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Chairman's Jottings
On this page I intend to put bits of news and information that I hope will be of interest.   The idea is to supplement the News Letters. 
I will try and put something new every month or so. 
Please feel free to e-mail me with any questions that you have. Contact.
PLEASE CAN YOU SEND FEEDBACK by e-mail or on our FaceBook page.
Louis Deliss
Chairman
The latest Annual Report has been added.

INDEX

  1. Visit Report 2017

  2. Annual Report 2016.

  3. How to get Soc's books.

  4. Archives.  Old special reports and previous visit reports.

 
Soc
Soc died of a heart attack during his usual morning swim on Sunday 23 September 2012. He inspired and created the British Palawan Trust and Bahatala.   He also inspired all of us who were his friends and co-workers.  There are many thousands of patients who would have never received any treatment without the leadership of Soc.  Obituary below.
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Palawan Visit Report 2019

 I visited Palawan from mid-March until the week before Easter.   I stayed in my usual hotel.   Small but comfortable where the staff know me.

 I take a tricycle taxi to the Bahatala clinic in Abanico Road each morning except on those days when we are doing an out reach clinic.  In Bahatala there are sometimes a patient or two that the PTs want to discuss.  Often it is because the patient needs an explanation from a doctor as they tend not to fully believe the PTs and nurses.   Others need a diagnosis which has to be made on history and clinical examination.   Occasionally patients have already been X-rayed.   I saw backaches, knee pains, shoulder pains and short legs due to untreated but healed hip fractures.

 One day a young girl came asking for help with her mother.  She had been hit by a motorcycle causing a comminuted fracture of lower tibia and fibula.  She was admitted to the Provincial Hospital in Puerto Princesa.   The attending orthopaedic surgeon said she must have “stainless” which is the local word for any fixation device, and that she should find 50,000 pesos (about£800) for the implant (a locking nail) before any operation could be planned.  She is from a poor peasant family and cannot afford this.  She could get it from PhilHealth if she can show she is over 60 and indigent, but she has never had a birth certificate.  When if ever she gets recognition from PhilHealth it will take 1-3 weeks to get final approval and then 3-4 weeks to buy the implant by which time the fracture is likely to be healed in angulation.   The local orthopaedic surgeons have no real idea how to treat fractures without stainless.   The surgeon has offered immediate operation in the private hospital at a cost of 200,000 Pesos (£3500).

 We also went on out-reach visits.  These are done in cooperation with the medical social workers who go around the communities and find patients for us.  They then gather at a central point such as the village hall.   Many are old and some have had strokes so all we can do is give them walking aids such as sticks or walking frames, but this if often enough to make their lives better.   There were the usual high number of CP children many of whom need wheelchairs or the specialist Reymon chairs for which they are measured.   I also saw three children with mildly hypoplastic legs, which I assume is from in utero infection.  There were also one offs such as severe syndactyly and many varieties of constriction band syndrome and some new club feet.   At least the social workers have learnt not to include non-orthopaedic conditions.

 We visited a pair of incredible Siamese twins.   They are now about 4 years old and are joined at the cranium with basically one brain so inseparable.   They have appeared on Philippine television.

 I met up with many old friends and visited some new restaurants.  Puerto Princesa has grown with the most obvious being new hotels and eateries.    The traffic is also much worse until you get out of the capital.   A new menace on the roads are the very large number of tourist buses.  These hold 10-12 and are mostly driven by maniacal speed merchants!

 The Unit is working well.  We seem to have lost the financial support from the German charity CBM.  It is not clear why this is but it seems to be related to a change in attitude to community based rehabilitation which has now been superseded by the two in words “inclusion” and “empowerment” neither of which are well defined nor do they have much practical application on the ground or the need for rehabilitation services.    New “buzz words” seem to have taken over overseas aid.

 Cecile Socrates is very aware that the BPT income is falling.  Fortunately, she has been very successful in raising income from other sources including the Philippine ones.    For this reason, I remain optimistic about the future.

Louis Deliss, Chairman

Report of Vist March 2018

I visited Palawan from 7th March to 28th 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.   Increasing numbers of people appear affluent.

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 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 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.

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.


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

Chairman British Palawan Trust

 

Report of visit March 2016

 I have just returned from Palawan and our clinic and workshop.  I come back more inspired and optimistic than ever.  The last twelve months have seen much changed.  An Australian Prosthetist and Orthotist funded by the Australian Volunteers for International Development was seconded to us.  Udo Forster and his wife and three lovely daughters lived in Puerto Princes and I think thoroughly enjoyed their stay, we certainly did.

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 only have one attending Orthopaedic Surgeon on one afternoon a week.  He really comes for our thriving Ponseti club foot clinic.  This means the emphasis of our unit is 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 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’.  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 undisplaced 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 & 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.

Louis Deliss

December 2015

Udo Foester is coming to the end of his time in Bahatala.   He has been an enormous inspiration to everyone and has changed the clinic and workshop immensely.  He will always be remembered by us all and we are extremely grateful to him, his family and AVID.   we wish him good luck in the future and hope to see him again in Palawan.

PALAWAN REPORT September 2015

It is three years since we lost Soc.   The unit he founded continues and has established itself in the health care system in Palawan.    The amount of work has steadily increased since the opening of the new clinic (The J A Socrates Rehabilitation Centre and Workshop) and even more since the Ponseti club foot training course run by Global Clubfoot Initiative.

 When I was there in February 2015 another exciting development occurred.    A visiting Prosthetist (Udo), funded by the Australian government, started a twelve month posting.   Udo arrived with his wife and three charming children.   The first job was to find them somewhere to live and this was achieved successfully as a friend of Cecile’s was letting her house.

 Udo then had to learn what we do and what our staff were capable of.    Our house prosthetist, Romy, had been trained some years ago and had not had any update training.   Reymon who does all the manufacturing of equipment for the disabled had always expressed a desire to learn how to make artificial limbs especially as he wears one.   Udo spent the next week or two getting to know everyone and see how the whole unit worked.   He came on some visits to outlying villages so that he could understand the practical problems of persons with disability.

 Since then Udo has trained the two men in the workshop in more modern techniques including the introduction of metal lower bits in place of the hand carved wooden ones.   He involved the Physiotherapists from the clinic in assessment and rehabilitation of amputees.  This may involve us in greater cost but we get most of the prosthetic costs from the Philippine system.   I am sure that all this retraining will give the workshop a new spark of life.

