I arrived in the Philippines on July 7, 2007 with bags and two cats. A half shipping container full of stuff would arrive from South Korea three weeks later. The idea was that Mary, her husband Walter and I would retire together in a large bungalow in a rather posh subdivision. They had already moved in.
Korea had spoiled me when it came to healthcare—inexpensive, efficient and effective. As part of my employment package at the Buddhist university in Seoul, I had Korean National Health insurance, which automatically paid half of any medical bill and drug cost. I’d gotten semi-annual checkups at Miz Medi, a women’s hospital, and had never left there without being in better spirits than when I went in. Probably in the late 1990s I’d had gallbladder surgery at the Samson Hospital near my university. The whole thing—surgery and hospital stay for five days—cost slightly more than two thousand dollars, a small fraction of what it cost in the United States. National Health paid half, and the rest was paid by my private insurer in Hong Kong.
Mary and Walter
Walter had already been diagnosed with prostate cancer in Korea before they left for the Philippines. Then one day after Fe, our indispensible housekeeper, took him for a short, slow walk around the subdivision, he collapsed. A week later Mary and I took him to Medical City, a swank private hospital, where he underwent prostate surgery. After a week he was moved to the Philippine Lung Center for treatment for pneumonia. As a national hospital, the Lung Center charged about a third of what Medical City charged.
In both places, the nurses provided strictly medical care, such as checking his IV and his blood pressure. Fe and Jessie, Fe’s husband, were at the hospital around the clock, bathing him, changing his diapers, or bedpans, pushing his wheelchair doing whatever he required. Mary maintained her schedules with the classes she was taking and teaching but came by when she could. I took care of the housework.
I assumed that this arrangement arose from Fe and Jessie’s affection for Walter. I knew that in China in 1985 patients at our university hospital were looked after by relatives, but I saw no similarities between those primitive facilities and Medical City.
Walter’s speech grew incomprehensible. Fe and Jessie were worried that something might happen to him when Mary wasn’t there. The four children flew over from the US.
When his platelets got low, Walter needed a transfusion. Usually in the Philippines when someone needed blood one of the relatives would donate. Since the children came from Mary’s previous marriages and were not physically related to Walter, the nurses called the blood bank to ask if his blood type was available. Fe went over there to fill out forms to reserve some when it came in the following day Gradually his condition worsened, and the doctor asked about Walther’s expressed wishes regarding life support.
When I arrived at the hospital I could see from the faces in the room that I was too late. In tears, the family, Fe, Jessie the doctor and I gathered around the bed, held hands and prayed. For years that moment stood out most clearly for me as the loving and caring of medical care in the Philippines.
In 2008, over a period of about six months, strange things happened. I got a rash which disappeared after I talked Fe into using my Korean automatic washing machine, which would bash detergent out of the clothes, instead of washing clothes by hand. My itchy skin got so dry it formed welts when scratched. My hair became dry and completely unmanageable from the chlorine and God knows what else in the subdivision’s swimming pool. I got another rash. I got an infection in a large skin blemish on my right earlobe, causing it to swell up to the size of a pidgin egg. I came down with intestinal flu. Twice I woke up with my right eyelid swollen shut, I think from an infestation of mites in my down pillows. A bug flew into my right eye when I was using the rowing machine and got stuck under the lower lid, causing the eyelid to get red and swollen. I slipped on the wet floor the swimming pool dressing room, hit my head on the wall and cracked my scalp open, requiring stitches. A bit of hot sauce from local restaurant hit my lower lip, causing it a swollen lump half the size of a pidgin egg. While demonstrating to Fe how to take her blood pressure, I discovered my own was too high.
The eye thing
One summer I lost two pairs of reading glasses. The one pair I had left was cracked. This turned out to be very fortunate, because when I went to an optician for a replacement she discovered that the center of my right eye was brown scar tissue. I went to the doctor on the University of the Philippines campus who had treated me for the bug-related eye problems, and she said this condition was new, definitely not there when she’d seen me before.
