Tuesday, January 28, 2014

A-Team Mission to Ormoc, Leyte - Team no 13.

I would like to dedicate this entry to the A-Team and the Mercy Malaysia team in Ormoc, Leyte, Philippines. It was a definitely interesting experience that I had; sharing knowledge, learning new things, made lots of friends & depositing it in my memory bank.. as well as this blog entry for my future reference.
*based on a true story with credits to Ashraff :)
Typhoon Haiyan (Yolanda) devastated much of the island of Leyte on the 8th November 2013. Whilst the city of Tacloban took a direct hit and sustained severe damage and casualties, serious damage was also inflicted on the city of Ormoc approximately 100km away. There is one major hospital servicing Ormoc City and it sustained 90% damage. Our brief was to restore acute orthopaedic care in the wards and the operating theatre of ODH. Our team comprised of two orthopaedic surgeons, an anesthetist and a scrub nurse. Our complete team enabled us to function independently with minimal disruption to ODH staff.

I was the first to arrive in LCCT that evening. I could not recognize anybody who I can pinpoint to be from MERCY. The instruction was to meet up in front of Old White Town Coffee shop. I guess it was obvious that i was part of this mission when a gentleman from afar greeted me. It was Ilyaas and he asked.." MERCY?" and i just smiled! Not llong after that I saw Ashraff, an old acquantaince from my housemanship days in HKL. We have not met since then eventhough through facebook, we do know of each other's progress.

Not long after, the MERCY representative came with his obvious MERCY shirt.. haha and we we then brought to check in as well as briefing about the mission. We then met Zulkarnaen, a trained OT staff nurse from HUSM. He looked a bit shy but i knew he must be really determined to have come all the way and volunteer for this mission. The big surprise was when we were entrusted with an amanah which made me feel.. hey.. ni betul2 macam secret agent.. hahaha. The flight to Manila was alright and we arrived in Manila just in time for Subuh prayers. I must say i am impressed with the facilities provided for muslims to pray. Certainly amazing!

11/1/14 Saturday
We travelled on Cebu Pacific from Kuala Lumpur to Cebu via Manila, arriving at 8am. We were met at Cebu airport by members of Team 12 who were on their way out. A superly brief handover was performed on the premises of an international coffee chain. Honestly i was not too clear about the handover because the team were so keen to share everything that in the end, i maybe understood only one thing.. hahaha  We then departed via ferry and arrived in Ormoc at 2pm after a perilous 3 hour crossing of the channel between Cebu and Leyte.The sea was rough and we had a torrid time in the ferry. I could not have been more sea sick but somehow managed to control myself from vomiting. Ashraff and Ilyaas was sitting on the deck and when they were asked to put on the life jacket, it was not an easy task to accept that we were in a crap condition! hahaha
The weather looked gloomy when we arrived in Ormoc. The destruction caused was still visible eventhough it has been almost 2 months since Haiyan striked. We were met by the local Mercy representative YuShen and the local volunteers. Of course, everybody was shy and it was our first step in getting to know them. They are a bunch of enthusiastic and determined volunteers right from the moment we met them :) Right after checking into our accommodation we were accompanied by Dr Amir Adham (of team 12)  to ODH to visit the facilities and review the set up of the operating theatre. A brief ward round was done to get to know the in patients. Dinner was hosted by Yati, who was on hand to take over from YuShen who was supposed to be on the ferry that night which was cancelled.
I totally cannot imagine how chaotic it might have been when Yolanda striked. 90% of the hospital services were crippled with all the roofs gone. Mercy Malaysia was a major saviour by initiating the rehabilitation of the hospital, it was simple. Fix the roof first! And indeed they undertook the project really well.
I had to set my mind straight as the GA machines available are not working due to the disaster. This was a regional anaesthesia mission and i guess claiming to be one, this is where it should happen! 

12/1/14 Sunday
We commenced our duties in ODH at 8am starting with a full ward round of all the patients. Dressing of all postop (team 12s) patients ensued along with all other inpatients with wounds. We managed to discharge 2 patients who had plating tibia done and one patient who had plating femur done by team 12. We also managed to meet up and dress the wounds of both of team 12s outpatients, one being the child with severe contractures whom team 12 performed surgery on in a private hospital in Ormoc the week before and the other being the patient with a very large granulating wound of his right leg who refused a split skin graft. Right after rounds we met Dr Harry Solubon, the resident Orthoaedic Surgeon who dropped by the wards briefly. He explained that due to the effects of Typhoon Yolanda he had personal matters to attend to and was planning to drop by the hospital intermittently.
After lunch we started with surgeries; orthopaedics procedure with the local surgeon. After completing ourduties, we returned to base camp at 7pm. Honestly, i was a bit intimidated with the OR staff because it was a Sunday. She did not look too friendly and who actualy works on Sundays anyway? haha Luckily Dr Harry was around to help us be familiar with their system. I will never forget when Dr Harry goes... " KKOOOOOLLLLL.." haha
We said our goodbye to Sean and Evelyn, the team 12.5 who were due that night. The channel was not so forgiving as at that time low pressure was setting in. Yati thought it would have been good to send people away first before the ferries are cancelled because of the sea condition.
13/1/14 Monday
Our second working day in ODH commenced late at 9.00am due to a shoe emergency. One of our team members suffered a shoe failure that required immediate attention of a cobbler enroute to ODH. We started with routine rounds and dressing of wounds. Two patients were taken to surgery on this day. As we completed our work on time,we were able to report back early to base camp at an honourable time of 7pm. We were warming up in getting to know the OR staff in Ormoc. They are very nice people and it was not long before we were all sitting together in the rest room with our cup of coffee gossiping! I had my short discussion with the resident Anaesthetist, Dr Pelikano regarding the system and how it has been since the disaster.It was interesting to note about their health system and how things work in this Island of Leyte.
During debriefing, i guess this was where the A-Team was born! haha We somehow identified ourselves with the famous TV series and hence, the 4 of us.. The A-Team!!
14/1/14 Tuesday
We decided to cover the mobile clinic as a change of routine. The new covering team had their travels delayed and there were no medical personnels to run the mobile clinic. We stepped in to avoid cancellation of a very valuable programme. Eventhough our team comprise of specialized discipline doctors, we are still intouch with our bread and butter basics of MBBS.
We were brought by the DHO team to a distant district clinic which is in Hibanuan. The route was challenging and we survived the humps and bumps of uneven gravel! We even had to hold on to the boxes of supplies we brought during the journey before it becomes a hazard to the passengers!
The beautiful Barangay of Hibanuan is surrounded by sugar cane plantation. We held our mini clinic in the main church of the Barangay. We covered 155 patients til 4pm. The patients varied from a 1 month old baby to a 85 year old senior citizen of Ormoc. It was satisfying to treat the ones in need and to see how appreciative they were of our services.
On our way back, we had an emergency call for our multi-talented anaesthetist.. haha me lah!  for an emergency Caesarean Section. There was no government anaesthetist cover on that day. It was unfortunate that the patient could not afford the private anaesthetist charges and she would have been delivered vaginally anyway. It was a 23 year old lady, G3P1, twin pregnancy with the indication of fetal distress for the Emergency Caesearean Section. Both the two babies and the mother was well post surgery.
The orthopaedics team did their PM rounds in preparation for surgeries to be done the next day. We met back at base camp at 9pm.

