Getting to bed well after 2am after shouting out our love for America and expressing our patriotism made for another tough morning. Dr. Schuster had to knock on our door to wake us up. Brigitte and I had to get up a little earlier because we would be spending the morning at the private hospital in Sorsogon at their DOT TB clinic collecting data for our research. DOT stands for directly observed treatment and its an initiative in the Philippines that started 4 years ago to try and eradicate the disease. We worked along side their program director who was incredibly welcoming, and some of the other employees. It was very productive especially after the young men employees who kept asking me if I was married started getting back on topic and answering my questions. The N95 mask was glued to my face the whole time. I do not want TB and it's almost ironic that I got an email the other day stating that there is a national shortage in the US for PPD tests which I need before school. The one time I need a TB test for actual exposure reasons! Anyway the clinic has some positive aspects but a lot more needs to be done if they really want to step it up and try and rid the disease from their country.
The DOT center in Sorsogon is the only one around in the area for hours. Patients who's sputum test positive for multi drug resistant TB are enrolled in the program and have to come ever morning Monday-Saturday for 18-24 months to receive and take their medications in front of the physicians at the clinic. Those with non-multi drug resistant TB are given their course of medications to take at home. The first problem is compliance. The meds have a lot of side effects and lots of patients stop taking them once they start feeling better or receive a negative result on their required monthly sputum test. Negative tests don't mean they are cured, and most times those patients get a reoccurrence that is multi drug resistant. Second problem is that it is the only clinic in the area and there are many people that live hours away that need their services. Therefore they are told to rent housing nearby, which means uprooting themselves from their jobs and families to get treatment. This is a very impoverished country already so the burden is immense on these people. The rest of the problems can go on forever. The people with TB clearly expose themselves to friends and family and most don't use protection at home (I asked a few patients if they did, and they don't). The clinic currently states that they have no cases of extra pulmonary tuberculosis which I interpret as them not having a means of diagnosing it properly since they only use sputum to culture and diagnose. We have seen multiple cases of extra pulmonary TB cases so clearly there is a flaw in the system.
Anyway, point in case, we are looking into researching how they manage and treat TB in the Bicol region of the Philippines in an effort to implement a system that will be more effective. One where we can provide TB screening and treatment to people in each Baranguay (village), that will aid in compliance, access to treatment, education and limit exposure. Our time at the clinic was very effective and we'll be going back tomorrow morning. They let us talk to the patients, auscultate their lungs and give out their medications based on their treatment regimen. We got a lot of research accomplished.
Brigitte and I waited in the hospital lobby for our ride for a while after we were finished. We even considered accepting a ride from one of the employees who had a trike but though "eh...better not." Good Jaclyn, good. Plus we had wifi at the hospital so waiting wasn't that terrible and the van came shortly. Don't get me started on the van driver. Our Jeepney driver must be very cautious because this guy drove SO fast. Like 100 kilometers per hour, weaving in and out of people and passing other vehicles. They are one lane roads in the Philippines and he drove just straight down the middle to pass everyone, forcing the trikes and motorcycles in oncoming traffic to move to the side of the road to make way. I would love to drive in a Ferrari with this Filipino driving. That is all.
After lunch (more like plain rice again) I was set to work in the OR. I feel queasy and have little to no appetite but I'm trying to make myself eat something. Ashik keeps telling me I look so dehydrated still and pale, so I'm trying. I still don't want to eat much though. My stomach just hurts at this point. Anyway the first surgery case I scrubbed in as first assistant to Dr. Schuster on a cyst removal from a lady's right eyelid. Today is the last day for all surgeries so we have time to follow up and provide wound care to those patients before we leave. As for the eyelid surgery it was incredibly important to understand he anatomy because a lot of important structures are right under the area he cyst was covering, such as the lacrimal duct. The cyst was huge, like an iceburg that kept going on and on. It was amazing to help with, and I got to close the wound with 5.0 silk interrupted sutures. I love using the thin thread to suture, and being meticulous about closing it so it leaves little to no scar. Plastics and reconstructive surgery is a fascinating field to me and I really enjoy surgical procedures on the face.
The last surgical case of the trip I got to be first surgeon on! It was a cyst removal from the left flank of a young man's back. I was thrilled! I love doing surgeries. I was a little limited without a good pair of iris scissors (most of ours at this point are dulled) so I used a pair with a blunt edge and my scalpel for most of it. The cyst came out beautifully but it was huge! And so deep! Brigitte was my first assistant and she got the opportunity to learn how to do some subcutaneous and deep stitches. The guy needed 4 layers of sutures to close the wound. One deep and one layer of subcutaneous done by Brigitte, then I finished up the surgery with another row of subcutaneous to bring the wound together and some running stitches to close. I haven't done running stitches yet, but Dr. Schuster gave me a great tutorial and they were very easy to perform. Well almost. The power going off for a few minutes just as I inserted my needle to put in the third to last suture made things a little more complicated for a moment. But hey, where's the fun of there isn't a little excitement? A headlamp was found immediately and I finished just as the power came back on. The wound looked wonderful after and the edges were perfect. No dog's ear at all. I'm so happy I got one last surgery in before I leave. As bad as I was feeling and as tired as I was earlier in the day, all that went away with the adrenaline of being in the OR for the afternoon.
When we got back to the dorms us girls just laid around and talked until dinner was ready. It's weird having the majority of the guys gone...far more quiet. I can only imagine the craziness their getting themselves into in Manila before they leave for home. After dinner we all hung out singing and dancing with the Filipino's which was a blast that went on for a few hours. The Fourth of July in the Philippines was a wonderful experience, as we celebrated our country's Independence Day surrounded by new friends from the other side of the world. I can't believe how time here flew by so fast.
The DOTS clinic
Nice job describing and showing your handiwork. Glad I was sitting so I didn't faint. Would be embarassing.
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