At the Medical City eye clinic I discovered I had the wet type of age-related macular degeneration. The first eye doctor I was referred to turned out to be completely unreliable. The second was a wonderful retinal surgeon, Dr. Arroyo, who treated me there but mostly at the American Eye Center in the Shangri-la Plaza in Ortigas. She has performed sixteen procedures on me, an injection of either Ludentis or Avastin into my eyeball while I tried desperately not to move. I did a post on this shortly after the treatment started. (Link)
Recently I’ve also developed cataracts, and we’re taking precautions against glaucoma. I’m dealing with this with technology, that is, magnifiers and computer software. I’ll write about this in a post coming soon.
When I went through menopause, my only side effect was insomnia. In the Philippines it grew worse, so that the day came when sleep deprivation drove me hysterical. None of the over-the-counter sleep stuff worked, from anti-histamines to assorted “natural” sleep aids. Two of my friends were nagging me about getting a doctor to prescribe temporary meds until normal sleep patterns could be established.
“Carol, you need to do something about this. I have a friend who takes the local version of Ambien. It’s safe and cheap, and you won’t be taking it for long.”
MD #1—The internist who’d prescribed blood pressure medication and taken care of minor complaints practiced at the Megaclinic in the Megamall in Ortigas, where she would totter in on very high heels, always an hour and a half late. On this occasion she told me in the Philippines sleeping pills were heavily regulated and she wasn’t licensed to prescribe them. She sent me to a colleague.
MD #2—After another appointment, another hour in heavy traffic and another long wait, the second doctor said she used to be licensed to prescribe Stillnox and Zolpidem, the local versions of Ambien, but her license had expired. She’d write a script anyway. Maybe the pharmacy wouldn’t check. It did.
MD #3—Thes was a psychiatrist at Medical City recommended by a friend’s doctor. The first question she asked was whether I knew someone who could send me drugs from the States because that would make them a lot cheaper. I was taken aback. How many broken laws would that involve? Wasn’t the local Ambien pretty cheap? Briefly, I recounted my history of insomnia. There wasn’t much to say, but she asked a lot of irrelevant questions. I had the impression that time was being wasted in order to justify charging me 3200 pesos for a “session,” In the Megaclinic the consultation fee was 500 pesos, or $10. At home on my computer, I discovered I’d been prescribed a benzodiazepine, which I’d heard was dangerous, and an anti-psychotic, which according to Dr. Google had insomnia as one of its possible side effects.
MD #4—In the meantime, my eye doctor was urging me to get plenty of sleep. The retina was not that far from the brain and was easily affected by sleep loss.
“I have insomnia,” Her reaction suggested she didn’t quite get it. “I don’t mean it takes me a few hours to get to sleep. I mean I may not sleep for a week.”
She looked up the contact information of a medical school classmate who might be able to help, although she didn’t know what the classmate was doing.
Doctor #4 maintained two private clinics that didn’t seem to have many patients. She explained that she couldn’t prescribe sleeping pills herself, but she could ask her colleague to do it. Fine.
For three weeks the medication worked. I’d take a pill, and I’d be out five minutes later. Gradually the pills became less effective. The real shocker came after I ran out of pills and needed another prescription. Nope, the colleague was in Peru and wouldn’t be back for three weeks. Another time he spent a week away from the office, and she didn’t want to trouble him to send me a prescription through express mail, I received no apology.
Telling myself it was only temporary, I got the benzo prescription from the psychiatrist filled and then refilled. Apparently this was less regulated than Stilnox or Zolpidem because those were ingredients in shabu, a methamphetamine a large percentage of the population was addicted to. I was feeling like an obsessed drug addict.
Over the following four months, #4 charmed or persuaded me into agreeing to buying ten sessions of totally infective “massage”—no, I could not just pay for one to try it out. I had to buy vitamins from the doctor’s office which I had to take by the handful. They were more expensive and unusual than the ones in the regular pharmacy. I paid an enormous fee to get blood samples sent to the US for tests that could only be done in a tiny spot in the US. This taught me a lesson: if a particular treatment is only available through a few people, it may well be because it doesn’t work. The test result showed only that I was low on histamine and should not take anti-histamines.
