March 2024 Blog: A perspective on Women's Day 2024

by Stefan

Women’s day reminds everyone about issues such as the struggle for equal opportunities, unequal pay, discrimination, sexual violence, inequitable access to healthcare, just to name a few. The Asian Development Bank #ADB points many of them out in their post including the fact that the situation is especially worrisome in Asia.

When reading this and seeing the images, I noticed the absence of one challenge - one barrier to be broken, although it is one of the most basic and important for women: Women mortality.

The ultimate failure of healthcare is death. People in healthcare look at that when assessing “mortality”, be it related to infectious disease, cancer or other ailments. Men face all risks of death women do except for one: the risk of dying during pregnancy. So is Women’s Day not a most appropriate day to also - or better specifically - remember the mortalities that affects women only?.

So what about Cervical Cancer, which we now know can be prevented by vaccination against HPV? What are we doing to prevent it? What about breast Cancer, the most common cancer in the world after skin cancer? Where are we with screening on a global scale? And what about maternal mortality?

According to the Pew Research Center, currently 86% of women in the United States between the age of 40 and 44 years old are mothers. In the Philippines, 10% of women are already mothers at the age of 20 years old (according to the Philippine Statistics Authority PSA). Fact is, the vast majority of women become mothers, which is why it is still a tragedy that every two minutes a woman dies of mostly preventable causes related to pregnancy. For us that means women’s day is most certainly also a day when we need to think about this fact.

Considering this, we are grateful that LMI has been recognized by the Department of Health and the National Commission for Indigenous Peoples #NCIP in the Philippines for its efforts to improve access to technology and decrease maternal mortality, the only mortality affecting women only.

So, while we celebrate women’s day by continuing our efforts benefitting the vast majority of them (and their babies), make no mistake- there is more work to be done

Abante Babae!

February 2024 blog

by Stefan

A few years back, there was this detective series on Netflix called “Death in Paradise“ I used to watch. It was an English series set on one of the Caribbean islands still part of Britain. The protagonist detective inspector lived in a house on a beautiful white sandy beach while solving murders on the island. I admit I felt a bit envious. But hey, it was just a TV series, right? Nice fantasy of doing good work in paradise like settings...

When we recently set out to visit the island of Linapacan in the province of Palawan, the Philippines, I found myself in the middle of such a fantasy in real life! Linapacan is a remotely located island with the clearest water I’ve ever seen in a harbor. Pristine beaches, almost everywhere you look as you approach the island. Uncountable fish swimming right next to the pier and even a blue starfish in plain sight as we step off the boat upon arrival.

There is a single physician on the island, who takes care of the roughly 17,000 population together with his team. Being the only(!) physician on the island, he is “on call” 24/7. When we visited Culion Island in August 2023, he had made the sea journey to see us asking us to bring our pocus ultrasound project for midwives and nurses to his island.

This physician, Dr Tejada, is a man on the move. The busy, but old birthing center is being replaced by a brand new building, which will house an x-ray machine and a stationary ultrasound machine. As we begin our discussions with our partner, the local government, it becomes clear that the mayor is genuinely interested in healthcare, taking care of the population and very much supports Dr Tejada. We realize, these are perfect grounds and conditions for our project.

Wherever we go here we encounter friendly folk, curiosity and enthusiasm. The challenges are many, the population, the majority indigenous people known as “Tagbanua”, is spread over multiple small islands and desperately poor. This is a “class 5” municipality, meaning it is the opposite of a rich town. The next hospital is a 4+ hour boat ride away (in good weather with calm waters). This means: preventing emergencies and preventing disease are key. That’s exactly what LMI is all about. We have come to the right place!

After spending our last 2 hours on a beautiful, white sandy beach (yes, like paradise!) and swimming in crystal blue waters we make the return boat trip to our “base” in the town of Coron on the island of Busuanga. With us on the boat happens to be a young lady patient in pain to undergo further diagnostics in the closest hospital. After the 4.5 hour boat ride with us the poor lady has to take yet another boat to Culion island, where the hospital is located. We tell ourselves: If this is what women in pain have to go through, what about an emergency at the time of birth? Surely, LMI is looking at the right place for its next project!

