Doctors, Hilots, and Albularyos: Medical Care in the Philippines – Part Two

“Medicine heals doubts as well as diseases.”

– Karl Marx

One day, we are visiting Elsa's parents in Mawab when Risa shows up and says that her son two-year-old Zion is ill. He has had a fever for three days. She wants to visit a well-known Albularyo. She takes Zion to see the Albularyo when the medical doctor doesn't seem to have a treatment for an ailment (and besides, he's cheaper). We first take a ten minutes tricycle ride over a rocky road to Andili, the Mawab barangay where Risa is living with Zion's father Patrick. We reach their house and I climb down from the tricycle. A dozen or so children surround me, shouting and screaming. One touches me on the leg.

“They've never seen a white man,” says Risa. “You're a big hit.” Elsa later tells me that many rural children see me as a magical being – a fairy or elf.

We pick up Zion and head down the road to an even rockier, dirt side road that cuts through a grove of coconut trees. The tricycle bounces over ruts and fallen branches for a couple of kilometers or so before we come to a clearing where a small bamboo home stands – actually a lean to with one side made of a loose weave bamboo and the other side a half wall made from coconut boards and blue tarp. There is no kitchen and the only stove is a fire pit outside. A small, wizened man in his 50s, unshaven and wearing a t-shirt and shorts comes out to greet us. He is the Albularyo. Risa says he is a holy man and heals many people through prayer. The Albularyo massages Zion's head and body and gives him a drink of coconut water. He also feels Elsa's side and back and says she was injured as a child. Risa and her are amazed by his wisdom. I remain a skeptic.

Jaredt, Elsa's oldest daughter, with medicines given
during free medicine day in the purok.

The Albularyo's wife offers me a drink of coconut water. I take a few sips; it tastes bitter, and I don't like it. Later, Elsa tells me there are three types of coconut and the ordinary one that I drank doesn't taste as good as Macapuno or San Ramon coconuts. The next day, Zion seems better, which Risa and Elsa credit to the Albularyo's treatment, but I attribute to the fact the flu generally runs it's course in three days.

*****

I buy a fan. Elsa asks me to keep it away from her. Fans spread “bad air” and cause disease she tells me. She also doesn't want to walk in the rain – even drizzles – because rain presumably causes colds and flus. Such notions are not so strange – some westerners hold similar beliefs, but they seem much stronger and more persistent here. Among Filipinos, there seems to be an almost paranoid fear of walking in the rain. People will hide under umbrellas even during drizzles (although Filipinos more commonly use them on sunny days when you see dozens of people shading themselves under the safety of open umbrellas). Some teachers don't show up for work when it rains and, one day, during a drizzle at a local festival, hundreds of people squish together under a huge tarp rather than brave the light rain (the huddling together would more likely cause colds and flu). Rain can shut down some businesses. The general alarm reminds me of Seattleites concern when it snows.

One reason for this concern about “bad air” and rain may be because germ theory has never been as widely accepted in the East as in the West. Prior to Pasteur showing in the 1860s that germs, i.e., bacteria and viruses, cause disease, people throughout the world, in the West as in the East, believed that “bad air” was the cause of disease. This“miasma” view of the world seems still prevalent here. Maybe that's why many people rarely wash their hands and why many public facilities (including hospitals) have no soap; there's just not the same concern about germs found among Americans.

*****

We visit Ramon Bandong, a friend of Elsa's, hospitalized at the regional government hospital in Tagum with complications from diabetes. The regional is a larger hospital than Bishop Regan's although it has comparable 1950s style equipment and facilities. Ramon, who worked in the provincial government with Elsa, is confined to a public ward with at least 25 other people. Care is free at government hospitals unless you choose a private or semiprivate room. Mariz Bandong, Ramon's wife sits at his bedside. They are a handsome couple in their 50s. There is no privacy and there seems to be only one nurse treating patients on the ward. Mariz is also a good friend of Elsa's, a Women's Council President like Elsa who has worked with her on several projects. Ramon breathes laboriously. He is on oxygen and seems quite ill. Mariz tells us Ramon has been ill for awhile.

Ramon dies a month later and we attend the funeral, the first of many I attend in the coming months. We view the body in Nabunturan at St. Peters, a franchise funeral home. Elsa's friend Marie Vising owns the local franchise. We bring some biscuits to share with the other mourners, a typical gesture at Filipino funerals. I'm the only man inside the funeral home. A few other men remain outside. After paying our respects, Mariz shakes our hands and thanks us for coming. Before we leave, Mare Vising takes us on a tour of the facilities. She takes us up to the second floor where she rents out apartments to tenants just above the funeral home. From the second floor, we can see tombstones on graves at the public cemetery a few blocks away.

Ramon was about the same age as Elsa's husband when he died from cardiac problems. Early deaths seem more common here. The mortality rate from heart disease, stroke and diabetes is three times that of the U.S. and the average life expectancy is only about 67 or ten years less than in the U.S. I'm not sure if this is due to the lack of medical care or diet – most Filipinos eat prodigious amounts of white rice – a large plate of rice with every meal. Several medical studies of Asian populations have suggested eating more than two cups of white rice a week is strongly correlated with diabetes, stroke and heart attack. Fried fish is the other staple and it's usually cooked in highly saturated palm oil.

