Biri Morning

The roosters begin to crow around three thirty a.m. There are hundreds on the island, as they are used not only for food but also for entertainment. Cock fighting is popular in the Philippines, and on this island of 11,000 people it competes only with karaoke as the favorite pastime.


Besides the roosters crowing, I hear rain falling on the clay roof. I've slept well, exhausted by two solid days of travel by air, land, and sea. The eight-by-six foot tiled bathroom is dimly lit, the ceiling bulb powered weakly by the hotel's small generator. Central power for the island is shut down from midnight until ten a.m., which means the fan in my room has no power. It's 85 F with 95% humidity, and I'm in need of a shower.


In one corner of the bathroom is a water spigot, and a drain in the floor. On the floor sits a blue plastic bucket. I turn on the spigot to fill the bucket with cold water-- the only option. A scoop floats in the bucket. There is no tub, and the shower head yields a scant trickle, so I employ the standard Filipino bathing method of soaping up then rinsing with the water collected in the bucket.


I wash the clothes I wore yesterday in the bucket and hang them over the balcony outside my room, hoping the rain will stop during the day. Across the street, an elderly man is sweeping the roadside in front of his shop with a bundle of straw fashioned into a broom. It's not yet daybreak, but all around I hear the sounds of the townspeople beginning the day.


The guesthouse where I'm staying is clean and well-maintained by the owner and her adult children. The five guest rooms are small but comfortable with private bathrooms and television. A small shop downstairs sells beer, water, snacks and sundries. The building is of concrete construction, in contrast to the plywood, cinderblock, and corrugated tin structures in which most of the islanders live.


Back inside, I pour the wash water into the toilet to flush it. I have yet to see a toilet on the island that is plumbed to flush any other way. Most do not have a tank attached. Toilet paper is not commonly used, and can never be put into the toilet. Instead, one washes with the scoop in the nearby bucket then pours the remaining water in to flush. It's bad manners not to fill the bucket again before leaving the bathroom.


Today is the first day of surgery. I'm assured there will be sterile instruments to use today, though the autoclave is currently not functioning properly so cleaning them for use tomorrow will be a challenge.


We have scheduled surgical procedures for over 200 people for the next ten days. People come from the larger neighboring island of Northern Samar, traveling several hours to have surgery they otherwise would never be able to access or afford. The local clinics and hospitals provide general medical care, but not surgery, and a trip to Manila where a full range of services are available for a fee requires a day or more of travel by boat, car, and plane. Those scheduled for today will arrive at the hospital by seven a.m. and wait their turn for surgery. The order of procedures is determined by which patients show up, the availability of sterile instruments, and manpower considerations. Some people will wait for hours.


Before going to the hospital, the team meets for breakfast at an outdoor dining pavilion next to the police station. Food has been prepared for us by volunteers from the community. Today we have a soup of cabbage and macaroni noodles in coconut milk and chicken broth, SPAM rice, and scrambled eggs.


The hospital is a ten minute walk from breakfast, and we are greeted there by patients, families, and staff including Dr. Alex, the resident canine. So it begins...