Monday, October 31, 2011

Donuts for the Dead?

At first glance, the deja vu was incredible. Big grassy knolls, portable shade tents, picnic foods, guys playing frisbee, and even the hotdog vendors brought all those Memorial Day weekend memories rushing back. But wait, something about this scene was different. It was at a cemetery!


All Hallows Eve (Halloween) and All Saints Day are a big deal in the Philippines, not for cute little fairies, batmen, and witches tromping to your doorstep singing out "Trick or Treat!," but because it is a day that people make an annual pilgrimage to the cemetery to pay "respects" to their dead ancestors. Anything from candlelight vigils to full on barbeques take place. People leave flowers, Krispy Kreme donuts, KFC, and even beer cans for the ancestors to enjoy. It is such a big deal here that both days are non-working holidays. And any experienced foreigner has learned to steer clear of all cemeteries to avoid major traffic jams.

In a way it's humorous to think that people believe this helps their ancestors (I mean, a donut? Really?), but at the same time it's sad. As a Filipino said, we should be giving them the flowers while they're alive. Yes, it's cultural more than religious, but it's also a good indicator of the amount of fear some people live in. To constantly live with the fear hanging over one's head that an action might anger a dead ancestor can be absolutely debilitating, and it is for many of the folks we work with. Many old practices (what we call "old wives' tales) are continued for fear of upsetting a spirit and causing harm to the family, often at the cost of the health and development of a newborn baby, something I see all the time.

So please pray for us as we try to bring them the love of Christ that casts out all fear. It's a delicate balance to bring it in a culturally sensitive way.

Friday, October 14, 2011

Raising the Uterus

I'm going to go out of sequence with my Palawan story-telling to post something that happened yesterday...

I've recently started doing ultrasounds for patients on my own, after being trained by a wonderful Swiss doctor. I just do the very basics: check for all major body parts, take measurements to get approximate gestational age, determine placenta placement, how the baby is lying, how many babies are inside, etc... I don't check for organ defects or other tricky issues. I normally scan 4-5 women in the afternoons following a prenatal morning.

Mavis approached me yesterday morning while I was checking hemoglobin levels, if I thought I should scan young Jolly who had been to a hilot with inappropriate size for dates.

A hilot is your run-of-the-mill village healer. This can be a witch doctor, a traditional birth attendant, the wise lady, abortion inducer, etc... They often do more harm than good and this appeared to be the case with Jolly.

That afternoon I sat down with Jolly and her boyfriend to get the story. It turns out she is only 19, but miscarried in February at 3 months. When she got pregnant again, she was pressured by her family to go to the hilot to "raise her uterus." Huh? I asked her how she went about doing this and apparently the hilot uses deep pelvic pressure to "massage" the uterus up, basically jabbing her hands into the lower belly while applying upward pressure. Supposedly this painful process helps prevent a miscarriage.

This prompted a quick anatomy and physiology lesson to explain how things work down there, and the danger of deep manipulative pressure during pregnancy. I also explained that miscarriages at three months are common if there are major defects or problems with the developing fetus. Jolly was very receptive and eager to do whatever was best for her baby.

Then we got on with the ultrasound. Her baby was extremely active and sucking it's thumb. I have so much fun pointing out basic anatomical features of the baby and the wonder in the mama's eyes never gets old. Her little one looked healthy, but a bit big for her dates. My guess is that she got pregnant a month before she thought. This happens quite a bit as women mistake their last period for implantation bleeding which happens at about 4 weeks. (PS - this picture is from the web, but you get an idea of what it looks like...)

I'm going to scan Jolly again in 4 weeks to make sure her little one is growing appropriately and confirm her due date. Please pray for Jolly, her boyfriend, and this new little one growing in her tummy.

Wednesday, October 5, 2011

Compassion International

Today was probably the most exhausting day of the trip (I'm writing this a week after the actual day). We were supposed to see 1500 Compassion International kids for their annual medical check-up. We arrived at the center where the kids meet every Saturday for kids' club to a full yard of kids waiting. What cute kids!

On first glance, these kids were day and night from the kiddos we'd seen over the past two days. Unlike the others, the Compassion sponsored kids were nourished, looked healthy, and had radiant smiles on their faces. Talking with them later, they could carry on a good conversation with me, look me in the eyes, and just had such a sense of inner joy. I was amazed at the difference. If I had ever doubted the effectiveness of child sponsor programs, all doubts stopped today. I am a firm believer now!

We were told there weren't going to be many prenatals as we were focusing more on the kids today. So I prepared to sit next to an MD and jump in. However, it soon became clear that perhaps someone could specialize in talking to the girls with "girly issues," and since it's such a sensitive topic, especially at that age, as a Tagalog speaker I fell into the role. I loved being able to dig deep into some of their fears in their own language. But no matter the language, teenage girls are teenage matter the country or culture. It is always neat to empower these girls about their own bodies and the unique needs and strength that women have.

