Part VII: Our journey to Taiwan

With the generous contribution of our MSD Family to Raphael Inigo's fund-raising, we were able to consolidate close to PhP 3,500,000 before we left for Taiwan, which was just enough for the estimated hospital costs (inclusive of the lab tests, Liver Transplantation, 2-3 weeks stay in the Liver ICU, 4 weeks stay at the general wards), travel fare, and living allowance for an estimated stay in Taiwan for 3-months.

I e-mailed Ms. Linda Lin to follow-up on our Acceptance Letter which was needed for us to know if the hospital would accept our son's case. He has been classified as highly complicated, and we were very worried that if they would reject our application, we would have difficulties in finding another hospital who would accept my son's case.

Luckily, after a few days, we received the acceptance letter stating that if we were willing to take the risk, we could come to Taiwan but with no guarantee of operation, it would still depend on the results of their physical evaluation, and we may go home to the Philippines even without operation. We didn't have any room for second thoughts, we immediately applied for our Visa, booked a ticket going to Taiwan, coordinated with our local doctors for clearance, deposited the amount needed via wire transfer to Chang Gung Memorial Hospital and prayed real hard for the success of our journey.

A few days before our flight, my son was once again admitted in PGH for blood and albumin transfusion in preparation for his upcoming operation. When we were discharged we headed off to my parent's house for our final goodbye's before we left for Taiwan. My brother and sister hugged and me told me how proud they were of me. I have always been the naughty one among siblings, but also the soft-hearted one. My aunt from the U.S. (Tita Teddy), who has been one of the biggest contributors to our fund-raising and had always sent monthly support for my son's medications, also hugged me and whispered in my ear, "I hope we had more time so we could have done more for you". I hugged her back and told her, "Tita, you have done more than enough". I bid her thank you and headed off to my Mom and Dad who were scheduled to follow us after a few weeks. My Mom and Dad, who had always been there through out our journey, hugged me and told me to be strong and assured me that they would be there on the day of the operation.

As days came closer, we had mixed emotions of joy, sadness, and fear. We were happy because finally we had the chance to save our son's life. Somehow sad, because we had to leave our eldest daughter, Angel, in the Philippines since her school had started already. And of course, in any operation the fear of the possible outcome was eating us up.

The day before our flight, we had our last minute preparations. Checking if all the documents were complete, medicines, milk, specialized water, clothes, and practically everything we needed were already in our luggage. I remember how hard I prayed that night. As I looked at my son, I whispered in his ear, "Anak, konti na lang magiging ok ka na, wag kang susuko ha" (Just a little more time and you'll finally be okay, just hold on and keep fighting). I hugged him and went to our eldest, Angel. It would be the first time, for a very long time, that I would not be able to hug her at night. I hugged her real tight and a tear fell down as I whispered in her ear, "Anak, alam kong mahirap pero kailangan natin tiisin to para sa kapatid mo. Wag kang mag-alala at susunduin kita kaagad ha" (I know it's hard but we have to do this for your brother. Don't worry I will be back for you soon). As I lied down beside Angel, looking at the ceiling, trying to fall asleep, I reminisced on all the hardships we've been through. I realized how lucky we were and as I fell asleep, I knew that God has never left our side in our journey.

Morning came, June 26, and as were on our way to the airport, we met up with my Mom and Dad at a gasoline station along the way. As we got to the airport, I pulled out a trolley, hugged my parents, said our farewell, and kissed my darling Angel good bye. We took our leap of faith and entered the airport with the hope that when we came back, our son would already be okay. As we flew off to Taiwan, we lifted up our journey to the Lord, that he may guide us in every second of the day.

We arrived in Kaohsiung Airport around 12:10pm and we met Jay Feliciano, the father of Job Tyrese Feliciano another Filipino Liver Transplant patient, who was waiting for us just in front of the exit door. As we approached him, he welcomed us and assisted us to the Taxi which would bring us to the hospital. We went straight to their dormitory where we met Sweet (his wife), Tita Raquel (his mom), and their little bundle of joy, Job Tyrese. We headed off to Starlight Plaza, where we were assisted by Ms. Ema, the land lady of our dormitory, to our room. As we entered the building she showed us around and gave the keys to our home for the next few months, Room 231.