At the end I was doing watercolor depictions of day and night, in keeping with her previous profession as art therapist. My sleep had not improved. At this point it was clear to me that she had no idea what she was doing. She was just playing around—except that over four months she’d managed to get more than two thousand dollars out of me.
The reason I’d stuck with his was that my retinal scans had stopped getting worse, possibly because of the vitamins. So I made a list of the vitamins I was taking and read it off to my eye doctor one item at a time.
“Is this good for my eyes? Is this?’
Finally, she demanded to know what was going on. I explained. It turned out none of them was protecting my eyes. It was my body responding to the sixteen eyeball injections.
Later a Filipina friend said she’d also been to an “organic” doctor who promised to cure her of some complaint for 80,000 pesos, or $2,000 at that time. “He said if the treatment didn’t work I didn’t have to pay him. I didn’t pay him.” We both laughed.
MD #5—Dr. Mike Sarte is the head of the sleep clinic at Medical City and a former classmate of the man I was doing Buddhist meditation with. During the time I saw him, Dr. Mike prescribed either Stillnox or Zolpidem, depending on which was available. Sometimes I had to go to more than one or two pharmacies.
I’d go to see Dr. Mike, who became a friend. We’d talk and laugh for about twenty minutes while he observed me and concluded that I wasn’t suffering any side effects. The medication helped some, but I didn’t like the idea of staying on it for a long period of time.
After a year or so, I moved from Metro Manila to Tagaytay, a quiet town on a volcanic mountain that was usually ten degrees Fahrenheit cooler than Manila. With Dr. Mike’s blessing, I stopped the pills and kept my own strange hours. As the Zen saying goes, “Eat when hungry, sleep when tired.”
Bob goes to Medical City
In the spring of 2015, my good friend Bob was on a year-long tour of Southeast Asia when he decided to interrupt his travel to get a basal cell carcinoma removed from his left shoulder blade. Now, when he was working in Korea several years before, he’d had one removed from his cheek in his dermatologist’s office—no big deal. Bob knew that the upcoming procedure would be more complicated. Three months into his trip, the carcinoma suddenly became a large, bloody mess, seeping and weeping and smelling.
Knowing that my experience with eye surgery in the Philippines had been excellent, he contacted me about coming to visit earlier than we had planned and having it done in Manila. At my next appointment with Dr. Mike he recommended a surgeon who also practiced at Medical City. When he arrived in Manila, Bob went to see Dr. Lourdes Ramos, the head of plastic surgery.
The operation went well. The recovery took longer than he’d anticipated, but after a couple of months he was ready to be back on his way. We did a post on his surgery and hospital stay before he left. (Link)
There were only two concerns. The first was the misunderstanding that developed between Bob and the hospital staff over what kind of nursing care they should be providing, although everything was settled amicably. As I said, I’d not picked up on what was happening during Walter’s hospital stay. After our post appeared, Dr. Mike said there had been several meetings at Medical City to ensure that patients coming from abroad would not misunderstand or be misunderstood. For example, the introduction to the facilities could include the fact that personal “companions” were available for hire during the hospital stay.
The other problem was worse. Bob’s insurance from the US refused to pay for healthcare received abroad unless it was classified as an “emergency.”An “urgent” procedure wasn’t scary enough. Bob figured he’d lose money by flying home and having it done there, covered by insurance, rather than having it done here and paying out of pocket. (Link) My own suspicion is that the greedy medical/insurance establishment in the US wants to stem the tide of medical tourism to places which offer excellent care for a tenth of what it costs in the US.
About a year after moving to Tagaytay, I got a bout of alternating diarrhea, constipation and nausea. I was very sick and unable to leave the house for two weeks, less sick for the following two weeks. T the Mayo Clinic website seemed to indicate that with my symptoms I did not need to see a doctor.
