Good Sam Medical Mission

Our Christmas 2010 Patients

2010-12-16T12:30:00.001+08:00

We want to take this opportunity to wish all of our friends and supporters a very merry Christmas season this year and to tell you all how very blessed we are to be medical missionaries here in the Philippines!

Thanks to your support and prayers and God’s abundant blessings we have been able to evangelize God’s word and deliver desperately needed medical care to the poorest of the poor! Lives have been saved, both spiritually and physically, severe illnesses have been cured and chronic illnesses are being treated!

These are just a few of our many patients seen this month! We are now seeing 15 to 30 patients almost every day. Some of them walk almost 10 miles to our home to be seen, though we are trying to establish a schedule to travel to the other villages so that care can be provided closer to their homes!

We pray that as you are preparing for this Christmas season that you remember the REAL reason for the season, that you hold your family and friends close, share Christ’s love and rejoice for the greatest gift we have ever received!

Thanks to your generosity and faithfulness to God’s word these patients and so many more have received the precious gift of good health and spiritual renewal, some for the first time in their lives! May God bless us, every one!

	This is a man who had chronic UTI symptoms but could not afford to be seen! He was found not only to have a urinary tract infection but a chronic prostate infection. After receiving adequate antibiotic treatment, he is symptom free for the first time in a very long time!
	This is a very kind and humble elderly lady who lives up in the mountains without electricity or running water. She came to us complaining of severe right eye pain and decreased vision for a few days! As you will see in the following photos, that is an under statement!
	This is a close up of what her right eye looked like when we first examined her! We started her on topical antibiotics and arranged to take here to an EENT specialist on the next island the next day!
	Here she is being examined by the EENT specialist. He started her on two topical antibiotics and steroid eye drops. We are taking her back for her follow up visit today!
	This is an other very pleasant elderly lady who was found to have significant high blood pressure that was untreated and bilateral cataracts. Once we have her hypertension well controlled, we hope to be able to find financial resources to pay for here cataract surgery!
	This is a young woman who ask to be seen for worsening eye sight. After examining her, we discovered that she had significant, untreated high blood pressure in addition to her complaint of worsening visual acuity!
	We began to treat her hypertension and took her to the EENT specialist who confirmed that, other than needing corrective glasses, her eyes were fine!
	Here she is after receiving her first and only pair of glasses! She now has excellent eye sight and can care for her children and husband and work in her garden and study her bible again! She asked we make sure that we thank all those who have generously donated to our medical mission and allowed her to have her hypertension treated and gave her back the gift of good vision and the ability to care for her family and to, once again, read God’s word!
	This is another elderly lady who asked to be seen for poor vision! We found that she had untreated hypertension and cataracts! We are now treating her hypertension and hope to soon have her evaluated for her cataracts!
	This middle aged woman has type II diabetes mellitus, however, she was often unable to buy the necessary medications or have her blood sugars tested! We completed her examination, found that her blood sugar was over 300 and began treatment. She is now feeling much better, taking her medications regularly and keeping her follow up visits. Her blood sugars are now in the 120’s!
	This woman had a long history of type II diabetes with several complications due to her lack of financial resources to buy medications or pay for medical care or blood sugar testing. The reason she came to us for care was that she had injured her foot and it became infected!
	This is her right foot and as you can see she had previously had to have her great toe amputated due to severe infection as a result of the complications of here diabetes
	This is a photo of her left foot on the first day she came to us for treatment. The injury was infected, her blood sugar was over 300 and she was also hypertensive. She had not been taking any medications because she had no money! We cleaned her wounds, started antibiotics, diabetes and hypertension medications and scheduled her for follow up!
	This is a photo of her having a sterile dressing being applied to her infected left foot injury! She has been seen a few times in follow up, her infection is healing without problems, her hypertension is now under control and her diabetes is also under control!
	This woman came to us with a complaint of chronic pelvic and abdominal pain. She said that she had seen a doctor in the past and was told that she had pelvic inflammatory disease. She had been able to buy only about 1 week’s worth of antibiotic. We have been able to have her seen by a GYN doctor and a GI doctor on the next island. The ultrasound showed polycystic ovary disease and venous congestion of her uterus. She is now undergoing appropriate treatment
	This young mother has a history of hyperthyroidism. She was supposedly treated and required being started on thyroid replacement medication. She came to us complaining of headaches and palpitations. We have stopped her thyroid replacement medication and are treating her with a beta blocker and continuing to monitor her and will arrange for her to have her thyroid function levels checked.
	Here my wife, Rhome is giving this patient instructions on taking his high blood pressure medications, diet and exercise. She is also giving him the necessary instructions for his follow up appointments.
	This is a young lady who wanted to be seen because she has had a mass on the side of her neck for a few years.
	Here is a close up of the right side of this patient’s neck. At present, my diagnosis is a branchial cleft cyst! We will need to schedule her for specialty consultation and possible surgery!
	We are continuing to see a significant number of patients, both young and old, with a variety of respiratory diseases. This is a young child with asthma that required nebulizer treatments. She is doing much better now, but will require ongoing asthma treatment for some time to come!
	Here is a teenage boy with asthma. He had a prior history but has seldom had the financial resources to be able to receive any sustained treatment! Hopefully, now that he is receiving care and medications through our Christian medical mission, he will be able to be treated appropriately and on an ongoing basis and to lead a a normal, productive life!
	Here we have a young girl who we have been treating for asthma. She is doing much better at this point, but again, will require ongoing medical care and medications if she is to have the opportunity to grow up healthy, attend school and become a healthy, productive adult!
	This is a young mother who is bringing her infant daughter back for a follow up appointment after she was treated for bronchiolitis! As you can tell from the mother’s smile, the infant is now doing very well!
	This is an elderly gentleman who has high blood pressure that is rarely treated do to his inability to afford medications. He also was a significant problem with arthritis in several joints. We were able to provide him with the necessary hypertension medications and his hypertension is now under much better control! We have been able to start him on ibuprofen for his arthritis symptoms now that his hypertension is under control and he is feeling much better!

This is a husband and wife who able to afford medications. Now blood pressures are under good	both have hypertension but who have seldom been they are both on appropriate medications and their control and they are feeling much better!
	These next several photos are of a young girl with a severely infected skin rash! This girl lives on the far end of our island and had no medical care since the rash started about three or four days prior and had had no medical care! She had been carrying around a stray puppy who looked infected with the mites that cause mange! She developed a severe, itchy rash shortly after carrying this puppy around!
	These next photos are somewhat graphic so please be advised! This next photo is of her chest and abdomen and the infected puritic rash. As you can tell by the expression on her poor face, she is a very uncomfortable and unhappy little girl!
	This is a photo of what can reasonably be shown of her groin area and you can see that this is a seriously infected rash that is very uncomfortable and need immediate treatment!
	This is a photo of the front of one of her legs which is also severely involved with this infected rash!
	Here is a photo of the posterior aspects of both of her legs and they are also involved and infected!
	In this photo you can see how wide spread this infected skin rash is and how severe it is, especially in this poor young child!
	This is a little broader view of this child’s back and again, you can appreciate how severe and wide spread this infected skin rash is and how urgently it needs treatment! We got her completely undressed, cleansed her all over with a antiseptic cleanser, thoroughly rinsed her off and then applied a light application of antibiotic and Benadryl cream! Then gave here some clean cloths that we had and started here on oral antibiotics as well. She is now doing a lot better!
	This is a young girl who came to us because she had developed a significant skin rash on he leg and it had slowly been getting worse!
	This is a close up of one of the lesions on here leg. I have a idea of the cause but I am also submitting the photo to other PA’s who work in dermatology for their opinion!
	This man presented to us with a significant swelling of his left cheek and jaw. it had been present for about 3 or 4 days and was getting worse! After examining the patient it looked as though he had a significant left parotitis! We started him on medications and appropriate ancillary treatments and will see him back tomorrow!
	This is a close up of his left cheek and jaw to try to give you an idea of the facial asymmetry and to the severity of his condition!
	This is a local “medicine man” who sought treatment for a “constant noise” in his ear for the last several years. This, of course, was tinnitus, but because it was unilateral, this raised the question of a possible serious underlying etiology. We did have him seen by the EENT specialist on Leyte and he felt that, due to the duration of his symptoms, and the lack of other physical findings that there was no need for further work up at this time!
	This lady was found to be hypertensive and to have had a recent CVA with some facial residual weakness. She had not been on any previous medications. We started her on anti-hypertension medications and low dose aspirin daily. We have seen her in follow up and her high blood pressure in now under control and there has been some improvement in her facial weakness!
	This is my wife, Rhome doing some patient education with one of our hypertensive patients.
	Here we are using a glucometer to check the blood sugar of one of our diabetic patients. So far all of our type II diabetes patients are compliant with their medications, dietary restrictions, exercise recommendations and all have had markedly improved blood sugars and reduced symptoms related to their diabetes!
	This is a photo of me receiving “payment” for treating the two asthmatic sisters! As you can see the mother is very happy that her daughters are now asymptomatic! If you look close you can see my “payment” is two live chickens in a plastic bag that I am holding and some fresh local bananas!