Jay and Sweet helped us with our luggage and after awhile left us so we could rest for awhile. We met again after a few hours as Jay gave me a brief tour at the hospital grounds. He showed me around and gave me a few tips on where to buy food and other medical supplies we would be needing during our stay in Taiwan. We went back to their dorm and we met Raymond Pascual, father of the other Filipino Family who also had their son's transplant done in the same hospital. He invited us to their dormitory which was just on the 2nd floor of the same building where we met his wife, Caress. They also shared their experience and had to cut the chit-chat short because they had to go back to the hospital.

As we went home to our dorm, we were enjoying the breeze of new hope. We knew that in a couple of days, a new chapter in Raphael Inigo's journey would begin.

Part VI: The final preparation

With only a few months left before my son reaches one-year old (the ideal age for operation), we did not waste time to have the necessary work-ups done for my wife. She had lab tests, x-rays, and other blood works done just to find out whether she was a suitable donor for my son. And finally, when she received the results of our CT Angiogram, she texted me immediately saying, "Dada, may pag-asa na tayo para kay gogo" (Dada, there is hope for Gogo). I can sense her joy that she was very happy that she was a suitable donor, but I could also sense the fear that she had. We prayed hard for guidance on the coming days. We knew we had to act fast. As soon as we had all the medical requirements needed for transplant, we sent it to Taiwan for review hoping to receive the acceptance letter soon. With our funds depleting, pledges backing out, and others we expected not coming, I took chances once again in soliciting for funds. I was working as a Pharmaceutical Representative for a Multinational Company in the Philippines and it suddenly struck me to try to appeal for help once again at work. It took me a lot of guts to e-mail the "big bosses" of our company in the United States, but I had no other option left. I humbly introduced myself and my son's case and asked if they could somehow do something to help us. A few days passed and still no reply. As a last resort, I once again e-mailed our family, friends, and charitable foundations again seeking for help, some didn't even reply, others even asked a couple of times if our appeal for help was real or just a scam. We were really getting stressed out because we did not know what else to do.

Until one morning, I woke up early, played with my son for half an hour and at the middle of our play time suddenly I smelled that he made some "poop". So I laid him down and as he was smiling at me, I opened his diapers and I was shocked with what I saw. There were strands of blood in his stool. I looked at it again and saw that it was fresh blood even staining our bed sheet. I panicked because I knew that this was already a sign of his liver deteriorating. This was his first episode of bleeding internally and so I woke my wife up, immediately called our doctor even though it was only 6:00am in the morning and asked what we could do, she told me to immediately rush him to the nearest hospital for first aid and when his condition was stable rush him to the Philippine General Hospital. We prepared our things, jumped at the car, and rushed to the nearest hospital. When we got to the Perpetual Help Medical Center we rushed inside to the Emergency Room to have my son evaluated.

When they gave us the go-signal that he was already stable, I once again called Dr. Gregorio and told her that we would be there in half an hour (although it usually takes an hour and a half to get to PGH from Laguna). We got into the car and I drove as fast as I could, beeping my horn, flashing my headlights, and even leaving the hazzard lights on. I did not care if I went over the speed limit or if I would get in any traffic violations. All I was doing was praying real hard and driving real fast (pedal to the metal as they say) just to get to the Philippine General Hospital as fast as I can. It took us less than half an hour to get there and we immediately rushed to Dr. Gregorio's clinic, she evaluated my son and told us that he needs to be admitted and given blood and albumin transfusions. As soon as I showed her the diaper with the blood, she told us he also needs another IV medicine called Somatostatin, which would help in the healing of the ruptured veins that caused the bleeding. We headed off to the admissions area of the hospital and waited until we got a room. It was a Monday, May 28, which made it more difficult to get a room coming from a weekend. When we finally got admitted, I messaged everyone in my phonebook once again asking for prayers. I was so scared and even more pressured because I knew that in order to save my son's life he had to have his Liver Transplant soon. I sent another e-mail to Ms. Linda Lin in Taiwan to follow-up on our application for my son's operation and I informed her of my son's current condition.

