1. Alejandro, Josefina Inoturan DNP, RN

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A SHORT, ELDERLY WOMAN was the first to greet me as my colleagues and I arrived for our 2-day medico-legal mission to the Philippines. The mission team included two physicians, two lawyers, a secretary, and two assistants. We embarked on this journey to bring the latest medical and legal expertise (including much-needed medicines and school supplies) to this remote area. After 40 years in the nursing profession, I was happy to return to this village, Lilo-an, located in the municipality of Malinao, as team coordinator in April 2014.

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"Hello! You delivered my son 40 years ago-do you remember?"


I was astounded that someone could remember my service after such a long time. This woman revealed that her son had since died. With this revelation, my mind traveled down memory lane as I walked on the now-concrete road.


Recalling the past

I remembered serving in Lilo-an (where my father, also a nurse, grew up) as a newly graduated nurse still waiting for the results of my licensure examination. The occasional visits of cargo and crowded vehicles had been replaced by the constant roar of motorcycles. I struggled to wed the memories of this once-quiet village to the evidence of its current prosperity.


I remembered how my father, a respected community leader, convinced the villagers to give up some of their land so that roads could be built to facilitate transportation. Without roads, he argued, crops couldn't be transported to the market to be sold, and the sick couldn't be brought to the municipal capital for immediate care. I appreciated my father's determination to serve the people in his hometown. I was carrying on my father's dream.


The medical staff during my first term of service had included two physicians, one nurse, one midwife, and one sanitary inspector, all of whom served the municipal capital and seven far-flung towns. Most of these could be reached only on foot, as they were separated from the capital by rivers and hills.


Back then, common illnesses included rashes and other dermatologic disorders, and abdominal pain from ingesting a fermented coconut milk called tuba. I remember an older adult who approached me one day and showed me his swollen legs. He had +4 nonpitting edema and scaly skin that he attributed to beriberi, which was common at that time due to malnutrition. He had diagnosed himself after seeing other villagers in a similar condition. I referred him to the municipal physician who confirmed the diagnosis and provided treatment.


Working in the present

By the time of our latest medical mission, the municipality's medical staff had grown to 1 physician (the municipal health officer [MHO]), 9 midwives, 4 nurses, 11 health workers, and a medical technologist. The population had also grown-from 100 families to 500 families. The local officials explained that people from the nearby hills migrated to Lilo-an when insurgents threatened their lives and livelihood.


Knowing the number of people who needed our help over the next 2 days, I was impressed by the efforts of the MHO, her staff, and the local leaders who were coordinating our mission activities.


Before our arrival, the MHO apprised me of the most common conditions the villagers had. These included hypertension, type 2 diabetes mellitus, heart disease, asthma, upper respiratory infections, urinary tract infections, arthritis, skin diseases, tuberculosis, stroke, and cancer. I wondered if the staff augmentation had led to the increase in diagnoses and treatment of these ailments.


A dream realized

Accompanied by two physicians (my niece and nephew) and two lawyers (my sister-in-law and her daughter), we held a lecture in the community hall on the day we arrived. The two lawyers had volunteered to be part of the team to assist residents with any legal problems or disputes over land ownership. To our physicians, the audience eagerly directed questions about hypertension, diabetes mellitus, and cancer. My niece, who works as a government psychiatrist, clarified misconceptions about Alzheimer disease.


Later, I mingled among the people in line for care at the hall, and many of them updated me on how their families had grown. Some former patients remembered that I'd administered their cholera immunizations and simple cough or diarrhea remedies.


Some older patients told my niece and nephew about how their grandfather (my father) campaigned for a healthy and progressive Lilo-an. It was heartwarming to learn that my father's dream of a prosperous village had been realized and witnessed by the next generation of his family.


As the other members of the medico-legal team distributed medicine, school supplies, and umbrellas, the people's gratitude was evident. The satisfaction that the whole team felt about their service surpassed our expectations. We knew that what we'd accomplished in our short visit made a significant, long-lasting impact on this village, and created new memories in the process for generations to come.