Written by Ijeoma Okwandu, MD, PGY-3 at Kaiser Permanente San Francisco Ob/Gyn Residency Program while on Global Health rotation with Bay Area Surgical Mission in Daet, Philippines in February 2018.
There have been experiences along my academic and training career that have been pivotal to forming the type of physician and surgeon I envision of becoming. The surgical mission to Daet, Philippines with Bay Area Surgical Mission is one of those moments.
At first sight, the group was clearly a force with a mission. The check in line at the San Francisco Airport international terminal was lined and stacked with about five dozen large boxes–each filled with medicine, supplies, surgical and anesthetic equipment. Looking back, the boxes seemed almost metaphorical for the group of people that came together for this very mission. Like the boxes, each person carried a specific need or role: From the premedical students, translators, anesthetist, surgeons, nurses, physician assistants, and volunteers. Each with a specific role, but we came together with…
an overarching sense of camaraderie and purpose.
After our thirty six hour journey and a night’s sleep we hit the ground running. Each box needed to be unpacked and the contents sorted into their appropriate place in the hospital. Afterwards we opened the pre-operative clinic where hundreds of patients were waiting for us. In anticipation of the group’s arrival, patients had already had labs and imaging completed. Our group interviewed each patient to confirm the diagnosis and history, performed an examination, and then scheduled each for surgery that week. The gynecology clinic was filled with women ranging from their mid-twenties to late seventies. Some were burdened by the weight of fibroid uterus; others bothered by the bulge of uterine prolapse, some with pelvic pain due to cysts or abnormal bleeding. An important part of the pre-operative processes was ensuring that each patient was appropriate for surgery.
Sometimes, that meant counseling a hopeful patient that surgery was not the best course of treatment. For example, young patient with a small endometrioma desired surgical removal. She had not yet attempted medical management, but she had the perception that this was her only opportunity to receive treatment. Due to inaccessibility of laparoscopy at the hospital, the only way the cyst (measuring only a few centimeters) could be removed, would be through a large incision. Despite discussing the risks of the surgery, and alternative use of oral contraceptives for management, the patient was persistent that she wanted surgery. After more probing, we unpacked her understanding and expectations. We were able to identify her persistence. As she put it, she “didn’t want to miss the chance for surgery.” This reiterated a core principle in global health. In addition to identifying the needs of a community, the intervention should also be sustainable. What I love most about Bay Area Surgical Mission is its extensive ties with the community of Daet, partnership with the local hospital, and commitment to returning again and again to serve the people. We were able to provide the young woman with a year supply of medicine. She was reassured to know that we would return for surgical management if her symptoms did not improve with medical management.
The operating days were long but fulfilling. We were able to make a direct impact on patients. Our team worked together to create a seamless process to care for over 200 patients who universally showed their gratitude. I will be forever grateful for the opportunity to provide such service to those truly in need. I feel privileged that they entrusted us to impact in their lives. I gained so much from this experience: friendships, surgical experience, and memories to last a lifetime. I feel inspired to do continue my journey in medicine. I am honored to have shared this experience with colleagues who I now consider friends, mentors who inspired me, and patients and their families whose journeys humbled me. This experience awakened my passion and reminded me of the reason I became a doctor in the first place.