As I was checking my e-mail, I received a very unexpected e-mail from Mr. Craig Kelly, Vice President (MSD Human Health Asia), saying that he has discussed my son's case to Mr. Ken Frazier, President (MSD Global), and they have decided to act on my son's case through the help of Mr. Chris Tan, Managing Director (MSD Philippines). A few minutes later, I received a call from Ms. Paula Salvador (HR Associate) and she told me that Mr. Mike Blanch (VAOW Business Unit Director) and Mr. Joey Briones (HR Director) would be visiting us in PGH within the week to check on my son's condition. I was so relieved with the new spark of hope that day. I knew that the good Lord has been true to his promise that he will never leave us in our times of need. I knew in my heart that in His time, everything will fall into place. A few days later, Mr. Blanch came to visit us in the hospital. I was grateful for his visit and he informed us that in the next few days they will be launching a campaign to help in our fund-raising. He stayed for an hour and headed back to the office after. Before he left, he asked me how much do we still need for the operation and I told him more or less PhP2,000,000. He left and told me, he'll see what he can do, leaving no promises and no commitments. And on the same day, I received a text message regarding an HR initiated "Leaves for Life" Campaign. An internal MSD fund-raising where employees may pledge a number of sick/vacation leaves that would be converted into cash based on the per day salary of the pledging employee. I was so happy while reading this message because I knew that it would generate even a hundred thousand at a conservative estimate of each employee pledging at least a single leave. But, I was wrong. Mr. Blanch called me and informed that as of 5:00pm, the pledges have reached almost PhP500,000. I was shocked and I stood there for a few seconds without moving. I thanked him as my heart jumped for joy. The following day, I sent a message to all of my office mates in my phonebook asking to encourage our other office mates to pledge for the campaign. By 5:00pm again Mr. Blanch sent me another text message informing of the developments on the campaign which read "Mellord, as of today we have just hit the PhP1,000,000 mark". I was so happy thanking him once again. I was having chills all over because I knew it was God at work doing all these miracles. I was really overwhelmed and I knew that from there we would only be needing a little more to complete our funds. We were discharged from the hospital on June 3, and as we were on our way home I kept on praying for good results from the campaign. I was asking the Lord to once again grant us this miracle of having enough funds and enough time to get to Taiwan for my son's operation. That day, I did not hear a word from the office. But come Monday, I was back to work and then suddenly I received another call from our HR Associate, Ms. Paula, she told me to be at the office on Tuesday around 10:00am, she said they're preparing the results of the campaign and would be giving it to me then. I was asking how much we were able to raise but she kept on saying it's a surprise.

The next day I went to the office having high hopes. As I approached the HR's cubicle, she told me to be strong and keep the faith. Then, Mr. Joey Briones (HR Director), talked to me for quite sometime and asked about how my son was doing. He then told me to come to the next room and as we entered the room I saw Ms. Karen Villanueva (External Affairs Director) and Mr. Mike Blanch (VAOW Business Unit Director) waiting for me with a big smile on their faces. Then Mr. Joey Briones handed me with an envelope saying, "This is from you MSD Family". And as I opened the envelope, it put me into tears to see a check for "PhP 2,008,868".I was very overwhelmed and then I cried my heart out and thanked them for all the help. In my silence I thanked the Lord for this blessing. It only clearly proves that God listens to our prayers. I prayed in my heart for God to always bless the good hearts of my office mates from Merck, Sharp, and Dohme Phils. because they may not fully understand what the campaign was all about, but they definitely helped in saving my son's life. The funny part is, the amount we received is the exact amount we needed. I once again thanked them and headed to the nearest bank to deposit the check. We will forever be grateful for the generous contribution of every one from Merck, Sharp, and Dohme Phlippines and Global to Raphael Inigo's Journey.

Part V: Preparing for Battle

We once again coordinated with Ms. Linda Lin and she emailed us the following requirements for possible admission in Chang Gung Memorial Hospital:

Dear Mr. Zarraga,

Thank you for considering Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan as potential partner in providing health care for your son who needs liver transplantation.

