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Medical Mission: Local doctor travels to Philippines with Minnesota charity care team

Removing the mastoid bone from a 5-year-old patient's ear takes skill. Especially when your microscope stops working.

But working slowly and carefully, maneuvering delicately past the facial nerves, Dr. Marty Janning managed to safely extract the tiny bone.

"You sit there and you wonder, 'How can I do this? How do I figure this out?' You improvise," he said.

Janning, an ear-nose-throat specialist with a private practice in Willmar, recently spent a week on a medical mission in the Philippines, bringing care to mostly poor, rural patients on the island of Cebu.

He called it "an amazing experience."

"It makes you a lot more grateful for simple things," he said. "I really wish my kids or any kids could experience this."

More than 100 volunteer physicians, nurses and other staff made the trip in late January, which was organized and sponsored by the Philippine-Minnesotan Medical Association.

The PMMA, whose 70 members are either Filipino or of Filipino descent, has been sending medical teams to the Philippines every two years since 2002.

On the first trip, six years ago, 26 volunteers provided care to 2,000 patients. This time around, the group included primary care doctors, general surgeons, plastic surgeons, anesthesiologists, ophthalmologists, dentists and nurses.

The primary care physicians alone saw 5,500 patients in four days. The team performed more than 100 major surgeries and 150 minor surgeries.

Large tents were set up outside Sacred Heart Hospital in Cebu City. Here, patients lined up in the heat and humidity to be evaluated and triaged.

Many of them came from miles around for care they probably would not have received otherwise, Janning said.

"They'd travel for a day or two. They'd wait two or three days," he said. "By Thursday we had hundreds and thousands of patients."

Janning, the sole ear-nose-throat specialist in the group, did nearly two dozen surgeries, mostly on people's thyroids.

In the United States, it's rare to see someone with the bulging neck characteristic of goiter, or enlargement of the thyroid gland. Most American patients with goiter are diagnosed and treated relatively soon, Janning said.

But on Cebu, he saw numerous patients with long-standing untreated goiters.

"By the time we'd see them, they've been growing for 20 years and they're enormous," he said.

Evaluating patients for surgery was complicated by the fact that many of them had co-existing diseases such as diabetes, high blood pressure and tuberculosis.

Although the delegation brought 50 crates of supplies, they soon started to run short. Pain medication had to be rationed, and the group's leaders ended up buying more from a pharmacy.

Janning had the bare minimum of tools for procedures such as removing nasal polyps.

"You have to be flexible anyway, but we took this to the next degree," he said. "When I wasn't working in the operating room, I'd run down to the ER. I would work as long as I could... There wasn't enough time and resources to continue. You could be there all year and not scratch the surface."

Some cases were simply too complex for the team to deal with, Janning said.

The hardest part was turning patients away -- especially as the group neared the end of its weeklong mission.

"It felt bad because we just had no recourse," Janning said. "I couldn't refer them to anyone. I couldn't say, 'I'll see you next time I'm here.' It killed me. I wanted to stay and keep working a couple more days but we just ran the system dry."

One of the things that impressed him most was the welcome the group received.

Their arrival at the airport was greeted by a band. They were invited one night to the governor's mansion, where they were treated with a colorful festival of music, dance and food. The final day of their stay coincided with Sinulog, a huge day-long festival that featured a five-mile-long parade of elaborately costumed marchers.

"We just felt so blessed because everywhere we went, we were treated like royalty," Janning said.

He was even more impressed by the patients and families he met.

Most were charity cases. One of the physicians in the group paid the travel costs out of his own pocket so a child and family could get to the clinic. Janning himself paid for a CT scan that one of his young patients urgently needed.

"Poverty is just everywhere. There are pockets of wealth but primarily it's poor," Janning said. "It's kind of a dichotomy. They have so little but they seem so happy. They're so appreciative. Everything you did, they'd thank you and thank you. It was so humbling. That's really what kept you going."

Now that he's back at his private practice in Willmar, the Janning Ear, Nose and Throat Center, he's trying to apply some of the lessons he learned in the Philippines.

"I think I've been able to defocus a little and expand into flexibility -- doing procedures with less," he said. "I do this anyway, but maybe I do it a little bit more now."

He'd also like to return to the Philippines with the PMMA in 2010, if he gets the chance.

"I hope I can go next time," he said.