Stories by Mike Comerford
Photographs by Mark Welsh
Daily Herald Staff
Second of five parts

Aldrin Pawa, 7, entertains his mother, Soledad, right, and the long line of people waiting for care at the medical mission led by suburban Filipinos in Puerto Princesa, Philippines. With no hands or feet, Aldrin suffers from an undiagnosed birth defect but is seeking medical help for a persistent cough.

PUERTO PRINCESA, Philippines — Armed Philippine soldiers hand out forms outside the sports coliseum-turned-medical-clinic as a line of sick people snakes its way down the street.

Scores of families have been waiting since the early morning to be tended to by physician Nela Cordero and her medical mission of about 50 doctors, nurses, dentists and pharmacists.

The South Barrington doctor grew up not far from here. She has returned with free medical treatment and much-needed supplies shipped ahead in a huge container.

The government soldiers stand as a reminder that the specter of terrorism hangs in the muggy air. The fate of the supply container hangs with it.

Cordero is one of three suburban volunteers on this mission. Mission co-founder Fe Hermosa works the pharmacy, while Wilma Tougas handles admissions. Hermosa and Tougas, both Des Plaines residents, sit on folding chairs.

The three are among 63,107 Filipinos whose arc away from their home islands brought them to new lives in the Chicago suburbs as part of the area's fourth-largest immigrant group. The women now return to fill a void they left behind.

The annual medical mission was delayed the last three years due to terrorism fears. In that time, the health-care needs did not diminish.

"Many of these people wait for the mission so they are very sick when we see them," Cordero says, dressed in her white smock. "They come in from the provinces but are so poor, some don't even have the money to go home."

Complicating matters further is a severe shortage of doctors and nurses who leave in droves for better-paying jobs in other countries.

The three-day mission peaks on the second day, with nearly 1,000 patients treated.

The hallway is filled by people with epilepsy, cataracts, goiters, cleft lips and palates, tumors, liver ailments, urinary infections, broken bones and common colds.

U.S. Palawan Medical Mission dentists pull a tooth in full view of other waiting patients in Puerto Princesa, Philippines. Volunteer dentists pull teeth from morning to night during the three-day clinic.

Volunteer dentists spend grueling days pulling teeth from patient after patient. Minor surgeries go on behind white, wooden partitions, with crowds of sick patients yards away. Volunteers are so busy, many speed-walk from task to task. They're rushing to help as many people as they can during the three days they have.

"We have to do this," Hermosa says as she hands out prescriptions, "because they need our help and we have to give back."

Exporting care

Such medical missions in the Philippines have become an unofficial necessity with the extensive emigration of health-care workers.

Estimates show 50,000 nurses left the Philippines in the last three years, making it the top exporter of health-care workers in the world, according to the National Institutes of Health in Manila.

Some doctors emigrate as nurses because it is easier and faster due to a higher demand for nurses in America.

A Philippine Department of Health study estimates 42 of the poorest cities in the country have no physicians at all.

Cordero and her husband, Henry, also a doctor, left for America in 1970.

In 1997, Cordero and Hermosa traveled to Palawan on their first mission, having raised just $1,000 for supplies. They co-founded the tax-exempt U.S. Palawan Medical Mission Group.

The Corderos since have sponsored four medical missions, spending hundreds of hours packing supplies and organizing fund-raisers.

Cordero's missions had always been informal acts of charity, arranged through the local hospital.

But this latest mission grew larger. Volunteers managed to raise $20,000. And the Pittsburgh-based charity Brother's Brother Foundation contributed about $1.5 million in used hospital beds and equipment that were shipped ahead by freighter.

In surgical blue uniforms, U.S. Palawan Medical Mission volunteers, foreground, work to sign up people in the crowd that began gathering before dawn at this sports arena-turned-clinic in Puerto Princesa on the Philippine island of Palawan. This mission was delayed for three years because of concerns about terrorism.

But the size of the container drew bureaucratic notice.

Delays in shipments to countries not accustomed to such generosity often are problematic, Brother's Brother officials say. This shipment was no exception.

As the 2004 U.S. Palawan Medical Mission treats throngs of patients in this Puerto Princesa sports complex, tensions among the volunteers heighten when they find out the container is being held by Philippine customs. Forms have not been filed and duties on the contents haven't been paid, officials say.

Mission volunteers are forced to use just the supplies they sent ahead by mail or brought with them.

To Cordero, the container is a hostage of government red tape and symptomatic of the state of the overall Philippine health-care system.

"I'm getting so frustrated," she says. "I told them I'm from the barrio. I'm from here."

A dose of laughter

Aldrin Pawa runs with glee down the coliseum hallway. He waves arms truncated at the elbows and swings legs that stop short at his knees.

Past lines of people awaiting treatment, the 7-year-old with no hands or feet somehow scampers, seemingly unaware of his disabilities.