To give you a brief summary of living donor liver transplantation (LDLT) in Chang Gung:

1. Total cost that the hospital requires wire-transferred before the patient arrives in Taiwan: NT$ 1.5~2.0 million (NT$ 1 = Phil Peso 1.5); that's roughly about Phil. Peso 2~3 million (depending on current exchange rate). This amount includes both recipient and donor operations. This amount covers operations, hospitalization (3-in-a-room + ICU), medications, and diagnostic tests. This amount is for uncomplicated cases. If this cost is not consumed, all unused money will be refunded. This amount excludes all travel and living expenses while your family is in Taiwan.

2. The family will stay in Taiwan for around 3 months. There may be a hostel (semi-furnished with kitchen, living room, bedroom, bathroom, telephone, cable TV, refrigerator, hot and cold water) available within the hospital compound. Rent is around NT$ 945/day. Payment for the hostel is not included in the NT$ 2.0 million.

3. Recipient will stay in ICU after the transplant for 2-3 weeks, 2-3 weeks in the ward, then 1 month in the house. The donor can go back to Philippines after 1 month.

4. Donor and Recipient must have same blood type or ABO compatible. Donor must be negative for HBV or HCV. Donor must be within 5th degree of consanguinity with the recipient or the recipient's spouse. Donor must be at least above 20 years of age.

If you decide on living donor liver transplantation for your son, please provide us requirement as follows for presentation.

Recipient:
1. Name, age, gender, body weight and height, blood type, birth date
2. Updated Clinical abstract, operations and treatments, medications, reason for transplant
3. Hepatitis profile: HBsAg, anti-HBs, anti-HBc, anti-HCV
4. Blood chem: CBC/DC, Albumin, AST, ALT, total and direct bilirubin, creatinine, pro-time with INR, AFP
5. Liver ultrasound
6. Liver CT Angiogram. (done by Dr. Santos-Ocampo or Dr. Jackson Dy in Makati Med Center-all Phil. patients that come to Chang Gung have their CTA done in MMC because their CTA is compatible with that being used here in Taiwan, otherwise, the CTA cannot be read by the computed here). Indicate for liver transplant recipient. Send us a copy of the CD.

Donor:
1. Name, age, gender, body weight and height, blood type, relationship with recipient (with proof, birth certificate, marriage certificate, etc.), birth date
2. Hepatitis profile: HBsAg, anti-HBs, anti-HBc, anti-HCV
3. Blood chem: CBC/DC, Albumin, AST, ALT, Total bil, creatinine, INR/protime, AFP
4. Liver ultrasound
5. Liver CT Angiogram. (done by Dr. Santos-Ocampo or Dr. Jackson Dy in Makati Med Center-all Phil. patients that come to Chang Gung have their CTA done in MMC because their CTA is compatible with that being used here in Taiwan, otherwise, the CTA cannot be read by the computed here). Indicate for liver transplant donor. Send us a copy of the CD.

The items and fees listed above are for reference only. All necessary checkups, procedures and treatments should be based on doctor’s final diagnoses, and the charge will be according to hospital’s fee schedule. I suggest the patient and his potential donor going to Dr. Gregorio who is working for Philippines General Hospital for preliminary tests. She will guide them to the relevant examination. They can do first the blood typing and hepatitis profile to screen both recipient and donor before going into the more expensive laboratory and diagnostics. We do this screening because if they go directly to Taiwan and if either recipient or donor is found to be unsuitable, it’s a waste of money (travel, laboratory, etc.).

If you decide to send the above materials via courier, please send it to the address below:

Linda Lin
Superintendent Office, Chang Gung Memorial Hospital
123 Ta-Pei Road, Niao-Sung, Kaohsiung, Taiwan, R.O.C
Tel. +886-7-731-7123 Ext. 3261
Fax. +886-7-732-3625
website:www.clchen.org.tw

After presentation, we will issue an acceptance letter to you if the recipient and the donor are suitable candidates for living donor liver transplantation. An acceptance letter is needed for fund raising. The patients who underwent liver transplantation will need to take immunosuppressants (medicine of anti-rejection) for lifetime to prevent rejection of their liver. Regular checkup is requested for liver transplant patient. In Taiwan, the estimated cost of monthly immunosuppressants and checkup is around NT. 15,000. Please also give this matter your consideration.