Well that brings us to the close of another update about our lives as Christian medical missionaries and our patients here on Pilar Camotes, Cebu, a small, remote, subsistence living island in the central Philippines!

We pray that you have enjoyed this update, that you will continue to follow our work in Christ’s name, for His glory and by His power! We also want to wish each and every one a Merry Christmas and a Happy Hanukah! We also ask that you keep us and our work in your prayers and that your blessings in the coming year be more abundant than you could ever imagine because you have certainly made our lives and the lives of all of our patients more abundant than they or we could have ever imagined!!!!

God Bless Us Every One!

Chip & Rhome Nuttall

pilarchip1@mac.com

A QUICK UPDATE ABOUT BLOG CHANGE

2010-12-01T10:51:00.001+08:00

Just want to tell everyone about a new feature that has been added to our blog!

Thanks to a fellow PA and good friend, Karen F., there is now the option to enter your email and automatically be notified whenever there is a new blog post!

This should simplify everyone being updated in a timely manner whenever there is a new post and make things more efficient! I want to assure everyone that your email addresses will not be kept, sold, rented or used for spam! This process is made possible through Feedburner, a standard in the industry for automating notification of blog updates! Please consider giving it a try and don’t miss any updates!

We continue to be quite busy! On Saturday after Thanksgiving we set a new one day record for patients being seen! We saw 39 patients on that day, the last 2 at 9 PM!

As we all get ready for the upcoming Christmas season We would encourage everyone to remember the “REAL” meaning of Christmas and what a truly WONDERFUL and LOVING Blessing God gave us on that day so many years ago, and that the blessing continues anew everyday for each one of us! That God has a plan for us, that He loves us so much and wants each of us to love and accept Him as our personal Lord and Savior! Please keep Christ in CHRISTmas! HE is the reason for the season!

May God Bless Us, Everyone!

Blessings,

Chip & Rhome

pilarchip1@mac.com

A THANKSGIVING BLESSING 11-21-10

2010-11-23T10:02:00.001+08:00

Hello everyone!

Thank you all for taking the time to spend a few minutes learning about what it is like to be Christian medical missionaries on a remote island in the Philippines!

We want to wish everyone a happy and blessed Thanksgiving this year!

We consider each opportunity to provide care to the poorest of the poor a blessing from our Lord, Jesus Christ! We truly love to care for each and every patient and to share God’s love for them! For many it is their first time to receive quality medical care! Many have died or have suffered serious morbidity as a result of such a lack of medical care. All are truly grateful for the care that we provide by the power of our Lord, in His holy name and for His glory!

We want to sincerely thank each person who has visited our blog, told others around the world about our blog and encouraged them to take a look, for all who have and are including us in their prayers and to everyone who has opened their hearts and donated financially to our work here in Pilar Camotes, Cebu, Philippines! Without your support we would not be able to continue this most important work! God bless you all!!!!

	This is a picture of our little island. It is 2.5 miles wide and 10 miles long. It has a population of about 11,000 people. Almost all have a subsistence life style, living in native houses, fishing or farming for a living. They have no health insurance! We provide the only quality medical care on the island and provide not only their treatment, but their medications and their hospitalization, when required!
	This is a picture of a person using a carabao to deliver fire wood. The fields are also plowed by using a carabao and an old fashioned plow!
	Here people are drying the corn that they have harvested. They remove the kernels by hand and then place it on tarps that are placed beside the dirt road to dry.
	This is a closer look at one of the tarps filled with corn drying in the sun along the side of the dirt road. Once the corn has dried sufficiently, it will either be ground in a corm mill for corn meal or stored for use as seed corn for the next season.
	This is one of the many patients we have seen over the past month for bronchitis and asthma. There has been a significant increase in the number of patients with respiratory problems including TB! He was treated with bronchodilators and antibiotics and is now doing well!
	This woman has hypertension and bronchitis. We have been able to control her hypertension and resolve her bronchitis. She is one of the many people who we have treated lately! There has been an increase in the burning of vegetation one or more times a day to try to reduce the mosquitoes. This has been because of the increased risk of dengue fever! We believe this has been contributing to the increase in respiratory illness!
	This is a young man who had a history of asthma and due to the increased burning of vegetation to produce smoke to ward off the mosquitoes has had a significant increase in his asthma symptoms and their severity! With the availability of nebulizer treatments, bronchodilators, and steroid MDI’s he has been stabilized!
	The children have not been spared the increased respiratory illnesses! The next several photos are some of the many children and infants that we have treated for asthma, bronchitis and bronchiolitis!
	This is a photo of the little girl shown above and her mother, sister and my wife, Rhome. She is shown receiving a nebulizer treatment and you can tell that her mother is quite happy to have such medical resources available and that her daughter is responding well!
	This little girl is one of our neighbors. She presented with significant bronchitis, fever and a productive cough with yellow sputum.
	Here she is receiving one of her nebulizer treatments. She was also treated with antibiotics, Tylenol, and increased fluids. She is now doing very well and is back in school!
	This is a young mother and her infant daughter who she brought to us because of fever, cough and shortness of breath. Her examination was consistent with bronchiolitis. We treated her with Tylenol, nebulizer treatments, antibiotics and fluids. She is now asymptomatic and is quite happy and strong!
	Here is another young child who is recovering from bronchitis and both he and his mother are quite happy that the worst is over!
	This is another young mother and her infant daughter who has a history of asthma and that was experiencing more frequent and severe asthma episodes since the increased burning of vegetation had started. She responded well to nebulizer treatments!
	Here is another young boy who was brought in for treatment of a worsening cough, fever and wheezing. His physical exam revealed that he had asthmatic bronchitis and he too responded well to appropriate treatment and is now doing much better!
	Here is a young boy receiving a nebulizer treatment for his bronchitis. You can see that his mother is happy that he is responding well! He is now well and back to school!
	Here are two sisters who were back for follow up for asthmatic bronchitis. At this point they were asymptomatic and were back to enjoying school and playing with the other children in the area!
	This young girl and the one in the next photograph both have significant conjunctivitis. There has been a literal epidemic of conjunctivitis on our island over the past month.
	This is another young woman with severe conjunctivitis! As I mentioned in discussing the case above, there has been an epidemic on our island, but, thanks to our Lord, we have successfully treated every case that has come to us for care and they have all been cured without complications!
	This is a young girl who came to us for treatment of a recurring draining abscess below her right jaw!
	This is a close up of the site. We cleaned the area and started her on antibiotics, but she has been lost to follow up. We are trying to locate her to insure she receives appropriate treatment!
	This is a young girl who has significant allergic reactions to the many mosquito bites that are all too common on our island. She now sleeps under a mosquito net, uses mosquito repellant and has been given appropriate combination Benadryl and hydrocortisone cream to apply to the affected areas!
	This is a young girl who was brought to us for care by her mother! Unfortunately, she has microphthalmia with fibrosis and has almost no vision in her left eye. The following pictures show some close up views of her left eye and her evaluation by an EENT specialist.
	Here you can appreciate that her left eye is smaller than her normal right eye and that there is fibrosis of the cornea!
	This is another close up where the fibrosis can be better appreciated.
	Here she is being examined by the EENT specialist in Ormoc City on the island of Leyte!
	This is a 15 year old girl with multiple severe dental cavities requiring extractions and antibiotics. It is, unfortunately, the case with so many of the school children on our island! This is why we are undertaking a dental education and treatment project this February and we hope to be able to provide each child with education and a new toothbrush and toothpaste!
	This is a young mother who had a significant fear of dentists due to a rather barbaric dental procedure that she witnessed her mother undergo when she was a child. She had an almost completely eroded wisdom tooth that required follow up for post extraction dental infection. She was treated with appropriate additional care and antibiotics and is now doing well!
	This is an elderly woman with hypertension and severe dental cavities which will require antibiotics and multiple extractions! We have started her on appropriate antihypertensive medications and antibiotics so that we can take her to a dentist in Ormoc City on the island of Leyte for her dental care!
	This patient came to us for left ear pain, swelling and drainage from her left ear. A large perforation of her ear drum was noted. We started her on antibiotics, topical and oral and transported her to Ormoc City where she was seen by an EENT specialist for evaluation and treatment for large perforation of tympanic membrane of left ear. She is showing good improvement now!
	This is a young woman with severe otitis media and otitis externa. She was treated with ear irrigation, topical and oral antibiotics and has shown marked improvement. We expect her to recover fully in the near future!
	This patient was 5 months pregnant and had a history of severe asthma with possible TB and a UTI. She subsequently had a miscarriage. While we were off of the island purchasing additional medical equipment she was evacuated by boat to Ormoc for worsening respiratory symptoms. Unfortunately, she died of respiratory failure!
	This gentleman has significant gouty arthritis of his left wrist and was treated with steroids on a tapering dose and has responded quite well!
	This is an elderly woman from up in the mountains. She had sustained a ground level fall about 5 days prior to being seen. She did not wish to have surgical inter-vention and so we splinted the wrist and also gave her a sling and plan to cast the fracture when the swelling decreases.
	This woman had sustained a spider bite and came to us for treatment. The picture below shows the site.
	There was some mild swelling surrounding the bite and surrounding erythema. She was treated conservatively and fully recovered within a few days!
	This is a patient with hypertension and noninsulin diabetes. We are checking her blood glucose level and counseling her on weight loss, diet, exercise and adjusting her medications.
	This is an elderly patient with a history of hypertension, but due to a lack of care and no financial resources to buy medications she had gone without treatment for an extended period of time. Now her blood pressure has markedly improved with proper medications!
	Here is yet another elderly woman with hypertension and noninsulin dependent diabetes. She too had been without treatment due to lack of financial resources and access to good care. She is now improving significantly after receiving proper medications and care!
	This is a local man who was involved in motorcycle accident late the night before. He had sustained a laceration and significant abrasions to his face, arm and leg/foot!
	This is some of the care we were able to provide, including care of the laceration, debridement of the abrasions, application of topical antibiotic cream and dressings and the administration of oral antibiotics. He is now almost completely recovered and did not develop any wound infections!
	Here is a picture of us cleansing the wound on his left ankle.
	This is a young boy who fell out of a tree and sustained a scalp laceration that required suturing. He was quite fortunate that he did not sustain a concussion or other serious injury!
	This is a picture of the laceration prior to any treatment!
	This picture is after the area was prepped and scrubbed. We are injecting the area to be sutured with local anesthetic.
	Here we are closing the laceration with some sutures! Once we were finished closing the laceration we applied a sterile dressing. He is now doing well! The sutures have been removed and he did not develop any infection!
	This is a local fisherman who came to us for care for an injury to his right eye. He sustained some conjunctival irritation when a piece of the fishing net material poked him in the eye. Previously he had sustained a corneal injury to the same eye that resulted in partial opacification of the cornea!
	This is a close up of his injured right eye that also shows the corneal scarring as well. He was treated conservatively and his injury resolved without complications!