Today, the “Death in Paradise” series is no longer available on Netflix. Hey Netflix: how about a new one called “Health in Paradise”?

2023 - Really such a bad year?

January 2024 by Stefan

On this first day of January 2024 I am looking over the calm San Francisco Bay with blue skies and bright warm sunshine. Many people taking a NewYears walk, some running, some walking their dogs. Canoes, kayaks and people on SUPs galore on the water. Certainly a picture perfect good start to the new year from this perspective. Yet - perspectives differ. An earthquake and tsunami in Japan has already been reported in the news just a few hours ago...

As everyone closed out 2023, there was a general sentiment that 2023 was not a good year. Too many wars and other conflicts, too many people suffering, no substantial progress with climate change, too many disasters. I received so many wishes for 2024 to be a “better year“. But isn’t this really a matter of perspective? The news’ perspective tends to focus on the negative events shaping this world anyway, right?

Looking back at 2023, we at LMI have every reason to celebrate. It was an incredibly good year! Our project in Pangasinan was a resounding success exceeding all expectations. And how much fun we had there! Ultrasound based early detection followed by treatment alone likely saved at least 5 mothers from potentially deadly complications later at birth. Even the poorest of the poor of the municipality for the first time now have access to the prenatal ultrasound examination the WHO recommends for everyone! Not just some, but all midwives we taught fully embraced ultrasound and(!) demonstrated competence at that! One even deferred retirement because of her newfound passion for the job.

Does all this sound like a bad year?

Seeing these successes developing and the overwhelming need in the Philippines over the second half of the year, we had to start setting the stage for two new projects (instead of one) for 2024 and developed a vision for beyond what we thought would be possible.

The partnerships we forged over the course of this year have also been very fruitful, the Culion Foundation Inc., our on the ground partner in the Philippines has been extremely helpful in preparing our next missions, SonoSim provided us with a fantastic simulation tool for POCUS teaching. Thanks to Clarius and their handheld ultrasound probes we will be exploring quality assurance with AI. And partnering with the Department of Health Center for Health Development of the MIMAROPA region of the Philippines helped set the stage for future scaling of our efforts - which our concept of “teaching teachers” is ideally suited for anyway.

We already have increased our team with some great additions from across the US solidifying our continuous remote practice QA and the teaching sessions throughout the year. Please visit them on our website. They make it all possible through giving their time and passion.

As we scale, we also have to look at our finances. We have applied for our first larger Grant (keeping fingers crossed..!). Truly amazing were our 2023 donors. We have received donations from many kind individuals, many of whom gave for the first time and some repeatedly during the same year. Their generosity and kindness is rewarded by the certitude that mothers are being helped and lives saved. However, we have to scale those fundraising efforts also, if finances are to keep the pace with our efforts.

So, was 2023 a bad year? Nope, not really. However I won't reject any one of the wishes for a “better” 2024. It’s going to be good. Why? It will be what we make of it. We have the right people, the right concept and the right support! And we have fun doing what we do! 2024, here we come!!

The Faces of Humanity

Octber 17, 2023 by Stefan

Every morning at breakfast time, I check the news from around the world. Just part of staying informed. Same today. Doing so I felt that this has become an increasingly tough thing to do recently. Terrorist attacks, wars, natural disasters, they seem to be an almost daily occurrence nowadays - and in so many places. And then - all this hate... Hateful content in politics, society, sports... speech becoming more offensive and there seems to be an increasing propensity for violence... I started to feel a sense of despair.

Later in the day, I had to go and see a notary public to certify some documents for next year’s medical mission required by the Philippines’ authorities. This can be challenging as the lines are usually long, the notaries often overworked and unsure about how to certify these documents destined for abroad. I told the first notary what the documents were needed for, but she was unable to help me. She barely listened. So, I moved on to another. Again, I explained about our missions and that we will be doing 5 of them altogether next year in remote islands of a province called Palawan.

