Published: September 29, 2015

Cleft lip and palate surgery in CebuExpanded from the print edition

Although I was not a stranger to large walk-in clinics before arriving in Cebu, our screening day was nevertheless an eye-opening experience. More than 200 patients, plus their families and sponsors, were packed like sardines into the hospital rooftop gymnasium-turned-waiting-room.

By Jamie L. Funamura, MD, AAO-HNSF Humanitarian Efforts Grantee

One of our Australian-American-Filipino OR teams. In the middle are Filipino scrub technician/trainees. Jamie L. Funamura, MD, is at the bottom left.One of our Australian-American-Filipino OR teams. In the middle are Filipino scrub technician/trainees. Jamie L. Funamura, MD, is at the bottom left.

Although I was not a stranger to large walk-in clinics before arriving in Cebu, our screening day was nevertheless an eye-opening experience. More than 200 patients, plus their families and sponsors, were packed like sardines into the hospital rooftop gymnasium-turned-waiting-room. Cebu City is a large metropolitan area of more than 800,000 people on Cebu Island, one of the central provinces of the Philippines. The month of March here is warm and humid, and only the occasional sea breeze filtered through the crowd in our makeshift waiting area.

I was at the Miller Adventist hospital in the center of Cebu City with the Operation Restore Hope (ORH) team. ORH is a long-standing joint Australian-American-Filipino humanitarian venture that has been providing care for children with cleft lip and palate in the Philippines via twice-yearly surgical trips for more than two decades. My mentor, Craig W. Senders, MD, was one of four senior surgeons on the trip. Despite the long-term dedication of the many providers and the local Rotary Club—or perhaps precisely because of such dedication—each screening clinic draws more patients with cleft lip and palate than the last.

Despite the heat, the crowd waited patiently to be directed down to the air-conditioned clinic space as the local Filipino Rotarians waded through the registration process. After all, what is a long morning and some heat compared to the days it took to journey from neighboring islands, the months since the last ORH trip was regretfully cancelled to prioritize disaster relief efforts in the wake of natural disasters in late 2013, and the years that some of these children and young adults with cleft lip and palate have waited to have surgery?

In many ways, my experience in the Philippines with ORH was exactly how I imagined it would be: a highly rewarding trip, filled with a new appreciation of Filipino culture and a sense of accomplishment as our team sent nearly 92 patients home with newly repaired cleft lips and palates. But just as often I felt insignificant, as it became more apparent to me that the patients we were treating represented a mere tip of the iceberg. Many patients who had traveled great distances to attend our screening clinic had to be turned away. Faced with limitations of time and resources, difficult questions would arise. Who should have greater priority in undergoing surgical repair of a cleft palate: a 15-month-old before compensatory speech patterns need to be unlearned or a 25-year-old who has been waiting for a team to take the extra effort and risk post-operative failure in correcting her wide cleft? Compared to my cleft team experiences back home at UC Davis Medical Center, the difference in patient-to-provider ratios was stark. At home we would surround the patient with an army of specialists; here in Cebu the number of patients far surpassed that of our Australian-American-Filipino team members.

Laden with more questions than answers surrounding surgery in a setting of limited resources, I found comfort in the familiar: the surgical steps that were the same to me in Cebu as in Sacramento, the same expressions of surprise and happiness on parents’ faces when they saw their children after cleft lip repair. Re-centering oneself around the individual patient and the goal at hand is a mindset I believe will serve us equally well at home as overseas: despite the challenges of healthcare reform and Medicare reimbursements that swirl around us, even if I am a simple cog in a big intricate wheel, there should always be solace in caring for the individual patient of mine.

For that reminder, I am indebted to our wonderful patients in Cebu. I am also extremely grateful to have been able to join the equal parts hard-working and fun-loving Operation Restore Hope team, and to the AAO-HNSF Humanitarian Efforts Committee for bestowing a travel grant to help make such participation possible.

 