As you can see, there is a tremendous need here on this remote island, and there are no local resources to provide the medical care that is so desperately needed!

It is ONLY through the prayers and giving Christian hearts of many who do not even know these people that we are able to be the “boots on the ground” and provide both spiritual healing, strength and comfort as well as physical healing, strength and comfort! At this time of year, and in this time of crisis around the world, we are especially thankful to our Lord, and to everyone who has and who continues to support this vital work in so many ways!

We ask that everyone would continue to include us and our work in their prayers, and for those who’s hearts are touched by God, to please donate whatever you can so that we can continue to provide care to the poorest of the poor and to lead them toward being able to self sufficiency through our other projects in the realm of agriculture!

All donations are fully tax deductable and can be made through our church in the US; Hilltop Community Church Carson City, Nevada! Their website is http://www.hilltopchurch.net/ Their mailing address is Send mail to: 3588 Romans Road, Carson City, NV 89705. Their email address is sukari@hilltopchurch.net

As always, we encourage everyone to spread the word about our work and our blog to your friends, neighbors and coworkers and ask them to take a look for themselves! We also ask everyone to make comments on our blog so that we can try to improve it in everyway possible!

Until next time;

May God bless us, everyone!

Chip & Rhome Nuttall

pilarchip1@mac.com

Narrowly Escaping Disaster Post For October 25, 2010

2010-10-26T16:30:00.002+08:00

Last Tuesday my wife, Rhome and I were traveling, via pump boat, to Ormoc City to see a patient, the brother of a caregiver on Pilar. He is the sole breadwinner for his family and has been so ill that he could not work for the two weeks prior to our visit.
Super Typhoon Juan had made landfall over Luzon a day or so prior and had not completely cleared the Philippines. The typhoon itself had a diameter greater that the Philippines north to south distance!

When we left that morning the weather was a bit windy and the waves were two to three feet in height. There were clouds but no rain and no visible thunder storms. Everything was going smoothly until we were about 30minutes away from arriving at the doc in Ormoc City. Then, all of a sudden, the boat turned 90 degrees and we could see a fast approaching storm that had come up from behind us! Swells were now in the 6 to 8 foot range, it was raining very hard, the wind was at least 30 to 40 miles per hour, and we were now traveling parallel to the waves! This made it very easy for the boat to capsize! The captain was trying to outrun the storm and get the boat to a sheltered cove so that we could ride out the storm. naturally we were all completely soaked as was our luggage! By the grace of our Lord the boat did not capsize (although is did come very close to capsizing) and we reached the shelter of the cove.

We then had to climb down from our boat and get on a variety of small fishing boats that took us to the shore! We then had to hike up to the road and flag down a small passenger van and about 20 of us crowded in along with our luggage and traveled on to Ormoc City after the storm passed!

I am sorry that I did not get any pictures of our grate adventure but we were all quite busy preparing to abandon ship if it was to come to that! I guess you could say that this journey to make a “house call” is one we will long remember!

Since our last post we have been extremely busy seeing a multitude of patients as well as continuing to make progress with our meetings with the professors at Visayas State University on the island of Leyte! They have been most gracious hosts and partners in our ongoing efforts to replenish seed corn stocks for the island of Pilar, develop composting using a new technique that they have developed which, we pray, will lead to the development of an organic fertilizer business here on Pilar! We have always wanted to find a business model that would allow us to employ people here on Pilar, thereby helping to improve their ability to rise above the subsistence life style that they have had no alternative to for many generations!

Here is a picture of the mountains behind Visayas State University. It was taken during our last visit.

This is the entrance to Visayas State University.

This is the entrance to the Agriculture Department of Visayas State University.

The two pictures above are of Dr. Asio, on the left, dean of the Department of Agriculture at VSU and professor Berta Ratilla, an agronomist at VSU.

If our Lord gives us the grace to see this project bear fruit, then we will not only have helped raise people out of chronic poverty but we will also have succeeded in providing a less costly alternative to commercial fertilizer, and at the same time, begin to enrich the soil in a sustainable way! The productivity of the cash crops of corn and vegetables will also improve as will the nutritional status of Pillar's population!
Now, on to a sampling of our recent patients!

This is a patient that sells vegetables “door to door” on the island but has very poor vision, “ I can only see shadows” she said. She related that this first started when she was age 10! She is now in her 40’s. The final diagnosis was, as I feared, optic nerve atrophy, a permanent, untreatable condition! Had she received treatment early on, it could have been cured!

This is the patient after we had to tell her the unfortunate news! All that we can do now is to try to ask if someone in the US would be willing to donate one of the page sized, illuminated magnifiers so that she could at least read her bible and other books and see photos of her family! Can you imagine, seeing just shadows and selling vegetables door to door!

This is a young father who earns a living for he and his family simply by fishing from a small non-motorized boat! He complained of having fever, a productive cough, and difficulty breathing with heavy work. He was diagnosed with bronchitis and treated with medications and is now doing well!

This is a young mother who came to us complaining of frequency, urgency and burning with urination. She was diagnosed with a urinary tract infection.
She was treated with an appropriate antibiotic, encouraged to drink plenty of water and use vitamin C four times a day. She was asked to return if there were any problems and to come back for follow-up in a week.

Here she is a week later with her infant daughter and her mother! She was completely without symptoms and was completing her medications as instructed!
We shared a prayer of thanksgiving with them and encouraged them to continue growing in our Lord!

This woman had a facial laceration that was sutured after a through cleansing and a sterile dressing was applied. She was started on antibiotics and instructed to return if there were any problems and to return in 5 to 7 days for suture removal!

This is a 15 year old who was brought to us for evaluation and treatment for a chronic pain and a “lump” just below his knee! There was no history of any trauma and no evidence of infection.

Here is a close up of his knee.
He was diagnosed with Osgood Slaughter’s disease, treated conservatively and reassured!

This gentleman came to us seeking care for a toothache! He actually had 2 significant cavities and we were able to clean things up a bit and put in 2 temporary fillings. We were able to provide him with some ibuprofen for pain and ask him to return within a week so that we could take him to the dentist in Ormoc City for definitive care!

This is a young mother with her, less than happy, infant! She said that the baby had been having a significant cough, runny nose, some fever and was not eating as well as was usual an not sleeping well! On examination the child had a significant bronchiolitis. We started antibiotics, a mucolitic, Tylenol and bronchodilator nebulizer treatments. With in 2 days there was a marked improvement! The baby is now doing well!

This was our young patient during one of the follow-up visits! You can tell that, although she was improving, she was still not thrilled with her care!

These are 2 sisters who have a history of asthma and were having symptoms of asthmatic bronchitis and fever for 1 week when their mother brought them to us for medical care. The initial exam revealed marked wheezes and some rales bilaterally! We started them on Tylenol, a steroid inhaler, bronchodilator nebulizers and a mucolytic! They are now doing very well!