 Udo also identified the need to develop our brace and splint making.   The local surgeons prescribe braces for many conditions and there is no facility on the island at present.  The first requirement was a special oven for thermoplastic heating.   Fortunately CBM were visiting and had some funds for special requests and have given us enough for the oven.   We are requesting other bits from a Korean aid agency.   So we hope to have brace making in our abilities to provide a full service for the people of Palawan.

 Meanwhile the work in the clinic keeps the two physiotherapists and one nurse busy.  Wednesdays are the day for club feet.   One of the new local Orthopaedic Surgeons comes to the clinic to perform tenotomies for club foot and will also see any other patients that the staff are worried about.   Since Steve Mannion taught our staff the Ponseti technique we have become the club foot centre for the whole province (now about 800,000 population).     In addition post injury patients and cerebral palsy as well as a few stroke patients keep the clinic full of activity all day.     Cecile arranges with Rural Health Units to visit villages all over the province including some of the islands in the north.    These trips enable us to check on old patients and make arrangements for new patients to come to the clinic for assessment, treatment or onward referral to appropriate specialists.

 We are very grateful to Australian Volunteers In Development as well as our generous regular donors for the assistance with our work.   Please contact me if you have any questions or would like to join our mailing list for regular news letters.

ORTHOPAEDICS IN THE HOME AND VILLAGE

The Orthopaedic Manual written by Soc before he died is now available.  The book called Orthopaedics in the Home and Village describes how those with no or minimal training can care for people with injuries such as fractures and dislocations.   I think that this book is essential reading for anyone working in or visiting low or middle income countries.   It is aimed at everyone not just doctors.

We are asking a minimum donation of £25 to cover costs and postage.  Please contact the Chairman (Louis Deliss) if you would like a copy.

The original book, "Appropriate Orthopaedics" is also still available.

Palawan Report 2015

 

            I visited Palawan for three weeks in February.   This turns out to be a good time to visit because it was “cold” by their standards which meant temperatures at 28-30°C, although on some days it felt somewhat more!  At night it was positively chilly at 25°.  It was also mostly dry as the wet season was over.

            The clinic and workshop were very busy.   The accessibility of the new compound makes it much easier for patients to attend.   Their cars, tricycles and motorcycles can get to a shallow ramp up to the clinic.   It is amazing how many people a motorcycle can carry.  They usually have mum, dad and at least one child on each! Tricycle taxis, built for five plus the driver often have twice that number.   Only a few patients come by car and those that do are usually quite good at putting something in the donation box which is prominently displayed.

Club Foot Clinic

This takes place every Wednesday and the unit is now the official and only Ponseti treatment centre in the province.   There are between two and eight patients at various stages of treatment.   The local orthopaedic surgeon, Dr Arnaldo Favila, attends in the afternoon to assess for the Pirani scoring and to carry out the Achilles tenotomies.   He will also assess other patients that the Physiotherapists bring up on the Wednesdays, and has recently started tutorials for the staff.

Fracture Patients

A number of patients with acute fractures still attend.   Whilst I was there I carried out a Colles reduction and reduced and cast a child’s forearm fracture.   When I am not there the Physiotherapists sometimes arrange an X-ray and send it to me by e-mail for me to suggest treatment.   Others are seen by Dr Favila either in our clinic or in the hospital.    There is still the problem that some patients cannot afford hospital treatment.

            Another group of patients are those seeking second opinion.   They do this mainly because the suggested treatment is nearly always open reduction and internal fixation (ORIF) which they cannot or do not want to pay for, apart from the fear of anaesthetic and surgery.   They have often seen the failure of ORIF which has been due to poor post-operative care or due to infection.  The girls either send me the X-ray and history or show the patient to Dr Favila.

            Patients who have been treated elsewhere come for post-injury physiotherapy and rehabilitation.

CP Children

            There are still far too many children born with cerebral palsy, an indication of the poor obstetric care.   A number come to Bahatala for assessment and physiotherapy.   Many require aids such as wheelchairs or Reymon Chairs (see spring News Letter).   By making them more mobile the life of the mothers is often greatly improved.   We also see other children with congenital deformities or impaired mental abilities.

Stroke Patients

These have been greatly reduced and rules made about the length of treatment.   A local neurologist has helped with this and has done some teaching sessions for our staff.  There are usually two or three such patients on three days a week.

Outreach clinics

Nearly every week Cecile and two or three members of staff visit another Municipality.   These can be nearby and done in a day or more distant when they stay overnight.  Dr Favila comes on many of these visits.

            The visits, often called a ‘medical mission’, are arranged with the local health care works, usually the Medical Social Worker attached to a Rural Health Unit.   The idea is that they gather orthopaedic patients for assessment.  The success of their screening varies so that some patients have other conditions or long standing minor aches and pains.   When I am there this can stretch me as I need to remember basic medicine!   Some patients are given a programme of exercises to do and others asked to attend the clinic.   Some are referred to specialists in Puerto Princesa.  Club foot patients are often picked up on these visits, as are patients with cleft lips who are scheduled to attend when the regular visit of the German Plastic Surgeons takes place usually at about Easter.

Prosthetics

We continue to be the only supplier and manufacturer of artificial limbs, mainly legs, in the province.  Romy, our Prosthetist always has a list of patients he is dealing with.   Unfortunately many amputees are children and they need new legs as they grow or after they break their prosthesis playing basket-ball.  Romy also helps in the clinic by removing casts such as those used for the club foot babies.   See more below.

Workshop

Reymon is equally busy making equipment for the disabled.   His speciality is his design of chairs, wheelchairs and standing frames for CP children.   He also makes various designs of tricycles; some have foot pedals others use hand-power depending on the individual disabilities of the patients. Many of his projects have been featured in the News Letters.  See more below.

 Development

            Whilst I was in Palawan an Australian volunteer arrived supported by the Australian government (AVID).   He is a Prosthetist and came with his wife and three charming daughters.   They will be in Palawan for about a year.  His remit is to asses out workshop; help to up-date our equipment and our techniques.  He has already made good progress.  He has identified an urgent need for a specialist grinder for which we have enough money from York Vikings Rotary and a donation by the German Plastic Surgeons.   He has also started training Reymon to manufacture prosthetic legs and splints.  He is also training the Physiotherapists in assessing patients for and making simple braces such as Ankle Foot Othosess for drop foot.

This week he and Cecile have identified a young man who might take on much of Reymon’s work.   He is an amputee we have known for some time and attends regularly for new legs.   Currently he is working in the workshop to be assessed as to his ability and suitability.   If this is a success it will go a long way to solving the problem of the long term successor for Romy.