I also helped a couple of the surgeons translate for their patients, such as the all important, "holler if it hurts!" after the lidocaine has been given time to work.

I haven't really mentioned my best coworker of the week. Jenni is a clinical nurse specialist (CNS) in education and used to work at the labor and delivery unit manager for a time. She brought a wealth of information and it was fun to learn from each other as the week went by. One of my favorite times was watching Jenni bring in whole families and talk with everyone about a specific person...such as the need to eat the right food, or practice good dental hygiene, or getting enough sleep. I've read about the family approach in textbooks, but hadn't really seen it in practice. Way to go, Jenni! (And a big thanks for the NRP and Fetal Monitoring textbooks!)

We worked until early evening, pulling out the emergency lights to help the doctors sitting at tables outside. We worked for about 30 minutes this way before the organizers realized that it was a lost cause. It was hard to turn kids who had waited a few hours to see us, but we couldn't keep going on empty.

Later over a light dinner, people started to spontaneously debrief and it became obvious we were worn down and at the third day hump. Were we doing any good? Was seeing 1500 kids in one day even possible? At what point were we perhaps compromising our medical judgment just to get through the day and as many kids as possible? Having been on the mission field for over half my life, I like to think I've gained a bit of perspective. It's not about diagnosing a hidden disease...after all, it's not until symptoms appear that diseases get diagnosed even in near perfect medical offices. Today was about seeing kids. Smiling. Touching. Encouraging. and sharing joy. A stethoscope placed on the chest wasn't just about listening for an irregular heartbeat, it was about showing that kid that they matter and have incredible value. I spoke up and shared this with the group... Most of those kids will never meet their sponsors who send in $30 a them, we were the faces of their sponsors. And that matters deeply.

We then started praying and encouraging one another. The night ended on a positive note as we fell into our beds before our last day of medical outreach.

Tuesday, October 4, 2011


The road today started out the same, but then we made a right turn onto a very bumpy dirt road for an hour and a half. If I'd had a jar of whole cream, it would have been butter by the time we arrived! We stopped several times for a potty-in-the-bushes break, a nausea break, a clear-the-giant-rocks-from-the-road break, a climb-out-of-the-van-so-it-can-make-it-over-the-muddy-hill break, and a crossing-through-the-river break before we finally arrived at the local community center. (pic of our military escort jeep bringing up the rear of our convoy. We road in the vans again, not these jeeps, FYI)

The dental and dermatology teams were set up in the existing midwifery rooms, while the medical team was set-up in little huts outside. In addition to medical/dental, there was counseling and hair-cutting provided by Life Church. I loved the open air feel of it all.

The highlight of my day was meeting a local young midwife towards the end. I commented on how amazed I was at the patient from yesterday who knew to take her iron with vitamin C. She got this big grin on her face and said, "that's my region and I'm the one who teaches them that! I learned it from a missionary birthing center in Davao." Stunned, I asked her for the name, and it turns out it's Mercy Maternity, the same center I visited in May. Not only did she spend time at Mercy, but she is the daughter of a helper (aka housekeeper) of legendary missionaries, Steve & Dottie St Clair...good friends of mine. It just warmed my heart so much that the work we do as missionaries MATTERS! This was the long term effects...the stuff that we normally never hear about and just have to trust God that He is continuing.

Another sweet time was after the clinic was over. We were all exhausted. It had rained during the middle of the day, which made things muddy and miserable for a time. The team members had worked tirelessly completely out of their comfort zone. As we were wrapping up, I noticed some of the kids playing a team building game in which they all put their left foot on one plank and their right on another. Ropes are attached that are used to lift the planks and you all have to step together, as in "1-2-3-LEFT! 1-2-3-RIGHT!" Some of the docs and nurses decided to race a group of the kids. What a sight! A group of Americans and Filipinos, laughing, falling, and speaking the same language of FUN. (picture "stolen" from Life Church)

The day ended on a sweet note as I ate dinner with long time friends, Bill & Donna Davis. My folks and the Davises both arrived in the Philippines in 1981 and went through language school together. They have both just celebrated 30 years here.

Tomorrow we start out medical outreaches with Compassion International. 1500 kids in one day. Yikes!

Monday, October 3, 2011


One thing I will never understand is people who willingly wake up before the sun. My body just is not wired that way... *sigh*, but when the alarm went off at 4:45am, I dragged my body from the sheets and blindly dressed and painted on a face. (Isn't it amazing how sluggish one can be in the early morning? I wonder if any adult has fallen back asleep brushing their teeth? Anyone?)

After a quick breakfast of rice, beef strips, and copious amounts of decent coffee, we piled into the same 15 passenger vans. (Note, these are typical US sized vans but with extra seats jammed in.) After an hour and a half of driving through stunning countryside, we pulled up to a village school in Inagawan, a Geographically Isolated and Depressed Area (GIDA). Our medical clinics were to be the kick-off for a huge environmental, sustainable agriculture, medical, and outreach project of our partner church, Life Church. I loved this part of the week, we weren't just dropping a Gospel bomb, there was going to be critical follow up!

