Are costs really so important?

I’m not trying to be facetious about the title of this article. I was inspired to write this posting a bit by a recent article that Dave Starr wrote on his blog, entitled, “Things To Consider Aside From Philippine Cost Of Living”. You see, there was a recent event in our lives that occurred that really drove home this point. I’ll relate the story below, and I hope that all of those who are considering moving here give this some serious consideration.

Dave mentioned that he gets frequent comments and questions from people wanting to know the cost of living: What does it cost to live here? It is an understandable question, given the considerable expense in moving here, along with the fact that many people who read LiP are intending to retire here, often on fixed incomes. However, any of the points that Dave mentioned in his article are valid, one perhaps more than any other: Healthcare.

Last month, Becky and I became Godparents to her newborn nephew, Geoff Zaldy Carrao. The baby was born, and seemed to be OK. After a few days, his mother became really concerned about the sound of his cries. She took him to the pediatrician in Aparri, and was told that there wasn’t a problem. Fast forward a month. The baby is crying nearly constantly. Several more trips to the hospital in Aparri (1.5 – 2 hours away from Abulug), and they tell her that there is some form of heart problem, but they don’t know what. The baby and his mother come to Manila to stay with us, and we bring him to Juanito’s pediatrician. Around 2 seconds after hearing the baby cry, he says, “I’m booking him into the heart center immediately… This is serious.” It turns out, there was a birth defect in his heart, where one of the arteries was transposed with one of the veins in his heart. The blood was not flowing through the heart, but rather, circulating within, and as a result, he is not getting enough oxygen. He has about a month to live if he does not receive the proper surgery. All hospital and surgeon’s bills in the Philippines need to be paid in advance. This surgery will cost several million pesos and Phil Health covers 20%.

Medical Bills
Medical Bills

The point behind all of this is that, beyond all of the “paradise, cheap cost of living, live like a king” talk, the Philippines is still a developing nation. The facilities and capabilities are simply not normally up to Western standards, outside of the major cities. The baby was misdiagnosed at first, then they couldn’t be certain without the expertise, then we have to bring him to Manila. Let me put it this way, and if I’m being too blunt, I apologize: If you are a retiree in his 60’s or older, and want to live in the Provinces, you may not survive a major medical problem or emergency. Most cities outside of Davao or Manila do not have 911. In most towns the local ambulances are used as personal vehicles for officials. If you do manage to get to a hospital, they may not have the proper equipment or drugs to even treat you. Don’t believe me? Then read this posting that John Grant wrote several months ago about the death of his friend. After reading this, I can’t help but wonder if he would have survived had he lived in Davao, Manila, the UK, or the States, or in the developed world. What was the cost of his living here? Well, you can never be certain, but it appears that the cost was very high indeed.

After what we are dealing with medically speaking, combined with the lower quality of provincial schools, this sealed the decision for Rebecca and I: If we continue to live in the Philippines, it will be in Manila. Juanito’s welfare is far too important to us to risk otherwise.

Moving across borders requires a hell of a lot of planning. If you are very young, and can easily bounce back, then fine… take the chance. However, there are many things to consider before making the leap, none of which are related to costs:

  1. Is adequate healthcare nearby? Do you have the means to pay the bill? (Many people have died in the hospital here because they didn’t have any money).
  2. What about local health insurance?
  3. What about life insurance? Can your family survive without you?
  4. What if your income stream dries up?
  5. What about fire, earthquake, flood?
  6. What about the schools for your children?
  7. Are you prepared to help with family obligations? (Back to my story… The parents have Phil Health and that is all… The rest has to come from somewhere. Guess where? Could YOU look at a godchild only one month old and say “NO”, when several doctors have said that death would be imminent?) Forget all the crap about being tough and putting one’s foot down… There are certain things that are out of your control, and when you marry here, you inherit certain moral obligations. In my case, this is not my fault (We are insured in this house), technically not my problem, but could YOU decide differently in my shoes? Could you come up with $30K – $40K in a similar situation? Healthcare is cheaper than in the West, particularly hospital expenses, but specialized care is still quite expensive… Far beyond the means of the average Filipino.
  8. Can you REALLY adjust to the culture? It is easy to go on holiday a few times, and say “Yes”. It is very different living here.
  9. Are you prepared to feel totally alone at times? You are, and always will be, an outsider. You can adapt, but bottom line, you will never 100% be Filipino. (Though, the longer you are here, the more integrated that you will become). Remember that you are leaving all that is familiar behind. Many people forget this fact and have a difficult time adjusting once they are here.
  10. What if you must be repatriated for some reason?
  11. Do you still have obligations, financial or otherwise, in your home country?