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 other improvement is the increasing co-operation with the local doctors which again will be very helpful to the long term of Bahatala.   All these advancements make me even more optimistic for the long term.

 Louis Deliss

Report of Chairman's visit in 2014

Towards the end of our financial year I paid my annual visit to Palawan.   I chose this time of year because it is the “Dry Season” which whilst rather hot (35C “feels like” 40+ with humidity over 85%) I like it and road travel is possible.   During the rainy season many inches of rain can fall in a few hours.

It was wonderful to see the new clinic and workshop both working well with many patients.   Most days were spent in the clinic either teaching or seeing patients.   Every Wednesday there were between two and eight club feet.   Some were new cases and others for re-casting, fitting braces or just for check-up.   I saw a number of fractures.   Some were “fresh” having had no treatment, except by the Hilots (lock traditional healers) but may have happened some days before.   The delay was either due to the distance they had travelled and some because they did not like the suggestion of surgery with its high costs.     If the fracture was simple and minimally displaced we put them into casts or in a few cases set up home traction for hip fractures or femoral fractures in children.

We went on a “Medical Mission” to the north.    We took the two Physios and Naldz Favila came with us.   We saw the usual mixture of diseases.   Many were musculoskeletal pain requiring simple physio, reassurance and simple analgesics.    Paracetamol is easily bought over the counter although some local doctors prescribe the more expensive NSAIDs and such as Tramadol.    Antibiotics are always recommended for all injuries even if there is no wound.    We stayed in some resorts (hotels) with amazing views over the limestone islands in the South China Sea.    We went by “pump boat”, wooden boats with two out-riggers and very noisy engines, to visit the Italians on their remote island.   One of the Italian ladies was stung by a Sting Ray which became infected, I advised that they fly home for which they were grateful.

I also met up with friends in Puerto Princesa and we went for dinner with the Evangalistas.   Susan and Oscar, see previous reports, are great supporters of Bahatala and are on our Board.   I am a member of the Board representing BPT but had to stand down as Chairman because I do not have a BIR (Inland Revenue) number.

Puerto Princesa, the capital of Palawan, has changed over the years.   There are many private cars, mainly large 4x4s and housing estates are being built.   There is a new huge shopping mall with all the normal international small shops in the enormous air conditioned building.

On the way back Cecile and I spent a day in Manila.   Manila is not a city I would recommend spending too much time in but it does have some interesting places to visit.   We went to see the local representative of the Cambodia Trust (now called Exceed International) to talk about the changes in prosthetic manufacture and materials.    I was pleased to find that the methods that Romy has used for many years does not need to be changed in a hurry.

I came away full of confidence for the future of our unit.

Louis Deliss

I have put in some new internet links as some were out of date.  There are some links to the Typhoon below.  Jan 2014.

STOP PRESS TYPHOON NEWS

Fortunately Puerto Princesa (the capital of Palawan) has only been hit by very heavy rain (up to one inch per hour) but not by the severe winds.  The North of Palawan (Basuanga island and other - See my report below) have been  hit badly.  It was the Pacific coasts that suffered the most.   we expect that there will be an increase in injured patients needing our services.  They will start arriving at our unit when the roads are passable again.

I now have a full report from the Palawan branch of the Red Cross.  there was quite extensive damage in the north especially on the islands.   there were about 125,000 people affected with 90% on the islands with 98 injured and 19 dead (so far as some still missing or in areas not yet reached.)    There were 18,000 houses damaged or destroyed.

For those asking how the typhoon affected Palawan go to http://palawanphoto.photoshelter.com/gallery/Typhoon-Aftermath-Images/G0000fsMB0gtCxkw/ where Kat Jack has put her photos.

or try http://www.gmanetwork.com/news/story/335781/news/regions/yolanda-leaves-at-least-20-dead-in-palawan-s-island-municipalities  or http://www.telegraph.co.uk/news/worldnews/asia/philippines/10441336/Typhoon-Haiyan-Our-houses-went-swimming-islanders-tell-British-and-Filipino-rescue-mission.html or 

http://newsinfo.inquirer.net/524675/tourist-haven-coron-suffers-heavy-damage-from-yolanda

Chairman’s Visits 2012 and 2013

             I was unfortunately unable to be in Palawan for Soc’s funeral but went a month later in October 2012.   This was a very sad time.    I hope I was able to support Cecile and the Bahatala staff a bit.   It was wonderful how many local people and ex-patients came to tell us how they admired Soc and how they hoped his work will continue.

 The work was indeed continuing.   I saw many patients both in the clinic and in their homes.   As always this was a humbling experience.    So many are truly indigent and live a subsistence life.   This means that something like a fracture is so devastating.   There are now four young Orthopaedic Surgeons in Puerto Princesa, but they like all doctors work privately.   The patients are told at the first consultation how much money they need to raise in order to be treated.     The amounts, from £200 to £1000 for a limb fracture, are completely out of reach for the families of patients.    Sometimes they pawn their means of livelihood such as land or a fishing boat to raise the money.   Some can get help from the Philippine Lottery but this can take weeks to arrange, not much help with an acute fracture.    The other problem, that I fear is now world-wide, is that the young Orthopaedic Surgeons seem to believe that fractures will not heal without implants and that these must be made of expensive titanium!  I did do some manipulations, without anaesthetic which they all accepted, for simple fractures, and taught the Physiotherapists how to do it.   Fractures that are only minimally displaced we put in POP casts.

I met the British ex-pat community at a meeting with the British Vice-Consul.   I was allowed to address them and asked that they consider raising some money.   A few were very enthusiastic but buy the end of the financial year no funds had appeared.   I will try again.   I also talked to some of the local people about raising money.   I am not too hopeful because the idea of charity donation, apart from to their church, is not in the culture.

 Cecile and I went to visit the new Prosthetic & Orthotic School in one of the teaching hospitals in Manila.   This is a new venture being supported by the Cambodia Trust, which has spread their work beyond Cambodia.   The unit is run by Helen Cochrane of Cambodia Trust and Dr Penny Bundoc a rehabilitation physician.    I hope that they will be able to help and support us.   We already arranged for Romy to go there for some extra training.   They will also help us up date our methods to come into line with the specifications that will be supported by local funds.

 I came back however with a feeling of great optimism for the future of Bahatala and the BPT.