His mother laughs with the onlookers as Aldrin stops at Cordero's side and starts pestering her for cough medicine.

"He won't leave me alone," the doctor says with a laugh.

A birth defect caused Aldrin's limbs to stop growing, the doctor says.

At about 2-1/2 feet tall, he's a tiny clown, winning over the crowd with antics that belie his physical condition.

The Philippine penchant for laughter is practically a national, unifying language. For years, one of the most popular sitcoms on Philippine television was called "Life Along the Rails," referring to the crushingly poor squatter slums that line Manila railroads.

This national trait even has Filipinos puzzled.

Film director Jose Javier Reyes, chair of the Philippines Directors Guild, and others say laughter is a coping mechanism in a poor country hammered by natural disasters that include an average of 20 typhoons a year.

The humor can be self-deprecating, face-saving, mocking or bonding.

Yet it also can be a hindrance, even to the Filipinos of the Palawan Medical Mission. They say they don't know what to believe.

Volunteer Garcia Fernandez Valledor, a doctor of internal medicine in Quezon City, has seen it in her own practice.

People bring in their elderly parents, but when she asks them what is wrong, the patients often laugh it off.

"That is why (even loved ones) don't realize they are sick," Valledor says.

She has seen Filipinos, young and old, come to her in an anemic state.

"They are starving, but they have a smiling face despite their poverty," she says.

Sometimes, it seems, laughter serves as both medicine and mask.

Cordero's black bag

One-year-old Patrick's family traveled eight hours on a bus from the rural north to have a growth on his neck examined.

It is clear, Cordero says, the growth should have been caught and treated earlier.

She reaches into her black leather bag for a tongue depressor and a stethoscope, looks down the boy's throat and listens to his chest.

Large fans swing and hum every few yards along the hall. Parents sit waiting their turn. Children make new friends and play. Nearly all wipe the sweat from their foreheads.

Suffering from a cleft palate and malnutrition, a young boy waits with his mother on a step of the coliseum that doubles as a medical clinic for a doctor to examine him. Poverty and an ongoing exodus of trained caregivers contributes to the Philippines' health-care crisis.

"His nose is wet, but his lungs are clear," Cordero says. "I gave his mother medicine for the fever. I brought some antibiotics. He's a little anemic, too, but the multivitamins are in the container."

Nearly everyone in this hall has delayed seeking medical attention and some will have waited too long, Cordero says. They need more help than the volunteers can give.

One-year-old Abegail Cordero, who is not related to the doctor, has congenital heart disease, something Cordero and her group cannot treat.

"I told the parents I cannot do that surgery here; they'll have to go to Manila for that," Cordero says. "I doubt they'll do it."

Terror vs. treatment

Mission doctors also sent Harold Grace to a hospital for help for his daughter, Abear.

Just four years ago, Grace was a top waiter at the tony Dos Palmos Resort. Tourism was good. So were the tips.

Among the 7,000 islands of the Philippines, Palawan is a western island otherwise known for its beaches, coral reefs, mountain jungles and an underground river. And Dos Palmos was at the center of that travel gem.

But terrorism altered the local economy, creating the perception that Palawan no longer is safe for tourists. In May 2001, 20 guests and workers were kidnapped from the Dos Palmos Resort, including three Americans.

One American was beheaded and a missionary couple abducted. The couple was held captive for a year before a government rescue attempt in which the wife was wounded and the husband killed.

Just a few years later, Grace sits in a sparse Puerto Princesa hospital room, awaiting treatment for his daughter's cleft palate. Now, because of terrorism's effect on tourism, Grace is indigent and unemployed. He is forced to seek free surgery for Abear at the provincial hospital down the street from the coliseum.

For two days, they've been waiting for word on when the surgery can be performed.

Forced to wait for mostly expatriate doctors and nurses to come to town, Abear was treated in 2003 by a Filipino-German medical mission. But she needs more care.

In a country where nurses make as little as $5 a day, surgery for the daughter of an unemployed waiter would be unthinkable if not for missions.

"Surgery can cost 50,000 to 60,000 pesos," or about $1,000, Grace says. "So, we wait."

A hurting hospital

Dr. Juan Glorifino Jr. is the head of Puerto Princesa's main hospital, which looks more like a M.A.S.H. unit.

The hospital's top administrator, he also is the top-paid surgeon.

He makes $500 a month.

Glorifino walks into the emergency waiting room making instant assessments and pointing to patients with bandaged wounds.

This young girl caught her hand in a generator, he'll take her first. A badly beaten young man has a broken leg, he's next.

In this hospital, the systemic ills of Philippine health care are exposed.

Glorifino also practices in America, but here he manages a hospital he concedes is underfunded, understaffed, overcrowded and outdated.

"Here, the problem is too much red tape and too much graft and corruption," he says. "We have money, but it isn't going where it should go."

