Cascading waterfalls of American volunteers’ depths of humanity: Dr. Peter Bretan’s surgeries into long-term mentoring experiences of medical professionals and students

Part II of II Series

“Betterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two. It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.”  - Atul Gawande, “Better: A Surgeon’s Notes on Performance”

Have you seen the 129-foot tall, fern-draped cascading waterfalls of McArthur-Burney Falls 60 miles northeast of Redding, California?

These waterfalls may not be the largest nor the highest in the world, but to me, the most beautiful that I have seen, as it drapes the granite with a continuous stream of waterfalls, being fed from the river.  It reminded me of being enveloped with great feelings of awe, from selfless volunteers, embodied by Dr. Peter Bretan, Dr. Alice Crane, Nurse Marisal Ante, Dr. Marlene Cordero, and the hundreds of medical, dental, ophthalmological professionals, psychiatrists, educators and students who joined this 2018 medical mission.

Bretan, a urologist and a kidney transplant specialist in Northern California, gave his consent to shadow him on January 23, 2018, while he performed two surgeries (on a hernia and undescended testicles) as part of the Philippine Medical Society Northern California (PMSNC)’s medical mission at the Western Visayas Sanitarium Hospital in Santa Barbara, Iloilo, Philippines.

In my last week’s column, Feb. 10, 2018, I wrote extensively about Bretan’s transcendent desire to save lives and help others reach their potentials.

He scrubbed and donned the sterile gowns. He took off from his private practice to give pro bono surgical services: “This is my marathon. This is my boot camp. This is my reality check. It is when you leave your comfort zone that you learn much more effectively– once you see this, you snag students to volunteer when they are young as the effect becomes lifelong for them. Be the highest potential you can be an d then be a volunteer, and be the best you can be!” He emphasized with conviction — much like the river that feeds to become the spectacular cascading Burney waterfalls.

I wondered what it would be like in a third-world setting of cramped rooms (where one equipment was removed while with snaking cords and with precise synchrony, another equipment is disconnected for another operating room’s use), limited access to surgical tools, scrubbing to the utmost, and gowning with best practices, to minimize bacterial contamination, yet with doors that swing open to a common hallway and with no negative air pressure? It made me recall a television show, “M.A.S.H.” where doctors set up ambulatory tents to operate on the wounded soldiers in Vietnam.

This was not quite the war zone, but you implore the Almighty, say your prayers and miraculously, the antibiotic-resistant organisms do not find this environment hospitable enough to thrive and give the collective feeling of “Relief!!” when the surgeries are done.

On Monday, January 22, 2018, it was 8:30 a.m., when we got to the gymnasium. It was humid and hot. Around 4,495 needy folks were triaged for five days for all kinds of symptoms, including dental cavities.

The medical mission was coordinated by Dr. Marlene Cordero of Atascadero, CA with Dr. Dennis Superficial, a surgeon, who is also the current three-term mayor of Sta. Barbara, Iloilo. He welcomed the mission volunteers on their first night in Iloilo and the first batch of five surgical patients into the West Visayas Sanitarium Hospital.

Marisal Ante, a nurse, described it as: “There’s a common goal and understanding when you do medical missions. You want to treat as many patients as you can in the most efficient and safe way possible. It’s understood that we may or may not have everything that we would normally have in order to complete our tasks. Our team did a great job with utilizing what we had in order to get our jobs done. When we didn’t have something, we worked together to find alternative solutions. Everyone’s creativity and resourcefulness really helped.”

Two-hundred eighteen folks got major, minor and surgeries to correct cataracts.

I witnessed two surgeries removing goiters, one of which was as big as a grapefruit. I wondered how goiter can persist in a nation with 7,107 islands surrounded by oceans, replete with oysters that are rich in iodine? What food do the Visayan folks prefer over the catch of the seas? Might that be why Japanese fishermen helped by showing fishermen how to organize oyster farming in the Visayas after Typhoon Haiyan?

Meanwhile, how do you manage to schedule hundreds of surgeries with the highest level of care, efficiency and safety, in a span of five days?

With skilled volunteer nurses, anesthesiologists and two biomedical engineers doing their part in devising medical equipment — for example, combining a CO2 tank, nuts and bolts to facilitate a laparoscopic surgery — and you simply are in awe of the collective sacrifices these medical professionals are doing, along with 150+ volunteers.