 I visited again at the usual time of year in March 2013.   I like to go in the spring when it is the “dry” season making travel easier.  This visit was much busier as the work at Bahatala had settled a bit.    Much of my time was spent helping Cecile oversee the builders and make decisions about what bits to buy at the local builders merchants.   There seemed to be new decisions every day so it was all very hectic.   We spent many hours discussing how we wanted the unit to develop.  Then we had to prepare for the Blessing by Bishop Arigo.   Bishop Arigo has always been a supporter of and admirer of Soc and his work.   It was he who gave us the land for our Training Centre.   There is a full report of this on the web site with photographs on the BPT Facebook page.  

 I saw many patients in the clinic.  One memorable one was a 14 year old girl with severe cerebral palsy.   She is wheelchair bound but was going to school.  She came because of discomfort sitting for a full day.  We came to the conclusion that the only thing we could do is give her a new larger wheelchair.   This needed to be ordered and I hope will be with her now.    I had to see a 10 year old boy with a fresh forearm fracture.   This was minimally displaced and so as I put on a cast I pushed it straight.   The local people all seem to tolerate this possibly because they know that the village Hilot will cause much more pain.   I did this without any x-rays.   His arm was thin enough to make the full diagnosis clinically.

 We also visited a number of patients at home.  This was mainly follow-up of elderly with proximal femoral fractures.   They had nearly all been treated on traction at home and we were there to advise on mobilisation.   We visited the 21 year old gardener from Bahatala.  He had come off his motorcycle when racing with friends.   A cervical fracture had left him with a fairly profound quadriplegia.    He was lying in his mother house on a bed which as usual had no mattress on the bamboo slats.   He was doubly incontinent and had a urinary catheter.   The inevitable result was a huge sacral pressure sore.    I could not give an optimistic prognosis.

 One patient illustrated the problems seen in Palawan.   A small boy (2 or 3) had been involved in a RTA when riding on his father’s motorcycle.   He was said to have had a head injury but was never unconscious and a fracture of the mid shaft of his femur.   He had been admitted to the private hospital where he had a CT head scan and a double spica cast applied.   They had been told that they should return for a further scan and x-ray.   The parents were not keen on this as the initial bill was £500 and they had pawned some possessions to raise the money.   In addition the girls from Bahatala were convinced that the fracture was being treated wrongly because Soc would have used home traction.     Whilst I agreed that traction would be satisfactory and possibly quicker I had to point out that the spica cast was an entirely acceptable way to manage this injury.   It had the side benefit that the family could all return to Taytay, a four hour bus ride north, rather than stay in Puerto Princesa until union on traction.    Soc had been rather naughty when he openly criticised other surgeons for using a method he did not like and now I have the job of showing the staff that other methods may be acceptable and successful.

 There were as always a number of club foot patients who came for casting or re-casting.   Fortunately the girls are quite competent at this.   I must arrange a Ponseti course in Palawan when I return. (I did achieve this and will report on it next year)

 The last few days were spent in the remote north of Palawan on an island called Cuyo.   This used to house the Philippine leper colony.    We were there at the invitation of the local Rural Health Unit workers.   They said they would get a lot of patients but only managed about 50.   They came with all sorts of conditions.   Some we could help there and others needed to come to Puerto Princesa for full assessment and usually provision of ADL equipment such as wheelchairs.

We took the opportunity to see the area.   This was a boat trip to some of the other islands.   One had a number of fresh water lakes.   These have cold clear water with unique fish in them.    We stopped at a Marine Park, an area of sea where fishing is banned.   The reefs had corals somewhat different to those near the mainland and many types and colours of fish.

The visit showed clearly that we need to develop access to the surgeons working privately in Palawan.   This will be hard work for many reasons.   I did get to meet a General Surgeon who agreed to help with amputations.    I also met the newest Orthopaedic Surgeon who trained in Manila.   I hope we can develop a working relationship with him.

I came away still optimistic but realised that there is much to do to settle the unit into its new roles.

Louis Deliss

 
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Dr Jose A Socrates

1948 - 2012

 Dr. Jose Antonio Socrates (Doc Soc) was born in 1948 in Ubay, Bohol and grew up in the University of the Philippines campus in Diliman where his parents were Faculty members. He and his eight siblings spent their happy childhood years inside the prestigious UP campus in a humble, Spartan home made of “sawali” (woven split bamboo.)    Despite their poor and simple life, their hardworking parents instilled in them the value of sound work ethic and the importance of diligence and discipline in their studies. All nine children successfully completed their college education with careers ranging from education to medical and paramedical professions.

 Soc originally graduated from the University of the Philippines as a Geologist.  It was in the field as a geologist when he met an impoverished and ailing old man from a local village tribe in Isabela (province in northern Luzon) who had insisted he was a doctor because he wore spectacles, that he started to wonder if he too (for his brother was already on the way to becoming one) 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.  An early post was as Prison Medical Officer in Iwahig the huge open prison in Palawan.  Then 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 until 15 years later, during which time he had acquired a medical license and trained in the United States. Then he explored what the United Kingdom's health service had to offer working in Bangor, Cambridge and lastly Ipswich.   He ended up specialising in Orthopaedics and earning his Fellowship of the Royal College of Surgeons of Edinburgh.  It was in Ipswich that he was shown the non-operative methods of fracture care that he put into practice later.   His hospital consultants in Ipswich were so impressed with his work ethic, dedication and resolve to return to his country that they all decided to help him. They formed the British Palawan Trust (a charity registered in the UK) in 1990 whose main objective was to provide health services for the people of Palawan, in particular orthopaedics and rehabilitation, and especially to those who could not otherwise afford them.   Soc worked tirelessly writing appeal letters to doctors in the UK raising sufficient funds to set up his unit. 

 He arrived in Puerto Princesa in Palawan (the third largest island of the Philippines) in 1992.  He rapidly became known to the people of Palawan especially the poor.   He never charged at all for his services and all expenses were met by the British Palawan Trust.   Within a short time he became the Provincial Heath Officer and was head of the Public Health department and medical superintendant of the Provincial Hospital.  He changed many practices in the hospital and built an Orthopaedic ward extension, again funded by the British Palawan Trust.   He made himself available for patients every day and all day.   For many 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 equipment and facilities were very limited so he developed his method of fracture management without surgery which he called Appropriate Orthopaedics that is outlined in his book of the same name.   This is still available from the British Palawan Trust.

His non-operative methods and giving his services for free did antagonise some other doctors especially those who came with a special interest in orthopaedics.   Soc never let this worry him and in fact he rather relished being different but it was often a worry for those around him.

