Mission of 2020

Feb 24-29.
Seven vasectomy experts from three countries, NSVI President Doug Stein, and NSVI Founders Ramon and Nenita Suarez volunteered their time, paid their own travel expenses, and made donations to NSVI to help cover the expenses of the mission including payments to staff, community educators, and facilities.

They traveled from two continents to join NSVI’s Domestic Teams in Manila and Cebu on our annual Philippines mission.

Manila Feb 24-26. Headquartered at Mary Johnston Hospital.
Cebu Feb 27-29. Headquartered at Sacred Heart Hospital.

Before the mission, NSVI had promoted in three ways:

  1. Online through Facebook: Frohnie Cagalitan, MSW, of NSVI’s Domestic Team in Cebu, maintains and regularly updates NSVI’s Facebook page, especially before international missions. With any Facebook search for Vasectomy in the Philippines (where Facebook is widely used), the NSVI page has an overwhelming presence. Questions sent via Facebook Messenger were answered promptly by Frohnie.
  2. Online through the pages in this website Vasectomy in Manila and Vasectomy in Cebu. These pages come up first on searches by the same expressions. Queries sent via the Contact Us page in this website were answered quickly by Doug Stein.
  3. Locally by our outreach coordinators in Manila and Cebu (Jelyn and Frohnie respectively). With NSVI funds, they (1) purchased and posted about 10 banners (see photos below) in community health centers and other public places, and (2) printed and distributed hundreds of simple brochures in Tagalog and Cebuano to community health workers supplied with many more for distribution in their communities.
  4. In-person community presentations in Manila (photos below) by Doug, Nick, and Melanie, who arrived in Manila two days before the mission. Jelyn had scheduled three locations for these Sunday presentations so that members of the community could meet face-to-face with the doctors who would provide the service.

Manila is larger then Cebu. With about 14,000,000 people in the Metro Manila and 21,000,000 in the larger urban area, it is the world’s most densely populated city, with a density (43,000/sq km) almost twice that of Mumbai (23,000/sq km). Mary Johnston Hospital is in Tondo, Manila’s most populous district. By comparison, Metro Cebu has a population of about 3,000,000, with a density about 16 times less than Manila’s and fewer large slums. From the view of this foreigner, the demographics of the two cities appear to be similar. The relative proportions of upscale districts vs. slums, well-to-do vs. poor, seem to be about the same.

Despite similar promotion in the two cities before the mission, there were profound differences in the demographics of the patients seen in Manila and Cebu.

While average age and family size were slightly greater in Cebu, notice that the Manila patients were MUCH more likely to have a phone and an email address than the men in Cebu. Most learned about the mission online through the use of their smart phones or computers, and only 12% (usually the ones without email addresses) felt a need for income replacement. In fact 36% of them made small donations to NSVI in appreciation for our services. Very few patients had come from the local barangays (neighborhoods) despite the promotions of our Domestic Team before the mission and the in-person presentations of the doctors on the day before the mission.

By contrast, even though Cebu has a huge population of men with computers and smart phones, only 12% of the men who came for vasectomy had an email address, 92% requested income replacement, and 90% were referred by community educators happy to receive a facilitator fee for their efforts. Only 2% made a donation to NSVI, despite the fact that the presentations of our intake staff were very similar with regard to options for income replacement vs. donation vs. neither.

We don’t know what we might have done differently to attract more low-income men in Manila, and we don’t know why we got so few men in Cebu who learned about the mission on the internet. Perhaps family planning alternatives are more readily available in the barangays near Mary Johnston Hospital, and there are social services that reduce the burden of large families. Only 6 of 60 men (10%) served in Cebu reported “FB” (Facebook) or “Internet” as their referral source, whereas 50 of 56 men (89%) in Manila who indicated a referral source reported that source as “FB”, “Internet”, “web”, or “NSVI page”.