Equally, one wonders how thousands of patients had tolerated their pain, over a long period of time, until this medical mission? Or is the need just so great that it overwhelms the entire delivery system of medical care? The local counterparts were scrambling to help in any way they can. Transport vehicles, one slated for an emergency, had springs coming out of its broken-down front passenger seat.

Why do these medical professionals travel out of their comfort zones, more than 10,000 miles, to help others?

Bretan calmly introduced the UC Berkeley’s team of students to the volunteer nurses and to Dr. Alice Crane, a urology resident on her 4th out of 6th years of medical residency, at the Cleveland Clinic in Ohio. He calmly set the tone that we are all a team here.

Crane is a young Caucasian female, with her Ph.D. and an M.D. from Buffalo, New York and on her 4th out of 6th-year residency in Cleveland, Ohio. She joined the 150+ volunteers from different parts of the U.S.: Chicago, Los Angeles, San Francisco, Atascadero, who all paid their own way to be part of the 2018’s Philippine Medical Society Northern California’s Medical Mission (PMSNC).

Expecting to do a kidney transplant in Iloilo, Crane said: “I was disappointed to not see what I had come to see and for the recipients expecting the kidneys. I was also nervous that I would not find a way to contribute and be useful to the mission and did not know what to expect.”

But, the medical mission offered a new dimension: “I believe that I got to have an altogether different experience and be more a part of the overall mission by not being at separate hospitals doing separate surgeries (ie the kidney transplants). I had the opportunity to see and learn from those in the outpatient setting as well as Dr. Bretan and the general surgeons. I felt satisfied with what I had to contribute both in assisting Dr.Bretan with urologic surgeries and independently in minor surgery. I had more interaction with my fellow volunteers than I would have otherwise which made me feel more a part of the team. I would not have traded this experience.”

Equally adept is Ante, a young petite Filipina clinical nurse who came from the Alameda Health Systems, in California. She is now on her second medical mission (first was in Nuevo Progreso, Guatemala). She recalls her patients travelling, hours long and who referred to them as “their angels from the north.”

She is quick on her feet, and fluidly moved from station to station to fill in the gaps to assist. She is alert in getting the surgical tools, handing them to the surgical nurse, as needed. She generously explained what was going on, as surgeons kept their focus on the surgeries.

“I helped with the tonsillectomies, hernia repairs, and hemorrhoidectomies. These are surgeries that I normally see at home [California], however, the biggest difference is the severity in the patients from Iloilo. Due to the fact that they don’t have regular access to medical care, their conditions had progressed further than a patient I would see at home. It amazes me that they were able to live with their conditions as long as they had,” she said.

The first surgery I witnessed

Have you been in a room with a colicky baby who is unconsolable? It was the same crying we heard from a 1-year-old infant with a hernia (a protruded body part that is not properly placed). It persisted for some time, until the anesthesiologist got the baby sedated. Imagine this baby without milk since 4 a.m., since the operation requires an empty stomach? Yet, the nurturing mother only had smiles for us. And the doctors were just calm, with serenity and focus.

Bretan smoothly demarcates where to cut the skin, and feels the swollen groin of the infant. He adeptly makes the incision. It made for a calm scenario, with all eyes on the infant and the monitoring screen displaying the vitals.

As Bretan locates the loose body part, he gently lays out the organ, and Crane cauterizes to ensure no further bleeding. Bretan adeptly puts the organ back in place. He then calmly motions with his hands what Crane needs to do. She gets ready for the sutures, calling out for what she needed, and then, with the needle, threads underneath the skin and across to the open section.

At this particular moment, Bretan makes way for the students to watch the suturing process. Crane explains that the needle must go underneath the skin and proceeds to suture. When she finishes the suturing, she asked for the dermabond and applies it to the newly sutured incision. This new technique allows the sutures to simply disintegrate and the skin heals.

After the wound is completely sutured, Bretan examines the work and I witnessed their collective sighs of relief – all smiles now. The work of recovery is now taken over by post-surgical nurses who monitor the vitals every 15 minutes until the anesthesia wears off and the baby wakes up.

The cry of the infant is now music to the ears of the mother but also for the surgical staff. Even the students collectively felt relief, as this writer.  We now could relax, until the next surgery.