 He acquired the use of an old building in the hospital grounds that was originally the house for the Medical Superintendant but was not being used.   This became Bahatala from Bahay Hawak Tayo Lakad which is Tagalog for "house to hold, to stand, to walk”.   This 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 on Abanico Road that the whole unit could move to.  Soc never saw it completed but it will open in 2013.   He obtained funds with the help of Handicap International (a French charity) and Tahanang Walang Hagdanan (The House without Stairs) in Metro Manila, to train technicians and build a workshop which is the only supplier of artificial limbs and braces in the province.   A second technician was trained to repair and modify wheelchairs and manufacture 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 from London University.   This led to the full development of the rehabilitation services both in Bahatala and in 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 and recognized the fact that he was a "brain gain" in the face of the exodus of health professionals from the country.   In 2005 the International Committee of World Orthopaedic Concern gave him the Arthur Eyre-Brook Medal.  In 2007, in recognition of his work in orthopaedics for the community, the World Health Organisation awarded him the prestigious Sasakawa Health Prize. In 2008 the University Of The Philippines ' Centennial Celebrations awarded him an Outstanding Alumnus Award for his work, in particular for services to those who can least afford them.

 Soc never forgot that he was a geologist and called himself a DOG, being a doctor of orthopaedics and geology.   It was always a pleasure to go for a walk with him because he could give full details of the geology of the area and of every stone he picked up.    His hobby was collecting stones with which he built rock gardens wherever he was at the time.   He became geological advisor to the Provincial Government and became very involved in the Philippine claim to the mineral wealth around the Spratly Islands on the Palawan Shelf.  He helped to set up the St Paul National 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 all miss Soc and will remember his enthusiasm, energy and inspiring leadership.  The people of Palawan will always be very grateful for what he achieved.  We must continue his work. 

 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.

 

There will be changes but we owe it to his memory to continue his work.
On a personal basis I am very grateful that he opened my eyes to the needs of the people of Palawan.   I and his family will miss him enormously.

 

Louis Deliss

Chairman of the British Palawan Trust

www.britishpalawantrust.org.uk

Blessing by Bishop Arigo of the building,

the staff and the patients.

The First Phase of Opening the New Clinic

 

I was privileged to be on Puerto Princesa for the first phase of the move to the new Bahatala clinic.    On 13th April the Bishop of Palawan, Bishop Arigo, led a simple service to bless the buildings and those who will be treated there as well as those who work in the unit.

 

Following the Blessing there were a few speeches by Cecile Socrates, myself, Angela Loonen (a Canadian visiting physiotherapist) and Soc’s sister (Luchie) before the traditional merienda food.   We were serenaded by Dempto Anda on the guitar.    Many people were present including the Board of Bahatala, local doctors, staff and helpers, patients who had been helped and a large group of supporters including some from Soc’s family.

 

The building is beautiful thanks to the work of Mr Quipquip (the architect) and supervision by Mrs Socrates.    It has high ceilings and is basically open plan.   This makes it remarkably cool helped by the ceiling fans.   The workshop where artificial limbs and aids for the disabled will be made and wheelchairs repaired and modified is a separate building.

 

The new unit is to be called Bahatala at the Dr J A Socrates Rehabilitation Clinic and Workshop.    Soc was the inspiration and driving force and it is fitting that we remember him this way.

 

There are a few finishing touches before the unit moves all its work there.    We hope that the final move will be completed before June.    Then I anticipate a significant increase in the number of patients because of the improved access and the publicity.

 

We will put more details in the next News Letter.    Meanwhile please continue your support as there are very many people here needing help.

 

See gallery and the BPT Facebook page for photos

 

Louis Deliss

Chairman

 

 

Report from Palawan October 2013

I have just returned from visiting Palawan.   I return in an optimistic mood.   Mrs Socrates (Cecile), the staff of Bahatala and the Board of Directors of Bahatala Inc are all very keen that the work started by Soc should continue.  The patients too hope that we will still provide free services for the indigent population.

The old clinic, Bahatala, in the Provincial Hospital compound is still open to patients.  The Physiotherapists continue to provide rehabilitation and therapy for post injury patients, stroke patients and cerebral palsy children.   In addition they have learned how to apply serial casts to club feet.   The Orthotist is very busy and has a waiting list for new artificial limbs and many people come for repairs.   The technician is carrying on his work repairing and modifying wheelchairs and making equipment for the disabled.   He has many cerebral palsy children needing his “Reymon Chair” (see last News Letter).

Cecile as well as managing the whole enterprise is very busy arranging patients for the Cleft Mission.  This is a group of German surgeons who come every year to treat the patients with cleft palates and hare lips as well as others needing plastic surgical expertise.  Patients with ophthalmic problems come to the clinic and we are very lucky to work with an excellent local eye surgeon.

Whilst in Palawan we went on an outreach clinic visit to Brookes Point, named after a British naval captain who established a base here.   We saw over 50 patients over two days.   They came with many complaints some of which required explanation and to be given exercises by the physiotherapists.   Some needed more and we arranged for these to attend Bahatala the next week.   We reimburse their fares and any other expenses.  There was a boy with a dysplastic hip for whom the local facilities could really do nothing as embarking on pelvic and upper femoral osteotomy would be unwise.  Another needs to be referred to the Orthopaedic Hospital in Manila after his tibial fracture had been treated in a cast for one week three months earlier, which was of course unsuccessful.

I also saw patients in Bahatala every day.  Many were old patients who were attending for Physiotherapy.   There were a couple of fresh fractures with minimal displacement that I could cast.    One boy came with an external fixator on his tibia that had been there since January.   Some healing had started so it was easy to remove the fixators and apply a cast which saved him the £900 that the surgeon requested.  There were many other memorable patients making my visit both enjoyable and productive.

Cecile and I spent two days in Manila.  We visited the Vice-principal of the Philippine Orthopaedic Centre who was a most enthusiastic Anglophile having trained at Stanmore.   I am very hopeful that he can arrange for a senior orthopaedic trainee to visit Bahatala on a regular basis.   This would give a reference point for any difficult problem patients and also give training to the Bahatala staff.  I also think it would be good experience for the residents (registrars).  We also had a meeting with the Under-Secretary for Health who is very enthusiastic about Bahatala and wants to reproduce the unit in other provinces of the Philippines.

The conclusion is that we will continue the work started by Soc providing you continue the donations that have sustained us for so long.   Please help and tell your friends and colleagues about our work.

Louis Deliss, Chairman.

 

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

 
 

Report from Palawan April 2012

         I have just returned from a visit 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 than 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. There are also some photos in the gallery.

