Stories From the Road: 23 Years of Service, Education, and Friendship in the Philippines

Merry E. Sebelik, MD, on behalf of the Humanitarian Efforts Committee

(Left to right) Renato “Noli” Zalamea, CRNA, and Dr. Nia Zalamea set up an operating room table in Carmona Cavite, near Manila.Twenty-three years ago, I was invited to join a new charitable organization, Memphis Mission of Mercy (MMoM), founded in 1999 by Philippine-American clinicians Norma and Renato Zalamea, a nurse and nurse anesthetist practicing and living in Memphis, Tennessee. Their daughter, Nia Zalamea-Ducklo, MD, now a practicing general surgeon, current Director of Global Surgery at the University of Tennessee Health Sciences Center, and current Vice President of MMoM, was in high school at that time.

Bridging Borders: A Unique Volunteer Collaboration

The principal aim of MMoM was and has been to conduct short-term medical and surgical missions, serving economically devastated rural areas, small mountain towns, and poor urban neighborhoods throughout the Philippines. The Zalamea family typically discovers those who need services via personal referrals and friends or family who are from underserved areas. One of the most unique and useful features of MMoM is the nearly 50/50 split between volunteers who live in the Philippines and those who travel there from the United States.

Surgical and Educational Impact that Continues to Echo

My value to the mission has been providing head and neck surgery skills for the large number of patients suffering from symptomatic endemic goiter and the many people afflicted with congenital facial deformities. I also offer surgical education skills. Involvement in this program has benefited my residents who joined the yearly missions and has allowed our team to attend surgeries at ENT training programs such as Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) in Bacolod City, Philippines.

One of the residents with whom we had the privilege to scrub-in with at CLMMRH, Allen Cypress Agbones-Elgado, MD (third from right in the first row), currently is completing a pediatric otolaryngology fellowship at Philippine Children’s Medical Center in Quezon City.In the first 10 years of my collaboration with MMoM, 17 otolaryngology-head and neck surgery residents from the U.S. accompanied us to the Philippines, five of whom continued volunteer work even after graduation. Of those, Douglas Denys, MD, went on to form his own nonprofit organization and volunteered in Kenya, Ukraine, and Rwanda. Dr. Denys wrote a book describing his life journey, Rhythm of a Runner, before his untimely passing in 2022.¹ Another from this group, Thomas Knipe, MD, is a member of the MMoM Board of Directors and volunteers every other year, taking time from his private practice in Seattle, Washington. Many of the residents invited to travel with MMoM have received AAO-HNSF Humanitarian Travel Grants to carry out this work.

The otolaryngology-head and neck surgery residency program at CLMMRH has grown dramatically and is now a premier regional training program with no need for outside attending support.

This map illustrates the broad geographic coverage of service Academy members have offered in the Philippines at the invitation of the MMoM.Location and Need

Historically, the Philippines, like many low-income countries, suffered from the dual problems of poverty and lack of access to care. The MMoM started by providing what they were good at, which was the delivery of anesthesia and surgical care.

Surgical diseases prevalent in the Philippines include facial cleft deformities, which may occur in 1 in 500 births there compared with 1 in 1,500 births in the U.S. Also, despite excellent public health efforts to reduce iodine repletion, the islands continue to suffer from iodine deficiency and consumption of goitrogens, leading to symptomatic, endemic goiters.

Addressing Persistent Health Needs

In 2001, there was a much greater mismatch between the number of local clinicians and patients in need, with a marked maldistribution between wealthier urban areas and the rural countryside. Twenty-three years later, the number of highly trained local clinicians has increased with equivalent training standards and access to technology and guideline-based care. However, as in high-income countries, the wealth divide persists. Poor people and people in remote areas who cannot easily travel continue to suffer. Memphis Mission of Mercy, through its unique partnership of Philippine and American volunteers, addresses this critical population.

Developing Point-of-Care Education Programs

(Left to right) Lisa Orloff, MD, Geraldine Luna, MD (holding Dr. Orloff’s comprehensive ultrasound textbook), M. Karen Capuz, MD, and the author, Dr. Sebelik, at the AAO-HNSF Annual Meeting in San Francisco in 2011.I still travel to the Philippines and care for patients through cultivated collaborations with colleagues and trainees. However, something seminal happened in 2011. Two otolaryngologists from Manila who had an interest in surgeon-performed ultrasound attended the AAO-HNSF and American Cancer Society (ACS) ultrasound course offered at the AAO-HNSF Annual Meeting in San Francisco, California. As a result of that encounter, M. Karen Capuz, MD, and Geraldine Luna, MD, embarked on developing point-of-care ultrasound education programs. 

Hybrid Ultrasound Course 2021.These courses are now offered throughout the Philippines to multiple training programs and graduate surgeons in Asia and offer unmatched training. The courses include advanced ultrasound-guided interventions, such as radiofrequency ablation and alcohol ablation.

The COVID-19 global pandemic did not slow them down. Dr. Luna and Dr. Capuz have perfected remote, hybrid, and in-person skills training to serve as a global standard for multi-site education.

Creating Lasting “Linkages” Between Students and Teachers

Conlon et al., in writing about teaching ultrasound in a “tropical country” in 2012, noted that a critical factor in sustaining and growing high-quality clinician-performed ultrasound is the establishment of long-term relationships between teachers and students, referred to as “linkage.”² I am humbled to be a small part of this linkage that has been so productive.

(Left to right) Nia Zalamea, MD, Vice President of MMoM, Frederick Durden, MD, Emory University, with Glenn B. Williams, MD.My stories from the Philippine roads started 23 years ago as simple tales of caring for the needy alongside old and new colleagues from the Memphis Mission of Mercy. Along the way, the beautiful side roads have taken me to mentees, friends who feel like family, students, and successors in education. I believe I have inspired other young otolaryngologists to pursue lives of service. I have gained colleagues and partners across the globe with whom I could talk for hours about ultrasound, teaching, and life.

One of my former trainees, Glenn “Blake” Williams, MD (1974-2018), who traveled with Memphis Mission of Mercy many years ago, said a lovely thing that was published in the Bulletin in 2010, “I may not be a better surgeon, but I am a better doctor.”³ I take it one step further—23 years later, I am a better human. 

References

1. Denys, D. Rhythm of a Runner. CreateSpace Independent Publishing. 2014.
2. Conlon R. Teaching ultrasound in tropical countries. J Ultrasound. 2012;15(3):144–150.
3. Sebelik ME. I may not be a better surgeon, but I am a better doctor: The value of missions for residents. Bulletin. March 2010, Vol. 29, No. 3:31.