Seeing the dentist in Buda on the Philippines

Dr. Flüthmann and Dr. Werth take part in the project in Buda of Doctors for Developing Countries – German Doctors e.V. They talk about their experiences in this blog:

„Did he use the drill? Surely not. When the dentist comes to Buda, he does not bring a drill but quite a range of pincers.

We could watch three times how teeth were pulled at piecework. The effort and costs for one filling is much too high, there are far too many patients, and usually the teeth in need cannot be fixed anymore.

That’s how a room in our tuberculosis house is remodelled to a dental surgery and for a day quite a couple of teeth are pulled. A dentist of Doctors for Developing Countries once said that – unlike in Germany – you don’t have to convince anyone to have a tooth pulled but rather to not pull all of them! Teeth are not necessary to eat the food here which usually is very soft; any tooth that remains is only the potential root of more trouble.

After all we get to see in the daily throat inspections we are quite thankful for the regular morning patient instructions which are a requirement for every treatment with the German Doctors. The patients are educated about dental care and once in a while you meet whole families who have good teeth although it may be obvious that they barely have enough money for a tooth brush and tooth paste. A big influence may also be the lack of money to buy sweets.“

Translation: Ulrike Peter

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A flying visit to the Payatas

Just before the end of my visit here on the Philippines, I have the chance to visit the slum Payatas in Quezon City together with my husband Robert Henker who has been working as a Doctor for six weeks in Cagayan de Oro and on Rolling Clinics – we get the chance to look at the slum, the dumpsite and also the health care center, which Doctors for Developing Countries – German Doctors runs here.

Dr. Huber holds consultation hours on the Payatas

The Project Doctor Erwin Huber currently works here. The German Doctor has been here for three and a half weeks and has a bit of a cold at the moment. But with more than 100 patients attending his consultation hours daily, he can’t afford to cure the cold in bed, he says laughing and with a broken voice.

„Most of the patients here suffer from respiratory illnesses“, says the German Doctor. „Many people come here every day – among them a lot of children – who get injured working with or on the rubbish, who get for example cuts on feet and legs.“ That’s not at all astonishing – the biggest part of the patients lives and works directly next to or on the dumpsite.

The Payatas: The slum is just beside a dumpsite. The health care center which the German Doctors run here is situated within the slum next to the biggest dumpsite of Manila. Payatas is a city with more than 200,000 inhabitants but the name often stands for the dumpsite located here. 530 lorries bring a total of 1,200 tonnes of waste from Manila, Quezon City and surroundings. 53% of people who live in Payatas work directly on the dumpsite – as a security guard, driver, vehicle guide, assistant („balero“), sorter, assistant in the waste collection centers. This is the official number we get during our visit on the dumpsite. Inofficially, there are a lot more people – including children – who work illegally on the dumpsite or who sort the waste outside or who run junk shops – waste collection centers of traders who resell the sorted waste to factories. Many people lost their lives during a slide on the dumpsite in July 2000. Consequently, the government officially prohibited child labour on the dumpsite; security guards watch the official gates. However, „jumper boys“ usually jump onto the lorries and enter the dumpsite that way or they pass through a hole in the fence in order to continue working there. 75 people each work on the six official waste sorting centers on the dumpsite.

Many parents bring the collected garbage home where the whole family, including small children, has to help sorting. It is necessary in order for a family to survive here and to earn 200 to 350 Pesos per day (3.30 to 5.90 Euro) depending on quantity, type and quality of the waste. The „garbagers“ or „scavengers“ sell the sorted garbage to the junk shops. Weight and type of waste influence the price: Garbagers receive only 8 Pesos for one kilogram of plastic but one kilogram of copper wire earns more than 200 Pesos. However, there is only relatively little copper wire in the waste which they have access to and it takes more effort to collect it.

Visiting the dumpsite and the slum, we keep seeing children who sort waste in the backyards. It smells of waste and smoke, drains are blocked with rubbish, the roads are made of mud and garbage. In the middle of it all – children working, playing, watching.

„A lot of children are underweight here“, says German Doctor Erwin Huber.