This very pleasant woman had a history of a persistent, productive cough, some fever, difficulty getting restorative sleep! Her exam was consistent with bronchitis. We started her on antibiotics, a mucolytic, increased fluids and bronchodilator nebulizer treatments! She is now asymptomatic and joined us in a prayer of thanksgiving for the Lord providing such care!

This is one of many (probably at least 20 to 30) patients that we have seen over the past 2 weeks or so for significant conjunctivitis! We treated her and most of the rest with ophthalmic steroid & antibiotic drops which required them to return to our home at least 3 times a day to receive treatment! They all responded well to the therapy and, hopefully, the epidemic is starting to subside!

This is a close-up of the above patient’s infected eye!

I will include photos of some, but not all, of the patients that we have treated over the past couple of weeks for conjunctivitis below this photo.

This is the young man that I mentioned in the beginning of this post! He is the only “bread winner” for his family! He is employed as a security guard but has been too ill to work for at least 2 weeks. His main complaints are of epigastric and right upper quadrant pain with some radiation of the pain through to his right shoulder. the second picture above is him being seen by a gastroenterologist. he is scheduled for a abdominal ultrasound tomorrow morning. Please keep him in your prayers! His name is Jo Jo.

This is a 15 month old boy who was brought in to us for treatment of a second degree burn to the inner aspect of his right leg just below the knee. He was riding astraddle of the gas tank on a motorcycle and during an accident he sustained this burn! We thoroughly cleansed the wound and debrided the burn. Then we applied a silvadine dressing and recommended that the child be seen the following day by a physician, as the family would be traveling back to Ormoc City then!
As you can see, the last few weeks have been filled to overflowing with adventure and blessing and protection by our loving merciful Lord and Savior, Jesus Christ! We enjoy providing medical care to all of those in need and look forward to every opportunity to share Christ’s word with them!
Until next time;
May God Bless Us, Everyone!

Chip & Rhome Nuttall Christian Medical Missionaries

Making Housecalls; A Long Trip To Tuberon

2010-10-04T20:24:00.005+08:00

A Blessed Good Day to everyone!

Thank you all for your continued support of our medical mission here in Pilar Camotes, Cebu - Philippines, and our blog! We are truly so very blessed by our Lord for His provision of resources of every type so that we may remain here and continue to provide medical care to the poorest of the poor, those who, despite being hard workers, live day by day, often not having enough food to eat, clothing to wear or adequate shelter!

We have been extremely busy these last two weeks with a significant increase in our patient volume, as well as with travel to Ormoc City on the island of Leyte for access to more advanced medical care and resources and travel to Baybay, Leyte, for a very productive meeting with the dean of the agriculture department and a professor of agronomy. This was to advance our efforts to provide additional corn seed for the local farmers as the recent year long severe drought severely depleted their seed corn supply! We made a good deal of progress in forging a cooperative partnership in obtaining the much needed seed corn stocks, but also in developing the possibility of creating a small business that will allow the employment of people here on Pilar as well as enhancing the production of agricultural products and improving the nutrition of the children of Pilar! We ask if you would please pray that our efforts, strengthened by God's grace will bear much fruit!

Though we have seen many patients since the last blog post, we felt that the focus of this post should be centered around one young patient in particular; a 3 year old girl who lived up in the mountains! We learned of her injuries about 1 week after they occurred. She slipped and fell into a large kettle of hot water heating over an open fire!

We had been contemplating expanding our access to medical care by making some house calls and this seemed like the perfect opportunity to make our first house call! I will start by showing you some photos of our journey just to reach this young patient.

Here we are leaving from the main town (Pilar) on the island of Pilar. We had just filled up the gas tank and we are ready to set off on our journey to Tuberon, a small collection of homes along the side of the tallest mountain on our island, Bandera.

This is a view of the side road to the village of San Isidro as we turn off from the main road and head into the mountains.

This is a view from further up the side road going to San Isidro village, the point from which we start our hike up the mountain!

To give you some idea of the poverty and the living conditions of most of the people on Pilar, this is a small house along side the road to San Isidro!

This is a side street as we are just beginning to enter the village of San Isidro. This shows some more of the typical housing in the village!

This is looking down the main street of the village of San Isidro. Basically the main street makes a loop around the village.

This is where we parked the motorcycle and began or trek up into the mountains. From here to Tuberon is about a mile and a half to two miles.

This is where the down hill ends as we cross the first stream via the little foot bridge. From here it is mostly up hill!

Here our guide, also a patient of ours, and my wife, Rhome, we are climbing up a slight up hill grade toward our first rest stop.

Here is our 1st rest stop! We were able to sit in the shade for a little while and visit with some of the people who live along the road as we journey further up the mountainside!

Here our guide continues to lead us along the trail and through some welcome shade trees. Just a little further up the trail we are about to discover a wonderful surprise!

Here is our wonderful surprise, a very young calf, just calmly nestled beside the path, right in the middle the jungle, what a sight!

As we continue on toward our destination I was able to take this picture of where we are headed.

This is another house along the trail. It is very similar to the other houses we have passed; bamboo and palm fronds, no electricity, no plumbing, no running water!

Here we are at last! This is the home of our 3 year old patient and her parents. Again you can appreciate the humble living conditions of so very many of the people on our island!

Here is a closeup of the face of our precious little 3 year old female patient, who, 1 week prior, slipped and fell in to a large kettle of hot water that was being heated over an open fire.

Since it had been 1 week since the burns had occurred, we feared the worst! Fortunately, someone was able to obtain a bottle of antibiotics which had been started. But the grandmother mixed up an old herbal remedy and applied it to the areas that had been burned.

What you are about to see is graphic and somewhat disturbing so please be forewarned!

Here is what we found when we examined the young child!

Remember, this is 1 week post injury with scalding hot water over an open fire. The only care that had been provided was 1 bottle of oral antibiotics and the herbal remedy that was prepared by the young child's elderly grandmother.

Considering the severity of the original injury and the complete lack of medical care, soap, running water,etc. I would call this nothing short of miraculous!

This is a closeup of the primary areas of involvement! Other than one mosquito that was stuck in the herbal remedy that the grandmother had made up and applied, everything else looked remarkably clean and noninflected!

Here my wife, Rhome is preparing to get the child to lay down so that she can clean the areas and apply some Silvadine cream to the burns!

Here she is applying the Silvadine cream to the burns, you can see by the expression on the child's face, that she has little if any pain!

While we were there the mother of the child ask if we could treat she her and her husband (sorry we have no photos of him as he was very shy and did not want to be photographed).

Our young patient is happy and running around the porch in the foreground!

The mother had complaints on intermittent palpitations and episodes of feeling faint. This had been going on for some time and was not worsening. The respiratory and cardiac exams, limited as they were, were benign. Due to an intermittent systolic click (Faint) and no other findings, it was proposed that she may have symptoms secondary to mitral valve prolapse. We started here on a trial of low dose metoprolol and will make the journey back up Bandera mountain in about a week!

Her husband, though a young man, had symptoms consistent with musculoskeletal low back pain with some sciatic components. Interestingly, he related surviving being struck by lightening as a child. We started him on a NSAID with GI precautions and will also see him in followup in about a week.

Here are some tools of my trade, medicine and a bible! The good Lord, after all, is the great healer/physician!

Well, that brings to a close, the tale of a traveling medical missionary/physician associate on a small, remote, subsistence living island here in the Philippines!

We will close with our heartfelt prayers that God will continue to strengthen us, provide the necessary resources to accomplish His work here on Pilar, and lead us in His love and grace and mercy as He has done so abundantly these last three years!

Until next time, we look forward to your prayers support, encouragement and comments!

We ask that you continue to encourage your family, friends and coworkers to visit our blog and hope that they will do likewise! We have had visitors from not only the US, and Asia, but the Maldive Islands, Hong Kong, Japan, Taiwan, Russia, Switzerland, the Ukraine, Sweden, Denmark, Italy, the UK, and India!

MAY GOD BLESS US, EVERY ONE!!!!

Chip & Rhome Nuttall

pilarchip1@mac.com

Good Samaritan Medical Mission Update September 19, 2010

2010-09-20T18:27:00.000+08:00

We pray that everyone had a happy and safe Labor Day weekend!

The drought brought on by El Nino seems to have finally ended after a severe year long drought!

We are in the process of replenishing the seed corn that was lost during the drought with the help of an agronomist and his wife, Jack and Melanie! They have been and remain a true blessing from God! There remains much work to do but we are confident that our Lord will provide everything that is needed in His time!

There is a huge increase of Dengue fever cases throughout the Philippines! The total number of cases just from January 2010 through August of 2010 has increased more than 85%! Dengue claimed 369 lives in all of 2009, this year 501 fatalities were recorded in the first 8 months of this year. In 2009 34,997 dengue cases were recorded from Jan1 to Aug 28. This year dengue cases have reached over 77,000 during the same period.

We have not been immune to the epidemic of Dengue Fever her in this area as well. While I do not have a detailed breakdown of the number of cases, I can say that it is very worrisome to everyone! We have just obtained the release of one three year old girl from the hospital in Ormoc City. Unfortunately, a friend of hers, another 3 year old girl died despite hospitalization!