This time I got lucky. The lady who helped me listened attentively. She knew exactly what to do and took the time to help me with the paperwork. When all formalities were done and I got ready to pay for the services, she refused to accept my payment. Imagine my surprise. “Consider it my contribution to the voluntary work you do there to help the poor mothers”, she said, and “God bless you!” It literally brought me to tears. When looking at this lady I had come face to face with humanity.

This reminded me of one indisputable fact: there is so much goodness, there are so many good people around us. Only last week at our monthly LMI meeting we had so many new people interested in our charity work. Everyone is super motivated. All our volunteers spend their own time and resources to travel halfway around the world to help make a change to the most needy there. 3 nights ago, I received a request to bring our mission project to two additional island municipalities and beyond. It shows there is plenty of positivity and humanity in this world - one just needs to open one’s eyes, see it and reach out.

The daily news we get to hear or see rarely focuses on such positivity. “Positive” is considered the baseline. Only the deviation, the “negative” is considered newsworthy. We have to remember this when we want to find out what is going on in this world. Traveling helps to get a more balanced perspective. The news won’t report much of the good to us, we have to recognize it ourselves in our daily lives. It is there.

And we can do our part and add to it. How? By displaying our own humanity in our faces.

Back in California!

September 2023 by Stefan

The memories of those dense waves of water heavily pouring down from the sky during my last days in Manila are still lingering in my mind. We had just completed our 2 nd round of medical mission in Santa Barbara, Pangasinan, and very pleased with the immense progress of the RHU midwives performing ultrasound. Prior to that, we had also visited Culion, Palawan as we prepare for our next big mission project starting in January 2024.

Our team got lucky for there was no rain during those days despite the typhoon season. But then, two cyclones passed by the Philippines within a week at the end of August. No landfall and no direct hit, and that meant no reports about damages in the news - but massive rains and local floodings nevertheless. Don’t get me wrong, I do appreciate the blessing of California’s best time of year with its late Summer sunshine now that I am back here.

Don’t get me wrong, I do appreciate the blessing of California’s best time of year with its late Summer sunshine now that I am back here. Yet, my thoughts are still with those people subjected to the rain when those two typhoons passed. The “Nipa” style huts made of bamboo, palm leaves and wood with dirt floors are not putting up much resistance to the elements. Not to mention the wooden houses on stilts with rusted corrugated roofs...

The rural poor already face food insecurity due to their dependence on agriculture. With those common natural disasters, they often lose what little crops they had planted as the base for their marginal existence. The diet they turn to then is simple: plain rice with ++ salt. Not sufficient for anyone, let alone a pregnant woman in need of iron and calcium for the new life growing inside her...

Food - when thinking about the Philippines, one sooner or later, has to turn one’s attention to food. I just recently found out that more and more of my “Fil-Am” (Filipino-American) friends and physician colleagues are becoming “pescatarians” (vegetarian diet plus seafood) in order to remain healthy as we all age. When we discussed this, we realized the irony in it. In essence, they are actually returning to the original Filipino diet of their forefathers, most of whom were fishermen in the Philippine archipelago. In the meantime, ironically, most urban Filipinos in the Philippines have turned to eating all sorts of meats from lechon (bbq-ed suckling pork, the crispy skin is considered a delicacy) to the highly popular “crispy chicken” soaked and fried in vegetable oil as offered in the ubiquitous fast food chains and small restaurants. Meanwhile,vegetables and fish continue to be considered as “poor peoples” foods, and sometimes even hard to find on the menus.

In Manila itself, this irony is turned on its head: Many of the “urban” poor in the slums rely increasingly on food from the garbage the very same fastfood outlets produce. Once dumped on a landfill, this garbage is scavenged for food scraps. Chicken bones with some meat left on them and other scraps are separated from dirt and inedible materials, washed, mixed with salt and some spices, deep fried in cheap vegetable oil for a second time and then consumed (often with delight) as “pagpag.” This process worsens the already poor nutritional value of fastfood,and adds the dangers of poisoning or infection if improperly done. If you click on the hyperlink below, you can watch and see for yourself. https://youtu.be/o8qhhNbxdKA?si=AKZiVWDmxHCmF5nl

There is hope: At some point, the idea of healthy eating will gain track in the urbanized areas (there are some signs of it among fashionistas in Manila already), become trendy everywhere and eventually (hopefully!) will end up in the rural areas as well. In the meantime, we at LMI, will have to do our part in spreading the dietary benefits of vegetables and seafood through knowledge transfer to the remote provinces...