„I already had three of them in the consultation hour today.“ It is not astonishing considering everything we experienced throughout our tour. In the tuberculosis center, the DOTS Center, 58 patients are treated, among them 8 children. Unfortunately, the ward round of the short-term Doctor and the tuberculosis therapy can only be carried out ambulantly ­ there is no infirmary here.

It is great that the men, women and children who master their lives under these inhumane conditions have a place to go in severe cases.

 

Children sorting rubbish

More than 100 patients wait for the consultation hours daily

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Quite an adventurous path to the operation

„I am happy that Rosebelle will get the operation!“, says German Doctor Robert Henker happily. Because he had quite a bit of convincing to do before this was possible! Not in order to manage for the operatin but to convince five-year old Rosebelle and her mother Marina about the necessity of the operation and the stay in the hospital.

Five-year old Rosebelle has a congenital incomplete cleft lip and palate

Rosebelle was born with an incomplete cleft lip and palate. This malformation is not rare here on the Philippine island of Mindanao: Especially young patients attend the consultation hours of Doctors for Developing Countries – German Doctors on almost a weekly basis. The German Doctors arrange an appointment for the patients, who are often small children or babies, to receive the operation and correction of the cleft lip and palate free of charge. It is not a dangerous intervention but does have a great effect: the cleft is closed and the part of the face is covered using plastic surgery: the patients can eat, drink and grow up normally after that – and the stigmatisation because of the cleft in the middle of the face disappears. Patients have to stay in the hospital for seven up to nine days following the operation.

The German Doctors team after a three-hour walk to the next village (left to right): driver Nazar, Doctor Robert Henker, area coordinator and interpreter Gaga and Nurse Nancy

Robert Henker came across five-year old Rosebelle during one of his Rolling Clinic tours in the remote village of Sinaysayan in the mountains in the area of Kitaotao. The next traffic road is at a distance of six hours by foot. It takes another six hours by bus to arrive at the next hospital which offers this operation.

„Her mother didn’t want to know anything about this operation at first. German Doctors had referred the child three times already to the hospital. Her mother never went with her to the hospital though“, says the German Doctor. „Despite the cleft lip and palate, Rosebelle was able to eat and survived for five years. Why should the family arrange for an operation now?“ This time again, her mother only brought her because of a cold and a cough.

Rosebelle had apparently been able to eat and drink without problems. But regarding her appearance, she is stigmatised with the cleft. In a couple of years she probably would have difficulties finding a husband and start a family – which would in turn mean that she would have to live with her family all her life and depend on them.

The operation demanded by the German Doctor has big consequences for the family. First of all, the mother or the father must accompany the child to the clinic, which means that they cannot take care of the other children. And Rosebelle’s parents have a total of ten children! It has to be considered carefully whether it is possible to put up with the absence of a parent for an undetermined period of time. Secondly, the parents and Rosebelle have never left their village in the mountains! How are they supposed to find the right way, travel by bus on their own and find their way in the 800,000-inhabitant city of Cagayan de Oro in which the operation would take place? Apart from that, it is uncertain how long Rosebelle would have to wait for the operation in the hospital – it might take various weeks. And finally, mother and child would have to travel the long way back to their village.

Area coordinator Gaga (on the right) in Sinaysayan talking to mum Marina

„Area coordinator Gaga, who organises the Rolling Clinic consultation hours, and I have talked to the parents for a long time“, the German Doctor continues. „The family eventually agreed after I had used all my persuasion and had made a promise.“

Robert Henker offered mother and child a place in the car of the Rolling Clinic team to Cagayan de Oro and promised them to organise the trip back. And he had to promise that mother and child would be back home again at the latest in two weeks time. „Otherwise the parents wouldn’t have agreed. They didn’t want to leave the father alone with nine children for an uncertain period of time“, Robert Henker explains. „You really have to think about what advice you give them – there is no use in arranging a necessary operation for a child if for instance two other children get sick and may die without the care of their mother.“

They agreed that the “Lula”, the grandmother of the family, would take care of the children together with the father during that time. Area coordinator Gaga and other local health workers would also keep an eye on the family during the absence of the mother.