In my mind, all of the above points are far more important than the cost of a loaf of bread. Overall, the cost of living IS cheaper than the West on most things in your daily life, especially locally produced food and rent. The problem is that when you see the ability to rent an entire house for the cost of a car payment in the States, it tends to distort reality. . Some things are also more expensive (Electricity, imported food, electronics, vehicles).Yes, you can get by on minimal funds here, and, God willing, no disaster will strike. You can also blow through money very, very quickly here, if you try to maintain everything just like “back home”.

The big drawback is that the infrastructure and public services in the country are developing. This is something that people from the first world tend to take for granted… If there is a burglar, the police will come. If there is a fire, the fire department will come. If you have a heart attack, the ambulance will come. In most of the Philippines, these things do not exist. Yes, there are enclaves where they do (most of Davao, Makati, and so on), but it requires planning and forethought well beyond price inquiries. Bob, Dave, and most of the other writers always suggest visiting at least once to decide if a location is the right one for you. Only you can decide if the risks and real, but intangible, costs, are worth the benefits.

In the long run, it may be far more expensive than you may realize!

*** UPDATE *** Little Geoff Carrao was given at best a 20% chance of survival before the surgery. The surgeon later confided that his real odds were 1 in 200… They almost lost him.  The surgery finished, and the staff called him “Winner”, because they didn’t think he would make it. He should leave the hospital tomorrow, he has good color, and is making soft happy noises instead of cries of pain. A miracle baby.

Geoff Carrao, last night… Look at those eyes!
Post Author: JohnM (207 Posts)

John Miele is a Citizen of the World, having spent time in many locations around the globe. Currently, he finds himself in Manila, but travels throughout the Philippines. John joined the Live in the Philippines Web Magazine in mid-2008.

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  1. Paul-T says

    A normal human being could not say no! I have never been in a situation as you just went through, I know it would hurt but thankfully I have the funds in the states to back me up.
    As for Ambulance service, my car has been used many times to rush neighbors to hospital while the Barangay ambulance is used to go shopping at the market. I would never say no to anyone and they all know it. My Insurance is accepted here, with me paying only 20% up front, and also covers my wife, yet I keep an empty Gold Card to get me to Singapore if I ever am that sick. John thank you for your grand act of kindness and compassion, you did the correct thing!

    • John Miele says


      No grand acts here… I’d like to think that people wouldn’t think of it as a choice.

      For your ambulance services, same thing… Could anyone really say “no” in a similar situation?

  2. says

    Really valuable article, John. I get so exasperated, sometimes even depressed, about the potential Philippine “movers/livers” who continual badger about nothing except ‘cheap’. There is so much more to consider, but getting people to think is more difficult than I can usually manage.

    Not only can one find themselves in very lonely situations, what a lot of guys in your/mine situation, where our wives are Filipino, you will also, inevitably wind up in situations where our spouses are left very alone as well.

    In my case I know for sure that my wife struggles mightily, many times a week, with continual calls to her since she is “well off”. I only know for sure about a small fraction of the ‘tugs on her sleeve’, she shelters me from a lot of them, but the problems don’t go away by ignoring them.

    I absolutely laugh when I read some of the comments from the “hard line” guys who can ‘always” say no. I think in many cases those, “not me, I don’t give any money” fellows have just never met their own personal Geoff Carrao.

    I especially love all the comments about how much better it is to live way out in the provinces, rather than in Manila. or close environs. Yeah, it’s cheaper in some ways … until someone gets an infection, or something worse. After a few dozen trips to Manila, hotel and other living expenses, etc., the cheapness of the provinces suddenly becomes a lot less pronounced.

    It’s never an easy choice … and the focus on cost of living is way, way in the background when it comes to the really important things.

    • John Miele says

      Dave: That’s why I liked to your original article… Unfortunately, it is the type of subject most people simply skim through. I really think that there are certain times that the cultural differences are downplayed. As your wife feels, there are times Rebecca has felt completely alone here. Having lived on my own in Abu Dhabi, there is a very big difference, also, from living as a couple. There, some cultural differences and challenges, but I was there just to earn money. When you are here for other reasons, things are vastly different.