Happy Mother's Day?

May 12, 2023 by Stefan

Recently, while attending an organ concert in the church of a small town, I happened to sit across from a most beautiful Madonna statue. The music - played by an artist unknown to me - was most inspiring too. Music and view made my thoughts wander to the upcoming Mother’s Day. I asked myself:

Why do we still need a single day per year to focus on our own mothers?
Should they not be a permanent focus?

My thoughts then wandered on to a recent article on the BBC website reporting on blind women in India screening for early breast cancers with their fingers taking advantage of the increased tactile sense related to their blindness. They are called Medical Tactile Examiners (MET). Quite amazing! No data regarding sensitivity available but being researched as a potentially more systematic screening tool. No mammography screening in India. METs instead? I couldn’t help but think: Amazing? Yes! But then - the blind screening for cancer? In 2023?

Can we not do better?

To this day, the majority of mothers in the world have no access to any form of breast cancer screening. 1 in 8 gets that disease. For so many, it is a death sentence. In 2022, breast cancer became the most common cancer in the world (both sexes combined) - and it affects women significantly.

Are we (almost literally) turning a blind eye on women, on our mothers?

In developed countries, we have mammography (now almost universally recommended annually for women 40 and older). Mammography screening is hard to translate globally due to the large expensive machinery especially to developing countries. However, ultrasound is not. Handheld ultrasound is (or at least can be) available everywhere even in the most remote corners of the world. We know we can indeed screen for early breast cancer disease with ultrasound avoiding cancers being detected at later incurable stages. Not as good as Mammography, but still better than nothing. So, we CAN do better.

SHOULD we not be doing much, much better for our mothers?
Should we not at least try harder?

Then, I remembered the latest statistics on maternal mortality (the number of women dying during pregnancy/childbirth). I had read just a few days ago - it is rising again both in the United States and in the Philippines. It jumped by about a third! In the Philippines, the increase reversed decades of a downward trend, and is now 2.5 times the value recommended by the UN 2030 SDG for the Philippines. We do have the tools to prevent most of these deaths.

Why don’t we do better for our moms?

At LMI, we focus on this maternal mortality. We are gaining momentum (now planning for intervention at 4 municipalities in the Philippine Islands starting in 2024). As younger women are increasingly afflicted by breast cancer, it’s obvious that at some point, we will have to include cancer prevention in our work.

Every single person has a mother. Would addressing their most fundamental health issues not make celebrating our Mother's Day much happier than before?

Come and join us. We can help keep moms healthy!

New Year

January 31, 2023 by Stefan

It’s another sunny and hot day in Makati, Metro Manila, The Philippines. Chinese New Yer Celebrations are over, Valentines Day decorations are popping up and it is hot! I am escaping record wet and cold days in California. Our January LMI mission in conjunction with PMSNC is over and I am waiting to take part in another medical mission while taking care of other business here in the capital.

Right now, I am looking at the first sonographic images acquired by the newly POCUS trained midwives from Santa Barbara, Pangasinan - acquired on their own. And how amazed I am! After going through one-on-one and group training they are now “flying solo”. Well, not quite “solo”, they team up in pairs and then submit their images to us for QA and feedback. But still - no one is holding their hands anymore. Yes, the week of in-person teaching was intense, but how much skill have they acquired in that one week!

The project is now in full swing. Theory and practical instruction phases are over, now it is their time to practice. And they started to do so with as much enthusiasm as they displayed when they soaked up all the information given to them. Most did very well already after 2 or 3 days of practical instruction. We were even able to identify some especially talented among them (so-called “super user material”), and of Choruses also some who need a little more help. The enthusiasm was equal among them all, which I personally did not expect. Much of this was due to the motivational abilities of our training trio (Dr David Walton, Connie Santos and Anne Haller). During the current learning phase the POCUS examinations performed will not be used for clinical decision making as per protocol.