 Louis Deliss

Chairman British Palawan Trust

www.britishpalawantrust.org.uk

PALAWAN NEWS

 

Special Appeal Edition

 

The activities of Bahatala

             The work in Palawan can be divided up into various parts.

     1.      Rehabilitation.

a.       Physiotherapy in Bahatala.

b.      Community Based Rehabilitation through our local workers.

c.       Manufacture of Orthotics and Prostheses.

d.      Manufacture and maintenance of wheelchairs

e.       Manufacture of Aids to Daily Living for the disabled and injured.

 

2.      Trauma & Orthopaedics.

a.       Treatment of fractures and soft tissue injuries.

b.      Treatment for congenital deformities such as club foot.

c.       Care of degenerative conditions.

 

3.      Training.  We have a separate purpose built Training Centre.  Here we train doctors, nurses and village health workers the principals of Appropriate Orthopaedics. (See Soc’s book for details.  This is available from the Trust)

 

           In order to perform all these services we acquired the use of an old building in the grounds of the Provincial Hospital.   This was named Bahatala from the Tagalog phrase Bahay Hawak Tayo Lakad or “House to Hold to Stand to Walk”.   It not only serves as a clinic area but also houses the Physiotherapy, the two workshops and the office.  The building itself is getting old and is now too small for our unit.  In addition the long term plan of the Hospital administrators is to build a new theatre block on the site, which is already surrounded by builders’ rubble from the first new hospital block.

We have found an ideal plot of land near to our Training Centre and not far from the Hospital.   It has no building on it which is good as we can put up one to our own design to fulfil our needs.    If we can have our own land and building it frees us from “political” interference and most importantly ensures our long term future.   We would also have enough space compared to the present cramped surroundings making it much nicer and more efficient for staff and patients.

This is where you come in. 

We need money to build the new clinic and to fund training.  

This is of course in addition to our regular income that is used for patient treatment.  We are appealing to individuals and companies in the Philippines and worldwide. 

For further information and to discuss how you or your company can help with these projects please contact me.

Louis Deliss. Chairman

e-mail.  palawanTrustuk@aol.com or louisjdeliss@aol.com

Presidential Medal

At the Combined Meeting of the English Speaking Worlds Orthopaedic Associations Mr Mike Bell, President of the British Orthopaedic Association presented the Chairman. Louis Deliss, with the newly introduced Presidential Medal.   This was a great honour and the citation read ,

"On the unanimous decision of the BOA Council the President, Mr Michael Bell, is honoured to award Louis Deliss the Presidential Medal in recognition of his outstanding services to orthopaedics in the United Kingdom and overseas.

In particular, Council paid tribute to Mr Deliss's Exceptional work with the British Palawan Trust in the Philippines.   His commitment and dedication have enabled the delivery of affordable orthopaedics, transforming lives and educating future generations of health workers."

Photos are in the Gallery as soon as possible

Please remember that costs are always rising and we are looking for new supporters.   Please tell your friends and let us know the address of anyone who would like to be on the mailing list.

DONATE NOW

Notice to all donors

  1. Thank you to all our loyal donors.  I am well aware that many of you make donations on a regular basis often more than once a year for which we are extremely grateful.  I apologise that I do not acknowledge all the donations but I feel that this is really a waste of our resources,  If you do require a receipt let me know.

  2. The work in Palawan is still increasing.  Not only do Soc and Cecile have to care for an increasing number of patients but the new training centre (Bahay Sanay) creates even more work - and of course needs even more money.

  3. The latest Annual Report is now available.

  4. We are about to send out a News Letter to doctors who are not on our Mailing List.   Please encourage others to support us and let me have the names and addresses of any colleagues who might be interested in our work.  Addresses on the Contacts page.

  5. It would help me enormously if donors who have previously signed a Gift Aid Form could let me know when they sent donations.

Louis Deliss

ARCHIVES

Below are some articles that have appeared in these pages over the years.

They may be of interest to new supporters.

top of page

Report of visit to Palawan March 2010

             I have just returned from another wonderful trip to see the work of the British Palawan Trust and to see more of the province of Palawan.  I flew via Dubai and was met in Manila by Soc.  The next morning we visited a very active convent where the nuns run schools for all ages.  We were asked to see a number of the nuns with various aches and pains mainly related to their great age.  Then we flew to Puerto Princesa.

            The whole of the Philippines is suffering from a severe drought that is also affecting most of East Asia, and is caused by El Ninõ.  This meant that it was fairly hot, usually over 35° C in the shade at midday but still very humid.   The fields especially the paddies were parched and mainly unproductive.   In addition the inshore fishermen were not catching the usual numbers as the fish had gone to deeper, colder water.   One island that we visited had caught no fish for two months which meant no income at all and little food.   They were understandably rather fed up!

            I stayed as usual in the simple but very pleasant little hotel, Casa Linda.   It has all one wants and is well situated being a short walk from Soc’s house and from the hospital, although I always took a tricycle taxi.   The price of a room has not gone up much although the weak UK pound has caused a slight rise over the last two years.   The staff, who remain the same happy bunch, now recognize me which adds to the pleasure of my stay.

            The week-days are all similar.   I start by arriving at Bahatala at about nine.  Soc is usually there as is the staff.  This includes the Therapists, the Prosthetist, the office girls and the odd job man who makes things and repairs them, things such as seating for children with Cerebral Palsy and also wheelchairs.  There are always a number of new and follow up patients being seen or treated.   We also visit the BPT ward.  This is now in general use, as there are currently two other doctors who treat trauma patients.  Soc usually has three or more of his own patients.  Unfortunately because we no longer have control of the ward it has deteriorated with dirt and loss of the pictures on the walls.

During my stay the ward patients included two fractured tibiae and four fractured femora.  One tibia was mid shaft the other upper involving the tibial plateau.  The shaft fracture was treated by skin traction and then put into a cast.  The upper tibial injury was taken home to be on traction there for about four weeks (see photo at the end).  The femora were at all levels; supra-condylar with extension into the knee, one mid-shaft, one sub-trochanteric and one per-trochanteric.  These were all treated with traction through a Denham pin, the first in 90/90, the second by classical Perkins traction followed by a thigh brace, the upper one in abduction and flexion and the NOF by traction and transfer to her home before early mobilisation.