South Barrington physician Nela Cordero, head of the medical mission to Puerto Princesa, examines a growth on a child's spine.

Those in need of major surgeries are being referred from the coliseum down the street to this government hospital.

Glorifino reserved an operating room for mission referrals, but the room is dark.

"We have the place," Glorifino says. "We have the patients, but we don't have the supplies."

Medical missions create a challenge at this hospital, Glorifino says, because the number of surgeries spikes as people who have been delaying treatment show up. But the budget does not.

This is a 150-bed hospital, but already 165 people have been admitted. An average of 18 children are born in the operating room daily.

Glorifino estimates that less than 20 percent of his countrymen can afford health-care services, leaving 80 percent with few alternatives beyond medical missions.

Patients with intravenous bottles hooked up to their arms line the hallways along with people wearing blood-soaked bandages. Everyone looks hot and bored. Visitors often stay all day and night with their loved ones, sleeping in chairs and contributing to the crowded conditions.

Most beds are wooden and don't have mattresses. About a third of the container held in customs contains beds.

The chapel roof is unfinished and open to rain.

Still, this is the hospital Glorifino says many Filipinos cannot afford.

As he gives a tour, a small, feral cat with patches of brown fur on its thin frame walks aimlessly down the hall.

Dancing in Princesa

At the end of their three-day frenzy, the mission volunteers are being treated like returning heroes.

On short notice, provincial Governor Joel Reyes has arranged a thank-you feast for the workers who make up the U.S. Palawan Medical Mission.

Volunteers sit at round tables under a steel canopy. It's an open, public area built for such events with an empty stage at the front. Local fare is served — bowls of pork, fish, rice, noodles — as waiters rush about.

Cordero and Hermosa sit at the head table with the governor. First, a slide presentation on tourism is played; then a dance troupe performs.

The dancers ratchet up the energy, smiling as they mix native dances with pop boy-band-type choreography.

The governor calls himself "The Realist" on his campaign posters. He's photographed with a hand towel around his neck, as if he has been sweating. Middle-aged and personable, he has an encyclopedic knowledge of family ties in his province and a politician's knack for working a room.

As he goes from table to table, he graciously thanks the volunteers.

Yet hanging over the celebration, at first unspoken, is the controversy of the medical supply container stymied by bureaucracy.

Medical missions play havoc with the emotions of volunteers, in part, because they have to turn people away. Volunteers know sometimes they are delivering death sentences that could have been commuted if only the patients had access to better care.

Cordero takes the stage to say a few words. She's gracious but voices frustration about the container held by customs.

The regional health officer follows her at the microphone defending the government.

South Barrington's Nela Cordero, left, and Des Plaines' Fe Hermosa take inventory in a sports arena where they jointly led a medical mission to Puerto Princesa on the island of Palawan, Philippines. A delay in the arrival of supplies frustrated mission workers but they still managed to treat thousands of indigent Filipinos.

The container won't arrive while the mission is in Puerto Princesa. It will be more than a week before it is released from customs in Manila and shipped by boat to Palawan. It will be several more weeks before Cordero learns the supplies did get to the local hospital.

The container drama only heightened aggravations.

One doctor said he had to keep reminding himself of the good he was doing because he saw so many he could not help.

Cordero doesn't know how many people went untreated due to the impounded supplies. Those patients might include Abear Grace, the girl with the cleft palate, and Aldrin Pawa, the frolicking boy with a birth defect.

But it is evident that a few thousand people did get help.

Cordero won't organize a mission next year. She might volunteer — she's not sure — on a medical trip, but that group isn't going to her home province.

"It's too much of an effort to be a doctor in Illinois and do this at the same time," she says, referring to the bureaucratic entanglement. "I do all this, then I get treated like this."

She and the others put off this mission for three years due to terrorism but, in the end, were waylaid by a bureaucratic dance.

At the appreciation dinner in Puerto Princesa, dancers bring out two bamboo poles for the traditional dance known as tinikling. Holding the poles about ankle high, the performers begin clacking the bamboo poles together in time to a drum beat as dancers jump in and out.

When audience members are dragged up on stage, the bamboo holders take mercy, going slower. But when the tinikling dancers jump in, the clacking and drumming reach a pitch and gain speed.

Soon, any sense for how the barefoot dancers escape the clapping bamboo is lost. They flirt with disaster. Dancing in and out, up and down, to drums and bamboo.

Disaster seems so close. But somehow, the dancers manage, barely, to escape catastrophe.

Cordero, Hermosa and Tougas sit smiling politely during the torch-lit show as they watch the dangerous dance.

They are pleased to be recognized for their medical charity. But again, it seems, the Filipino smiles serve as masks. This time, the smiles cover the frustration the suburban women feel over a mission not fully accomplished.

IN PART 2:
• Trying hard to help heal
• Why nurses leave the Philippines
• Manila call centers may surpass India
• More photos from part 2