The German Doctors team, mother and patient plus five horse packed with medicine have to walk to the car crossing mountains, rivers and valleys

German Doctor Robert Henker coordinated „Project Rosebelle“ via mobile phone with Philippines coordinator Dietmar Schug and got an “OK”: Rosebelle would receive an appointment for the operation in a short time and would return home within two weeks.

And now it was time to put everything into action. With their bag packed, mother Marina and Rosebelle were ready to go the next morning. The necessary “social survey” was carried out by coordinator Gaga making sure that the family is really in need and thus entitled to treatment free of charge by the German Doctors. And finally, everything was ready for departure. „We had to walk three hours to the car on a quite adventurous path “, Robert Henker describes the first part of the journey.

A river is on the way to the car – it must be crossed individually one after the other on the back of a Carabao (here: Nurse Nancy)

The German Doctors team, five horses packed with medicine, mother and patient had to climb mountains and walk through valleys and they had to cross a river on the back of a Carabao buffalo – each one individually. The real adventure for mother and child started when they got into the car. „The two of them had never been on a car before“, says Robert Henker. „The poor mother suffered from sickness and vomiting throughout the journey!“

On arrival at the hospital, the German Doctor talked to long-term Doctor Martin Grau and coordinator Dietmar Schug and made sure that Rosebelle would be operated as soon as possible. And it turned out exactly that way: The very next day, Rosebelle was admitted to hospital and attended by the treating surgeon. An operation plan was put up and the operation was scheduled for the next day: an unusual, very lucky circumstance – for the patient as well as the family.

Rosebelle and mum Marina are waiting for the operation

Robert Henker and I are visiting Rosebelle and her mother there just before the end of our stay in Cagayan de Oro. The little patient is sleeping. „I am in a city and in a hospital for the first time“, says mother Marina excited. „And I miss my husband Rohelio and my children.“ I’m asking her to name her children and without hesitating she tells me their names and age: Ramel (20), Rochilin (18), Realin (16), Rohelio Junior (15), Rosemary (13), Rexter (11), Aljey (10), Rodele (8), Rosebelle (5) und Gerald (1,5).

One week after our visit, Robert Henker and I receive the happy news and a picture from Doctor Martin Grau. „That’s how fast it can go: Rosebelle has been successfully operated and has recovered. 12 days after her admittance, we put her on a bus. She should be at home by now.“

Rosebelle directly after the operation. The scar will hardly be visible anymore later.

We are so happy about this! „I would like to advise every German Doctor who takes part in a Rolling Clinic not just to refer patients or to tell them to go to a special Doctor. You should rather check and find out whether it is at all possible for the family to put the advice into action“, Robert Henker summarises his experiences in retrospect. „The Philippine mentality makes patients never to openly reject an advice of the German Doctor. If a family has not followed a referral two or three times despite confirming it to the Doctor, you should look into it more in detail and not bring reproaches on them. According to my experience, it is import to take a lot of time for the patients – if possible – and to be friendly in order to sometimes force their happiness upon them with a lot of sensitivity. In the just-mentioned case, Rosebelle would have never received the operation if the whole team hadn’t taken two or three hours for her and her condition.

Translation: Ulrike Peter

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What makes you happy? – Part IV of the mini series

I receive quite different answers to this question from the people whom I talk to here on the Philippines during the Rolling Clinics, visits to villages or hospitals. Some of them immediately know an answer and are happy to tell me. Others hardly understand the content of my question. Sometimes they have to think about it for quite some time, talk to a neighbour or (if available) to an interpreter for some minutes. Others don’t know what to do with this question, and others associate a wish or a dream with it.

Everyone interprets the question quite individually and gives their personal reaction and answer to it.

Marquesa (15)

„I can only say what would make me happy: If I could continue with Highschool. I would really like to become a nurse.“

Marquesa (15)

Marquesa has a hard destiny: Shortly after her father left the family and moved to the city, he got shot. Her mother also died five years ago. She and her three brothers have been living with an aunt since then. Marquesa has to help on the farm and with the housework on a daily basis so her family can make a living. She cannot go to school; they don’t have enough money. She has been to the German Doctors Hospital for three times now because of a congenital heart defect and attends the Rolling Clinic consultation hours on a regular basis.