Sincerely yours,

Linda Lin
International patient coordinator
Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan

We knew that we had to accomplish all of these the soonest possible so I volunteered and we decided that I would be the donor for my son's Liver Transplant. We also began to had weekly check-ups with Dr. Germana Gregorio for close monitoring of his condition.

We were once again admitted at the Perpetual Help Medical Center on April 14, 2011 and was discharged on April 18, 2011 for blood and albumin transfusion. And after another month we were admitted at the Philippine General Hospital on May 6, 2011 and was discharged on May 8, 2011 for the same reason. Our son's condition was getting worse and we knew he had to have his operation soon. We immediately scheduled him on April 29, 2011 for the CT Angiogram to be done at the Makati Medical Center under Dr. Jackson Dy (Radiologist).

We were starting to get frustrated because our financial resources were starting to get drained due to the monthly confinements, monthly lab tests, expensive medicines, and specialized formula milk reaching up to millions in total. During one of our check-ups, we were referred to Dr. Allan Concejero (Liver Surgeon) who was currently in the Philippine General Hospital and is part of the Surgery Department of Chang Gung Memorial Hospital. The minute we walked into his room he immediately told us that I could not be the donor for my son because I was too big in height. He said it would be better if my wife would be the donor, so we had no choice but to once again repeat the work-ups, this time with my wife having to undergo all the blood tests and lab tests. This was a challenging event throughout Raphael Inigo's Journey.

Part IV: Chasing the dream

The Christmas Season was fast approaching, even faster than ever. I knew in my heart that this Holiday Season was special. Not only for me but for our whole family. People everywhere was rushing buying gifts for their loved ones, giving thanks for all the blessings received for the past year, or praying for a special present during the holidays. But, for us, this was the time to be truly grateful for the gift of life, love, and family. I was touched to hear my daughter, Angelica Yvonne, pray one night. She said, "Papa Jesus, isa lang po ang hihilingin kong gift this Christmas, yun ay ang gumaling si Gogo (Raphael Inigo's nickname) at makasama namin siya ng mahabang mahabang panahon" (Papa Jesus, I only have one wish this Christmas, that is that Gogo would get well soon so we could be with him for a very long time). My heart was crushed when I heard this from my 6 year old daughter. It made me think and re-affirm our goal to have my son have whatever procedure needed for him to be well. We enjoyed the Holiday Season with the company of friends and family. And soon the year ended.


As we welcomed the new year with a new hope, we knew this would be the start of a challenging year. Before the the year ended, we were supposed to have another confinement due to my son's recurrent infection. We started the year by immediately contacting and coordinating with our doctors. Raphael Inigo was scheduled to be confined at the Philippine General Hospital (PGH) to have tests done to determine the cause of the recurrent infection. Since it was just the beginning of the year, our doctors were mostly out of town or were still just arriving from their vacations. We were issued an admitting order by Dr. Jossie Rogacion (Pedia-Gastroenterologist) and was admitted on January 4, 2011 and after a few days and a lot of laboratory tests they found out that the cause of the recurrent infection was, besides the Vesicoureteral Reflux (VUR), he was also diagnosed on January 6, 2011 with Urinary Bladder Diverticulum or an out pouching of the urinary bladder creating an extra space for storing urine and not fully releasing it. Since he still had infections, we were referred to Dr. Germana Gregorio (Pediatric Hepato-Gastroenterologists) for proper monitoring and to lead in the management of my son's case. She told our doctors that they had to first address the infection before leading on to other procedures. After a series of tests, Dr. Nikko Magsanoc (Pedia-Urologists) informed us that my son had to undergo another procedure to clear him from infection. And on January 17, 2011 they conducted a Cystoscopy Procedure hoping to address the Urinary Bladder Diverticulum. We were later on discharged on January 19, 2011.

During our confinement, we were contacted by a group of mountaineers known as the Voyager Adventure Club (VAC) led by Mr. Al Del Barrio and offered us a fund-raising activity. They organized "Climb for Baby Raphael" at Mt. Galugod Baboy, Mabini, Batangas on January 29, 2011 with our son as the beneficiary. We were moved by their efforts in organizing this event as it was not everyday that a group of people would offer to climb a mountain to raise funds. Their efforts are truly appreciated.