The school was set up nicely for a medical outreach with the triaging in one of two courtyards and a waiting area with live entertainment set up in the other. The various classrooms were occupied by the docs, dermatology/minor surgeries, dentists, etc... They weren't expecting to have some nurses qualified to do basic prenatal exams, so we got placed with the minor surgeries for privacy. I actually didn't mind because it was more quiet, a bit off the beaten path, and I loved keeping tabs on what kind of surgery was happening across the room.

I was SO impressed by the ladies I saw. We had copious amounts of prenatal vitamins to pass out, so before I handed a pack to one preggo, I asked if she was already taking something. Iron with Folic. Great! (The Philippine Gov't has really gotten the ball rolling for handing out free iron and folic to all pregnant women through their community health centers) As I gave her the vitamins, I instructed her to take it with her biggest meal to avoid stomach upset. She then said, "But I take my iron at dinner time with a big glass of calamansi (lemon) juice, should I take it at the same time?"

WHAT?!?! What women knows and volunteers the info to take iron with vitamin C, especially in a small, rural village like this? Absolutely unheard of. I really encouraged her to keep taking the iron and C at night, but take the prenatal vitamin with breakfast. Later I snapped a picture with her, her cute-as-a-bug's-ear daughter, and the other nurse, Jenni.

My favorite surgery was on a middle-aged man who had a grapefruit sized sebaceous cyst removed from his right buttocks. How in the world did this man sit with that thing? I cannot imagine living with that thing for years as he did.

While we were treating the sick, another team was doing community service, painting a little native hut to be used as a classroom for the high school students. They were supposed to be building high class playgrounds they had shipped from Hawaii, but the mafia run ports kept slapping them with all sorts of "fees," even though they had all the correct documents. Now we're praying it gets released in time for the follow-up trip next year! :) Here's a picture taken by one of the team members.

After we finished seeing over 1000 people, we got back to our hotel and showered and got all dressed up for a fancy-shmancy dinner with the mayor of Puerto Princessa. It was a delightful dinner that he couldn't attend due to other obligations, but after sitting through 30 minutes of a powerpoint presentation regaling all the good he had done for the city (do I sound ungrateful? sorry), we got to see a wonderful cultural show put on by an award winning group.

Again, LOUD or LOUDER. I wanted so badly to turn the speakers directly at the sound men and give them a sampling of the pain they were inflicting.

Tomorrow is a 5:30am departure time... (thus the reason I am writing all these posts a week later and adjusting the post date...haha!)

Sunday, October 2, 2011

Palawan Trip Day One

I got an email the day before my flight that due to a Philippine Airlines strike, our flight had been bumped up from 8am (nice) to 6am (horrid). This meant that I had to wake up 3:15am to get to the airport on time. BUT, I was so excited to go to Palawan (an island in the Philippines, NOT Hawaii!), that I didn't care...well, maybe not too much!

But let me back up a bit. Last June, I shared in my church about the building project at Shalom (blog here). A week later, an American approached me who had newly arrived in the PI and was looking for opportunities to get involved in local missions. He was excited that I could speak the language because his church back home in Hawaii, First Presbyterian of Honolulu, was sending a huge medical and pastoral team out in October and could he pay my way for me to join them. He thought that only good could come out of having an American nurse who could speak Tagalog on the team. I got the appropriate approval from my agency and purchased tickets.

When I arrived at the airport, I was surprised at the size of the group - TWO tour buses full of mostly haoles. It turns out there were folks from First Pres, Aloha Medical Mission (non-faith based), an Arizona dental office crew, and a few odd balls who heard of the trip and me. I sat by a dermatologist and nurse on the plane and just got so excited about their stories. The nurse was an 80+y/o retired nursing instructor! Talk about gumption and guts!

When we arrived in Puerto Princessa, the capital of the island, we were greeted by a tiny airport with one baggage claim thingy, a shell necklace, and the beautiful smiles of our "buddies," selected youth from the partner church who would act as our tour guides, liaisons, and friends for our week. We were piled into 15 passenger vans (think NO leg room!!!) and brought to our beautiful hotel for a buffet breakfast and orientation. After, we were given the option of attending church or resting. Let me tell you, after the 3:15am wake-up call and knowing the grueling week before us, the message on "dreams and visions" at Bedside Baptist was amazing! ;)

The afternoon consisted of unpacking and sorting meds, a mandatory souvenir trip, followed by a major outreach event that evening. As much as I love Filipinos, I have never understood their need to rupture ear drums at big events. Being the honored guests, we were of course placed right up front and center, just by the speakers. I'm not sure how well our hands over our ears were received, but we DID have to listen through stethoscopes the following day!

We all fell into bed that night, warned of our 6am call-time for our first day of medical clinics. Sweet dreams!