NSVI would like to thank Glenn Roy Paraso, MD, the Medical Director of Mary Johnston Hospital and Chito Salazar, PhD, President of Southwestern University PHINMA (owner of Sacred Heart Hospital) for opening their hearts and facilities to NSVI as it partners with us to make vasectomy readily available to Filipinos in two of the three principle metropolitan areas in the Philippines.

Photo Summary of the 2020 Mission:

North Americans from the east had taken the shortest route to the Philippines: over the Arctic Ocean and via Seoul. It’s a long journey.

On arrival in Manila, we were all pleased to see that our mission took top billing on the marquis of Mary Johnston Hospital.

Sunday, February 23:

Weeks before our visit, our domestic staff had hung banners and arranged for presentations at many locations in the community served by Mary Johnston Hospital. With a day to spare before the mission, Doug and Nick and our Domestic Team headed on Sunday morning to these prearranged locations for presentations to barangay leaders and health care workers. Meeting sites and groups were small, but Jelyn and Ralph did a fine job translating. Wives are often more enthusiastic about vasectomy than husbands are.

Each barangay has an elected leader. We provided brochures and explained that facilitators would be paid to distribute brochures and pass on what they had learned during our presentations.  Our morning locations all had computers and projectors.

By afternoon, Melanie and husband Jean-Francois had arrived. We set out in jeepneys … for Barangay 123. Once again, we met with barangay leaders, but this time we went right out into one of the few open meeting areas deep within the maze of homes. We trekked through tight alleyways, skylight barely passing in from above. Deep within, we passed tiny internet booths connecting inhabitants to the outside world.

We soon found ourselves in a courtyard and in no time we had drawn a crowd. We tried to keep it simple and left hundreds of educational brochures. At another location, Melanie presented the option from a women’s point of view, even confiding that she had performed her OWN husband’s vasectomy!

Back at Mary Johnston Hospital, Nat had arrived and we began setting up for the next day …

… making ourselves feel right at home.

Monday, February 24:

On the morning of the first day at MJH, 30 patients arrived before the doctors did, which provided an opportunity for group counseling.

The Welcoming Committee made sure NO ONE got lost.

Nurses Glenda “Glen” Rada and Jannete “Jay” Macatangay kept an eye on Chirag …

… while Wendell Enocido marveled at the best performances of Melanie and Nick.

JB trained Urology Resident John Laylo while John tried to impress his professor Dr. Ulysses Quanico.

Nat struggled with this retractile side and really had to put his weight into it.

With this young man, Nick provided an overview while Lucy made sure he didn’t miss the fine print. Good thing the patient had two sides so that they could share.

54 patients later and the team STILL looked fresh.

HOW many did we do?

Time for that final shot of the day while Lucy still had on her bright pink scrub top. Let’s hope we inspired urology residents John Laylo and Jessie Harina.

Tuesday, February 25:

After spending the day before with Nick, Lucy was ready to learn the PROPER technique. One great thing about missions is sharing ideas. I got to operate with Lucy …

… Meera got to operate with Nick …

… and EVERYBODY got to operate on Chirag.

Only 9 patients the second day, so plenty of time to review policies for the Domestic Team, make plans for next year, and get some great group photos.

Missions are a great mixture of productivity, camaraderie, and fun.

Wednesday, February 26:

Departure Day. While five of our group took a final tour of the local area, JB, Nat and Doug stayed at Mary Johnston to serve any 3rd-day patients. Our reward was (1) personal receipt of the awards of Certificates of Appreciation and (2) photos for Mary Johnston’s promotion as the center of vasectomy services in Manila.

OK … so one final photo with our super staff when the wanderers returned. If you ever join a Philippines mission be prepared for hundreds of photos …

… and great food artistically presented, as here at Blackbeard’s Restaurant on our way to the airport for travel to Cebu.

Sad to leave Manila after 3 great days, but new adventures awaited in Cebu.

What did waiting passengers do before smart phones?

Whatever happened to reading books and magazines?

