THE

BRITISH

PALAWAN

TRUST

2018

ANNUAL

REPORT

BRITISH PALAWAN TRUST

Aims of the Trust. “ ..to relieve sickness and suffering and preserve and protect the health of the people in Palawan in the Philippines particularly by the establishment and maintenance of an Orthopaedic Project.”

Registered Office:

The Orthopaedic Department,

The Ipswich Hospital,

Heath Road,

Ipswich, Suffolk, IP4 5P

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2017-2018

Mr. Louis Deliss FRCS. Chairman.

Mr Mark Bowditch FRCS (Orth).

Dr Stephen Ball, BSc, MB, BS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Miss Clare Marx CBE, PRCS.

Mr Sam Matthews.

Mr. David Sharp, MD, FRCS.

Mr. Mike Shanahan, FRC

Dr Phyllis Turvill, MB, BS.

Public Benefit Statement

The principle charitable purpose of the Trust is "the advancement of health" by providing medical care for the people of Palawan (population about 800,000) in particular the indigent people. The care is specifically for those with orthopaedic conditions, congenital deformities and those affected by musculoskeletal trauma. We also provide for "the relief of those in need by reason of disability" through our Community Based Rehabilitation Service and workshop.

In addition, we work for "the advancement of education" through training courses where we teach our methods to other health care workers and doctors.

These fulfil the Charity Commission purposes b), d) & j).

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

THE BRITISH PALAWAN TRUST

CHAIRMAN’S REPORT 2017-2018

The work of Bahatala is providing much needed help especially for the poor people of Palawan. The various elements, Physiotherapy, Rehabilitation, Club Foot treatment, stroke therapy, artificial limbs, splints and braces, and various methods of supporting Persons With Disability are appreciated and needed by the population. I must once again say thank you to all the staff of Bahatala and special thanks to Dr Favila, a local Orthopaedic Surgeon who attend the clinic in a regular basis.

Looking at the financial report from Bahatala the situation looks much better. They are getting a substantial amount locally from NORFIL (https://www.norfil.org/) and from personal donations from Philippines and USA.

A little under half of the funding for Bahatala is still coming from BPT but there are increasing donations from within the Philippines and from the US diaspora. The two groups CBM and NORFIL help a great deal. Norfil is now a Philippine charity supported by Lillianes Fonds, the Dutch charity, and a Norwegian charity as well as getting donations locally. Unfortunately, you will see from the accounts that the income of BPT has fallen. We are able to send the same amount each year because of reasonably healthy reserves. Bahatala must continue to find more money locally and BPT must increase its income. The imbalance between income and expenditure is increased by the exchange rate which has fallen to between 65 and 70 pesos to the pound which I think is realistic and I hope will remain steady. There are many Trust funds in UK that give to working charities and we must exploit these.

The Trust in UK still gets the bulk of its donations from doctors on the mailing list who are stimulated to give by the very good news-letters that Cecile writes, and the staff send from Palawan. The cost of the news-letters has gone up due to the cost of postal stamps. We might save money by sending them from the UK, but I feel they would lose impact.

I believe that the Trust should be looking for some new and younger Trustees. As in previous years I would encourage some other Trustees to visit Palawan which they would find interesting and rewarding. The sooner the better as tourism is growing which makes some places on the island are becoming crowded and a bit less enjoyable. I feel privileged that I saw Palawan before it was developed.

Finance

There is a summary of the financial position at the end of this report and a separate full report by our accountant Beatons Group.

At the present balance we have about ten years covered by reserves.

Suggestion about increasing the donor mailing list or finding other sources of income would be very welcome. I already get a few thousand from some donor trusts plus help from others such as Rotary but if you know of other funders please let me know.

Louis Deliss

THE BRITISH PALAWAN TRUST

REPORT OF CHAIRMAN’S VISIT 2018

I visited Palawan from 7^th March to 28^th March 2018. The total flight is about 24 hours, so I pay for an upgrade to business class which makes it more bearable for an old man! I stayed in the same hotel in Puerto Princesa that I have used for over twenty years. It is very simple, and I now know many of the staff.

Much has changed on the island especially in the capital, Puerto Princesa. The traffic is now a major problem despite some road improvements. The number of tricycle taxis and private cars has increased beyond recognition. People many of whom seem much more affluent seem more numerous. There are now two huge shopping malls and many more shops and eateries. Fast food is unfortunately becoming the norm for many.

Bahatala on Abanico Road is much the same and the hard-working staff have not changed. I spend most of my time in the clinic seeing some patients and talking to the staff. I went on Out-reach Clinic visits which are an integral part of the unit’s work. These are arranged with local medical social workers. The girls visit small towns and individual houses which means many new patients as well as follow up of old ones. It is on these visits that one sees the huge largely unmet need of the population for simple health care support. The disabled (called in the Philippine “Persons With Disability” or PWDs) are a group that can often be helped with minor aids and simple physiotherapy.

We all visited some local sights. These visits are mainly for “team building” but also for interest and education. One place was an organic farm growing turmeric on a fairly large scale. It is run by a Pilipino entrepreneur who has set up similar farms on other islands and has several small shops selling turmeric in various forms. He may turn out to be of help funding Bahatala. I visited again the Crocodile Farm, now a wildlife zoo, mainly to get photos of the Palawan Peacock Pheasant for our local vet who is an expert in worldwide pheasants.

Food is important in the Philippines and I tried some new restaurants trying to avoid the fast food outlets. There is a new one nearly opposite the clinic in Abanico Road. This time I did not eat anything exotic or new as I have tried most things. I must pluck up courage to eat Balut, which are duck eggs left under the mother duck for 28 days and then hard boiled. There is a partly formed duck embryo inside.

Overall my visit inspired me to work harder to get the necessary funds for the unit to continue and encourage others to do the same.

Louis Deliss

BRITISH PALAWAN TRUST

Summary of Accounts 2017-2018

		£
Total income		33,412
Charitable expenses		40,131
Total other expenses		2,739

Deficit for the year		9,421

Total reserves		96,277

Our accountants, Beatons, have produced a separate full financial statement.

