Secretary for Health who is very enthusiastic
about Bahatala and wants to reproduce the unit in other
provinces of the Philippines.
The conclusion is that we will
continue the work started by Soc providing you continue
the donations that have sustained us for so long.
Please help and tell your friends and colleagues about
Louis Deliss, Chairman.