She does understand my question in English. But she has difficulties giving an answer in English. That’s why I am writing my question on a piece of paper and suggest her to write the answer in the Visayan languages. She is taking some time to do it. But – she makes it and gives me her answer.

„I love cooking! I prefer cooking vegetables with coconut milk.“

Riza Mae (17)

Riza Mae (17)

Riza Mae attends the Mother’s Classes regularly with four-month old Windel, her first child. She still lives with her family in a village at the coast, 65 kilometres away from Cagayan de Oro on Mindanao.

„I am happy to have a job and be able to work for German Doctors.“

Rofine (46)

Rofine (46)

Rofine has been working for Doctors for Developing Countries – German Doctors for 23 years. Currently, he interprets for the German Doctors in Buda. He really loves his work. „I have seen a lot of Doctors arrive and leave. I got to know many“, he says. He is married and has three children. His wife has a heart disease and will be operated soon. It really upsets him. „My wife gets all the attention at the moment, that’s why we don’t have a lot of time for our children sometimes.“

Teresita (46)

„I am happy that God gives me everything I need for living; I am healthy and financially I’m doing ok. I lead a simple life but for me that means happiness.“

Teresita (47)

Teresita has been a midwife for 26 years in the mountains of Cabanglasan on Mindanao. She has two adult daughters and a son as well as two grandchildren. She has been married for 27 years. Her husband is a rice farmer. Her biggest wish is that her son Joshua Jean will get help one day: He has a congenital heart deffect and still lives at home because of it.

Avito (74)

„I am happy that I have three meals a day.“

Avito (74)

Avito is a widower. He has spent his life in the mountains of Bukidnon on Mindanao as a farmer and used to grow corn. Only three of his twelve children are married, it makes him sad. If he has any other wish? No. My interpreter suggests: „Maybe a new wife?“ He is laughing – no, not even that anymore.

He attends the consultation hour of Doctors for Developing Countries – German Doctors because he suffers from toothache. Unfortunately, it is not possible to help him today.

Translation: Ulrike Peter

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Suzana’s story

During the tours with the Rolling Clinic of Cebu, I had the chance to talk to a lot of patients and to find out more about them and their lives. And I got to know why they need and attend the consultation hours of Doctors for Developing Countries – German Doctors.

Suzana suffers from an advanced form of goitre

As a representation for many others, I would like to tell the story of Suzana, a goitre patient.

Suzana sticks out – she has a big swelling directly underneath her face – the result of a long untreated thyroid dysfunction.

But I do not only notice her because of her appearance. We start talking rather out of coincidence. She tries to help interpreting while I’m talking to an old man. She is laughing a lot and has a notably positive charisma.

Suzana is 50 years old, she has two children and is divorced. „My husband left me and married another woman when my neck got bigger and bigger due to goitre“, she tells me sadly. „But it also has a good side“, she adds. Her husband used to come home drunk, beat his wife and the children. „Everything made him crazy!“, Suzana says. „I talked to him when he was sober, but without results.“ She didn’t know any other way to help herself than to go to church every Sunday and to pray „that everything would be fine“.

A couple of years ago, Suzana used to have a shop where she was selling rice. After that, she was a vendor for cosmetics. She had to pay in advance for the orders. When some customers did not collect the products they had ordered and thus didn’t pay anymore, the situation got dicey. Moreover, her husband used to spend the money, which she earned with her jobs for the family, on alcohol. She couldn’t pay anymore and had to stop her second business, too. Until now, she hasn’t found work again. Little by little, she sold the few things she owned. Recently, she sold her little gas cooker to buy food for herself and her children.

What is life like for her, I’m asking. „Really very difficult and bad. But I always try to laugh and be strong!“ I really believe what she’s saying. Throughout the talk, I never hear a word of self-pity from her. She is laughing, she tries to see something positive in everything.

