From Zero to 20/20 - Cataract Mission to the Philippines (July 2011)

The Physicians for Peace mission to Tandag, the capital of Surigao del Sur on the island of Mindanao in the Philippines, was my first international surgical experience.  The entire Neatrour family travelled with Dr. Juan Montero, a well-known local general and thoracic surgeon, to his home province half-way around the globe.  After 22 hours of flying to land in Manila, we spent the next ten days 12 hours ahead of Hampton Roads.
In Manila, we visited Paradise Heights/Smokey Mountain Community and Gawad Kalinga which were fairly new communities built to replace those living on the dump and in the slums.  In these communities where 280 days of sweat equity provides the resident’s living accommodations, Physicians for Peace Seeing Clearly has been a contributing supporter by providing an eyeglasses clinic at each site.  The children were adorable and very appreciative of the photo ops.  Products made from recycled materials, such as juice box tote bags and magazine paper jewelry, were sold to raise funds for the community.
Shortly thereafter, ten Americans were off to Mindanao with nine additional bags of surgical supplies and instruments for the mission.  After 1 1/2 hours by plane and 4 hours by bus (through rice paddies and banana trees), we arrived in Tandag, a city of 60,000 people.  Many lived in wood shacks on stilts over water and were transported by “petty cabs”, which were no more than motorcycles attached to a cab with one wheel that could hold up to 8 people (illegal by US standards, of course).  We quickly realized these people were among the poorest of the poor; they lived off the land on rice and pigs or chickens grown in their backyard.  We Americans were treated like royalty, from the provincial governor on down to the hospital staff.  In many ways we felt “godly”, parting the waters to serve and administer good will.  Mothers brought their children to us in search of a cure – like the 9 year old girl blinded by congenital glaucoma who sang courageously for us at the welcoming dinner.  Sadly, this 9 year old had a 4 year old brother with the same condition. I had to let this mom know that it’s too late to regain sight for her children; we sought help from the governor to have her transported to a major city like Manila to receive what help they could from a glaucoma specialist.  There are NO ophthalmologists in the entire province of 500,000 people in Surigao del Sur! ( Virginia Beach, with a similar population, has at least 30 ophthalmologists.)  We heard many more similar stories and will share some of those on whom we made an immediate impact.
Opening day of our mission was blessed during Catholic Mass, heralded by a motorcade through the town and many speeches by Governor Pimental, congressmen, town mayors, Dr. Montero, and other prominent sponsors.  In total, the Physicians for Peace mission brought 9 ophthalmologists (8 in-country ophthalmologists), 4 optometrists, 4 sponsors, 13+ partners, and many support staff members together to ultimately serve those who could make it to the Adela Serra Ty Memorial Medical Center for 2 ½ days of cataract surgery.  Two ORs were used, one for cataract surgery and the other for surgeries including squint (eye muscle) and pterygium (a fibrovascular growth on to the cornea from sun and wind exposure).  Three to four cataract surgeons were at work simultaneously in one OR! 
Mission challenges surfaced before we left when I realized how many additional suitcases were needed to send over the surgical supplies necessary for my planned 48 cataract surgeries by phacoemulsification.  Despite sending the phaco machine to the Philippines early, it arrived on the evening of the second surgery day, having been help up in customs.  We were told upfront to be patient, to expect the unexpected, and to be even more patient.  So, with supplies for 48 cataract surgeries, I was only able to perform 9 with only one day left on my medical license to practice in the Philippines.  Another huge hurdle for me was the realization of the meaning of the word “cataracts” in the Philippines.  The majority of the patients seen for cataract removal could only see “count fingers” or “light perception only”.  The cataracts were so dense that they were difficult to remove by phaco.  Hence, the reason why the majority of the cataract surgery here is done by the old method - Extracapsular Cataract Extraction - the method I (and the majority of others in the US) abandoned after medical school.  I wondered how these patients arrived here, without broken limbs, from being nearly blinded by cataracts.
Without the phaco machine, I performed A-scan (ultrasound) biometry to measure the length of the eye in 100ths of a mm.  (This is important in choosing the IOL power and was the first time this technology was used in a Seeing Clearly eye mission!)  We were successfully able to transport this new piece of equipment and were thrilled to be able to donate it for future mission work.  I trained a tech as well as our lead local optometrist from the Physicians for Peace Seeing Clearly program, Dr Chris Buniel.