A few months later I developed abdominal cramps along with constipation, alternating with diarrhea. The cramps would last for hours, with and without vomiting. Finally, in desperation I went over to the Tagaytay Medical Center, a private but not fancy hospital. I said I was in pain and would see any MD who was available. A nice man prescribed something for the cramps. A week later when I went back, he confessed that he had no idea what the problem was, but he would prescribe something. The problems persisted.
The next time I went to the hospital I asked for a specialist and got an internist. Immediately she asked how long I’d been seeing the first guy and pointed out that he’d prescribed only half of a course of antibiotics. She ordered a CT scan. During the test I had a bout of diarrhea, but Fe and the lab techs could not have been more helpful even for their own mothers.
The test revealed that I had diverticulitis, is inflammation or infection of small pouches that develop along the walls of the intestines. The otilonium bromide she prescribed is keeping it in check.
The doctor asked how much Id been charged for the test, apparently out of concern that the American wouldn’t be overcharged in this tourist town, and seemed satisfied when I said $600. About the same time in Massachusetts, Bob had a CT scan for a different condition, and his was $8,000
A few times back in South Korea, when I was walking down the steep hill outside one of the university gates, I felt my right knee give way suddenly. It was disconcerting, given the steepness of the hill and the busy highway below, but I was always able to right myself, straighten the knee and move on.
In Tagaytay not long after the diverticulitis crisis, I noticed a persistent soreness on one side of my right knee. I thought I might have pulled a tendon, although it didn’t hurt that much. Finally I went to Tagaytay Medical Center and was paired off with a doctor who prescribed pills and wrote out a prescription for x-rays.
“Don’t get them done here,” he said, “The machine here produces feathery-looking results. Go to this clinic in Mendez.” The clinic was in the backend of nowhere, a modern, empty-looking place with glaring but dim florescent lighting, where for $12 I got four x-rays, two for each knee. When I brought the x-rays to the doctor, he looked at them and said I needed surgery. I said I’d check with my health insurance.
He gestured, holding thumb and forefinger an inch apart and expressed unease about filling out the insurance forms which could be this thick. He had that desperate look I’d seen far too many times on failing students. I wasn’t going to trust my knees to a guy who was incapable of filling out an insurance form.
He mentioned the pills he’d prescribed, and I said I wasn’t taking painkillers when I wasn’t in pain. He took offense at my refusal to follow his orders. I wanted to yell at him, “How could you prescribe opioids? Do you have any idea what kind of damage they’ve done?”
A friend in Manila said she knew three people who’d had knee replacements. Two were very happy, and the other couldn’t walk at all.
When I asked Dr. Mike for advice, he said before I did anything as drastic as surgery I should see a couple of his colleagues.
Assuming that surgery was still a long way off—after all, so far it was just soreness, a tendency for the knees to suddenly give way and ex-rays that were not encouraging—I went back to the diverticulitis doctor for a referral. The second bone doctor prescribed a supplement which was supposed to stimulate replacement of cartilage and increase elasticity—whether or not it actually did—and physical therapy. Somewhere I’d heard that once the squishiness was gone from your knees it was gone but you could build up the nearby muscles to compensate.
I was immediately impressed with the physical therapy department, where you could make an appointment at the desk instead of going through the silly girls who made appointments for individual doctors with the cell phones they might or might not answer.
The doctor in charge looked at the x-rays and assigned a friendly therapist to put me through a regimen of hot packs, electric stimulation, ultrasound and exercise with ankle weights and a stationary bicycle. I went twice a week and always walked out on happy knees, When the treatment was over I bought a combination elliptical/bicycle machine to use every morning after breakfast.
After a while I must have slacked off a bit because I had sudden weakness in the knees. I almost fell down a few stairs when leaving a restaurant. The following morning I was unable to board the bus for Manila. The bus conductor grabbed me and hoisted me up the stairs and into a seat on the first row, which was reserved for the elderly and the handicapped. I was mortified and very uncomfortable in a seat with so little leg room I was unable to move my knees.