The out-patients varied from simple closed fractures of the arm to more difficult cases.  The arm fractures were most often in children.  Distal radius, fore-arm bones and supra-condylar fractures made up the majority.  There was a case of tibial osteomyelitis in a teenage boy requiring sequestrectomy.    I was asked to see two cases of pseudo-winging of the scapular producing muscular pain and both caused by mild mid-thoracic scoliosis in young women.   There were two cases of fractured clavicle plus a fracture of the glenoid neck.  One had minimal displacement but the other had an upper brachial plexus lesion with a Horner’s syndrome.   All the fractures are treated without any internal fixation. 

We saw one case of carpal tunnel syndrome and one bilateral ulnar palsy from elbow pressure whilst in hospital.    A young man presented with osteoarthritis of the hip secondary to either an impacted subcapital fracture or possibly a slipped epiphysis.  There were the usual number of babies (Soc seems to have dealt with the older untreated club feet) coming for change of plaster using the Ponsetti method, and also patients with the puzzlingly common constriction band syndrome.  There are usually a small number of elderly patients who appear to have “burnt out” or quiescent Rheumatoid but I have never felt any evidence of synovitis.

I am sure that I have left out many patients but I do know that any visitor would see a vast and wide variety of both orthopaedic and other specialty pathology.  It is often a test of one’s retention of basic medical school training!

Two days were spent in Bahay Sanay our purpose built Training Centre.   The programme was to teach doctors from the, often remote, Rural Health Units.  Some are recently qualified and are sent to the more remote parts on a Government scheme.   They were shown how to apply bandages and slings, how to set up upper and lower limb skin traction and how to apply POP back-slabs.   They were very enthusiastic and keen to go back and try out their new skills.   On their return they started sending photos by text taken on their mobile phones for advice about management.

Some of the most interesting days are spent visiting patients in their homes.   We went south principally to measure a number of patients, paraplegics, amputees and cerebral palsy children for wheelchairs.  We now get the wheel chairs from a factory set up in the Philippines by Handicap International.   These chairs are of a very high standard and are able to cope with the local conditions.  The rough ground and the humidity wears out less well made chairs very quickly.

            We made three visits to the north of Puerto Princesa to follow up patients.   These included a young woman confined to a wheelchair because of Polio with major social problems.  Another was an 89 year old spinster who farmed in a very remote part of the country.  Four months earlier she had fallen (pushed by a bad spirit she said) and fractured the mid-shaft of her femur.    She came to hospital which must have been a difficult and painful journey in a bus where she was treated with traction followed by a thigh brace.   She was delightful and because I was the first white man to visit her we had to go upstairs for a cup of coffee.

            The trips to the outlying barangays (villages) are not always pure work.  Once we stayed on a small island on a reef, CocoLoco.   Quiet and remote with the most marvellous coral and fish just a meter or two down.  Another time we stayed in a new very comfortable resort (the local name for hotels with the rooms in individual huts or buildings) on a beach near the St Paul’s Park, a World Heritage site.    The sea water is always as warm as a bath and crystal clear, the beaches white coral sand and almost empty.

            I spent a great deal of time in discussion with Soc and Cecile.   The Bahatala building in the hospital grounds is beginning to show its age and we need to start making plans to replace it.   This will take time and, of course, money and will be outlined in a future News Letters.

            I would like to thank all the people who made my visit so enjoyable, Soc & Cecile, the Staff of Bahatala and the many friends in Palawan especially Oscar and Susan.

Louis Deliss

2008 Outstanding Award in Community Empowerment/Service

SOC IS GIVEN SPECIAL AWARD

by THE UNIVERSITY of the PHILIPPINES ALUMINI ASSOCIATION

 

GARI M. TIONGCO (Chair, UPAA Search & Awards Committee and President, U.P. Alumni Association) wrote to Soc.

Congratulations!  The UPAA Board of Directors has confirmed your award as 2008 UPAA Outstanding Awardee in Community Empowerment/Service.  We are proud to note that you have used your education from the University of the Philippines as a springboard to your total development in your profession.  We recognize your achievements in your particular field, and your leadership in projects which contribute to the welfare of Filipinos and to the larger society.

This is a great honour for Soc.  He and Cecile attended the meeting in Manila during the celebrations.  This year is the 100th anniversary of the founding of the University making the award to Soc very special. 

There are some photos of the event in the Gallery.

Sasakawa Health Prize

I am delighted to report that in Mayoc attended the World Health Organisation (WHO) Sixtieth World Health Assembly at the Palais des Nations in Geneva. He was there to receive the Sasakawa Health Prize for 2007.   The prize is given for outstanding innovative work in healthcare development.  this is a wonderful achievement and recognition of Soc's work in developing appropriate Orthopaedic and Rehabilitation in Palawan that is applicable in many parts of the world.

Photos of the award ceremony can be seen in the Gallery.

Further details can be found on the following links.

http://www.who.int/gb/ebwha/pdf_files/EB120/B120_DIV3-en.pdf  See notes on page 4.

http://www.nippon-foundation.or.jp/eng/brief_dtl/20070528HealthPrize.html

http://information-hub.ofw-connect.com/OFW_Articles/?q=Palawan_Doctor_to_receive_WHO_Award

Photos on  http://www.who.int/mediacentre/multimedia/2007/wha60/en/index2.html

 

Report of visit to Palawan August 2007

My annual visit to the Philippines started with two days in Manila.  Soc had arranged meetings with various, hopefully, influential people.   These were both in government and at the University of the Philippines.    Some would be helpful with Soc’s medical activities and some for his geological work as he still advises the Provincial Government on geology.   I was also scheduled to give a talk to the Orthopaedic Department of the Philippine General Hospital.   The PGH is the main hospital and medical school in Manila.   It was interesting to be shown around by the Chief Resident (SpR).   I lectured on Appropriate Orthopaedics as I see it, concentration on the need to question the excessive use of internal fixation.   The senior Consultants agreed but the juniors had more difficulty!

Then we flew to Palawan.   There are not many changes but a steady increase in the signs of affluence.   There are more cars and tricycle taxis on the road and more smart shops and restaurants as well as many new buildings.  The other measure is the tripling of scheduled flights from Manila.   I stayed as usual in a fairly simple wooden hotel near the centre where they are extremely welcoming.