*****

We visit Dr. Concepcion Balunos, Elsa's gynecologist, at Tagum Doctors' Hospital. This hospital seems a little more modern than Bishop Regan and the facilities are in the midst of an update. Still, the CRs have no soap or toilet paper and the doctor's offices have plywood ceilings and cramped spaces. Dr. Balunos is a middle-aged woman, pleasingly plump, and personable with a caring manner. She spends more time with her patients than physicians do typically in the U.S. and discusses personal issues with Elsa, not just her medical condition. Dr. Balunos is one of our godparents and because of this relationship, offers us free consultations. Being a godparent at one's wedding is more than just a ceremonial occasion, but a lifelong obligation here in the Philippines.

I haven't completed my overseas inoculations and ask her about them. She administers the second of my Hepatitis B shots. I need my second inoculation against Hepatitis A, but there is none available for adults. There are also no vaccines against rabies or Japanese Encephalitis, injections I didn't have in the U.S. because I was expecting to get them much cheaper in the Philippines. I also ask Dr. Balunos whether MRI is available in Tagum since I recently developed a neuralgia condition that was diagnosed using MRI. She tells me there is a new MRI machine, but it hasn't been set up yet and we will have to travel a couple of hours to Davao to find a functioning MRI.

The hepatitis B vaccine was much cheaper than in the U.S. – it costs about $15, much less than the injection I had in the U.S. I do have to purchase the vaccine in a pharmacy and carry it back to Dr. Balunos office where she administers the injection – different from the U.S. where the vaccine would be available in the medical facility, not a pharmacy, and would be administered by a nurse or technician – rarely, if ever, a doctor.

Many medicines are cheaper than in the U.S., but some are not available or some are much more costly. Preparation H for hemorrhoids typically costs $5 to $10 in the U.S. I attempt to buy it at a local pharmacy in Tagum, but a small tube costs almost $50. I buy a local hemorrhoid medication and it still costs over $10 for a small supply of suppositories. Statins are widely available and relatively inexpensive – about 50 cents a tablet. Some prescription drugs are sold without a prescription – illegal, but not an uncommon practice here.

Most medicines come in strips of five or ten tablets, not the month or three month supplies sold in bottles in the U.S. Paracetamol, the Tylenol generic, is the most commonly used painkiller here. Ibuprofen, while available, is not commonly used and aspirin even less so. Elsa's daughter Kristna tells me she tried aspirin for a headache, but it didn't prove helpful. I latter find that aspirin typically comes in 80 mg pills, the size sold for children in the U.S., and a dose too small to be helpful for most adults.

David Wasson, a U.S. expat friend of mine who started the Tagum City Food Bank, is admitted to Mission Hospital for back surgery. I visit him at the hospital and ask about his pain medication.

“They just give me Paracetamol,” he tells me.

“No morphine, codeine or oxycodone? I ask.

“Doctors here won't give stronger drugs than Paracetamol because they think they're too addictive.”

I hope I never have to have surgery here.

Dental care also is problematic in the Philippines. Filings, crowns, and root canals seem uncommon here. The poor cannot afford dental care and so if they experience tooth pain, they simply have the tooth extracted. Many of those over the age of 50 have only three or four teeth left.

Elsa needs some bridgework, and I need a cleaning, so we visit a dentist Lorna has recommended. We take a tricycle down Pioneer Street to an old, dilapidated building in downtown Tagum. The dentist's office is a cave like space at the corner. We climb down some stairs into a dark and dank reception area with a concrete floor, low ceiling and unadorned concrete walls. It looks like a tomb. Again, we have no appointment, so we take a seat and wait. Three people appear to be waiting for treatment. As we take our seats, one of them rises from his seat and goes to a desk and signs us in – he's the receptionist and not a patient.

We wait about an hour before the receptionist finally motions Elsa inside and motions me to follow. The treatment room is just four bare concrete walls with a curtain separating me from the chair where the dentist works on Elsa's teeth. There's only one chair and one dentist. The only decorations on the walls are some embroidered cloth horses. The dentist, a portly, slightly disheveled man in his 50s works in his jeans and a white shirt. He only wears one latex glove.

While the dentist is fitting Elsa's appliance, a seven- or eight-year-old child wanders into the treatment room. He reaches behind a side wall for a banana and eats his snack in the treatment room. Then the dentist's wife comes into the treatment room and starts texting. Such is privacy here in the Philippines.

The dentist finishes with Elsa and asks me to take her seat. He asks we when I last had a cleaning. About nine months ago I tell him – the longest time I've gone without a cleaning in years. I usually have three or four cleanings a year. He is surprised my last cleaning was so recent.

“We usually only do a cleaning once a year,” he tells me. He does a minor visual examination of my teeth then applies some polish. The cleaning seems superficial and he doesn't probe my teeth for bleeding or loose pockets. The treatments are cheap though – less than 3,000 pesos (about $65) for Elsa's new partial plate (pustiso) and only 300 pesos (about $6 or $7) for my cleaning. Such is health care in the Philippines.