The financial statements are produced according to The Deeds of Declaration of The Trust. The Income and expenditure accounts are limited to transactions in The United Kingdom. Accounts are monitored in Palawan by Bahatala Inc. The chairman makes regular visits to Palawan to check local accounts and expenditure, and to attend board meetings of Bahatala Inc.

It should be noted that the surplus is maintained for the following agreed purposes,

1. To allow continuation of the Trusts work if donations are insufficient until such time as new funding can be identified.

2. To provide for future capital expenses.

3. To allow for any local natural disasters.

4. To allow for unexpected incidental expenses.

5. To compensate for fluctuations in the money exchange rates.

Bank. HSBC

41, Woodbridge Road East

Ipswich

Suffolk, IP4 5QN.

Independent Examiners Beatons

and accountants. Chartered Accountants

York House

2-4 York Road

Felixstowe

Suffolk, IP11 7QG

~~~~~~~~~~~~~~~~~~~~~

This Annual Report and the Report and Financial Statement (Beatons) were accepted at The Annual General Meeting of the Trust Board held on 13^th January 2019.

Louis Deliss M.B., Ch.B., F.R.C.S.

Chairman of the Trustees.

BRITISH

PALAWAN

TRUST

2017
ANNUAL

REPORT

BRITISH PALAWAN TRUST

Registered Office:

The Orthopaedic Department, The Ipswich Hospital, Heath Road, Ipswich, Suffolk, IP4 5PD

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2016-2017

Mr. Louis Deliss FRCS. Chairman.

Mr Mark Bowditch FRCS (Orth).

Dr Stephen Ball, BSc, MB, BS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Miss Clare Marx CBE, PRCS.

Mr Sam Matthews.

Mr. David Sharp, MD, FRCS.

Mr. Mike Shanahan, FRCS.

Dr Phyllis Turvill, MB, BS.

Public Benefit Statement

The principle charitable purpose of the Trust is “the advancement of health” by providing medical care for the people of Palawan (population about 700,000) in particular the indigent people. The care is specifically for those with orthopaedic conditions, congenital deformities and those affected by musculoskeletal trauma. We also provide for “the relief of those in need by reason of disability” a Community Based Rehabilitation Service. In addition, we work for “the advancement of education” through a Training Centre where we teach our methods to other health care workers and doctors.

These fulfil the Charity Commission purposes b), d) & j).

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

THE BRITISH PALAWAN TRUST

CHAIRMAN’S REPORT 2016-2017

The year has been one of consolidation. This is especially true of the workshop since the additional training and equipment following the visit of Udo Forster, the Australian Prosthetist. The new modular prostheses are much quicker to make and easier to repair and adjust. This is especially important for growing children.

The clinic still treats many different conditions and patients. The Club Foot clinic is very busy with new and old patients each week. Dr Favila attends most weeks and carries out all the tenotomies on babies in the clinic. The older patients need in-patient care and general anaesthetic which we are able to fund with the help of Norfil. There is the usual stream of post injury patients and those with orthopaedic pains, back, knee, etc. as well as the stroke patients. The clinic was boosted by a visit by Johannes Hemmelar. Johannes is a Dutch physiotherapist currently working in London. He first visited many years ago as a VSO volunteer. The staff were all delighted to see him again and benefited from his tutorials.

Outreach clinics visiting other towns and villages (barangays) continue to be important. They provide a service to remote areas and patients. Some patients need to come to Bahatala, and these visits allow follow up without the patient having to travel. Travel in Palawan is not easy. The Jeepneys and busses are quite expensive for the poorer people and can take many hours. Some even must take a boat from islands and villages without roads and then a Jeepney. For some the whole trip to Bahatala takes a few days during which time the patients and parents are unable to work. The clinic staff also make home visits to follow up patients some of whom have been treated with home traction, mainly hip fractures, and femur fractures in children.

Cecile works very hard but has been able to delegate some of the administrative work to the existing staff. She is however still essential and one day will have to train a successor.

Stephen Ball and some of his family visited Palawan during the year. They had a wonderful time and I am sure that Stephen would talk to any other Trustees who are planning a trip to Palawan. Some areas like the Underground River and El Nido are getting rather overfull with tourists, there are many unvisited beaches, towns, villages, and jungle landscapes to be discovered.

Finance

You will see that income has fallen below expenses. This is a result of lower a donation total. Fortunately, we still have about 500 loyal donors many of whom have increased their donations. We have lost some donors mainly though death but some who move do not let us know their new address. There has been some increase in funding from within the Philippines and an increase from the Filipino diaspora in the US.

There is a summary of the financial position at the end of this report and a separate full report by our accountant Beatons Group.

Suggestion about increasing the donor mailing list or finding other sources of income would be very welcome. I already get a few thousand form some donor trusts plus help from others such as Rotary but if you know of other funders please let me know.

Louis Deliss

THE BRITISH PALAWAN TRUST

REPORT OF CHAIRMAN’S VISIT 2017

I visited out unit in Palawan in late March 2017. I was pleased to find that the whole unit is busy and providing a need especially for the indigent patients.

The Clinic has two Physiotherapists and one Nurse. They continue to deliver physiotherapy for CP children, post-injury patients and stroke patients in the early phase of recovery. There are still a small number of acute injuries and fractures that attend the clinic. Some have insufficient funds for the “essential operation” recommended by one of the local Orthopaedic Surgeons. Why is it that the modern Orthopaedic Surgeon believes that fractures will not heal unless internally fixed and have no concept of non-operative management? The staff make a full assessment and arrange for X-rays (if not already done) and then often send it all to me and together we decide on management. This involves plaster cast or home traction but if these are not appropriate we try and help them to raise the necessary funds. We visited one such patient who had suffered a per-trochanteric fracture about a month earlier and been treated with home traction. Such patients heal very quickly in the home environment and we took off the traction and started her walking. In addition, the unit hosts the Ponseti Club Foot Clinic which is attended by Dr Favila one of the new young Orthopaedic Surgeons. He carries out the tenotomies and he will see other patients that the staff are worried about. There are about 16-20 new patients a year out of the theoretical 20-25. The message about this clinic has yet to spread to some of the more remote villages especially in the far south and the smaller islands.