These are a couple of pictures of a 3 year old girl who required hospitalization because of Dengue Fever. The first picture also shows her mother who is quite overjoyed that her daughter is nearing the day she can go home!

         Here she is just an hour or so before her discharge and she is          very happy that she will be able to go home with her mother!
        She was the fortunate one, as her 3 year old playmate died of
        Dengue Fever, despite being hospitalized!

I have listed a number of patients in this post as "bronchitis," but I have some serious concerns that, in fact, at least a couple of them may have really been Dengue Fever patients. To make a confirmatory diagnosis would have required us to transport them to Ormoc City, Leyte for evaluation by a physician and to undergo blood testing. Even then the diagnosis would be presumptive, because the rapid test kits for Dengue are not available in this area!
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This woman had a history of a high fever, dry cough, headache, and aching joints and muscles. She is one of the patients that I was worried about having Dengue fever! We treated her symptomatically and kept a close watch over her just in case her symptoms would worsen. By God' grace she improved slowly and is now doing much better!

This is a 3 year old little girl who has symptoms of fever and cough along with a stomach ache! Her lungs were clear and her abdominal exam was benign. We treated her symptomatically and she too slowly improved and is now her precocious self!

This is a 10 year old girl who presented with a high fever, chills, cough, headache and generalized muscle aches. Her lung exam did show some course breath sounds but no signs of a pneumonia! Her older sister also developed very similar symptoms a few days later!

We treated them both symptomatically, but as their "house" was in an area that had an abundance of mosquitoes, we purchased mosquito nets for the family.

They are both doing fine and love the mosquito nets, the first time they have ever not been covered in bites!

This young girl was bought to us by her mother because she had worsening cough and fever for 3 days. Her lung exam did so some consolidation and we started her on antibiotics and Tylenol. Within 2 to 3 days she was much improved and her fever had resolved and her lung exam was much improved!

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This young fisherman came to us because he had pain in both of his eyes, left worse than right, and would awaken with his eyelid "glued" shut. This had been going on for almost 5 days and was getting worse.

This is a closeup of the young fisherman. His eye exam was consistent with conjunctivitis of both eyes, but with significantly worse involvement in his left eye. We started him on antibiotic eye medication and warm compresses 4 times a day and instructed him to not go fishing for at least 2 to 3 days. That was very difficult because that is how he provides food for his family! He did follow our recommendations and his eyes were much improved after 3 days!

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This is a 1 year old little girl! As you can see, she is quite unhappy! She has had several oral.tongue lesions that were diagnosed as viral by a pediatrician in Ormoc City. We purchased the recommended medications and began treatment as he directed. Unfortunately, progress has been very slow and it has been very difficult to get her to take adequate nourishment. If she is unable to regain any of the lost weight soon we will need to make an extended journey to Cebu City, Cebu to seek specialty consultation and treatment! This has been going on for about 6 to 8 weeks! Please pray for her!

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This is an 8 year old who was brought to us by his father.

He had had and area of irritation just above the medial aspect of his right ankle that had become infected and had progressively worsened over the preceding 3 weeks.

As you can see by the close up of the area of infection it needed immediate attention!

We cleaned the area thoroughly, debrided the necrotic tissue, applied a antibiotic cream and a sterile dressing (which was changed twice a day) and started him on oral antibiotics.

The area showed marked improvement within 3 days and is now completely healed! He says he wants to become a doctor!
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This is the follow up evaluation of the young fisherman with conjunctivitis which showed a marked improvement from 3 days prior!

He was very happy to learn that he could return to earning a living for he and his family!

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This is a young girl that I had seen earlier and treated for a middle ear infection. This is a followup visit and she is doing well and is happy that there is no more pain in her ear!

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This is a picture of the young fisherman and his wife standing beside their home!

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Now I would like to, once again, take you on a little tour of our little island in an effort to give you a glimpse of what it is like to live on a small, remote island and live a subsistence life style! It is a very poor but beautiful island filled with some of the most friendly, happy, hardworking, ingenious people that you will ever meet! I hope that you will enjoy the tour!

Please, as always, take a moment to leave your thought and comments as they are encouraged and welcomed! I would encourage you to become followers of this blog, you can do so synonymously, that way you will automatically receive an email notification whenever there is a new post! I am going to try to add a new widget to the blog before my next post that will allow you to enter you email information (it will never be used for any other purpose) and also automatically be notified via email whenever there is a new post! Please consider telling (or emailing) your friends, family and coworkers about our medical mission and this blog!

These three pictures were all taken on one afternoon as we were going for a little ride on our motorcycle!

For most of us it is very hard to imagine any of these as your MAIN modes of transportation, yet for these people that is the case and they are very happy!

This is an example of what I would describe as a some what better than average house for most of the population here on Pilar. It has a tin roof, electricity, a TV and some of the walls are made of plywood!

These are some fishing nets that have been cleaned and partially dried before being bundled up and hung on the tree to finish drying and await the fisherman who will soon cast them out upon the ocean to make a humble living for themselves and their families!

This is a woman we met along side of the road on our way back home. She was "pasturing her goats which are a very good source of food here on Pilar, especially if you are blessed enough to acquire a male and a female, because then you can breed them and have a small income and have meat to feed your family.

If you look behind her you can see a small field of native corn growing. We are just now recovering from a year long drought that caused much of the seed corn from last year's crop to become depleted trying to plant and grow corn during a drought with no irrigation!

These are strips from the Romblon Leaves that have been harvested and split into strips and are drying in the sun.

When they have dried sufficiently they will be hand woven into sleeping mats for the family and the excess will be sold at the market to provide money for rice so that they can eat!

This is a Romblon plant or tree from which the leaves are harvested, split and the dried before they are hand woven into sleeping mats and other items that the family will use. Any extra items will be sold at the market and the money will be used to by rice and other staples!

This is a Breadfruit. It is a staple food item for the people of Pilar. To give you an idea of the size, each full sized leave is between 18 and 24 inches long!

This picture is of one of the streets of the town of Pilar. You can see the various stacks of wood that are placed there to dry in front of the homes along the street. Once the wood has been dried sufficiently it will be used to cook the food for the families that live there.

It seems just a little more time consuming that turning on your stove, don' you think!

This is just one of a great variety of flowering plants that grow wild all over our island! This one is often found growing near a group of banana trees which also grow all over the island and are used for food and sold in the market place!

This flower is very pretty and is often used by the girls and young women to decorate their hair for special occasions!

We hope that you have enjoyed our blog post and the mini tour of our island!

We will close for now with the good news that Peacemakers International has made a very generous donation for our medical mission and it will allow us to purchase some much needed medical equipment and provide a resource to pay for critical hospitalizations! Our church back in the US, Hilltop Community Church, has been able to receive donations and forward them along to us as well as provide us with a monthly allowance in an effort to allow us to continue with our medical mission! Hilltop has also blessed us with the collection of 2 boxes of medical supplies and has just recently shipped them to us. We should receive them in about 6 weeks.

Recently someone ask me why we are here. I said to provide medical care to those who are in need and can not afford to pay for it, and to encourage them in their faithfulness to our Lord and Savior, Jesus Christ! I though surely there are many verses in the bible that could provide a better answer! The parable about the good Samaritan, the widow's two copper coins and son on. I would close this post with a much better answer that the Lord has provided: Psalm 82:3-4. "Vindicate the weak and fatherless; Do justice to the afflicted and destitute. Rescue the weak and the needy; Deliver them out of the hands of the wicked." Yes I hope someone else asks me why we are here, that is what I will tell them!

May God bless us, everyone!

Until Next Time

Chip & Rhome Nuttall
Christian Medical Missionaries
Pilar Camotes, Cebu, Philippines

Update August 30, 2010 An Island Tour And Some Patients

2010-08-30T22:36:00.001+08:00

Hello to everyone!

It has been a busy time this past week and a half! As Always there are too few hours and too many jobs to be done.

We start our mornings usually between 4 and 5 AM. and we finish each night about 8 or 9 PM. There are animals to feed and watered twice a day; pigs, chickens, ducks, goats, and rabbits. Then the goats must be "pastured" 2 to 3 times a day. Monday through Friday food has to be purchased and prepared for sale in our little eatery ( we are lucky to make $10 to $20 profit in a week but it helps people who would not have a nutritious meal otherwise!

Sunrise From our bedroom window after we have been up working for an hour or two, but still very beautiful!

Sign on the Nepa palm roof of our "restaurant"!

The sign was hand drawn and painted by someone here on Pilar. Not bad for all freehand!

Here is a photo of our "restaurant" form the main street in the main town on Pilar, about 1 mile from our house/clinic! The bottom line says "Best Food On The Island" and I believe it is the truth!!!!

We also must either go to Ormoc City once a week ourselves, or get someone on the crew of the boat, to purchase food and supplies. It takes about an hour and twenty minutes each way to ride the boat!

Here is a picture of the boat leaving the dock in Pilar, heading to Ormoc City, Leyte. It Takes about an hour and twenty minutes each way if the weather is good and the engine is working normally!