At the American Eye Center, I was put into a wheelchair. Wonderful Dr. Arroyo came rushing over to ask what was wrong and then went to the clinic next door to see a doctor about doing some tests, The tests came out negative. Back in Tagaytay I got back on the bike, and after a week my knees were fine.
Three years into my stay in Tagaytay, I was revising my estimate of the ratio between idiots and non-idiots among the local doctors, so that it stood at 4:3. About two and a half months earlier my dry scalp suddenly got so itchy it was difficult not to refrain from constant scratching. I sent Fe out to get some Head and Shoulders shampoo and conditioner. That did not work.
So I went to a dermatologist who had her own little clinic. She examined my scalp for lesions and dandruff and didn’t find anything. She sent me off with a small bottle of expensive shampoo and prescriptions for a liquid to massage into my scalp twice a day and ointment to put on the sore spots. Two days later, I thought the treatment was working. I gave Fe a huge bottle of shampoo and another of conditioner, since I now wasn’t supposed to use either.
After that, the discomfort seemed to vary. It was tolerable at some parts of the day, a killer at night when my head was in contact with pillows. I went back to the dermatologist, who looked at my scalp again and wrote another prescription and a recommendation for an expensive baby shampoo. I was told to come back in a month. Back again, the doctor examined me and said I should see a neurologist at Tagaytay Medical Center. It might be diabetes or a nerve problem.
“You could have told me that six weeks ago!”
“Well, at least your scalp isn’t dry now.”
I thought it was actually drier because of that stuff I’d been rubbing into it, which smelled like a quick-drying chemical.
“Your scalp is very dry,” The neurologist said after showing up five hours late for her office hours. She thought the problem could be diabetes or some nerve problem from the shingles I’d had on my scalp years before. She gave me a prescription for a long list of blood tests with different fasting requirements, as well as another expensive baby shampoo.
Okay, so one morning after starving myself, I went to the hospital for the first bunch of tests, took them and was told to eat and then come back in two hours. Over a sandwich at the coffee shop I decided to postpone the tests and see if my hairdresser could give me an overdue haircut. As soon as the hairdresser got her hands in my hair, she freaked.
“You have lice! I’ll get some shampoo from the drugstore and come back and give you a shampoo.”
While she massaged the stuff into my head, thoroughly twice, I told her the story.
“I’m surprised the doctors didn’t see the lice,” the hairdresser said. “Maybe they just wanted to get money out of you.”
Having been scalped by the #4 sleep doctor, I doubted it. The dermatologist had a standard consultation fee of 500 pesos and had only sold me one bottle of shampoo. Besides, her waiting room was full of people who didn’t look rich.
The hairdresser took some photos of the lice eggs with her phone, showed them to me and pointed to a dead black insect on a white towel. She said, “The only people I see with lice are kids who play outside in the hot sun. Otherwise, if you are sleeping with someone who has lice?”
She laughed. “Cats don’t have lice.”
I went home with directions to keep my scalp dry. Use a hairdryer. Wash my hair every day with regular shampoo, not baby shampoo. Use the lice-killing shampoo once a week, Yes, if I wanted to I could come back once a week and she’d do it. Boil the bedding or put it aside for at least two weeks. Immediately I went to the dry cleaners with my goose down pillow. This was a new one purchased in Manila and advertised as treated for mites.
The next day I went back to the hospital for the rest of the blood tests since I’d already paid for them. Who knows when they might come in handy.
“I thought it might be lice,” another friend said. “When I was a child I had black under my fingernails from scratching the lice on my scalp. I didn’t want to say anything because suggesting someone might have lice sounds so awful.”
I was sad for my friend, who’d often been ashamed as a child, whereas I didn’t feel the infestation was any reflection on me. The people at the hairdresser’s seemed to think it was funny that the one with head lice was the “rich American.”
In the end, I was grateful not to be digging into my scalp and berating myself for doing it, grateful that I didn’t have diabetes or nerves having seizures on my head. I was just wondering if actually I was the idiot.