Out-reach clinics have become an important part of our work. These are arranged with the local Medical Social Workers, who compile a list of orthopaedic cases and persons with disability for the clinic. The team that goes out usually includes the Physiotherapists and the Nurse but may take Romy (the Prosthetist) and Reymon depending on the needs of the patients. Dr Favila often attends which is a great help with new patients and we are most grateful for his support. I went on one of these clinics in a town 2-3 hours drive north. We saw about 40 patients and it was a humbling experience and tested my diagnostic abilities. Treatment was always based on what is possible and available, no clever European horrendo-plasties!

The workshop has been revolutionised since Udo Foerster (the Prosthetist from Australia) spent a year in Palawan. The prostheses are all made using metal component parts sourced from China. This has increased the turnover and reduced the waiting tome for a leg. The production of aids for the disabled is also a busy part of the work. We make special chairs for CP children and some adults. We provide wheelchairs (Supplied by the Mormons) and help train users in maintenance and carry out some modifications. Reymon, the carpenter and metalworker (he also makes legs) can turn his hand to anything such as making new furniture for the clinic.

An increasing amount of funding is coming from with the Philippines and from the Filipino diaspora in USA. The Philippine sweepstakes will pay for artificial limbs for the poor and Norfil in Manila (supported by a Dutch Charity, Liliane Fonds) will pay for the treatment of children up to the age of 18. We still get significant help from Christoffel Blindenmission (CBM).

I spent most of my time in the clinic trying to teach and encourage the staff. But it was not all work, I have many friends in Puerto Princesa made since my first visit in 1992. I therefore attended many parties and dinners. The whole of the staff went on a “bonding” trip. This involved going up a river with jungle down to the water’s edge by boat. We then walked a short distance to “The Mother Tree” a huge Dao tree where we had a picnic.

Finally, I must thank our very loyal donors in the UK without whom we could not continue.

Louis Deliss

Report Visit to Palawan 2017

By Johannes Hemelaar, Physiotherapist

Introduction

From 28 February to 18 March 2017, I visited Palawan to see how Bahatala had developed over the years and at the same time of course took the opportunity to meet old friends and colleagues again. In January 2017, I wrote a Proposal for the Board of Trustees of the British Palawan Trust, outlining the goals of my visit. This report will cover the points in the Proposal. Towards the end of my stay I had the pleasure of sharing my thoughts with the Chairman of the British Palawan Trust, Mr Louis Deliss.

Orientation of Rehab Services

My fist goal was to see how Bahatala had continued to provide rehab services to the people of Palawan. During my visit, I got the impression that the target group was largely the same as when I was a VSO volunteer. The focus on the orthopaedic outpatient element was clearly less than before. This element is now largely linked to the presence of the young orthopaedic surgeon and Palawenian Dr Favila. He is an important referral source, holds regular clinics at Bahatala on a voluntary basis, and oversees the weekly Clubfoot Clinic on Wednesday afternoons (also voluntarily). During my stay he took part in the Outreach Project, involving two days visiting clinics at Brook’s Point in the South of Palawan. I was fortunate to travel in his car and share his clinic and clinical reasoning and discussion. I noticed that he, as well as the rest of the team welcomed the event, almost as a thing to be part of. It was certainly good for team building.

This visit I saw Bahatala on its own compound with the treatment centre and orthopaedic workshop for the first time. It was very well kept, clean (much cleaner than in the time when located on the hospital compound), well organised, spacious, and with visible treatment resources available. In terms of quality, the facilities resemble more private than public health conditions. The designs of the buildings and the staff make Bahatala attractive for foreign/international organisations, such as Liliane Fonds, the team of German Plastic Surgeons that visits Bahatala annually, and Christoffel Blindenmission (CBM). For the latter Bahatala and other partner organisations were invited to present their reports during the annual CBM conference in Manila. Cecile Socrates and Administration Officer Deng designed the report, after which Deng travelled to Manila to present the slideshow. On her return she told us that Bahatala’s presentation stood out from the others. The element of pictures detailing the visible progress of patient conditions over time stood in contrast to dry textual reports submitted by other agencies. It clearly impressed the audience in Manila.

During my stay I learnt that over the last years Cecile has increased the community involvement. She has systematically planned outreach clinics all over Palawan. I took part in a two-day outreach trip of the team to Brook’s Point in South Palawan. It was a follow up from an earlier visit about a year ago. In preparation to the clinic activities, Cecile contacts the local Health/Social Authority to explore if the initiative is welcome, and to make a suitable selection from the patients locally. On arrival in the community venue and staff support are provided. In our case the mayor paid for the cost of accommodation and meals. She also paid a visit to our clinic in action. Our team consisted of clinicians only: the orthopaedic surgeon Dr Favila, the two physiotherapists Angel and Jane, the nurse Mitch and myself. Cecile remained in Puerto Princesa. The clinics were very well visited with adequate crowd control. All team members appeared to work well together. Following assessment, a treatment plan was proposed, which could include a Home Exercise Programme, self-help advice, recommendation to visit Bahatala for treatment, and provision of mobility aids such as wheelchairs. The latter were donated by The Mormons Charity. The wheelchairs were of high quality (good for off-road conditions) and aesthetically pleasing. Transfer paperwork was completed, and I was asked to take pictures with patients and their mobility aids to be added to the reports. Several team members updated me about various other locations that have been selected and visited in the past.

Clinical activity in Puerto Princesa, dealing with patients

Bahatala welcomes patients from a variety of referral sources.

1. Referrals from Dr Favila;

2. Self-referral (word of mouth);

3. Referral from local Health/Social Authorities (outreach clinics);

4. Referrals from local medical officers.

The last referral source can raise a dilemma such as prescription/request of frequency and type of treatment not supported by the management. I took part in a meeting in Bahatala where a referral was discussed from a rehab specialist, the physiatrist Dr Bartholomeus. He had referred a stroke patient and requested a high frequency treatment including massage. It posed a dilemma for the physiotherapists Angel and Jane, who were instructed by this higher ranked medical officer to carry out treatment not supported by international guidelines and Bahatala principles. This kind of dilemma is best addressed by management or someone medically trained, and with a degree of tact.