You can see the jeepneys parked on the pier. They come from as far away as the south end of the island carrying passengers, livestock and cargo to be transported to Ormoc City!

Here is a view from the boat while we are traveling to Ormoc City, Leyte!

Those are the mountains on Leyte. You are looking east at about 8:30 AM. Very beautiful sight, I never get tired of seeing it no matter how many times I have seen it before!

Here is a picture of Ormoc City, Leyte as we are approaching. There is a haze from all of the moisture, it is not pollution!

The white object in the center of the photo is a ferry that travels to Cebu, a city about 35 miles away. The large building on the right side of the picture is the hotel Don Felipe.

This is a photo of another boat leaving toe dock in Ormoc City as we are approaching the dock from Pilar island. Perhaps this will give everyone some idea of the appearance and size of the boats we use to go back and forth in!

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Then there are our patients to look after and teach basic health sanitation and nutrition to! We truly love helping these people as best we can! It is such a joy to see the people after they have gotten well and are able to work in the fields and/or spend the day or night out fishing in their little boats, trying to have enough to feed their families for the day!

This is an 88 year old matriarch of a family! She had been having a fever and a productive cough for about a week and has a history of chronic, but stable, hip pain from arthritis!

We saw her back in followup about a week later after treating her for bronchitis and her arthritic hip and she was doing great! She walked to our house/clinic, a distance of at least 2 to 3 miles as she lives up on the side of a steep mountain without electricity or running water.

This is a closeup of a young man's upper arm. He came to seek medical attention after he had been bitten by a spider while he was working on a boat at the south end of the island. Fortunately is was not a very poisonous bite and with some conservative, symptomatic care he recovered nicely in a few days!

Here is the same patient a few days later when we saw him back for followup!

This is a 3 year old little girl with her mother. The mother brought her to be seen for an earache and fever for 3 days. Her temperature was 102 F and she had a significant middle ear infection. We were able to treat her with antibiotics and Tylenol. When we saw the in church the following Sunday she was running and playing as though she was never sick!

Here is another photo of her and her mother while I was completing her exam.

This is a 1 year old baby with persistent tongue lesions. She was first thought to have a yeast infection but did not respond to the usual treatment for oral yeast infections. In fact, she seemed to get somewhat worse and had bitten her tongue a few times while sleeping.

We took her to see a pediatrician in Ormoc City who felt that it was a viral infection and prescribed the medications he felt that she needed.

Here is a closeup of her tongue and as you can see she has quite a bit of increased saliva production.

There has been some minimal improvement, but we remain quite concerned, as she has a difficult time with eating or drinking, and of course it is no easy task to keep the lesions cleaned.

There has actually been some erosion involving the tip of her tongue. I am afraid that she will require further specialty medical attention in Cebu City and right now we have expended all of our cash reserves and are awaiting financial assistance!

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We thought that we would try to show you around our little island during this blog post as well as spotlight a few of our patients. We hope that you enjoy it!

This is a large Limestone outcropping that is close to our house.

The entire island is made out of limestone. The white line crossing the outcropping near the bottom of the photo is the main water pipe for the island!

This is one type of native fencing material. It is dead palm fronds woven between posts to create a fence, though fragile it may be!

This is a young field of native corn.

You can not truly appreciate how steep the hillside is, but you can get some idea of how rocky and poor the soil is.

This is another view of part of the same corn field.

You will notice the large limestone bolder right in the middle. It was just too large to break apart with just a heavy steel bar!

This is another picture of the same corn field from the other side of the curve in the road.

If yo look closely you can get some appreciation of the steepness of the hillside!

Here is a closeup of a section of the cut on the side of the hill.

I want to try to give you a better idea of the poor quality of the ground that people must try to grow crops on and raise the food with which they are to survive!

Typically there is only one or two ears (small) per stalk of corn when it is finally ready to harvest!

This is our neighbor's house.

Is very typical of the housing of most of the population on the island of Pilar! No electricity, no running water, no indoor bathroom!

This is a picture of our garden.

My wife, Rhome, is on the right and the lady on the left is Norma. She is a patient of ours in whom we diagnosed TB.

It took about $ 400 dollars US to get her to Ormoc City, be seen by a physician and then have a chest CT with contrast (after her labs showed that she had normal kidney function. She is now on the correct medications and is already feeling much better. She offered to help us in our garden and brought some vegetables from her garden and a chicken too!

If you wonder why we have so many pictures of the native corn crops growing on the island, it is to show you what poor soil some of the farmers have to work with.

The one crop that is growing on the side of a steep hill close to our house is more limestone than soil. The people had to use a heavy steel bar to dig through the limestone and, one by one, create little pockets to plant each corn seed!

We have been very blessed by two members of our church back in Carson City, Nevada, Jack and his wife, Melanie! They have been working tirelessly to help research ways that we can help the farmers with their corn crops here on the island.

Besides the many areas of very poor soil, there is often no money for any fertilizer and there is no ability to provide irrigation! They must pray for rain!

I know, it sounds crazy to have to pray for rain in the tropics, but there has been a severe drought for most of the past year. You see El Nino here produces drought. The poor farmers take their precious seed corn saved from last year's crop and plant it and, pray for rain! Many of the farmers this past year used up all of their seed corn trying to get a crop to grow, but without rain, the crops weathered and died or did not even sprout at all! The same fate awaited their other vegetable crops!

Little or no food equals starvation and disease!

Even though there is a water supply here on the island, many can not afford to connect and pay the monthly fee! They must travel, often by foot, to the nearest public water station (a water faucet) and fill whatever containers they have and then bring them back to their houses.

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There have also been severe tropical storms here in the Philippines this year; China, Taiwan, Vietnam and Hong Kong have also been affected! We luckily, have, by God's abiding grace, been spared the worst of the wind and flooding so far!

This is a graphic that does a pretty good job of identifying three severe tropical storms and a couple of low pressure areas with the potential to become tropical storms or typhoons!

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Just recently I came across an article about "counterfeit" drugs being shipped and marketed, on a large scale, in east Africa! I will include part of the article here. The poor people here in the Philippines, the few fortunate enough to have a few pesos to buy medications, are victimized in the same manner and to the same degree!

CNN.com

9 Tons of Fake Medicine Seized in East Africa

* The two-month operation was conducted in six nations

* The counterfeit medicine problem has grown in recent years

* Fake drugs can lead to death, World Health Organization says

(CNN) -- Authorities have seized 9,072 kilograms (20,000 pounds) of counterfeit medicine and arrested 80 people suspected of illegal trafficking in six East African nations, Interpol said Thursday.

More than 300 premises were checked or raided in the two-month operation across Uganda, Burundi, Kenya, Rwanda, Tanzania and Zanzibar, according to a news release from the international police agency.

The confiscated loot included anti-malaria drugs, vaccines and antibiotics. There was also a significant quantity of government medicines diverted to illegal resale markets.

It was the third such seizure operation in as many years in East Africa, intended to curb the manufacture and distribution of counterfeit medical products.

Representatives of the six nations are scheduled to meet in Zanzibar next week to discuss the seizure and the extent of the counterfeiting problem, Interpol said.

The World Health Organization defines counterfeit drugs as "medicine, which is deliberately and fraudulently mislabeled with respect to identity and/or source."

Counterfeiting can apply to both brand-name and generic products, and forged products may include those with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients, or with fake packaging, WHO says.

The United Nations agency created a global task force in 2006 to deal with the problem, which has been growing as international markets expand and become globalized and internet commerce has taken off.

The fake products can prove detrimental to public health efforts in disease-ridden countries and in worst-case scenarios can cause death, according to the WHO task force.

© 2008 Cable News Network."

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There were also several policemen on the next island that were ambushed and killed by a communist guerrilla group last week!

Published August 21, 2010 Associated Press
Communist Rebels Kill 8 Police Officers In Ambush In Central Philippines, Seize Weapons

MANILA, Philippines (AP) — Communist rebels killed eight police officers in the central Philippines and took their weapons and uniforms in an ambush Saturday as they escalate attacks against security forces.

The New People's Army guerrillas killed a local council member in Northern Samar province's Catarman township then lay in wait for soldiers or police to respond.

They planted explosives and took up ambush positions on a road into the village. When a police truck carrying the officers passed by, the rebels set off a land mine then fired on the officers in the burning vehicle, killing all eight. The rebels seized seven pistols and four assault rifles from the slain officers, who were also stripped of their uniforms. Unexploded mines have been recovered along the road.

The Maoist rebels, who have been waging a 41-year-old insurgency, have become more active in recent months, attacking remote military and police outposts to seize badly needed weapons. Last month, the rebels ambushed soldiers on an army truck in Bontoc township in northern Mountain Province, killing seven and seizing their firearms.

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Then finally, there was a significant volcano eruption Sunday in Indonesia!

Jakarta, Indonesia (CNN) -- A volcano that had been inactive for more than 400 years erupted in Indonesia early Sunday, causing thousands of people to flee their homes, officials said.