„You know“, she continues. „I always go to church and pray to God. I trust in him. That gives me the strength to deal with all the problems and challenges.“

She would like to open a little shop again and make her own money. But she doesn’t have enough money to get started.

At the moment, she tries to get an operation for the goitre. After that, she will see what happens. „Everything is in God’s hands. I’m doing what I can.“

Translation: Ulrike Peter

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Happiness is a balloon

Omang is happy

During the Rolling Clinic consultation hours on Mindano, I received a lot of answers and reactions from patients and staff of Doctors for Developing Countries – German Doctors to the question „What makes you happy?“. I didn’t have to ask little Omang what makes him happy.

The three-year old was born as the fifth child of his parents in the mountains of Cabanglasan. His mother and father belong to the indigenous population, the Umayamnun. Until recently the family lived a couple of walking hours away from the next village. As his brothers and sisters now visit primary school, the family moved to a village near Cananga-an.

His mother Ay Ay brings Omang to the Rolling Clinic consultation hour. Ay Ay sticks out among the patients: because of her indigenous appearance, her worn-out clothes and especially because of the areca nut she has on her lips. „My children always ask me for money for food, but I don’t have any“, she says. Even my interpreter can’t find out what the family really lives from. But what I can see is: they are poor, the little boy seems neglected.

After the examination, Omang receives his possibly first toy ever from German Doctor Robert Henker – a balloon. It really touches me how happy it makes him. The recording is a cut because the situation lasted about 15 minutes and may seem a little odd. Omang is certainly a special child. But it shows a boy who experiences happiness – I am sure about that. Two minutes of it all – Watch the video:

 

Translation: Ulrike Peter

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Breastfeeding – not just for financial reasons

The last report of my little series on the breastfeeding topic on the occasion of the World Breastfeeding Week 2011 is about the ones who deal with it on a daily basis: as mothers, midwives or doctors.

 

Many women with their babies come to the consultation hours of the Rolling Clinic. Many breastfeed their children while waiting or even during the consultation. During a 10-day Rolling Clinic in the area of Cabanglasan on Mindanao at the beginning of August, I recorded their opinions on the breastfeeding topic, the challenges which midwife Teresita Manatad and the team of Doctors for Developing Countries – German Doctors have to meet.

 

Video:

At the Rolling Clinic consultation hour in Mandahican, the consultation hour in Cananga-an, and the consultation hour in San Vicente: Many mothers with their babies usually wait in the villages which the Rolling Clinic serves.

„I breastfeed my baby because I cannot afford milk powder or baby food“, says Joy.

This is the very first answer many mothers give me when asked about breastfeeding. But they also know that breast milk is the best nutrition for their little ones.

„My child stays healthy when I breastfeed it“, says Angel. „Especially in difficult times, for example during teething.“

„Breast milk is healthy. And it strengthens the immune system“, Emelyne tells me.

That’s what the mother learn in the local health centers. Just as in the Health Center of Cabulohan.  Posters underline the advantages of breastfeeding. In many places, they even show how to do it right. Consulting services are also offered. Midwife Teresita Manatad currently provides advice to 16 young mothers at the Health Center of Cabulohan.

“The consulting service two month after birth is particularly important”, she says. That’s the latest time most of the mothers have to return to working. They must or want to stop breastfeeding at that time. Being a midwife, she encourages women to continue breastfeeding and gives practical advice about pumping.

The team regularly talks about breastfeeding at the Rolling Clinic consultation hours of the German Doctors. Just as in Cananga-an. Nurse Cheche explains that mothers shouldn’t give their babies any other nutrition before the fourth but better the seventh month.

This kind of education given by the Rolling Clinic Team remains very important. German Doctor Robert Henker always addresses the breastfeeding topic after examining mothers, babies or small children.

Robert Henker, German Doctor: „The mothers usually tell you that they breastfeed, five to ten times a day, even four or five times per night. But if you watch it, you can see that they do it relatively shortly, one or two minutes, and the baby just started sucking. We usually advise every mother to breastfeed more than five minutes, at least ten, alternating left and right.“

That’s how young mothers in Cabanglasan receive manifold support to give their child a healthy start into life.

Translation: Ulrike Peter

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