During my visits to the clinic I observed regular patient treatment. Sometimes the clinic was quiet with only staff members present. I used such quiet times to give trainings/workshops. Quiet times were not frequent enough to complete all the trainings I had prepared. We managed to have five training/workshops (see below: “Teaching and training”).

Records are kept of patient attendances. In checking the outpatients’ records (more than 100) I observed that note keeping of clubfoot patients had generally a much higher level of detail than regular outpatient treatment. Assessment forms of the latter were very small in numbers. Good quality assessment forms (for spinal, upper and lower limb assessment – usually two or more pages long) were available but not in use. Perhaps the extent of detail in these forms makes them less user friendly. I designed a one-page short assessment form (with emphasis on ease of use) and introduced it in one of the training sessions. I was pleasantly surprised to observe Jane using the form very soon. Note keeping is an area with room for improvement. Patient attendance is irregular, despite the use of an appointment system. As far as I know discharge planning is not as defined as where I work in the NHS in London, where I have a clear cut off point and report back to the referring GP. Feedback to the patient’s doctor by means of a discharge letter could promote awareness of Bahatala in the medical community.

Cecile arrives at the clinic each morning. She is taking care of a number of controls as well as the day-to-day management of the team. Different communication lines, including face-to-face, e-mails, and mobile phones are used effectively. Cecile has an interest in each member of her team, and makes an effort to keep morale high, using variation of activities/locations, delegation of some responsibilities, team building events, provision of snacks/food, and other means. She knows the value of commitment of staff, as this underpins the quality of Bahatala services. Also, Cecile appears to be well aware of team dynamics, and uses a clear leadership role with room for interaction/discussion. It is fortunate that the clinicians also have clinical leadership in Mr Louis Deliss and Dr Favila.

Teaching and training

During my visit to Palawan I delivered five training sessions to the clinical staff (Angel, Jane, and Mitch) involving the following subjects:

Assessment review, screening for red flags, spinal problems, spinal palpation techniques, mechanical diagnosis and treatment (McKenzie approach), differentiation between tendinopathies and articular problems – assessment and treatment, and dealing with chronic and widespread pain patterns. Furthermore, I have provided on-the-job training, involving assessing patients, promoting clinical reasoning, and assisting in a treatment plan formulation.

Also, I gave the admin staff some advice on use of IT, and provided access to Microsoft Office tutorials.

Networking opportunities

Networks can serve different purposes. They can be a referral source for patient treatment at Bahatala, or medical networks can deal with onwards referral where physiotherapy/rehabilitation is no longer effective. They can be used for Continuous Professional Development (CPD). Also, participation in networks can provide financial support.

The medical community in Palawan has increased significantly since 2012, with an increase of specialised services in the form of four orthopaedic surgeons, two neurosurgeons, and the presence of a Pain Clinic. Dr Favila appears well positioned in these circles, with regular meetings and sessions involving continuous professional development (CPD). Regarding patient referrals, at present Bahatala’s main contact with the medical community is Dr Favila. I would recommend exploring opportunities for more contacts. In my opinion Dr Favila would make a good ambassador for Bahatala, as he is clinically trained and well known in the medical community of Palawan.

CPD for Bahatala staff in the form of clinical training would keep the clinicians up-to-date, stimulate professional development, and contribute to morale/motivation. Such training could be provided by external sources such as visiting health professionals from abroad, or perhaps sharing in training with other institutions/health centres on Palawan or maybe even Manila.

Looking at networks for financial support, I would recommend exploring additional funding from the Provincial Health Office (PHO). I have listed the following reasons for requesting a financial contribution.

1. The PHO’s primary aim is to promote/improve the health of the people of Palawan. Bahatala supports the PHO in this vision by means of a wide range of services for a specific patient group. To sustain this support for the people of Palawan (in particular those with disabilities), financial support would aid the PHO in obtaining their goal.

2. Bahatala is already involved in the provincial network via Outreach Clinics, catering for those who have difficulties accessing the services in the provincial capital. The PHO can be asked for financial support to continue with the provision of this initiative.

3. Dr Socrates has been an important public figure in the recent history of Palawan. He has received international awards from the WHO, University of the Philippines, and others. His legacy is dedicated to the health of the people of Palawan. In order to keep his place in history alive, and sustain his legacy, the Provincial Government may consider making an annual contribution to Bahatala.

Disabled people are entitled by law to certain support. It may be helpful to explore which institution in Manila is responsible for this, and if Bahatala would be able to access funds for the disabled people of Palawan.

It is with pleasure that I look back on my visit to Palawan and Bahatala. I found it encouraging to observe that Bahatala has continued on the path that Dr Soc has initiated, and developing in its own direction (with among other things more focus on community/outreach involvement). Also, characteristics such as volunteer involvement, international links, and commitment to the disabled people have continued to be at the core of the project. In my opinion it is the strong commitment of the people such as Cecile, Louis Deliss and others who shape Bahatala to what it is today.

Finally, I would like to express my gratitude to Louis Deliss, Cecile, and the Board of the British Palawan Trust for their support for my visit.

Johannes Hemelaar

April 2017

BRITISH PALAWAN TRUST

Summary of Accounts 2016-2017

		£
Total income		33,780
Charitable expenses		40,450
Total other expenses		3,404

Deficit for the year		10,074

Total reserves		105,698

Our accountants, Beatons, have produced a separate full financial statement.

It should be noted that the surplus is maintained for the following agreed purposes,

1. To allow continuation of the Trusts work if donations are insufficient until such time as new funding can be identified.

2. To provide for future capital expenses.

3. To allow for any local natural disasters.

4. To allow for unexpected incidental expenses.

5. To compensate for fluctuations in the money exchange rates.

Bank. HSBC

41, Woodbridge Road East

Ipswich

Suffolk, IP4 5QN.

Auditors and accountants. Beatons

Chartered Accountants

York House

2-4 York Road

Felixstowe

Suffolk, IP11 7QG