More from October 2015 - Vol. 34, No. 09
mpfs
PROPOSED CY 2016 MEDICARE PHYSICIAN FEE SCHEDULE (MPFS)What does it mean for you?
On July 8, 2015, the Centers for Medicare & Medicaid Services (CMS) posted the proposed Medicare physician fee schedule (MPFS) for calendar year (CY) 2016. The Academy submitted comments to CMS on the proposed rule on September 8, 2015. The Academy also developed a Member summary, which goes into greater detail of all of the important proposed requirements.
data
The power of data raises the bar on patient care
At our spring Boards of Directors meeting, the BOD made the courageous decision to fund an otolaryngology-specific clinical data registry. That decision will “empower our Members to provide the best patient care” as well as satisfy reporting requirements for both CMS and private payers. The BOD charged the Registry Task Force, chaired by Lisa Ishii, MD, MHS, to create a business plan and select both a model and vendor for our registry.
Sujana S. Chandrasekhar, MD
Thoughts on the June 2015 health policy course at the Heller SchoolExpanded from the print edition
When I applied for the AAO-HNS/ACS Scholarship to attend the Health Policy and Leadership Course at the Heller School, I knew that I had ascended to a high level of leadership in medicine but that I needed more intense and detailed education on various aspects of U.S. healthcare policy, financial assessment, and leadership skills. I was grateful when I received the scholarship, but even more so once I attended the week-long course in June.
eartubes
Academy collaborates with Anthem to refine ear tubes medical policy
Thanks to the Academy physician leaders’ comments and clinical recommendations, Anthem has revised the Anthem Medical Policy for Myringotomy and Tympanostomy Tube Insertion. Key changes include a revised pediatric extended otitis media effusion (OME) hearing loss requirement from 30 dB to 20 dB, new medical necessity indicators, and allowance for myringotomy as a stand-alone procedure for select populations.
Liana Puscas, MD
AMA HOUSE OF DELEGATES REPORTIssues impacting otolaryngology
The American Medical Association (AMA) House of Delegates (HOD) held its annual meeting June 2015 in Chicago. Representing the Academy were Liana Puscas, MD, Delegation Chair; Delegates Michael S. Goldrich, MD, and Shannon P. Pryor, MD; Alternate Delegates Robert Puchalski, MD, and Academy EVP/CEO James C. Denneny III, MD. Of note, Dr. Puchalski gave a stirring AMPAC speech about the importance of engaging in advocacy in his new role as Chair of AMPAC, the AMA’s political action committee.
AM16logo
CALL FOR SCIENCE Be part of the 2016 AAO-HNSF Annual Meeting & OTO EXPOSM
We invite you to submit proposals and abstracts to be considered for presentation at the AAO-HNSF 2016 Annual Meeting & OTO EXPOSM in San Diego, CA, September 18-22.
The AAO-HNS is looking for volunteer State Trackers in Iowa (Iowa Capitol pictured) and eight other states.
Gearing up for 2016 legislative sessions
During the 2015 state sessions, legislators across the nation introduced a wide variety of bills that would inappropriately expand the scope of practice for certain nonphysician healthcare providers.
Tech assessment of imaging for diagnosing rhinosinusitis
As Members may know, the Washington State Health Care Authority (HCA) paves the way for many public carrier policies across the country through its Health Technology Assessment (HTA) program. The HTA program was designed by the state to ensure medical services paid for by its state entities are safe and effective. This program has created a following with many other states entities looking to it when creating their own policies.
journalcover
Journal showcases young physicians
The October 2015 issue of Otolaryngology–Head and Neck Surgery celebrates the achievements of young physicians. The issue comprises 40 articles whose first authors are under 40 years of age. These “40 under 40” submitted their articles in response to the journal’s first-ever young physicians call for papers.
devices
FROM THE MEDICAL DEVICES AND DRUGS COMMITTEEThe reprocessing of devices so designatedExpanded from the print edition
Reprocessing of medical devices is an important—and largely transparent—part of an otolaryngologist’s practice. Whether it is in the office setting or operating theater, reprocessing of durable devices is essential to our ability to deliver safe, effective care. This has been in evolution and under scrutiny recently.
2016 Cochrane Scholars travel grants available
Interested in systematic literature review training? SAGE, the publisher of Otolaryngology–Head and Neck Surgery, will offer two grants of up to $4,000 to help Members attend the October 2016 Cochrane Colloquium in Seoul, South Korea.
2016 G-I-N Scholars travel grants available
Interested in Guideline development, dissemination, and implementation? Through the G-I-N Scholars program, the AAO-HNSF will fund up to five Members to attend the September 2016 G-I-N North America meeting in Philadelphia, PA.
mentoring
The value of mentoring relationships
Of all the relationships possible during the lifetime of an individual, mentoring relationships are some of the most formative you’ll ever experience. These relationships can exist for a short period or last a lifetime, but whatever their length, they can change lives forever.
Susan R. Cordes, MD
Gold Humanism in Medicine Award
In 2009, the Arnold P. Gold Foundation selected the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) as one of three medical specialty societies to confer the Gold Foundation’s new Humanism in Medicine Award, with the goal of advocating for the compassion, empathy, and sensitivity displayed by practicing physicians caring for their patients.
Sanjay R. Parikh, MD
BOARD OF GOVERNORSResponding to those who say guidelines don’t make sense
I was recently at an otolaryngology conference in line for lunch with some friends when the topic of tonsillectomy guidelines came up. One of my good friends, Dr. X, explained to me that he was not following our AAO-HNSF guideline recommendation to stop using antibiotics after tonsillectomy. Dr. X explained to me that “Guidelines don’t make real sense. They are made up by a bunch of academicians who don’t grasp what surgery practice is like in the real world.”
denneny
The dawn of a new era
I have just returned from a most exciting AAO-HNSF 2015 Annual Meeting and OTO EXPO held in Dallas, Texas, which showcased a number of initiatives designed to add value to your Academy membership. Our new format and pricing structure allowed most attendees to markedly increase their CME activities at the meeting.
sujana
Of gavels and goals
When Gayle E. Woodson, MD, passed me the gavel at the Annual Meeting Opening Ceremony in Dallas last month, she was symbolically putting our Academy into my hands, which is a solemn trust. The Academy’s many strengths include the strategic plan, responsiveness to external forces affecting otolaryngologists, staff support, and finances.