Mount Sinabung in North Sumatra province had been inactive since the 1600s, but spewed volcanic ash nearly a mile into the air Sunday. We don't know the character of this volcano because it's been dormant for so long,

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Well I guess that brings everyone up to date for now!

Please feel free to offer your comments about our work and our blog!

I will close on a lighter note with a couple of quotes that I read recently:

"Life with out God is like an unsharpened pencil! It has no point!"

"Just because you go to church doesn't make you a Christian anymore that standing in your garage makes you a car!"

God Bless Us Everyone!

Chip & Rhome Nuttall
Christian Medical Missionaries
Pilar Camotes, Cebu, Philippines
pilarchip1@mac.com

Good Sam Medical Mission Update August 16,2010

2010-08-16T16:45:00.000+08:00

Greetings to everyone who is following the progress of our (Chip & Rhome Nuttall's) Good Samaritan Medical Mission here on the small, remote Philippine island of Pilar Camotes, Cebu!

I had hoped to get this new blog post up about a week ago, but there has been a lot going on (as usual)! I was specifically waiting to get a definitive diagnosis on one of our seriously ill patients, a fifty-four year old, wife, mother and grandmother. She had come to us for care complaining of a slight cough, but most concerned with an enlarging, mildly painful mass just above her right clavicle. It had been present for at least 2 months. Upon examination, I noted a group of approximately 5 matted, minimally tender lymph notes in the right supraclavicular region. She is a non-smoker, non-drinker, but her husband is a smoker. My main concern was to make a accurate prompt diagnosis! My differential diagnoses included tuberculosis versus lung or GI cancer.

Having just lost a patient to lung cancer a week earlier, I was determined to do whatever it took to get a final diagnosis and do it promptly! So the next morning my wife Rhome, I and the patient set off on an hour and a half boat trip to the island of Leyte (Ormoc City) where I had become friends with an ENT doctor. He agreed with my possible diagnoses and ordered labs and a chest CT scan. The labs showed normal renal function and the chest CT scan was scheduled for the next morning.

After the CT scan was complete, I was able to meet with the doctor and review the findings. The good news is that there was no evidence for cancer. The "not so good" news was that she has tuberculosis! So the next step was to buy her medications and to council her on her diagnosis and the importance of following and completing her medications.

Although we only had $500 US left before we provided the care for this patient and after all was said and done, we only have $200 US left to live on. Though this has put us in some dire financial straights, we have no regrets and are certain that we did the right thing!

With this case and the next 2 cases we will be sharing with you, we have again been shown that we are indeed here for a purpose and will continue to strive to remain here! These people have no money, they are lucky to be able to buy a sack of rice now and then! They are truly subsistence living and there is no hope of employment on this remote island and without us there is no real medical care!

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The next patient's story is truly very sad! He was a husband, father and grandfather. He had complaints of a cough and progressives shortness of breath for a while and had developed an enlarging mass on the side of his face. Before coming to seek medical care from us, his daughter, Juliet, who works as a housekeeper, in Dubai, had sent money home so that her father could go to Manila and be seen! A chest Xray was taken and a needle biopsy of the facial mass was obtained. The biopsy of the facial mass showed metastatic small cell carcinoma secondary to his lung mass (cancer) seen on his chest Xray! His diagnosis was of course, terminal! However the patient nor his family, including his daughter, did not really understand the meaning of the chest Xray, nor the biopsy of the facial mass. All we could do was to explain his diagnosis and terminal prognosis, provide him with pain medication and get him on oxygen. He passed away just a day after his daughter took the picture posted below!

The good news is that in his final days he did accept our Lord Jesus into his heart!

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Our next patient was brought to our house/clinic one night by her frantic mother and father! They told us she had had a seizure! Upon examining her she had a fever of over 103, was responsive and without focal weakness and had no prior history of seizures. The rest of her exam, except for generalized malaise and some mild dehydration was unremarkable. We learned that her older brother had had a URI a few days to a week earlier. Diagnosis; febrile seizure. We treated her with Tylenol, re-hydration, close observation. we told the parents to come to our bedroom window and wake us up if she became worse during the night and to bring her back to our house/clinic in the morning to be rechecked. She recovered very nicely with no additional seizures and we are all very happy!

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I just want to add a couple of additional items before I close this post.

Here on Pilar as I have explained, we are subsistence living, as there are no jobs to be had since it is a small, remote island (~2 1/2 miles wide by 10 miles long)! There is no real medical on the island except for us. If one does not grow it or catch it, or is lucky enough to have a family member working overseas and sending money home, then you just don't have it!

The island, in fact, the whole Philippine archipelago, has been experiencing a severe drought for over a year (due to El Nino)! Here an El Nino causes drought, not cooler and wetter winters! This has meant that much of the corn seed has been used up trying to grow a crop without any results other than no crop ( there is no capability for irrigation)! We have been very blessed to have obtained some assistance from an agronomist and his wife from our church back in Nevada! They are assisting us in locating non-hybrid corn seed to help replenish the stock of seed corn so that, now that the drought has ended, people can begin to plant corn so they can eat and have seed corn for the next planting season! God bless you Jack and Melanie Krause!!!

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Finally, I have been asked by the schools to help with a annual dental hygiene workshop that is put on every February. This is designed to teach the children the importance of good dental care and to try to provide them with a toothbrush and some toothpaste! Many of the children arrive at the schools with just a small guava branch with a few leaves on it as they have no toothbrush or toothpaste! Hope sad is that! It is bad enough that tooth decay is epidemic here and multiple missing teeth are the norm! But as most of us now know, poor dental hygiene causes chronic inflammation, and chronic inflammation of any type leads to an increased risk of stroke and heart disease! No wonder there are so many deaths here from stroke and heart attacks! If anyone can help us locate and obtain toothbrushes (children's) and toothpaste please let us know!!! Perhaps someone has a good hearted dentist or has some connections with one of the companies that manufacture toothbrushes or toothpaste! If you can just lend a hand then we can help the children and, in the long run, save lives too!

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I have mentioned in earlier posts that our non-denominational church back in Carson City, Nevada has offered to help us accept donations (tax deductible) and to help with shipping of medical supplies here to Pilar. So if anyone finds it in their hearts to donate financial aid in any amount, medical supplies, or dental care supplies for the children of Pilar please contact me at pilarchip1@mac.com for details!

May God bless us all, each and every one! Thanks so very much for your prayers, interest, support and getting the word out to your friends, family and coworkers!!!

Until Next Time,

Chip & Rhome Nuttall

Medical Mission Update July 26, 2010

2010-07-26T13:02:00.000+08:00

As promised here is the latest update on our medical mission here on the island of Pilar Camotes, Cebu Philippines, just at the mouth of Ormoc Bay, Leyte!

It has been a busy ten days! There has been the tropical typhoon that I last posted about, a severe water shortage due to an almost year long drought as a result of El Nino, and now severe flooding in some places by a tropical storm. On top of this, there is an outbreak of dengue fever on the island of Mindanao that has resulted in several deaths and is being investigated as a possible new strain!

Here on Pilar we have had another death from a stroke, a major motorcycle vs. child pedestrian vehicle accident that resulted in one child with a significant head injury and another with a fractured hip. These children required evacuation and hospitalization on the island of Leyte.

We have continued to treat several people as part of our medical mission and helped with a one day medical mission that happens about once a year! This medical mission came from the island of Cebu which is about 35 miles away (about 2 1/2 hours by fast ferry)! This one day medical mission clearly displays the medical needs of this island and I will include some pictures on this post.

I am very thankful to a fellow PA, David Mittman, who has a PA website, Clinician 1, and has graciously offered to include my medical mission blog on his website!

This is Pastor Luis getting a blood pressure checkup and my wife, Rhome.

This is only a portion of the patients waiting to be seen as part of the one day medical mission!

This is some of the continuation of patients lining up for treatment and there is another line just as big on the side of the building!

These are a few of the patients that required minor surgical procedures.

This is a photo of the surgical instruments waiting to be used.

This is a patient being prepped for excision of an infected sebaceous cyst below his ear.

This is a young boy who has had a fractured elbow about a year ago.

This is a young woman who has significant hypo-pigmentation of here face (Vitiligo) since she was in the fifth grade.

This is a young boy who has a toothache from a cavity.

This is a patient with diabetes, hypertension and renal failure.

This is a young girl with conjunctivitis and a URI.

This is a young fisherman who sustained some injuries to his leg from the spines of a sea urchin.

This is the daughter of a patient with end stage lung cancer who only has a few weeks to live. The patient did not wish to be photographed.

Well the boat is about ready to leave to go back to Pilar so I will sign off for now! I hope this post has been educational in relation to the seriousness of the need for medical care on our island!

May God Bless You All! Bye For Now!

Chip Nuttall, PA-C

Update Pilar Medical Mission July 14, 2010 Typhoon Conson

2010-07-14T12:19:00.000+08:00

Hi everyone!

I just wanted to give you an update about things here in Pilar concerning tropical typhoon (hurricane) Conson.