It’s hard to express how proud I am of our entire group during this mission. The prenatal care team was just as successful as the ultrasound team. Home visits accompanying midwives in their “Barangays” (the smallest community unit in the Philippines, formerly known as “Barrios”) allowed for identification of their challenges, which were addressed by team leader Dr Seema Shah in several lectures. As it turns out, many of the patients the midwives take care of give birth in a private hospital. Hence the public health midwives see many more patients during their prenatal period than during the actual process of delivery. So focusing on prenatal care became much more important than anticipated.

The students in our data collection teams are currently analyzing the data, some of which will be used to improve the understanding of the mothers repreventive care not just for themselves and the baby, but the entire family.

Exciting stuff, won’t you agree?

Did I even mention the warmth and cordial atmosphere we experienced during this week? Already, we are all looking forward to going back later this year to reinforce what has been learned and build on the achievements for a truly sustainable effect.

It is still too early to declare success. After all, our focus at LMI is on outcomes, not on output. But one thing is for sure: The municipality of Santa Barbara is one step closer to establishing Universal Healthcare (UHC) at the grassroots level.

So this is Christmas...

December 20, 2022 by Stefan

It’s a cold but sunny mid December day. I am driving on the freeway from Sacramento back to the Bay. I had just submitted some paperwork to the California Secretary of State for yet another medical mission next year in the Philippines. It’s a boring drive and I tune into “the Bay’s Christmas Music Station”. I recognize the voice of John Lennon. He is stating the obvious first: “So this is Christmas…”. Oh yes, John Lennon also had to write a Christmas song. Of course! He goes on: “… and what have you done? Another year over…”.

Uh-oh! There it is: the reminder to reflect on the past year. With Christmas the year is coming to an end triggering such reflections on this past year and hopes for the best in the next.

So this is Christmas - and what have I done? This year full of war, climate catastrophe, “triple” pandemic, inflation… What a crazy year - And what have I done? I quit hospital medicine in the hope I could dedicate myself to making a difference for people who need it the most - with LMI. You know? Reduce maternal mortality by teaching midwives and pregnant ladies using the medical mission concept. That kind of thing. Yet, so many of catastrophes hit home this year: death, dementia, disease, depression, disability - in various forms, some striking at the same time. And what have I done? Tried to deal with all of it as best I could. And God’s wisdom came through yet again: a beautiful spring, summer and fall without fires, the glistening bay shore in front of me, the sun a constant companion, the right people in our organization and LMI’s work sorely needed in a place in the Philippines. We can’t solve every issue, but what we can do is stay focused on the good, the big picture and deal with every other issue that comes up along the way with the tools God has blessed us with. Life is good!

So, off to the Philippines in January 2023. Let us make sure fewer women die from preventable causes related to pregnancy! We will show this with data and hopefully we can convince people like you, as you read this, to join and support us.

Next year when John Lennon will ask us again “and what have you done?” - we can just smile...

All the while, his song is still in the air:
“A very merry Christmas
And a happy New Year
Let’s hope it’s a good one
Without any fear”

Happy Birthday LMI!

November 21, 2022 by Stefan

It has been exactly 12 months since the founding of Life Matters International (LMI), our nonprofit organization changing the “medical mission” concept from the notorious suspicion of “serving the missionaries more than the intended population” toward an evidence based impactful agent of sustainable improvement for healthcare in developing countries.

I am immensely proud to announce LMI’s next intervention in the municipality of Santa Barbara in Pangasinan, Philippines. Our goal is to decrease maternal mortality. Hence we will train local midwives and nurses in point of care ultrasound #POCUS, address local needs in prenatal care and explore ways to increase mothers’ engagement in preventive medicine - all based on local conditions and customs in a culturally sensitive way.

Kudos to our team of volunteers who will travel to SB to pass on their knowledge focused on metrics and outcomes rather than output through doling out freebies. Godspeed to those at the receiving end of our “knowledge transfer” to embrace the change, improve care and help those without means experience better healthcare and better outcomes.

A big “Thank you” to our partner organization PMSNC (Philippine Medical Society of Northern California), whose forward thinking leadership is exploring ways to turn their annual medical mission into an effort resulting in greater impact, focusing on outcomes over output and lasting change for needy populations.

