Doctors, Hilots, and Albularyos: Medical Care in the Philiippines – Part One

“If you are poor in the Philippines, and you have no political connection, and are not known to the medical service provider, and if the latter thinks you have no education, you are likely to die.”

– Danilo Reyes in an article published by the Asian Human Rights Commission.

One reason many expats cite for moving to the Philippines – you can obtain medical care as good as in the U.S. at much less cost. The doctors are well-trained, often in the U.S., and the hospital facilities excellent. This is true – if you live in a major metropolitan area such as Manila, Cebu, or Davao. Outside of these major urban areas, a quite different picture emerges.

In these areas, not only are the facilities substandard, medical equipment and technology outdated, and medicines and technology such as MRI rarely available, but access to them can be difficult. On top of this, traditional beliefs often undermine proper recourse to treatment. Because of prohibitive cost, people will seek care from traditional healers before going to the hospital often complicating or compromising their care.

For expats, and those who have more money, health care is more readily available. But for those who live in extreme poverty, (over 25% of the population according to the Philippines government), medical care remains almost nonexistent, particularly here in the southern Philippines where in some provinces almost 50% of the population lives below the poverty line.

The national health care plan, Phil Health, provides some support, but typically covers only about 40% of medical costs. The cost is cheap for expats, but among the poor even the modest Phil Health fee of 200 pesos a quarter is prohibitive. So they resort to traditional medical practices like Hilot (a form of reflexology) and herbal treatments from folk healers such as the Albularyo.

Image courtesy of  www.nerdygaga.com/

Hilot is a 1,000 year-old healing tradition still commonly practiced here in the Philippines. The Hilot practitioner is typically a midwife who sets broken bones through massage. However, Filipinos consult Hilot practitioners for all kinds of conditions, not just musculoskeletal conditions for which you might think massage would be useful, but for flus, colds, and just about any condition.

The Albularyo focus on diagnosing imbalances in the body. They feel your pulse or use mystical means to tell which of the four elements (earth, water, air or fire) in your body is imbalanced. After the diagnosis, they use Hilot and/or herbal medicines to treat the imbalance.

Mothers in Montevista receive free medicine from Bridgettine nuns.
            Such donations at the only source of medicine for some of the poor. 

Associated with faith healers and popular religiosity, it's easy to dismiss these traditions as superstition. I find my Western skeptical mind going there often, but some commentators have pointed out that this is a judgmental term used by dominant religions to categorize and denigrate earlier, less sophisticated religious attitudes and behaviors. Others argue that these practices represent a rejection of colonialism and an attempt to cope with the experience of oppression.

Nonetheless, some of the practices seem bizarre to my skeptical Western mind. One day I have a cold and one of Elsa's friends rubs an egg in the crook of my arm and then spins the egg on a table, supposedly divining the seriousness of my illness. Another time, the family dog bites a neighbor's child and Elsa takes the child to see an Albularyo in Nabunturan. He proceeds to lay his hands on the child's head, making a fist with one hand and laying the other hand against it as a barrier. He whispers an incantation into the fist, then spits on his thumb and rubs the spittle into the wound. He repeats this process three times. I'm hoping the spittle isn't giving the child an infection.

“Why go to an Albularyo for this treatment?” I ask Elsa.

“He is gifted in diagnosing rabies,” she says. I shake my head. Fortunately, Elsa also recognizes the need to send the child to a doctor for an injection.

* * * * *

One day, Elsa complains of pain in her chest. It's a chronic problem that she attributes to an injury sustained when she was three years old and living in Ilo Ilo. Playing in the kitchen, she fell through a hole in the floor on her family's pole house (a bamboo hut raised on stilts). Her mother called in a Hilot to treat Elsa. I'm wondering if the massage contributed to the problem since it doesn't seem like reflexology would help with a bruised or broken rib. The pain arises periodically to this day.

After enduring the pain for a couple of days, Elsa's friend Lorna tells her about a new Hilot she has consulted who employs a rougher form of massage. Elsa wants to try it out. She suggests I try the Hilot as well since I'm suffering from bronchitis. (I seem to be constantly fighting off a cold or diarrhea or stomach flu). I tell her that the bronchitis is due to a virus and no amount of massage or chants will help, but she insists I try. I want to see what it is like anyway. So I agree to give it a try.

So the next morning, we walk past the provincial capital, turn left on Pioneer, and up a couple of blocks where we turn into a subdivision made up of narrow rows of hollow block homes – Villa Magsanoc Subdivision. Lorna's house is on the corner one block from the highway. Vines and flowers hide the entrance.