~~~~~~~~~~~~~~~~~~~~~

This Annual Report and the Report and Financial Statement (Beatons) were accepted at The Annual General Meeting of the Trust Board held on 14^th January 2018.

Louis Deliss M.B., Ch.B., F.R.C.S.

Chairman of the Trustees.

THE

BRITISH

PALAWAN

TRUST

2016
ANNUAL

REPORT

BRITISH PALAWAN TRUST

Registered Office

The Orthopaedic Department,

The Ipswich Hospital,

Heath Road,

Ipswich, Suffolk, IP4 5P

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2013-2014

Mr. Louis Deliss FRCS. Chairman.

Mr Mark Bowditch FRCS (Orth).

Dr Stephen Ball, BSc, MB, BS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Miss Clare Marx CBE, PRCS.

Mr Sam Matthews.

Mr. David Sharp, MD, FRCS.

Mr. Mike Shanahan, FRCS.

Dr Phyllis Turvill, MB, BS.

The past year was remarkable for the developments in the Workshop. This was dominated by the presence of Udo Foester. Udo is an Orthotist and Prosthetist funded by the Australian Volunteers for International Development and lived in Puerto Princesa for a year. Initially he spent time assessing our unit and its needs. Then inevitably came requests for equipment, which we were able to fulfil mainly using locally donated funds. Then Udo started training. He began by introducing modern modular manufacturing methods using prosthetic parts he had bought and then by purchasing them from China at a considerably lower price than the European firms. He taught our original technician, Romy, then trained his assistant, Reymon. In addition he involved the staff of the clinic one of whom made a complete leg.

The arrival of the thermoplastic oven towards the end of Udo’s time enabled all the staff to be taught the basics of orthotic assessment and fabrication. We are hoping to get another Orthotist to build on this early training as soon as possible. The development of the ability to make braces is important. The local doctors prescribe a lot of braces and we will be able to make them and charge for them as well as enhancing the treatments available to patients.

The increasing co-operation with the local doctors has continued to develop. The outreach clinics have also been repeated and now encompass many new parts of the province. These have changed a bit as it was found to be more successful to work with the Medical Social Workers (MSW) rather than the Rural Health Units as the MSWs are responsible for supporting Persons With Disability (PWDs) and this is a large group that can benefit from our services.

All these advancements continue to support my optimistic view for the long term.

A full financial report by our accountants, Beatons, is available separately. However there is a summary at the end of this Annual Report. It shows good reserves but we are planning building maintenance and equipment renewal.

The donors within the UK both individuals and various Trusts have maintained their loyal support so that income has been good. We also carry on getting support from CBM. Norfil (who have taken over the work of Lillianes Fonds) and PCSO (Philippine sweepstake). We are also getting increasing donations locally both direct and into the clinic donation box. This is helped by a number of Filipinos living in the USA. Suggestions about how we might increase our income would be gratefully received.

All the staff and the members of the Board of Bahatala Inc. are looking forward to meeting some of the other Trustees in the near future.

I visited Palawan and our clinic and workshop in March 2016. I come back more inspired and optimistic than ever. The last twelve months have seen much changed. Udo Forster an Australian Prosthetist and his wife and three lovely daughters lived in Puerto Princes and I think thoroughly enjoyed their stay, we certainly did. Udo’s work is described above in the Chairman’s Report

Udo’s job description was to modernise the methods and equipment in the workshop. We have been making prostheses and other aids for persons with disabilities for twenty years but were still using the techniques that we started with. Mrs Socrates and I had been worried about this for some time especially as our in-house prosthetist is nearing retirement age. Our worries were quickly dispelled by Udo’s enthusiasm and work ethic. He soon identified our needs. He introduced new, modern techniques to the prosthetist and also involved all the other members of staff. He reorganized the layout of the workshop and requested new equipment which with our funds and locally raised funds we were able to purchase. Now we have three people who have made legs from start to finish independently. This is one reason for my optimism and we are very grateful to Udo and the Australian Government.

The other optimistic development is the change of emphasis and working methods of the Clinic. We have one attending Orthopaedic Surgeon on one afternoon a week. He really comes for our thriving Ponseti club foot clinic but will see other patients.

The emphasis of our unit is now more on persons with disability (PWDs) and we have found that working with the Municipality Medical Social Workers rather than the Rural Health Units allows us to help many more patients. We still help many people with fractures and other orthopaedic conditions some we can treat, others need finance and an appropriate referral. Unfortunately, the cost of healthcare is too high for the majority and the standard of specialist ability (all specialties) is generally low with resulting poor patient confidence making some opt for no treatment or to attend ‘faith healers’ (hilots). The generally low standards coupled with the total lack of any commitment to post-graduate education is very concerning for the future. I have offered to help develop some form of CME but can’t even get the three or four orthopaedic surgeons to meet. They perceive that they are in competition and are jealous of their income. (Thank goodness for the NHS). The recent Lancet Commission has some ideas and leads as did the GSF Conference at the RCS that I hope will help.

I was not idle whilst there. I saw many patients and treated some. Two patients with un-displaced tibial fractures were initially told there were no doctors in A&E as it was a ‘holiday’ then that they would need to find over 100,000 pesos (£1700) as a down payment for the “essential” surgery. I put the both in POP casts with weight bearing. The youngest aged 7 was clinically healed before I left.

We also went on “out-reach” clinics to two remote towns. There we saw between 40 and 90 patients a day. The spread of diagnoses was truly incredible. A 30 year old man who had dislocated his knee twenty years before leaving him with an under developed leg and a 90 fixed flexion at the knee. We gave him a pair of crutches. Many were easier, lots of children with cerebral palsy needing wheelchairs. Older patients after stokes needing physio, walking aids or wheelchairs. A not insignificant number of amputees who were waiting for legs or who did not know how or where to get one. The national sweepstake funds support the cost of limbs for indigent patients. There were many other patients some of whom can be seen on the British Palawan Trust Facebook page.

There is still a good flow of funds from our loyal supporters. This is supplemented by grants from other European charities and from donations from the USA. Locally we get an increasing amount into the donation box in the clinic, from local donors and Philippine government sources.

It should be noted that the surplus is maintained for the following agreed purposes,

1. To allow continuation of the Trusts work if donations are insufficient until such time as new funding can be identified.