      • John Miele says

        Dave: As an aside, for those that insist, my daily living expenses are, on average, about 50% lower than when I lived in LA, with primary savings coming from rent and food. If I tried to maintain a US lifestyle, those expenses would really start getting close to parity, though (With so many extra people in the house this last month, I almost had heart failure from the electric bill!).

        • roy says

          So True John! I read from another blogger who is well-off in the Phil that her bill is P42,000! & She was outraged and delineated all her efforts to save electricity. & boy, she knows a lot like most Filipinos do. Things that I never worry about here, like unplugging appliances if not in used. So she used her blog to call the attention of Meralco who promptly went to her house. & like I predicted, she’s screwed–doomed to pay exorbitant fees.
          $950. for electricity is really unbelievable. & when the rich starts to complain, that’s how bad it is.
          On another note, you don’t have to zero in on Manila if you consider other first class cities or nearby Calabarzon areas.

          • John Miele says

            Roy: My one weakness towards American lifestyle is aircon… Even though window units are more efficient in that they don’t cool the whole house, they suck up power big time. My office, without AC, would be nearly impossible to work in (Top (3rd) floor… 35 degrees outside, 45 deg inside: like any other attic.). Now that I travel less, I see the impact on my bill.

    • BennyM says

      Im one of them brutally hard and tough Kano”s and I make no apologies vein that way. Money does not grow on trees. Not even in the mighty US. A mate of mine in his early 20s half filipino married a pinay 10 years his senior whom he now has a hold with. Greedy, shameless brothers whine and moan how great a family man he is by providing for his wife and kid instead of them. Because I understand Tagalog and and bisaya contains some of those words, I hear first had the complaints about this Kano and that Kano being “damot” and ” with kwarta. Typical requests are sponsors, fiesta”s, sabongs and bogus emergencies.

      Yes provinces are cheaper and I pay no accommodation and pay half the koreante (power from midday to midnight only) so 800 my share. 3000 a week for food, couple of 100 peso for skooter fares into town, 1500 peso a week gasolina pag lights and all is well with the world. Admittedly if you have a heart attack your gone but I’m far off that stage and it’s something locals have to deal with also. All you kano’s out there keep saying no and stop creating a sense of expectation lol

  3. queeniebee says

    Hi John,
    So glad that your new godchild is doing so well.
    Although some things in life are really out of our control, and a decision to live abroad is really a “leap of faith”, I agree that these issues are all very important to considered. Many of these health issues, if not all, pertain to everyone, but especially to those who might be up in age, have chronic health concerns, or have a young family. The other considerations which have to do with personal finances, family situations and outlooks might be different depending on the individual, but must still be considered and prepared for. I guess we would all like to think that we can just “wing it” and hope for the best with luck or the grace of God, and that’s true to some extent, but having money set aside for these possible eventualities is important. It doesn’t really have much bearing on day-to-day living expenses.

    • John Miele says

      Queenie: You are so right… Certainly, there is room for concern about day to day expenses, but the reality of living here makes those concerns secondary, at best.

  4. hudson says

    Hey John,
    What kind of insurance plans are available there? You mentioned Phil Health, Can you buy a full-coverage insurance plan?

    • John Miele says

      Hudson: Phil Health is an option, but the plan is not so good, and, as illustrated above, really doesn’t help much. You can get private health insurance here… We have coverage for major medical. Routine doctor visits are inexpensive enough that I’m mostly concerned with the big stuff. To give you an idea of cost, the hospital bill for Geoff was 12K pesos per day regular room, 20K for the ICU. Three weeks in the hospital. The surgeon’s bill was 1 MM pesos. Anesthesia bill was 250K. Add in medications and supplies. The same surgery in the States would have easily cost $1MM. Nevertheless, that is still a substantial amount of money (Note: I am NOT complaining… merely trying to give an idea of the cost structure. Compared to daily expenses, it is a lot of money)

      As to insurance, an expat health plan for our family, coverage worldwide except the USA, would run $4,000 per year. That is overkill since Becky and Juanito do not leave the RP. For local coverage, my plan is about 7,000 pesos per month for all of us.

      • queeniebee says

        John, That insurance coverage that you have sounds pretty reasonable–Could you give readers any information about it or any other suggestions?
        Also, let’s say that a person relied on Philhealth and had a medical emergency, and had the means to pay expenses up-front. How much of that hospital bill would be reimbersed to them later?

