Nov 032014

Cleft lip and palate repairs in Tagaytay City, Philippines

I joined an American charity called PAGES (Philippine American Group of Educators and Surgeons) for a week from Feb 7th to 15th. This is the 24th year that this group has been coming to the Philippines; performing cleft lip and palate operations for those who are unable to get this care normally.

This year the mission was set up in a small community maternity hospital in Tagaytay City, in Cavite a province 50 miles south of Metro Manila. Before our arrival the advance team had set up the existing delivery and theatre area into our temporary theatre complex. Moving and unpacking theatre tables, anaesthetic machines and surgical equipment from the groups warehouse storage unit in Manila. This just left the set up, unpacking and checking of the anaesthetic and surgical supplies for us to carry out on our first day before operations started.

The medical team included: eight anaesthetists (six from the uk either in their final year of training or post CCT); nine surgeons (four trainees – two from US and two from UK); two paediatricians; and seven nurses. Eight local nurses from the region also joined the team, however, unfortunately this year there were no additions to the team from local surgical or anaesthetic staff.

Patients were recruited in conjunction with local medical teams, media and local government; and in the week before the mission the pediatricians and lead surgeon screened these patients. In total the group performed 103 procedures (46 cleft palates, 53 cleft lips and 4 other facial operations). I anaesthetised 17 patients in total: 11 cleft lip repairs; four cleft palate repairs; one cleft lip and palate repair and one otoplasty; six were aged under one years, four 1–5 years, four 5–16 years and three were over 16 years.

The clinical problems I faced were unsurprising: pneumonia and URTI; small children; language differences; unfamiliar environment; lack of monitoring, drugs and equipment; and the sole use of oxygen cylinders rather than pipeline gas.

I found that my non-technical skills were challenged the most and although this mission has helped me improve these significantly. It has highlighted that they are the more problematic and complex side of anaesthetic practice.

On this mission the risk benefit balances were different to the UK system. In some cases if a child were to be cancelled it was thought that there was a risk that they would never get the procedure completed. So this led to challenging decisions for individuals and the mission team as a whole. On multiple occasions a difficult balance of risks and benefits had to be assessed.

Despite the many complex situations and challenges that I faced I thoroughly enjoyed my time on the mission. As well as being fortunate enough to be able to provide much needed medical care to the local population and help local healthcare staff further their learning it has really highlighted how fortunate we are in our UK system. My time on this mission has helped to rejuvenate my enthusiasm for medicine and made me appreciate our NHS system again.

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