This Annual Report and the Report and Financial Statement (Beatons) were accepted at The Annual General Meeting of the Trust Board held on 8^th January 2017.

THE BRITISH

PALAWAN TRUST

2014
ANNUAL REPORT

BRITISH PALAWAN TRUST

Registered Office:

The Orthopaedic Department,

The Ipswich Hospital,

Heath Road,

Ipswich, Suffolk, IP4 5P

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2013-2014

Mr. Louis Deliss FRCS. Chairman.

Mr Mark Bowditch FRCS (Orth).

Dr Stephen Ball, BSc, MB, BS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Mr. Ivan Hudson, FRCS.

Miss Clare Marx CBE, PRCS.

Mr Sam Matthews.

Mr. David Sharp, MD, FRCS.

Mr. Mike Shanahan, FRCS.

Dr Phyllis Turvill, MB, BS.

The principle charitable purpose of the Trust is “the advancement of health” by providing medical care for the people of Palawan (population about 700,000) in particular the indigent people. The care is specifically for those with orthopaedic conditions, congenital deformities and those affected by musculoskeletal trauma. We also provide for “the relief of those in need by reason of disability” a Community Based Rehabilitation Service. In addition we work for “the advancement of education” through a Training Centre where we teach our methods to other health care workers and doctors.

The year saw a new beginning with the move to our new site in Abanico Road. This was a long time in gestation and was one of Soc’s dreams which he saw started but not completed. Cecile and the staff of Bahatala have worked very hard to achieve the dream and make it work.

The move from the very dilapidated and threatened old building in the grounds of the Provincial Hospital was accomplished in June 2013. Immediately patients started attending especially as the access to the clinic is so easy for those in wheelchairs and with walking difficulty. There were some problems without the medical input from Soc but we quickly developed a system. The girls in Bahatala took a history and made an examination sometime supplemented by an X-ray and sent the details to me by e-mail. Then by return e-mail or by using WeChat I could give some advice. This was often physiotherapy and sometime application of a simple cast but at other times the patient needed to be sent to one of the four orthopaedic surgeons or other specialists. We helped such patients to raise the necessary money for medical fees.

The new workshop also started work, Romy making artificial legs and braces, and Reymon making many pieces of equipment for the disabled. They were also busy making final touches to the buildings. Reymon and Mang Andres had done much of the work such as making windows, grills and furniture.

hen an exciting new venture occurred in September. Steve Mannion (Orthopaedic surgeon in Blackpool & Malawi) supported by CBM and Global Clubfoot Initiative ran a Ponseti course. This added greatly to the skills of the staff in Bahatala to replace those that Soc had learned at such a course in Finland. In addition Dr A Favila a local, new orthopaedic surgeon attended. He was shown how to perform the necessary Achilles tenotomies. These he now does under local anaesthetic in the clinic. He attends every Wednesday afternoon to assess and treat the club feet. Romy makes the braces that he was shown by the Prosthetist who came with Steve. So now Bahatala is the Ponseti centre for Palawan, one of the first in the Philippines. We also have an orthopaedic surgeon who teaches the girls and assesses other patients meaning that I receive fewer e-mails with patient problems. Naldz Favila often accompanies Cecile and other staff when they go on out-reach medical visits. Cecile continues to run the whole unit the future for which I believe is very good.

There is a full examination and report from our auditor, Beatons. But there are some things that need expanding.

Income has remained fairly good thanks to our generous and loyal donors in the UK. There has been a slight drop in donations which this year was slightly offset by a legacy. We have covered the cost of buying land and building the new clinic and workshop without using all our reserves. This is mainly due to the generosity of Dr Phyllis Turvill. Our reserves now stand at about two years of expenditure which is within the limits advised by the Charity Commission.

We are still not certain if the costs of the new clinic are as I suspect somewhat higher than for the old building but so far we seem to be living within our income. I have been trying to get new donors but with limited success possibly a bad time to ask for money but as the recession fades maybe we will be more successful. We continue to be supported by the Oak Trust, the Cadburys Trusts and others including some Rotary Clubs notably the Vikings in York. Income from within the Philippines is still too low and Cecile and I will be exploring this when I visit in February.

Suggestions about how we might increase our income would be gratefully received.

It should be noted that the surplus is maintained for the following agreed purposes,

1. To allow continuation of the Trusts work if donations are insufficient until such time as new funding can be identified.

This Annual Report and the Report and Financial Statement (Beatons) were accepted at The Annual General Meeting of the Trust Board held on 18^th January 2015.

THE

BRITISH

PALAWAN

TRUST

2012

ANNUAL

REPORT

BRITISH PALAWAN TRUST

Registered Office:

The Orthopaedic Department,

The Ipswich Hospital,

Heath Road,

Ipswich, Suffolk, IP4 5P

Registered Charity number ~ 328651

Web site: www.britishpalawantrust.org.uk

BOARD OF TRUSTEES 2011-2012

Mr. Louis Deliss FRCS. Chairman.

Mr. Andrew Gibbs, BSc, FRCS.

Mr. Andrew Gunn, MA, FRCS.

Mr. Jeffrey Hallett, FRCS.

Mr. Ivan Hudson, FRCS.

Mr. John Powell, FRCS.

Mr. David Sharp, MD, FRCS.

Miss Clare Marx CBE, FRCS.

Mr. Mike Shanahan, FRCS.

Mr R Baxandall, FRCS (Orth).

Mr M Bowditch FRCS (Orth).

Mr J Hopkinson-Woolley FRCS (Orth).

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Public Benefit Statement

The principle charitable purpose of the Trust is “the advancement of health” by providing medical care for the people of Palawan (population about 700,000) in particular the indigent people. The medical care is specifically for those with orthopaedic conditions, congenital deformities and those affected by musculoskeletal trauma. We also provide for “the relief of those in need by reason of disability” a Community Based Rehabilitation Service. In addition we work for “the advancement of education” through a Training Centre where we teach our methods to other health care workers and doctors.

These fulfil the Charity Commission purposes b), d) & j).

