Global Health Reflection – Aldene Zeno, MD

Written by Aldene Zeno, MD, PGY4 at Kaiser Permanente Santa Clara, Obstetrics and Gynecology Residency Program on a Global Health rotation with Bay Area Surgical Mission in Daet, Philippines.

The Bay Area Surgical Mission (BASM) has provided surgical services to patients in the Philippines for over 16 years. It is based at the Camarines Norte Provincial Hospital in Daet, Philippines. The BASM team members were skillful yet humble and loads of fun. We stayed in this amazing hotel owned by the mother of one of the trip leaders. The hotel certainly lived up to its name, “Zenaida’s Palace;” the daily breakfasts, refreshing swimming pool, proximity to the ocean, and evening karaoke were just a few of the things that made me feel like global health team-royalty.

In our first full clinic day and in the times that we saw patients in between cases, our gynecology team acquired a busy service. Most patients were referred to our clinic, and some travelled as far as 6 hours. Other than paying for tests needed for their workup, the surgeries were performed charitably. In 4.5 short days I operated on 14 patients. I primarily signed myself up for abdominal hysterectomies since most of my training has been in laparoscopic surgery. Other gynecological surgeries I performed include adnexal surgery for ovarian masses, vaginal hysterectomy, and myomectomies. My attendings, Dr. Cosca and Dr. Ryujin, were very experienced in operating in low-resource settings. Their guidance gave me the confidence to approach some very challenging cases.

I will never forget one case in particular, where we had a 20 cm posterio-fundal fibroid. We cut through the entire myometrium to get to this fibroid, and in that case we easily lost 1 liter of blood in what felt like 1 min. Typically we would inject vasopressin at home to decrease blood loss, but in that setting misoprostol was much cheaper and served as an adequate substitute. This patient had a family member pre-donate blood, so fortunately we had blood products available to transfuse her. Situations like this encouraged me to operate more efficiently.

Another thing that will stand out for me are the blackouts. Blackouts occurred most days but usually the generator would start shortly after. This blackout occurred during a critical portion of the surgery and probably lasted about 30 mins but felt like forever. We were trying to ligate the main blood supply to the uterus. When these blackouts occurred the only light sources we could rely on were from our headlamps. However, we had no substitute for suction or cautery other than good surgical technique. It’s in those moments that my surgery fundamentals were really put to the test.

Working with BASM during my elective month will be the highlight of my residency 4^th year. However, going into the trip I had my reservations. Even though this is my second medical service trip in residency, I was nervous to leave my husband as he dropped me off at the airport. I once again signed up for a trip where I don’t know anyone, except for briefly having met the trip leader. That day I had taken my ob/gyn yearly resident exam, CREOGs, and between the 5-6h exam and rushing to pack with only a carry-on under 15lbs, I was feeling a little frazzled. I arrived 30 minutes later than the scheduled meeting time. Coming into the airport I met the other ob/gyn resident on the trip, who also happened to be 30 minutes late and had taken the same exam. I think that’s when I knew this would be an unforgettable, “unregrettable” experience. I will be forever grateful that I showed up just in time for this amazing trip.