Soc and Cecile were also most welcoming but got me down to work straight away.   Off we went to the Bahatala building to meet the staff including Angela a Canadian VSO Physio.   Then we went to see patients both in the clinic and in the ward.   There are the usual large numbers of Club Feet, many Constriction Bands, skeletal trauma and infection.    The first patient in the ward had a nice cold abscess with muscle wasting and osteoporosis making the diagnosis of Tb easy.   There were also the large numbers of forearm fractures in children and some in adults.   These fractures vary from fresh to a few weeks old, some even hoping for correction years later.  The fresh ones are treated by either manipulation under haematoma block or a few days on skin traction, often at home, before casting.    Fractured "NOF" are as usual not treated surgically and do very well, as do the femoral shaft fractures.   The sub-capital fractures often do not come in but are given a few days rest and then mobilised with sticks or crutches. The per-trochanteric are mobilised the same way after 1-3 weeks on traction.   Femoral fractures are treated by traction, skeletal in adults, on a Perkins’s bed for 4-6 weeks and then put in a thigh brace and mobilised.

We had a trip out as always.   This was to follow up some patients and to see new ones.   We went to Taytay which is the old Spanish capital of Palawan north of Puerto Princesa.   It was particularly nice to see “Lee” (see under “gallery” on the web site) who was at school and came running across in normal trainers.  We also saw new patients that had been “found” by Aimee, the local CBR worked attached to Bahatala.   These varied from simple trauma to complex difficult cases some probably infective and the usual congenital problems and CP.   Whilst there I unfortunate caught the local ‘flu and found a fever in temperatures of 95+ quite difficult.  But at least it was not Malaria!

The last week of my visit coincided with a two day course for doctors.  They came from most of the municipalities of Palawan to learn some Orthopaedics.   They are often the only doctor for many miles and have to be “multi-skilled”, performing Caesareans and treating the two common diseases of childhood, gastroenteritis and Malaria, but must be ready for anything including trauma.    I was able to present Soc with the Eyre Brooke Medal awarded by World Orthopaedic Concern International at the opening ceremony.  I then gave opening and closing talks, Soc did the most and short talks were given by the VSO Physio and by Cecile.   Everyone seemed very keen and to enjoy themselves.   The meeting was held on the BPT Training Centre (Bahay Sanay.   This building is in constant use for meetings and training courses.  It is definitely showing its worth.

I spent much time with Soc and Cecile talking about future developments and inevitably about finance.   The exchange rate has fallen a bit after the spectacular climb from 43 peso to the pound to 110.  It has now settled at about 90.   This means that the inflation proofing effect of the exchange rate has stopped and slightly reversed.   In addition the costs inevitable increase and the Training Centre will have revenue consequences.   Below is a table I will put into the 2007 Annual Report.  It shows the additional funding that Cecile skilfully and successfully arranges.  The small but increasing local contribution is very reassuring for our long term sustainability.   All the funds in Palawan go through the NGO we set up, Bahatala Inc.  There are in addition some other local donations for the supply of wheelchairs.

Income Source 2006

Notes

Percent of total

British Palawan Trust   

 

68%

Christoffel Blindenmission

1

24%

Stitchting Lilliane Fonds

2

7%

Local donations

3

1%

 

 

 

1.       CBM International (German).

2.       Funding individual children (Dutch)

3.       Up from 0.3% last year

             I hope that we will be able to increase our income by completing the revision of our mailing list.   This has already gone up by about 15% but we need to increase further to cover increased costs.  Please consider us when making charity donations and pass on the news about our work to your colleagues

Chairman British Palawan Trust

www.britishpalawantrust.org.uk

2 September 2007

Report of 2006 visit by Trust Chairman

 

My annual visit in 2006 took place over Easter.  Being there over this devoutly observed religious holiday is a mixed blessing.  The whole island is in holiday mood with small shrines in each street and the Stations of the Cross at Calvary, a hill on the outskirts of Puerto Princesa which is part pilgrimage and part fiesta.  On the other hand the work stops and it is really to see the work being done that I visit, although the enjoyable holiday is another good reason.   I was greeted by Soc and Cecile at the airport and after dumping my things at the hotel it was straight to work.  

I saw very many patients with both traumatic and orthopaedic problems.   I spent time in the Bahatala building and with the staff we employ.   I even saw some new patients on my own when Soc was off doing other things.  It all brings home the excessive reliance on high technology that is the fashion in the west! 

I was also able to spend a great deal of time talking to Soc and Cecile.  Sometimes I talked to them both at other times I was able to talk to them separately.  The result was that I learned much and began to understand what the real problems had been over the last year.   It is now, I am pleased to report, all irrelevant as Soc is now reinstated with full admitting rights in the hospital.   The week after I left he had two operating lists and has had more since.   He is also once again using the BPT ward that we built as an extension of the hospital.   However one must remember that the majority of his patients do not require in-patient care

The new training centre, now called Bahay Sanay the Tagalog for Training (and exercise) House, is a really wonderful facility.   We must be very grateful to the Bishop of Palawan for most generously giving us the land.   The building, funded by an oil company, is in the grounds of a seminary close to the Bishops Palace.   This means that it is totally free from “political” interference.     The centre will be use for training courses.   The first is on 6th & 7th June and aimed at the School Nurses.  It will also be used for training village health workers.   At the opening I invited the Palawan Medical Association to use it for their meetings and I hope they will take up the offer.  I have suggested to Soc that training sessions for local doctors should start as soon as possible.

The cost of building the new training centre was all met by an oil company but there will be an ongoing cost for courses, upkeep and electricity.   In addition the number of patients increases each year.   Cecile has been very successful in obtaining additional funds from partner charities such as CBM (Christoffel Blindenmission), Stitchting Lilliane Fonds and others but the British Palawan Trust will have to find more money.  To this end I have been working with Soc on the mailing lists and NewsLetters.  I will also try to find companies to give donations and look to others to do the same. 

In summary the work of the Trust is still needed and appreciated by the Palaweños.  The numbers of patients and of the disabled who benefit is enormous and growing please keep supporting us. 

 

WOC International Eyre-Brook Medal Award

Soc received this letter from Mr K Tuson F.R.C.S. in 2005.

 

Dear Dr Socrates,

I am delighted to be able to tell you that I was able to announce to the International Committee of World Orthopaedic Concern that your nomination by WOC UK for the receipt of the Arthur Eyre-Brook Medal has been approved. As you know, the Arthur Eyre-Brook Medal is named after one of the founders of World Orthopaedic Concern and designed to recognise the efforts and input of surgeons like yourself who spent many years working in areas of great need. Many congratulations. I hope that Dr Rajasekaran, who is visiting the Philippines shortly, will be able to make contact with you to present you with this medal.

 

P.P.S.  I presented the Medal to Soc at the opening ceremony of the Doctors Training Course in August 2007.  I had been asked to do this by WOC.  The Medal now hangs in a frame with the certificate in the Bahatala staff room.  LD.

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