15/1/14 Wednesday
Still no sun when i woke up in the morning. We started the day with the usual ward rounds. The orthopods team were able to identify 4 orthopaedic cases needing surgical intervention. The team split into two and we set about dressing the wounds of cases done in the previous few days. We were pleasantly surprised to be joined by the resident orthopaedic surgeon for our first case. It was a give and take as Ashraff had his objective in doing the case together.
What happened next? well.. its always better when it is being written by a third party. Here I will share with you what was written by Ashraff and this is not a myth.. hahaha 

"Our second case was  a 24 year old gentleman with a closed fracture of the distal 3rd humerus on the right side sustained the night before. He complained of inability of extending the wrist and fingers. This case was particularly satisfying as our anaesthetist who was well versed in performing interscalene brachial plexus blocks via nerve stimulator guidance without an ultrasound machine; which allowed us to do the first upper limb operation in ODH since the tragedy of the Yolanda Hurricane. The local anesthetists were taught on the aspects of this block and they claimed that it was probably the first interscalene block ever performed on the island of Leyte. We performed an open reduction and internal fixation of the right humerus with a narrow DCP plate. Dr Mafeitz was mobbed by all the student nurses after successfully performing his block!"
16/1/14 Thursday
Our day started with the usual morning rounds and dressing. We were then driven by the very able Mercy drivers to the city of Tacloban to meet up with the Hospital director of Leyte Provincial Hospital (please see adjoining report). We were able to meet up with team 14 at Tacloban airport before returning to Ormoc at 8pm. It was devastating to see Tacloban and imagining how it was before the tragedy. The disaster was not unexpected but the magnitude of destruction was something unthinkable by the people.
We proceeded directly to ODH to review any new admissions and performed a right big toe ray amputation on a diabetic patient with big toe gangrene. We completed our work atmidnight and returned directly to the accommodation.
17/1/14 Friday
This was another busy day for us commencing at 8am with the usual rounds and wound dressings.I managed to perform another interscalene block for a humerus procedure and it was satisfying to do so. I guess my hardwork in performing nerve stimulator blocks during my Masters training really helped in this kind of situations when resources are limited.
We completed our work and returned to base camp at 7pm.It was sad to say goodbye but i guess we have done what we were meant to do here.

18/1/14 Saturday
This was to be our final day in ODH. All the patients had been operated on and were given plans once we were to leave. All the fractured patients were discharged home well with antibiotics. We completed an instrument inventory and moved all the surgical sets to base camp. We also presented a large bouquet of flowers to yati.
We then received the bad news that night during debriefing as all ferries were cancelled and all flights were suspended. Haha What a way to finish off the trip! We did our planning that night on Sunday was a que sera sera day.
 19/1/14 Sunday
We were off from Ormoc at 5am in the morning. Our destination was Tacloban International Airport with 100% uncertainty. Typhoon Agaton hit Mindanao the night before and all ferries were cancelled. Pak Azam told us to be at the airport and gamble your chances! Haha This was something I've not done before and I guess it was worth trying. We tried to get on the 9am Philippines Airline to Manila but it was not possible as we were no 25 on the waiting list.
Never would I have thought, at 11.59am in Tacloban airport without any tickets knowing what will happen next and what will be. And by Allah's grace, there was suddenly an Air Asia Zest flight that touched down at 1230 and 1300pm flight to Manila. And again b Allah's grace, we were in Manila at 5pm, waiting at the boarding gate to fly back home to KL! Sbhanallah.. Allah is great!

My take of this whole experience? Honestly it was my dream to be part of missions like this. I have always envisioned myself to experience such situations and Alhamdulillah, it was granted. I learnt a lot of things, be it material or emotional; and i guess it is part of my journey in life to experience such a thing. I was lucky that the group I was with were all enthusiastic and dynamic. we all had fun, laughter but all in a good manner and choice. Thank you very much MERCY MALAYSIA for the opportunity. 
I live to tell the tale....

Displaying Medical Report -The A team (11 - 19 Jan 2014).docx.

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