Indigenous Peoples’ Day - or - what good can come out of having a concussion?

October 10, 2022 by Stefan

It was almost 6:00 am local time and it was still dark. I was carrying a table (table-feet first, tabletop against my chest) to prepare for a group session of a group of healthcare providers. We were on a medical mission in central Yucatán peninsula in Mexico serving locals including indigenous Maya people with poor access to healthcare. These quiet, hard-working and equally stoic and resilient people rooted in a highly sophisticated civilization have suffered much over the past centuries under colonial rule. I was looking forward to seeing the pregnant patients of the village for prenatal care including ultrasound later that morning.

But - things changed abruptly: On the poorly lit path I carried the table (feet first) and suddenly hit an invisible obstruction. The recoil pushed me backwards, I lost my balance at the path’s edge and fell - head first, table second - hitting the concrete floor and blacked out.

After a 2.5 hours (!) rumbling drive I arrived at the closest town with a CT scan in the back of a van owned and driven by one of the volunteers while being closely observed by one of our nurses (Thanks again, Gary!). After 2 additional hours in the public hospital’s ER the CT was finally done (I was brought there not on a stretcher but in a rumbling wheelchair). No radiologist around for interpretation, so being one myself, I was shown a cellphone recording of the ct scan to look at (1 additional hour later). How relieved I was to see just a broken nose and not any bleeding inside my head (all this while having dizziness, vertigo, pain and lightheadedness)! I was discharged a few hours later, of course ONLY after the CT scan, saline infusion and ER stay had been paid in cash. 60+ hours later I was seeing patients again.

This morning, I checked my iPad during breakfast for the latest news. I learned about today being indigenous peoples day in addition to Columbus Day and the President’s appeal to recognize and address their plight in both past and present.

I realized, I was beyond lucky during my misadventure in Mexico! True, I got to the hospital only after 2.5 hours and had to wait another 2 to get my CT scan. I had to interpret it because no radiologist was around. I had to pay to be discharged. In my place, a local campesino or his wife will not even make it to the hospital, because there is no van to transport them and they would not be able to pay for the transport if there were. Even if they are close to a hospital, they won’t be able to pay for the CT scan, infusions or ER stay.

How is this related to the indigenous people? Well - Is it not the indigenous communities (whether in the US, Canada, Latin America, Africa, Asia), the American Indian, the Maya, the Ati or the Igorot, that to this day face the greatest hurdles in accessing even basic healthcare due to their location far away from modern cities - displaced by European invaders to places where there are few, if any, doctors or hospitals?

So, where is the light at the end of the tunnel here? Here it is: The driver of my van turned out to be a local congressman who happened to volunteer for our mission. Unhappy with his government’s healthcare policies and having learned about the work of LMI, he approached me again 3 days later expressing his desire to improve maternal mortality in his district.

We agreed to explore holding a future mission project there. How much work is there to be done in and beyond treating individual patient. I am grateful for being part of the LMI team, which tries to tackle this work.

Women and children first!

March 4, 2022 by Stefan

I had a discussion with two women from a UK-based non-profit group called "Women and Children First". Joanna Drazdzewska is the Head of Programmes and her colleague Annemijn Sondaal is the Programmes Manager. Joanna and Annemijn developed a tool that helps connect healthcare workers with pregnant women in communities in Ethiopia. The tool is a simple calendar. It is designed to help women become enaged in their pre-natal care. This simple calendar might be a good resource for Life Matters International because it is paper-based, it doesn't even require a computer! This is an important feature when we conduct medical missions in rural areas that lack technology infrastructure.

Joanna and Anemijn are still in the process of collecting data. They expect to present the data that qualifies and quantifies effectiveness in mid May 2022. This fits into LMI's timeline for conducting the first medical mission in late 2022. I see a great potential in partnering with "Women and Children First" by helping them test this calendar tool.

Check out their tool at https://www.womenandchildrenfirst.org.uk/blog/calendars-crucial-health

It's always nice to see great ideas come to fruition from groups and individuals who share our passion.