The mentees and observers experience life-changing moments

“This wasn’t my first time doing multiple surgeries in one operating room and it wasn’t that surprising. When you participate in medical missions there are always surprises along the way and instead of dwelling on them or complaining about them you find ways to make them work. Being fluid and flexible is key! Every time I volunteer it reminds me that there’s so much more I should be doing. I live such a privileged life and have had so many opportunities that most people haven’t had, and that inspires me to give back whenever I can. It’s an important reminder to focus on the blessings you have, and not on what you don’t have,” Ante shared.

Crane felt very gratified and said, “we were able to help children with limited access to care. It was a truly eye-opening experience to perform operations that we take for granted and do routinely in the US. I also was surprised at how smoothly everything went, given the wildly different resources of the hospital than what I am used to and working with anesthesia, nursing and surgical teams that do not normally work together. I thought it would take some time to get used to each other and work as a team but since we were all devoted to the same goal and focused on the patient, that was not the case.”

What does it feel like when mentored by Bretan, I asked her?

She replied, “As alluded to above, there is always some trepidation stepping into an OR with an unfamiliar lead surgeon in terms of their expectations of the trainee (myself) and possible different surgical approaches. However, Dr. Bretan made everything go very smoothly and I thought we worked well together. I had not met him in person before the mission and had known of him through alumni connections. It was a pleasure to be able to assist Dr. Bretan and learn from him.

“I rarely have the opportunity to work with college-aged students and it was my pleasure to teach them some basic surgical skills. Being able to interact with those new to surgery and see their energy and interest allows me to remember just what a privilege it is to operate and prevents me from forgetting that even routine surgeries are not routine. I hope that they took away [with] an enthusiasm for patient care.”

I asked her if she was changed by this medical mission? What will you bring back to the U.S., in terms of lessons learned and intangibles as a human being?  Overall, what is your assessment of this Iloilo medical mission —  what went right for you?

“I believe that I was changed by the mission. I rarely have a week packed full of so many ‘firsts’ — The first travel to Asia, my first interaction with Filipino culture, my first medical mission, my first time joining a group of people I had never before met in a foreign country…and of course, my first time at Dinagyang! I am an introvert by nature and was essentially a stranger with only second-hand connections to PMSNC… I was warmed and surprised by how welcoming everyone was and very touched by everyone’s compassion. I hope to bring back some of that compassion towards well-intentioned strangers in my own life. I also plan to encourage my colleagues to step outside of their comfort zones and participate in a medical mission. That the only connection needed is a desire to help others.

“The most important thing that went right was the warmth and hospitality of both PMSNC and the local Filipinos as well as the support and mentorship of Dr. Bretan as well as all of the general surgery team – particularly Dr. Cordero. Everyone had a quiet implicit confidence in their colleagues which I found inspiring. I think the mission helped many thousands of patients and I am grateful that I was able to help some of the surgical patients. I also appreciated the confidence the patients had in our care and I just hope to take back to the US that positive attitude and assuming the best of one another.”

Dr. Atul Gawande is so right, that surgeons make the world a much better place by their superior performance, but to me, they also light up the different parts of the world with their humility and depths of caring for others.

I am bathed in this wonderful cascading waterfalls of humanity and I am forever changed by this 2018 medical mission, my very first! I am still crying recalling all these experiences.

Thank you, Dr. Peter Bretan for your implicit trust and Dr. Marlene Cordero for accepting me as a journalist volunteer, to Enrique Delacruz (my husband) who encouraged and supported me in this trip, and to Cora Oriel for her trust to do this, on behalf of the Asian Journal.

Happy Hearts Day to all!

* * *

Prosy Abarquez-Delacruz, J.D. writes a weekly column for Asian Journal, called “Rhizomes.” She has been writing for AJ Press for 10 years. She also contributes to Balikbayan Magazine. Her training and experiences are in science, food technology, law and community volunteerism for 4 decades. She holds a B.S. degree from the University of the Philippines, a law degree from Whittier College School of Law in California and a certificate on 21st Century Leadership from Harvard’s Kennedy School of Government. She has been a participant in NVM Writing Workshops taught by Prof. Peter Bacho for 4 years and Prof. Russell Leong. She has travelled to France, Holland, Belgium, Japan, Costa Rica, Mexico and over 22 national parks in the US, in her pursuit of love for nature and the arts.

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