        Another aside, many readers say that besides themselves and their immediate family, they really only would only care or need to pay to take care of their wife’s mother and father and draw the line there. Aging parents alone though, can develop medical conditions that sometimes require surgery and hospital stays, and sometimes require daily medication. If you want to be able to contribute, you have to have some money set aside…

        • John Miele says

          Queenie: I shopped around… Most of the local policies were in that range, but requires a health exam. Many of the major Life companies offer health… Actually, most of the banks have insurance departments that can issue your policy (I know the bigger Metrobank and BDO offices do) One interesting fact was that the major medical is much cheaper, due to the lower costs. Expect a higher deductible, though.

  5. says

    Touching and thought provoking story, John. I am sure that you and Geoff are going to develop a special relationship. I am also sure that you will always know in your heart that you did the right thing.

    I’m glad that Geoff is on the path to good health.

    • John Miele says

      Thanks Bob… I know it… There really was no question about it. The doctors are saying that he will be able to lead a normal life after he heals. Biggest concern now is infection. We are making a “clean room” in the house… Everyone sanitizes before entering, and no smoking indoors. Becky and the maid are bleaching every surface today. Biggest problem is keeping our 5 year old nephew and Juanito away from the baby… He doesn’t need any germs now.

  6. AmericanLola says

    An excellent article, and right on the beam. No, I could not say no! So glad Geoff is doing well! What you say about realistic about healthcare is so true! The truth is, most places in the Philippines, if you have a major heart attack, you will die. Period. If you are in an accident and have major trauma, the same. (Most places you can’t drive fast enough for major trauma to result, so that’s a blessing.) Except for city centers like you mentioned, and probably Cebu as well, things are at least 10 years behind, medically. If you are healthy and or ready to face death, it’s not a huge problem. And, as you mentioned major care costs major money here too. So, thanks for the wake up!

    • John Miele says

      American Lola: You are right… Provincial life is so different, until you experience the reality, there is no way to compare. Anyone who doubts, a simple visit to a provincial cemetery to view birth / death dates will show how much younger people tend to depart out there.

  7. richard says

    I have high regard for Philippine medicine and competancy both in the Province and of course in the major cities once you actually get to a real hospital. However your point of getting to that hospital for emergency care quickly does depend on where you are located in the country. And I agree completely most places in the province are just not equipped for serious emergencies but that is mostly an equipment iusse and not so much a competancy/experience issue at least in my experience.

    I had direct experience about 5 years ago with provincial medicine.

    I was scuba diving in Puerto Galera and about 30 minutes after getting back to my room and showering I felt dizzy. Right after the shower I started sweating profusely like I had my own personal rain cloud above me. I felt nauceous and just horrible. I asked someone if there was a doctor around and they pointed out a medical clinic about a 5 minute walk from my hotel. I walked into the clinic and immediately upon seeing me come in the doctor came rushing over and said I must be having a Myocardal Infarction and to sit dowm. She asked about pressure on my chest and I said no but had breathing problems. She put me on oxygen right away.

    She said that we had to get to Batangas (about 2 1/2 hours away by Banca) and if I knew anyone to meet me on the other side to drive me to the hospital in Batangas. Never was there a mention of a possibility of an airlift by helicopter or an ambulance waiting for me at the pier. I contacted my friends who were in Manila and they met me after my 2 1/2 hour Banca ride and drove me to the Hospital in Batangas with a total time to this point of over 3 1/2 hours since I entered the clinic in PG. I was immediately administered a drug that removed a blood clot that was depriving me of proper blood flow to my heart. I spent 3 days in the hospital there. I then spent a further 3 days in Makati Medical having every imaginable test under the Sun. My total bill was a very acceptable $7,000 USD. It would have been about $73,000 had I been in the USA.

    My Observations

    1. The doctor in PG in a way saved my life by keeping me calm, administering oxygen and accompanying me to the port near Batangas. She however was not equipped to handle my situation in her clinic in PG.
    2. The Doctor in Batangas saved my life by giving me a shot of a clot busting medicine. It was the only dose they had in the hospital. Had they not had it I would have died. I still ended up losing 25% of my heart and the total loss of an artery.
    3. My doctor in Makati Medical was a graduate of John Hopkins and he was amazing telling me everything I needed to know about my Heart and my future. Fortunately, I don’t have any heart disease and the clot formed as a result of a medication I was being given for an arthritic condition. I think it was Prednizone which it turned out I had an allergic reation to.
    4. During the time I was in Makati medical other tests showed I suffered from another serious illness.