“Ayo Ayo?” calls out Elsa (“is anyone home?”). A heavy set woman opens the door and leads us to a small sofa where we take a seat. She is Lorna's cousin visiting from Lanao in northern Mindanao. Lorna has a sari sari store attached to her home where she sells snack foods, soft drinks, cigarettes, seasonings, instant coffee, Milo (a chocolate and malt powder) and laundry products. The sari sari store is a popular alternative to the convenience store found throughout the Philippines.

Lorna's cousin enters the store and gets us some cheese filled crackers and soft drinks. The Hilot is already there – a heavy set man in his 40s. He massages Elsa first. She cringes a little as he kneads and pulls. After a few minutes, he finishes and motions to me.

“How was it?” I ask Elsa.

“Rough,” she tells me. I take a seat and he begins. He kneads my back and shoulders and legs and the pads between my thumbs and forefingers. He is rough and it's painful and I don't want to ever try it again, especially since I don't notice any results for Elsa or me.

Hilot is not just for the superstitious or uneducated. Lorna, a widow in her 50s and a cancer survivor, initially sought treatment from a medical doctor, but with the cancer in remission, she now chooses to use herbal medicine. Even though she is well-educated, a chemical engineer by training, she prefers traditional Filipino herbalism to modern western medicine (perhaps if I had had to go through radiation therapy, I might feel similarly).

For Elsa, the pain doesn't get any better and finally she asks me to take her to the hospital. She is convinced she has a heart problem. We take a tricycle to Bishop Regan Hospital and walk in through the emergency entrance. The facilities remind me of something from the 1950s with plywood walls and ceiling, old, stained tile floors and cheap wooden counters – not at all the spanking, new, antiseptic appearance of American hospitals.

While the technician takes Elsa's information, I go to the comfort room (bathroom) and here, even in the hospitals, there is no soap, no flush toilet and the facility reeks of urine; there doesn't appear to be a semblance of regard for cleanliness and hygiene. The emergency room consists of a wooden desk with a few plastic chairs scattered around and a couple of old crank up style beds with thin mattresses. They look like donations from a 1940s U.S. Army hospital.

A few health care workers are milling around; I don't know who's a doctor, or a nurse or an aide. Finally a man in a blue hospital gown comes over and takes Elsa's blood pressure. He motions her to lie down on one of the beds. There are splotches of dried blood staining the sheet. The man wheels over a cart equipped with an old EKG machine. He pulls an old, cloth curtain around one side of her bed, and I sit in a plastic chair at her feet. The man starts to attach wires and heavy metal clamps that look like car battery cables to Elsa's chest.

We get the results immediately – normal. We go to the counter and pay our 200 pesos (about $4) – at least the cost is low. The health care worker suggests we consult with Elsa's doctor in Mawab. Unfortunately, he's out of town and so we visit another doctor, Dr. Sanchez, in Nabunturan.

The next day, we take a bus to Nabunturan. We leave the terminal and the bus winds up a hill and through the mountains until the road descends about 30 minutes later into a river valley where we pull into the Mawab bus terminal. We wait for 20 minutes or so before the bus continues on its journey to Nabunturan (the provincial capital of Compostela Valley, halfway between Mawab and Montevista where Elsa has her house).

The name “Nabunturan” means “between the mountains” and they seem to disappear as we drive on past rice fields and stands of coconut and banana trees. We arrive at the Nabunturan terminal about 20 minutes later and take a tricycle to a nearby clinic where we meet Dr. Sanchez. She examines Elsa and reads the EKG results. She orders a chest x-ray and charges us about 250 pesos for the x-ray and about the same for her consultation.

A week later, we return to Mawab and finally see Dr. Brigas. We arrive just before noon and he is at lunch, so we sit and wait. There are rarely set appointment times with doctors here. You just show up and wait in line often for an hour or more. Specialists will take appointments, but even so, you may wait for a considerable amount of time because there are insufficient numbers of specialists.

Dr. Brigas finally meets with us. He is a handsome, affable man who looks to be in his 40s. He says that the test results are all negative. He tells me he is the family's doctor and has treated Elsa for years. On several occasions in the past she has experienced chest pains that led her to fear heart problems and she has frequently consulted with him always with the same results.

“It's just muscle pain,” he tells us. “Muscle pain and anxiety.” The muscle pain probably comes from her old injury, and is exacerbated by her anxiety. He prescribes Xanor (called Xanax in the U.S.) an anti-anxiety medication that also seems to relieve some muscular pains. Almost immediately, Elsa says the pain goes away. She takes a low dose once every week or two and, when the need arises, consults a hilot, and that seems to sufficiently manage the pain for awhile.