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

THE BRITISH PALAWAN TRUST

CHAIRMAN’S REPORT 2011-2012

I have to report the tragic death of Soc which has overshadowed everything. He died of a massive heart attack whilst on his usual early morning swim. I have included a brief obituary in this report although it occurred in the year after the period covered by this Annual Report. There is a fuller obituary on the Trust web site.

In the year to March 2012 the work in Palawan continued unabated. The path to the Bahatala building in the hospital compound became more and more difficult due to the construction works for the new extension of the Provincial Hospital. Despite this many patients attended but some, those in wheelchairs and with strokes, found great difficulty getting to the clinic. One of our Physiotherapists resigned towards the end of the financial year, as she had to return to her home to assist her mother who runs a Call Centre. This means the staff now consists of two Physiotherapists, a Nurse, two technicians and two in the office with Cecile overseeing them all. We also now have an auditor, Charlie, who visits on a regular basis and provided a full audit at the end of the year (31 December in the Philippines) to satisfy the Government’s requirements.

There continued to be some difficulty with the Director of the Hospital, Dr G Juan. He has an Orthopaedic interest and still resented that Soc and Bahatala provided the indigent patients with free treatment. He is due to retire in August 2012 so the relationship with the hospital should improve. The Secretary for Health (based in the Department of Health in Manila) is very keen to support this beneficial co-operation. In fact he has expressed the desire that the British Palawan Trust should act as an advisor to the Philippine Government as they wish to set up similar units attached to the Government hospitals in all the provinces of the Philippines.

Work at the new site in Abanico Road has got on quite well despite the early start of the rainy season. I met with our Architect who is very enthusiastic about the work. We agreed to use some of the additional funds from a generous donation from the Girdlers Company to authorise the hiring of a mechanical digger to speed up the work on the foundations. The Architect was hopeful that the building could be finished by spring 2013 at the latest.

The finances remain healthy with a good response to our special appeal. It is gratifying that the “credit crunch” does not seem to have affected us too much as our regular donors have remained very loyal and income from this source had remained about the same. The combination explains the increase total income which also included over £6000 recovered from Gift Aid. The report by Beatons is summarised in this Report and a full audit appended.

I visited in March 2012 and my report is below. I also visited in October 2012 following the death of Soc and a report of this will be included in next year’s Annual Report. I remain hopeful that another Trustee will visit soon. Perhaps the opening of the new clinic in March or April 2013 would be the ideal time.

Louis Deliss, Chairman.

Dr Jose Antonio Socrates MD, FRCSEd.

1948-2112

Dr. Jose Antonio Socrates (Doc Soc) was born in 1948 in Bohol and grew up in the University of the Philippines campus where his parents were Faculty members. He and his eight siblings spent their happy childhood years inside the UP campus where their parents instilled in them the value of sound work ethic, diligence and discipline. All nine children successfully completed their college education.

Soc originally graduated from the University of the Philippines as a Geologist. It was in the field as a geologist that he wondered if he too, like h is brother could be a doctor. He returned to Manila and graduated from the U.P. College of Medicine in 1974. Whilst at Medical School he met and married Cecile who was studying psychology. Soon after he left the country to join the United Nations as a UN Volunteer in 1977 and was posted in Africa.

He did not return to the Philippines for 15 years, during which time he acquired a medical license in the United States. Then he experienced the UK health service working in Bangor, Cambridge and Ipswich. He specialised in Orthopaedics and gained his Fellowship of the Royal College of Surgeons of Edinburgh. In Ipswich that he was shown the non-operative methods of fracture care that he used later. His hospital consultants in Ipswich were so impressed with his work ethic, dedication and resolve to return to his country they formed the British Palawan Trust in 1990 whose objective was to provide orthopaedics and rehabilitation services for the people of Palawan especially to those who could not otherwise afford them.

He arrived in Palawan in 1992 and rapidly became known to the people of Palawan especially the poor. He never charged for his services and expenses were met by the British Palawan Trust. He became the Provincial Heath Officer and medical superintendant of the Provincial Hospital. He changed much in the hospital and built an Orthopaedic ward, funded by the British Palawan Trust. He made himself available for patients every day and all day. For years he was the only doctor with orthopaedic training on the island so was incredibly busy. He treated thousands of patients who would otherwise have no treatment because it was not available or they could not afford it.

Soc found that the facilities were limited so developed his method of fracture management without surgery which he called Appropriate Orthopaedics, outlined in his book, which is still available from the British Palawan Trust. His non-operative methods and giving his services for free antagonised some doctors especially those with an orthopaedic interest. Soc never let this worry him and in fact he rather relished being different but it was a worry for others.

He started a clinic at the hospital, this became Bahatala from Bahay Hawak Tayo Lakad (Tagalog for "house to hold, to stand, to walk”) which remains the headquarters of all the work supported by the British Palawan Trust. In the last year of his life he was working hard to develop a new building that the whole unit could move to. Soc never saw it completed, it will open in 2013. He obtained funds with the help of Handicap International and Tahanang Walang Hagdanan (The House without Stairs) in Manila, to train technicians and build a workshop which is the only supplier of artificial limbs in the Palawan. A second technician was trained to repair and modify wheelchairs and make aids for the disabled.

Throughout his work he was very ably helped by his wife, Cecile. She gained a degree in Community Based Rehabilitation in Developing Countries in London. This led to the full development of the rehabilitation services both in Bahatala and the community. They made a wonderful team despite their occasional differences as Soc was not always the easiest person to work with.

Soc has gained many honours. In 1999 the UP College of Medicine awarded him an Outstanding Alumnus Award. In 2005 the International Committee of World Orthopaedic Concern gave him the Arthur Eyre-Brook Medal. In 2007the World Health Organisation awarded him the Sasakawa Health Prize. In 2008 the University Of The Philippines ' Centennial Celebrations awarded him an Outstanding Alumnus Award.

Soc never forgot that he was a geologist and called himself a DOG, a doctor of orthopaedics and geology. It was always a pleasure to go for a walk with him because he could give details of the geology of the area and of every stone he picked up. His hobby was collecting stones with which he built many rock gardens. He became geological advisor to the Province and helped to set up the St Paul Park which has recently become one of the New Seven Wonders of the World.