Arrival at the Best Western Lux in Cebu. A luxury hotel for $50 per night.

Thursday, February 27:

Back at Sacred Heart Hospital where NSVI performed its first mission 18 years ago. The old ER where we provided SO many vasectomies has been reborn.

And dead center are the two men who started NSVI: Founding President Dr. Ramon Suarez and Filipino anchor surgeon since Day 1, Dr. Joe Alesna. And to their right, Nurse Myrna Danuco, Founding VP Dr. Nenita Suarez, and Social Worker Frohnie Cagalitan, all still strong after 20 years.

Drs. Ramon and Nenita Suarez, Founders of NSVI and 1965 Graduates of Southwestern U. Medical School, and Frohnie Cagalitan, co-anchor of NSVI’s Domestic Team for 20 years.

Doug quickly set up to keep 5 eager vasectomists busy.

At a major health sciences teaching center, it’s not long before …

… excited nursing students arrive to witness a procedure still rather uncommon in the Philippines.

Fresh youth are always eager to pose with the “older” doctors …

… especially the REALLY old (and best looking) doctors.

We cannot overstate NSVI’s gratitude to Myrna’s husband Jun Danuco and Frohnie’s husband Edgar Cagalitan for their assistance before, during, and between NSVI missions. Here we are joined by Merlyn Rodriguez of REACH HEALTH, a project funded by USAID, and Dr. Jerry Go, an ENT surgeon who would like to join our Domestic Team in Cebu as a vasectomist.

For the second year in a row, Doug performed a vasectomy reversal during the mission. Here he and Nat, preparing for the next day, make an operating table from an ambulance stretcher suspended between a procedure table and a work vanity. This provides leg space beneath the table so he can sit for some of the 3-hour procedure.

Friday, February 28:

For that $50 per night at the Best Western? An elegant breakfast included.

All reversal equipment (except for an electrocautery generator) was brought from Florida. The patient was a man originally from Belgium, 15 years out from his vasectomy, but still sperm on both sides.

Meanwhile back in one of two multi-table rooms, Nick observed the younger doctors to gain some good ideas about proper technique.

Meera was particularly helpful.

Melanie demonstrating perfect hand position.

After his 2-year absence from missions to manage health issues, it was great to have Ramon back. As honored graduate and big supporter of SWU, his presence adds prestige to the group. Here he is with Merlyn Rodriguez of REACH HEALTH and Cecille Moncada, RN, Assistant Population Officer of the Cebu City Health Office. Frohnie is NSVI’s liaison with the City Health Office.

SWU-PHINMA administrators are proud of their institution’s role in helping Filipinos manage their family size, and they host NSVI for a nice dinner every year.

Saturday, February 29:

Meera Shah began our Saturday morning Symposium for the SWU Medical Students with a nice overview of contraceptive options.

Then Doug focused on the no-scalpel vasectomy technique with mini-needle and no-needle anesthesia …

… while Nick and Meera conferred about all of the things he was saying that were simply not correct.

Nick then explained how much simpler vasectomy is in Australia.

Meanwhile, back in the procedure rooms, Nat had the help of Myrna’s daughter Rosemyrn, herself a star medical student and budding vasectomist.

Dr. Nenita Suarez and Social Worker Frohnie maintained patient flow …

… while inspired medical students came to watch vasectomies in real time, here Chirag and Doug working on a tricky one.

JB was happy to see that Nick finally got one right.

… but there were mixed opinions about the outcome.

This was the third year for these senior medical students. Future vasectomy stars?

What better setting for evening cocktails than the rooftop lounge of the Best Western Hotel?

That looks like too much Red Horse beer …

… making everyone a little silly. If NSVI missions look like more fun than work … well, you’re probably right.

Farewell dinner …

… and Certificates of Appreciation …

… before late-evening departures to the airport.

No certificate is more heartfelt than the ones to the Suarez family for founding NSVI and making this all possible.