The following month, my high school friends from De La Salle Lipa called me and said they wanted to help. They told me that instead of giving us money, they will provide some goods to sell. We finally decided to start the "SAVE a Liver, wear this BALLER" Campaign initiated by Ms. Trina B. Caldito and Ms. Trizha Dimayuga.

I was really touched with their efforts of cutting out and putting tags in each baller. Through this campaign we were able to raise awareness not only for my son, but also for his disease. We were able to sell these baller's nationwide and even reaching some of our friends abroad.

With the continuous success of our fund-raising activities, we were sure that soon my son would have the operation he needed. Although we still haven't decided where to have the operation yet, we consulted both doctors who were known to be well-versed in handling cases like this. We had check-ups done at The Medical City under Dr. Vanessa De Villa (Liver Surgeon) and at the Philippine General Hospital under Dr. Germana Gregorio (Pediatric Hepato-Gastroenterologists). We were praying hard on where to finally have his surgery done since we were running short on time. We were informed that in The Medical City their package costs PhP4,500,000 which covers for the Liver Transplantation with one-month hospital stay. While in Chang Gung Memorial Hospital in Kaohsiung, Taiwan their package costs (for non-complicated cases) NT$1,600,000-NT$2,000,000 or PhP2,300,000-PhP3,000,000 which covers for the pre-evaluation tests, Liver Transplantation, hospital stay (2-3 weeks in the ICU and 4 weeks in the ward) excluding the lodging at the dormitory, food, transportation, and other medical expenses.

We coordinated with a local support group which consists of post-transplant patients from Taiwan. We met with Mrs. Aurea Cabacungan-Ravelo (Ate Au) and Mrs. Gina Monasterio (Tita Gina) and they were kind enough to answer our inquiries with regards to Liver Transplantation. They told us that if we were to choose to go to Taiwan we should prepare around PhP3,500,000 to cover for the hospitalization, plane tickets, and other expenses for a 3-month stay in Taiwan. At that time, Tita Gina's grand daughter was still currently in Taiwan, so we took that opportunity to be able to ask directly to the hospital's International Coordinator, Ms. Linda Lin. I e-mailed Ms. Linda for the requirements needed and coordinated promptly on her inquiries. We then decided to have the operation done in Taiwan due to the urgency of my son's case, high success rate of up to 97%, and affordability of the transplant package (PhP3,500,000) compared to the local package (PhP4,500,000).

We knew that planning to have the operation done in Taiwan would not be as easy as it sounded. Our doctors told us that, first, my son had to be physically, mentally, and emotionally prepared. As we were slowly moving towards our plan, we noticed that after all the procedures done to him he was still having fever caused by infection. He had to undergo another procedure called CT Urogram, to thoroughly check his urinary tract. And from there, they found that the Urinary Bladder Diverticulum and Bilateral Hydronephrosis was still present. That's why we were advised to have another operation to finally clear him from infection.

We were admitted at the Asian Hospital and Medical Center on February 28, 2011 under the care of Dr. Maria Imedla Vitug-Sales (Pedia-Gastroenterologists) and Dr. Sally Gatchalian (Pedia-Infectious) on March 7, 2011 he was scheduled to undergo his final operation before his Liver Transplantation. The operation started around 8:00am with Dr. Nikko Magsanoc (Pedia-Urologists) as lead surgeon assisted by Dr. Jonathan Lao (Urologists) and Dr. Rodolfo Tuazon (Pediatric Surgeon) and took eight (8) long hours before it was over. They conducted the following operation: Cystoscopy Procedure, Repair of Inguinal Hernia (Hernitomy), Urinary Bladder Excision (Diverticulostomy), Re-implantation of Left Kidney Ureter (Uretral Reimplantation), and Circumcision.

We were finally discharged on March 13, 2011 and as we went home we knew that my son would definitely be free from infection this time. And from there we began to prepare for Raphael Inigo's Liver Transplantation in Chang Gung Memorial Hospital Kaohsiung City, Taiwan. We now had a clearer direction in Raphael Inigo's Journey.