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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