We are fine as the typhoon, the 1st of the 2010 season passed just to the north of us. We just received so wind, no damage or injuries, and some much needed rain! There has been a drought due to El Nino.
I will include a couple of photos from the satellite and JTW tracking data for you to see.

This is the track and projected track of the typhoon. It never really did turn to the north. It is still heading west. The main part of the typhoon should be out over the South China Sea by this evening and should not have time to restrengthen before it reaches the coast of southern China.

This is the satellite image from last night, July 13, 2010. You can see the rainfall scale at the bottom. But Tropical Typhoon Conson stranded more than 1,300 people across the archipelago before weakening further Wednesday, as it rolled westward over the Philippines,

It is difficult to describe how even a heavy rain storm can devastate people by causing the shanty homes to be damaged severely, their few possessions to be damaged or destroyed, their drinking water sources to be contaminated and their animals killed! Then come the contaminated food and water borne illnesses as well as the variety of injuries sustained in a storm and many have no access to medical care and many that do have no means to pay so they are turned away!

The picture below is but one glimpse of the kind of damage that even an average tropical depression or storm can cause to those that are poor beyond description or true comprehension! There is a saying here in the Philippines among the many small businesses that the poor struggle to keep going; yes we are profitable, ramen profitable! Meaning that there was just enough profit to buy the bare essentials of life such as soap, toilet paper, water and --- ramen noodles!

Others, however, were not nearly so fortunate!!!!
Residents repair their damaged shantyhouses along the coastal road in Paranaque, outside Manila, Philippines, on Wednesday. Up to more than 4 inches of rain has fallen in some places! The National Disaster Coordinating Council of the Philippines said it knew of 19 missing fishermen, but the weather and choppy seas precluded officials from mounting search and rescue operations. Emergency responders were on alert.

I won't include any patient photos in this blog post but I would ask each person who reads this post to consider how blessed they are by our Lord for the abundance they have and ask that each person who reads this to consider donating some small amount on a regular basis to our medical mission so that we can continue to care for those who have nothing, not because they are lazy, but because there is NO way to earn a living here on their island! I do continue to pray that one day I will be able to change that and start a small business that can employ at least some of the people so that they can have at least enough to feed their families and educate their children and receive medical care when I run out of funds to provide for them myself! You can donate (tax deductible) through Hilltop Community Church in Carson City, Nevada. Their web page is:
http://www.hilltopchurch.net/ their address is; 3588 Romans Road Carson City, NV 89705
The Outreach/Mission Pastor is Don Baumann, he can be reached at; baumannhcc@gmail.com
All donations should be marked for the Philippine Medical Mission; payable to Hilltop Community Church.

May our Lord Bless & Keep Us, Every One!

With Prayers Of Joy & Thanksgiving,

Chip & Rhome Nuttall
Christian Medical Missionaries
Pilar Camotes Cebu, Philippines

Blog Update For July 10, 2010 A Work In Progress

2010-07-10T19:59:00.000+08:00

Welcome back to everyone who has been patient enough to continue to follow our blog about our life as Christian medical missionaries here in the Philippines and about the care we are providing to our patients, people who live a subsistence lifestyle and have no access to good medical care and no means to pay for it!

I do apologize for the problems I have with creating a pleasing look to this blog but this is my first attempt at creating a blog and including photographs along with the text! I have continued to experiment over the last couple of weeks as time has permitted. I have made some changes to the appearance and functionality of the blog. This includes a "slide show" feature near the bottom of the page. You can click an any of the slides and you will be taken to a full size version of that slide.

We have continued to see patients on a regular basis except when we have had to travel to the next island to purchase medical supplies and food for our home. We continue to raise our animals and take care of our garden as well. The drought has seemed to become less severe and we have had a little rain over the last couple of weeks.

Unfortunately I had to give one of our congregation members and her family some bad news, her husband has terminal lung cancer and probably only as a few months left.

My wife, Rhome has started her weekly woman's bible study and has had two sessions already. Both have been very well received!

I will try to include some additional patient photos here but they are not all inclusive!

The first picture is of a young boy who has recovered from an elbow fracture.

Leaving the Dock In Pilar

Mountains of Leyte on our way to Ormoc City

Arriving at the dock in Ormoc City

Closeup of loss of skin pigmentation

Second closeup of pigmentation in a young woman


1st Woman's Bible Study Session Started By My Wife, Rhome

Severe Vasculitis/Phlebitis

Patient seen for loose stools

Patients on our solana eating lunch after follow up visits

Well I have learned a bit more about arranging the segments on a blog since my last post but I will need to close for now as I need to help my wife, Rhome prepare the materials for her next bible study session next Tuesday!

Bye for now and may God bless you all!

With Prayers of Joy & Thanksgiving,

Chip & Rhome Nuttall
Christian Medical Missionaries

Good Samaritan Medical Mission Update 6-16-10

2010-06-17T09:19:00.000+08:00

Hi everyone!
Sorry that it has been a while since my last post! I and my wife, Rhome, have been quite busy seeing patients and providing care for those who cannot afford to seek medical. There was one death this past week. He was a thirty something male who was not known to have any health problems. He died in his sleep. He leaves a widow and two sons.

There was also the seventeenth anniversary of our Christian church which took a lot of time in preparing the message as I was asked to give a special message for the service, and of course there was a lot of food preparation as well. The was good attendance and everyone said the service was very inspiring.

We are just returning from a two day trip to Ormoc City on the island of Leyte (about an hour and a half away from our island of Pilar. This was necessitated to provide further urological workup for one of our patients, a 12 year old boy, who has had difficulty with a significantly decreased ability to urinate adequately since he was age 5. The workup, including a CBC, UA, renal panel and renal ultrasound were all normal, as I expected they would be. I believe that his diagnosis is urethral stenosis/stricture. This will require us to get him to the city of Cebu on the island of Cebu as that is the closest place with a urologist. I will post an update as soon as I can raise the money needed for the 5 hour boat trip, lodging, meals, urological consult and surgery.

Our many other patients since my last post include 2 children with chicken pox, 2 ladies with neck masses, a lady with thyroid problems, only 1 kidney, hypertension, and a UTI, a girl with a foreign body in her eye and conjunctivitis, a man with bronchitis, women with hypertension and diabetes, a women with heel swelling, a lady with probable tinia versicolor, women with GERD, a lady with TIA's, a lady with superficial phlebitis of her leg and an infant who was unable to have a bowel movement for 4 days.

I will post some pictures of these patients along with this post.

We will be buying more medications here in Ormoc prior to our return to our island, Pilar, later today. I would ask for your prayers for us and our patients and the family of the young husband and father who died unexpectedly this past week. If the Lord puts it on anyone's heart to donate in support of our medical mission here in the Philippines you may do so by donating to Hilltop Community Church in Carson City, Nevada and just specify the donation is for the Good Samaritan Medical Mission. Their website is http://www.hilltopchurch.net/
Their address is 3588 Romans Road, Carson City, NV 89705. Their phone number is; 775-267-3588. The missions pastor is Don Baumann. All donations made are fully tax deductible! Please consider mentioning our medical mission and our need for support to your family, friends, employers.

May God bless each and every one of you, and we sincerely thank all of you for your support and prayers!!!

Until next week;

With Prayers of Joy & Thanksgiving,

Chip & Rhome Nuttall
Medical Missionaries
Good Samaritan Medical Mission
Pilar Camotes, Cebu Philippines

Introduction To Good Sam Medical Mission

2010-05-20T10:47:00.000+08:00

Island Of Leyte From Pilar

Hi! My name is Chip & my wife's name is Rhome. I am a physician assistant and my wife is a surgical scrub tech. We are born again Christians and we have moved to a small subsistence living island called Pilar Camotes, Cebu in the Philippines where, for the last 3 years we have been developing a medical mission on the island.

Almost all of the ~ 11,000 people living on the island live a subsistence life and have no resources for medical care! We provide any needed medical care including medications and hospitalization for those in need. We do this in the name of our Lord, Jesus Christ and ask only that they thank Him for their care, not us! We invite them to join in our bible study group if they desire and also invite them to attend church services with us if they would like to!

We under took this medical mission approximately 3 years ago when we sold everything we had and took our life savings and moved to Pilar. Our medical mission has been funded by our savings and some donations, both monetary and medical supplies!

This mission has been a true blessing from God and we plan to do this for the rest of our lives!

At the urging of friends we have decided to start this blog to let others know of our work and of the need for medical care on this island in the Philippines. If anyone wishes to comment or make donations, money or medical supplies, or time, please contact us. Donations of money or medical supplies can be made through our church, Hilltop Community Church Carson City, Nevada (hilltopchurch.net), back in the US and thereby insure that proper tax deduction credit will be assured and that shipping of medical supplies will be taken care of.

I have limited internet connection capability on our island but will be updating this blog at least weekly, hopefully more often. photos of the island and our patients will be included in our blog.

May our Lord bless each of you and touch your hearts to pray for us and the people of Pilar Camotes, Cebu Philippines!