A Neurologist on a Medical Mission

For the past 8 years, I have participated in annual medical missions to rural areas of the Philippines with Lingkod Timog, a nonprofit group composed primarily of Filipino Americans. Lingkod Timog, translated as “Service to the South,” is composed of volunteers with no paid administrative overhead. This structure allows us to dedicate all fund-raising toward the purchase of medicines to distribute during medical missions. Lingkod Timog’s mission is to conduct “charitable, educational, cultural, medical, and life enrichment activities to needy areas in the Philippines. We strive to alleviate poverty while strengthening relations between the Philippines and the United States.” Volunteers come from the US, Philippines, Portugal, and Sweden.History of Lingkod TimogLingkod Timog was created in 2004 by Irene Sabban and Cecilia Heredia, both wives of Filipino military officers who wanted to help tribal people in the Philippines. Since then, the group has performed annual medical missions with the assistance of the Philippine Armed Forces in diverse areas of the Philippines, including rural areas of Mindanao Island (Basilan, Davao, Zamboanga) and several locations on Palawan Island (Bataraza, Coron, Rizal). In these regions, health expectations and standards of safety are clearly different from what most of us are used to. Our missions are scheduled months in advance in cooperation with local governments and not in response to natural or man-made disasters. I have written about our missions here, here, and here.Mission 2015This year, our group of 22 members flew from Manila to Puerto Princessa, the capital of the island province of Palawan. We then drove by convoy to the southernmost region of the island, stopping at a Marine base along the way. We visited this same region in 2012. Last time, the drive took more than 6 hours and was punctuated by a minor traffic accident due to a giant pothole. On this trip, it took only 5 hours, since more of the narrow road had been paved. Over the next 2 days, we performed clinics in 2 locations; Barangay Culasian, Rizal, and Barangay Ocayan, Bataraza. We were joined by military physicians and local health workers, which enabled us to provide medical, dental, and surgical services, as well as malaria screening, haircuts, and circumcisions.SecurityMost of our mission locations are far from “civilization” and unsafe for the casual traveler because of the presence of rebel groups and virtual absence of police protection. The Philippine Armed Forces, including Marines, Navy, and Army, provide Lingkod Timog with logistic support and security. The Philippines has no shortage of rebel groups, such as Abu Sayyaf, the New People’s Army (NPA), Moro Islamic Liberation Front (MILF), and Bangsamoro Islamic Freedom Fighters (BIFF). The presence of these lawless groups hinders development of infrastructure in these rural areas, thereby perpetuating poverty and limiting access to social services. Thanks to our military escort, I have been privileged to visit rural areas that would be off limits to a tourist because of real threats of kidnappings. To date, we have never had a security incident, most likely because of our extensive preparation in cooperation with local authorities and overwhelming military presence during the missions. Our medical efforts are performed in concert with the military’s peaceful outreach programs. Medical ClinicOur group treated approximately 800 patients a day, which is typical for our makeshift clinics. I personally saw about 100 patients a day, along with my translator/assistant, Irene Pallir. Histories are complicated because many patients do not speak Tagalog, the national Filipino language, but rather a regional dialect, in this case, “Native Palawan.” Needless to say, patients receive an abbreviated history and physical exam. Although I keep my own notes, there is no formal visit documentation. If the patient has an illness for which we have a medication, they receive a prescription and are sent to our “pharmacy,” where they receive free medication and instructions.Typical prescriptions are antibiotics for urinary tract infections; antihistamines and decongestants for children’s colds; analgesics for aches, pains, and headaches; and a month’s worth of antihypertensives for high blood pressure. Untreated high blood pressure is common, with many patients relying on herbal medications of unproven value. (I suspect that many early deaths in this population due to myocardial infarction and disability due to stroke could be averted if high blood pressure were consistently controlled.) Unfortunately, we did not have any skin creams this year and were unable to treat patients with severe skin ailments.Given the rudimentary nature of our clinic and limited supplies, many patients receive insufficient diagnostic investigations or treatment. I often have to balance my frustration regarding the inadequacy of our services with the rationale that our clinics are better than nothing at all, often the alternative for these tribal people. When we do identify a problem that needs further evaluation, patients are referred to local facilities or the military hospital.Medical missions with Lingkod Timog provide a glimpse into the health care needs of tribal peoples in the Philippines. Although there is much that we cannot deliver during a brief mission, we do provide clinical evaluations, minor surgical procedures, teeth extraction, malaria screening, and antibiotics and other treatments. It is my impression that “laying on of hands” offers encouragement and hope. Eventually, as local infrastructure improves, our medical missions will no longer be necessary. I hope I live to see the day.[Note: My assistant, who speaks fluent Tagalog, does much of the communication with patients on our missions. Patients are routinely asked for their permission to use their photographs.]