Our first day with patients. The initial sights and scenes seemed so pleasant and pastoral. We took a paved road from the town of Paluan towards the center of the island and about 2 kilometers in we pulled over the side of the road and walked the rest of the way to a quaint little church that sat next to a village with thatched roof huts. A crowd of people were gathered at the front of the church, and a small line wrapped around the side.
For me, growing up in the Caribbean and having spent plenty of time on a farm, the goats and chickens and even the smell of fresh manure was nostalgic. I felt at home with the mud and sounds of animals, kids running around playing with tires and sticks. But as we got nearer I started to notice the clothing and the footwear (or lack of) on the children, their sunken faces and protruding bellies, the look of weariness and fatigue in their mothers’ eyes.
The local health officials from the town had sent us ten nurses and a medical technician who could run urine samples while we saw patients. It was much needed measure of support because apparently there were over 120 people waiting to see us that day. The health officials also sent aides with them who had prepared hot porridge for the village children while they waited.
After we introduced ourselves to the team of nurses and staff, we made our way inside the church where some families were already waiting. That was the first major shock. The dirt, the crowded pews with breastfeeding mothers and crying kids, the babies crawling with their almost bare bellies on the same floor that the stray dogs were lying on, getting picked apart by flies everywhere, on trash and spilled porridge.
Every part of me wanted to yell STOP! and trying and reset everything the way it should be. But where would we start?
We dove in to our task of medical assessments immediately.
We set up in the front of the church, got the crowd lined up outside, only sending in the ones who were screened and triaged by our nurses. We saw them either individually or as a team of two like on our ambulances back in NYC.
We treated wounds, fevers, sore throats and runny noses, lots of coughs and colds, almost everything related to malnutrition and poor hygiene. Children had sores and rashes from washing and playing in water that was dirty with bacteria and animal waste, or infected after scrapes because they weren’t cleaned or dressed properly, teeth had fallen out from lack of brushing…
And the line built up and kept steady. Joe and Rob were treating patients on the right side of the room, Adam and I on the left, I would look up after we treated 3 or 4 and somehow the pews behind us would have 10 more people. I knew they were desperate because they would come directly up to me or Adam with their children in outstretched arms, telling the nurses who translated for us “ask the doctor for help”.
(Only later that night did Carlo our video editor tell me they had thought I was “the doctor” so a lot of them lined up on our side of the room).
Joe made us take lunch in turns, but it was really difficult to stop working. We were determined in the way that only working to the end of the line would fix,. After seeing a child who weighed approximately 20 lbs and learning she was 5 years old, I was choked up and feeling frustrated. At first I thought it was from a throat infection that was plaguing me for almost a month beforehand, but it was something else. Although I had seen a lot of poverty before, especially in some parts of South America and in India…it was never quantified with hard data (we weighed and measured everyone ) showing how wide the difference was.
By 4:30-5:00 in the afternoon we had seen approximately 100 people. There was much less light to work with and we still had the public health aspect of the mission to attend to. We had sent the media team out with Adam to survey, sample and test the local water sources and they were waiting for us to push into the village and talk with the villagers, some of whom we had seen back at the church.
The village brought the reality closer in to focus. It also gave us an opportunity to apply public health initiatives directly. Rob had treated a baby earlier in the day for an open sore on his scalp, irrigating and dressing the wound, cleaning up the pus and drying the area. We ended up at the household the baby belonged, seeing firsthand how bad their living conditions were and how the donation of the Sawyer water filter and Luci solar light were going to help. It was our first stop but not our last. The Mangyan in that village needed proper sanitation and lighting, they needed footwear, and they needed clean water desperately.
This was the aspect of the medical mission that dealt with the structural problems in the long term, and it was something we were very excited about doing. To be able to meet the families in their living spaces and show them what our goals were felt as natural as our patient care from earlier. In a sense we brought our own model of community paramedicine to Mindoro.
We gave out several water filters that day, but more importantly taught them as much as we possibly could in that short period of time about clean water and hygiene, using what was best described to us in medic school as a “teachable moment”. We distributed solar lights as well, and made sure they understood how to use them. Around 7 pm that night, we said goodbye to our nurses and medical technician, managed a few selfies with them and their Army escorts, and headed back to the town proper, where we interviewed Dr. Ramos, the head of the local health unit and the local coordinator of the day’s initial screening mission.
For our first day treating patients and meeting the Mangyan, it was quite an experience. We were able to achieve far more than expected thanks to the nurses and staff, and our spirits were far brighter than the overcast skies and soggy clothing we were wearing would indicate. As we climbed into our vehicle to make the plodding and choppy drive back to Mamburao, we fell asleep with a sense of accomplishment.
It was good day indeed.