Finally, the phaco machine arrived, having cleared the custom’s confusion and the challenges of flying an overweight-limit crate.  We unpacked it carefully and then I joined to do my share of the last day’s cataract surgery load.  And, I was privileged to be assisted in cataract surgery by two medical students, Hakan (2nd yr student at the University of Virginia Medical School) and Kristin (my oldest daughter and 2nd yr student at Eastern Virginia Medical School). My patients ranged in age from 22-80+ and had familiar names from Jocelyn to the last name of my last patient…Montero!   The limited quality of the operating microscopes available and the dense cataracts were the biggest challenges.  Some of the in-country ophthalmologists regularly use the phaco machine and will be able to continue to use this technology here on future missions.  Knowing these patients only had surgery on one eye, we gladly left supplies and equipment for future cataract surgeries.
Post-op checks each morning revealed smiling and happy patients as their patches and shields were removed and they could start to see what they had been missing for the first time in a very long time.  Pen light exams were performed as they all sat lined up in rows.  (I forgot to bring a pen light, so without an examining room or a slit lamp, I had to use a flashlight!) Eye drops (courtesy of Congressman Pichay’s pharmaceutical company) and protective sunglasses (courtesy of Beach Eye Care and the Neatrour family) were distributed.  Over the 2 ½ days of surgery, we performed 113 cataract, 20 pterygium, and 8 squint operations.  Incredible smiles and that gratifying feeling of mission accomplished were shared and capped off by the memory of my 22 year old patient waving to me as she rode off in a petty cab!
While I was busy attending to the cataract patients, my wife Leslie, two daughters Kristin and Katie, son Greg, and medical student Hakan were busy screening 250 patients for diabetes.  Kristin and Hakan, with the help of donations from Eastern Virginia Medical School, organized and directed the diabetic screenings.  From taking measurements on height, weight, waist circumference, blood pressure, and blood glucose to asking pertinent questions and using translators to counsel, they were able to identify some pretty serious health risks.  A hospital cardiologist summoned his resident physicians to help with prescription writing and counseling.  It was an amazing sight to see and the patients were drawn from those waiting to receive cataract surgery or eyeglasses.  Patient #5 had a remarkable story.  She was a 61 yrs old, 125 lbs small-framed woman who was encouraged by her husband to attend the free diabetic clinic   Her blood sugar registered high, twice, which Kristin identified as over 600!  Patient #5 answered “yes” to many of the questions on the diabetic survey, classifying her as a high risk diabetic.  The cardiologist sent her to the ER.  They found her 2 days later, wandering in the hospital courtyard, with her son holding up her IV bag.  She had been admitted to the hospital and was taking insulin.  Her blood glucose level was now 121 (normal range)!  Hopefully, she will be able to remain on insulin to control her diabetes.
Meanwhile, other members of the mission team worked diligently.  Dr. Montero, his son Dr. Paul Montero, and Paul’s wife Charlotte (ICU RN), performed 19 minor surgeries, removing lumps and bumps from patients waiting for eye services.  The in-country optometrists prescribed 231 eyeglasses/reading glasses and 116 lab-processed prescription eyeglasses.  We all did our part to contribute to a very successful mission.
Upon our return to Manila, Kristin, Hakan, and I lectured to physicians, resident physicians, faculty members, and medical students at the East Ramon Medical University on “The Dangers of Diabetes and Diabetic Retinopathy”, “Advanced Technology IOLs in the US Today” and “Beach Eye Care – A Contemporary American Eye Care Practice”.
As you can tell, we had an incredible experience, receiving much more than we could ever give to the people of the Philippines.  The program coverage for Vision 2020 Surigao del Sur (a program with grass roots in the World Health Organization’s Vision 2020 initiative) encompassed 17 municipalities and 2 cities.  Special thanks go to Dr. Juan Montero for his connections that made this trip an amazing experience for all those touched.  Physicians for Peace, Beach Eye Care, and our many spiritual and financial supporters are equally acknowledged with appreciation as well. 
We look forward to returning!   We now know better what to expect and what to bring the next time around.  I am working on a team to recruit a full-time ophthalmologist to the Tandag hospital to use the donated equipment.
Our vision is their vision…to see and enjoy to better serve the world!
G. Peyton Neatrour, MD
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