Operating a Clinic in the War Zone

With the retreat of the United States Army from Manila in December, 1941, and the occupation by the forces of Japan in Janu­ary, 1942, the very bottom fell out of the organ­ized medical missionary work which had been carried on in the Philippines by Seventh-day Ad­ventists. The school of nursing at the Manila Sanitarium was soon broken up, as the Japanese navy moved into the building and established themselves there for the duration of their rule of the Pearl of the Orient. At the time communica­tion with the other islands and different sections of Luzon was cut off.

Things were in a state of confusion for the first several weeks, but soon the foreign section of the Philippine Union Mission began to lay plans for ways by which aliens on American soil could make use of their time and talents while they waited for "Uncle Doug" MacArthur to return.

In April, 1942, plans were made for the faculty members of Philippine Union College to return to the compound from which they had evacuated into Manila late in December, 1941. The two American physicians and three of the five Ameri­can nurses from the sanitarium were also sent there to live. The opening and running of a clinic in the college for the faculty, students, and Ameri­cans on the campus, and the Filipino people of the neighboring barrio of Baesa, was our task while we impatiently waited.

Within a week the two rooms chosen to be used for the clinic were scoured and scrubbed and equipped with what available supplies could be obtained from the college infirmary, and what could be salvaged of the equipment left at the college by the United States Navy when they had hurriedly fled before the Japanese entered the city.

The people in Baesa heard of the clinic, and very soon twenty to thirty patients were coming in each day. The services were free—we asked only that the patients pay for medicines or surgical dressings, if they could do so. We also asked for-donations of any medicines or supplies they could spare, and found them to be most liberal with what few things they had. The prices on all medical supplies and medicines increased by leaps and bounds, and many things were soon gone, but we carried on with what we had as best we could.

The types of cases treated varied greatly, and the diagnoses were fairly representative of a cross section of the more common tropical diseases—ulcers, infections, malnutrition, deficiency diseases, malaria, dysentery, eye and skin diseases. We also did some tonsillectomies and deliveries. The clinic was open each weekday morning, at which time the patients could consult with the physician, and in the afternoon they could come by appoint­ment for treatments and dressings.

There were several Filipino graduate nurses and student nurses living in the community of the college. We were free to call on them for help at any time. Two of these nurses were health workers for our mission, and lived in Baesa. They came and went during the war months. Whenever they were there, they were most willing to assist with the work of this clinic. There was also a male nurse living on the college campus, and he could be called on to give the treat­ments to the men patients. There is a very definite prejudice in this community against women nurses caring for men patients.

I made frequent home calls to give hydrotherapy treatments, or to see how the alternate hot and cold arm baths were being carried out which had been ordered by the physician. It took much pa­tience on my part and repetition of demonstrations to get the patient and his family to execute these treatments in the proper way.

There were numerous requests for obstetrical care and for home deliveries. The Filipinos tend to have a fear of the hospital, and it is commonly regarded as a place to die. There was a mater­nity hospital in the community, but it was difficult to get the patients to go there for delivery. There­fore, the clinic personnel organized an obstetrical clinic with home deliveries.

Here I shall try to give you a word picture of the Filipino home. A common type made of native materials would have a framework of bamboo strips spaced one-quarter inch apart; the roof of nipa, a thick covering of overlapping palm leaves affording excellent protection from rain and sun.

Many of the homes have no electricity, and the only lighting is the flame of a coconut-oil lamp. Very few of the houses have water piped into them, and water has to be carried from some dis­tance in five-gallon oil cans by suspending the cans from each end of a bamboo pole carried over the shoulder. Needless to say, water is not un­necessarily wasted.

The stairs may be wood or bamboo. Large rounds of bamboo are used. The incline of the stairway is very steep, and there is no hand railing on the wall. Western shoes do not grip the rounds as well as native bare feet.

The Filipino bed is nothing more than a woven mat spread out on the floor during the night and rolled out of sight during the day. A cotton spread is used for a covering. Giving hydro­therapy treatments and bedside nursing care to a patient lying on his mat on the floor is an experi­ence not soon forgotten. I had many a sore muscle after giving such treatments. Most of the homes have at least one bedstead, which can be used when a member of the family is ill.

SETUP FOR DELIVERY.—Whenever it was pos­sible, the prospective mother was visited in her home before the time of delivery. During the visit the mother and the nurse selected the most desirable place in the house for the delivery, and the nurse enumerated the necessary articles which the mother should plan to have ready for use dur­ing confinement.

If there was no small table in the house which could be used as a worktable, and for a place to care for and dress the infant, there was most surely an antique Singer sewing machine. If you have ever wondered what happened to all the old tread models when the electric sewing machine came into the American home, you need only visit a few representative Filipino homes. Almost without exception a Singer sewing machine is found in the nipa hut as well as in the more modern wooden structure with the galvanized iron roof. It makes a good worktable, and is more ideal as a bath table for Baby Pedro than a mat on the floor.

The usual mode of travel about the barrio was by foot, but there was the occasional time when the prospective father would come for the doctor and nurse in a caretella—the mode of travel used during the Japanese occupation of the Philippines_

The caretella is a three-seated buggy, with two very high wheels on which the vehicle is balanced by the proper seating of the passengers. It is drawn by a small, undernourished-looking horse. During the night, if it was the dark of the moon, the Filipinos would come with a small coconut-oil lamp or lantern, so as to avoid slushing through the mud and carabao holes.

Frequently there were calls to deliver a woman who had had no previous prenatal care. The clinic personnel were hesitant in answering such calls, and would insist that the patient go to the hospital. Such a procedure served its purpose by teaching the patients the necessity of prenatal care rather than waiting until time for delivery to seek medical attention. Even when prenatal care had been given, the family seldom called the physician and nurse until the patient was ready to deliver. There were not the hours of watching and waiting that I was used to in the hospital, but only time enough to get the instruments boiled and things set up. The birth chamber in the Filipino home is so silent a place that I was amazed time and again.

It was very common never to hear one audible utterance of pain by the mother during delivery. The Filipinos have many superstitions which I shall not mention, but I had some amusing moments when I learned of them for the first time.