Soc was a humble man with very simple needs, a wonderful companion in all his activities. I was very privileged to know him. We will miss Soc and remember his enthusiasm, energy and inspiring leadership. The people of Palawan will always be grateful for what he achieved.

Soc is survived by his wife, Cecile, his daughter, April and his Grandson, Ethan. We extend our sincere condolences to them and all his siblings.

Louis Deliss

THE BRITISH PALAWAN TRUST

REPORT OF CHAIRMAN’S VISIT MARCH 2012

I visited in March which was before the death of Soc, to see the work being done in Palawan, Philippines. We now work through a locally registered NGO called Bahatala which is still based in the old building in the grounds of the Provincial Hospital. The work has gradually changed a little over the years. We now have a very active rehabilitation service to complement the orthopaedic work of Dr Socrates (Soc) that treats post-injury patients, amputees, CP children and others with physical disabilities. The rehabilitation is carried out by about (the number varies from time to time) four physiotherapists in our central location and by many and various health workers in the more remote areas, that have trained in our Training Centre. Soc makes visits to the outlying villages taking two of the Physiotherapists and sometime the prosthetist with him. Cecile is also an important part of these visits taking photos for the records, making lists of patients for the German plastic surgery team and arranging funding for indigent patients.

The typical cases seen every day are CP, strokes, post fracture and those requiring prostheses and wheelchairs. The prostheses are made by our “in house” prosthetist. The technician mends and modifies wheelchairs and well as making standing and sitting frames for the CP children. He has developed a padded wooden chair with wheels, the “Reymon Chair” which enables these children to sit up and be taken out of the house.

Whilst there, I saw a great many patients some of whom are more memorable. There were three fresh tibial fractures treated by manipulation or traction and then a cast. All were open fractures requiring intensive wound care. One boy presented with a displaced upper tibial fracture. He had sustained this six months earlier but because he could not raise the money (about £500) required as a deposit by the surgeon (he did not ask to see Soc) he went away untreated. The fracture had healed with gross deformity of the tibial articular surface and now requires osteotomy and fixation. We will arrange for him to be treated in the Orthopaedic Hospital in Manila as Palawan does not have the necessary equipment or good enough theatres – yet.

A 40 year old man who worked as a diver collecting shellfish presented with a collapsed femoral head due to Caisson disease. The only treatment would be a THR but again not available in Palawan and completely outside his ability to pay. THR in Manila costs more in surgeon’s fees than the average in UK.

On our trip to a distant Municipality, Sta. Vincente, my general medical knowledge was stretched by three children. All presented with discharging ears. No otoscope was available but I did find a torch. Two had foreign bodies, probably pebbles, and one a fairly gross infection with, I think, a perforated tympanic membrane. We arranged for them to come to Bahatala where we would refund their travel costs and refer them to a local ENT surgeon.

A number had knee pain following minor trauma. Most of these appeared to be minor medial ligament sprains. One was more difficult as he had injured the knee a year earlier and treated himself with OTC oral steroids and now had a chronic synovitis. One had suffered a gap fracture of the patella but, again, decided to have no treatment as he could not afford it. He had a gap of about 4 inches but walked remarkably well. His worry was a common one in the Philippines that it would develop into a cancer. The swelling of callus if often thought to be cancer and cancerous swellings are thought to be fractures.

There were patients with often minor fractures, Colles and others that had very severe swelling. This is caused by the Hilot, the local traditional healer, who treats every injury with vigorous massage. These healers can often be as expensive as more conventional treatment but like alternative therapists in the West make a good living based on the natural ability of the human body to heal itself. One patient had spent about £600 on ineffectual treatment by one well known Hilot.

It was not all work. We went to a small island for a short stay. It has white coral sand with completely clear and warm sea. A few yards out there are magnificent reefs with corals and fish of every shape and colour. No need for full scuba kit as they are only a few feet down and a mask is all that is necessary. We walked through jungle (rain forest) and groves of coconut palms to visit some patients who lived literally “off the beaten track”. Sometimes this was hard work especially at mid-day when the temperature was well over 95°F with humidity over 85%. At these times the offer of fresh young coconut water (Buco) was very welcome. A small boy often sub-teenage was sent to climb the trees, some over 40 feet high, carrying a machete and without any aids. They are aware that their drinking water, often rainwater, was not safe to drink especially for a European.

I spent some time visiting the site of our new clinic. They have cemented the road outside which makes access easier. The workshop is virtually finished, and then it will become the secure storage for the materials needed to build the clinic. The exact site of the clinic was marked out for foundation digging to start the week after I left. Our local architect is very good and came with an outline model of the new clinic building. It is all very exciting and hopefully we will move in within the next twelve months. We do still need some more funds for this building so please continue to be generous with your donations.

My visit was exciting and enjoyable. I came back filled with enthusiasm and optimism for the future. Soc and Cecile are aware that they cannot go on for ever and are working towards sustainability for both personnel and local funding. Palawan is a wonderful island for a holiday and well worth a visit.

For those with access to Facebook the British Palawan Trust page has some photographs of my visit. I have also updated the web site.

Louis Deliss

BRITISH PALAWAN TRUST

Summary of Accounts 2011-2012

		£
Total income		100,454
Charitable expenses		47,489
Total other expenses		4545

Surplus for the year		48,420

Total reserves		169,343

Our accountants, Beatons, have produced a separate full financial statement.

It should be noted that the surplus is maintained for the following agreed purposes,

1. To allow continuation of the Trusts work if donations are insufficient until such time as new funding can be identified.

2. To provide for future capital expenses.

3. To allow for any local natural disasters.

4. To allow for unexpected incidental expenses.

5. To compensate for fluctuations in the money exchange rates.

Bank. HSBC

41, Woodbridge Road East

Ipswich, Suffolk, IP4 5QN.

Auditors and accountants. Beatons

Chartered Accountants

York House

2-4 York Road

Felixstowe, Suffolk, IP11 7QG

~~~~~~~~~~~~~~~~~~~~~

This Annual Report and the Report and Financial Statement (Beatons) were accepted at The Annual General Meeting of the Trust Board held on 4^th November 2012.

Louis Deliss M.B., Ch.B., F.R.C.S.

Chairman of the Trustees.

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