    I then decided to go to the states to get a second opinion. I ended up spending 7 days in two different hospitals and after a battery of mostly similar tests as I was given in the Philippines the same exact conclusions were reached but my bill was over $50,000.


    There is no question I feel totally confident in Philippine medicine. They also practice compassionate medicine here and of course very affordable medicine. I would have absolutely no problem having any major surgery done here in hospitals like St. Lukes or Makati Medical.

    If I did find myself in a provincial hospital with a very serious emergency it would be a question mark if I could get the treatment I would need to at least hold me over until I could get to a major hospital. This is a drawback of living in a 3rd world nation but I will say I am very surprised by the quality of medicine I have received during my 5 years here.

    I have also have insurance which I pay $550 a year for with 80% coverage

    • John Miele says

      Richard: My experiences with the provincial doctors has been that they are usually dedicated to helping their patients, and, honestly, the “face to face” time is far greater than you would receive in the States. However, the hospitals frequently have very little in the way of supplies or drugs, and many times, if you even get there, the best they can do is stabilize you for the trip to Manila or elsewhere. In Geoff’s case, the closest MRI facility to Abulug is 620 km…Manila.

      Additionally, 20 years ago, one of Rebecca’s brothers was nearly killed in a motorcycle accident. Manila was the only place that could treat him. All the local facility could do was try and make him stable enough to travel (They were out of pain medication, by the way).

  8. richard says

    Because of my health issues I would never consider living far from a major city in the Province. So I would definetely suggest any foreigners without a death wish to do the same and live within an hours drive of cities such as Cebu, Davao, CDO, Dumaguete, Iloilo, Bacolod,…etc. In these cities I would have total confidence of medical care I would recieve in their private hospitals. I would also suggest to foreigners is every few months they donate blood for their own account in their hospital. This way you would have it if you need it.

    2. If you are married get Phil Health and a private insurance like maxicare
    3. I would also suggest those who are single or on prolonged visits get an expat medical insurance plan. Generally they work on a reimbursement basis. the policies usally covers emergency air evacuation nad are valid for 5 to 24 months.

    • John Miele says

      Richard: In Geoff’s case, the heart center required that we find enough donors to replace the blood used before they would do the surgery.

  9. tony says

    Nice to see the little fighter pulled through, hopefully he will make a full recovery. Looking forward to see more photos when he celebrates his 1st birthday :)

  10. Ron LaFleur says

    John thank you so much for this article. I am at that cross road in my life about the Philippines and I needed to read what you just wrote. One of the questions I have always asked you is where to live and you answered that for me today. Like everyone here I am happy that the little guy is pulling through this. You and your wife are good people. I am proud that I can be your friend. You make a difference.

    • John Miele says

      Ron: Glad it helped… You did what I hoped… Gave it some thought. When you get here, send me a note and we’ll have a San Mig moment, or two.

  11. says

    John, another excellent article on health care in PI, differences between medical care facilities in the Provinces and in the Cities. Here in Marinduque, if you have a heart attack and do not have the money to charter an airplane to fly you to Manila, you might as well say goodbye. It is the equipments and medical supplies problem, not medical or nursing personnel “know-how” that is lacking.

    So every year for 4 to 5 months, I hope and pray everyday that my wife and I will not have a heart attack, while enjoying our “snow bird” lifestyle in my island Paradise. Minor health problems, and other minor surgeries can be handled by the local medical personnel and provincial hospital.

    But at our age, we are resigned, if I our time comes, so be it. So for the most part, I psyche myself not to worry about having a heart attack while we are in Marinduque. To me, the pollution- free air, slower lifestyles, no traffic congestion and lower cost of living, abundance of fresh fruits and vegetables are more important than residing in crowded cities such as Manila, Cebu, or Davao where medical facilities are superior. So it is a matter of choice for those planning to reside in the Philippines. If you are young and healthy, do not be discourage about experiencing life in the provinces, specially if you or your wife have social support system ( relatives) in the area. Loneliness can KILL! If you are an OFW or have lived in another country, you how it feels to be lonely in a foreign land. Good Day to ALL!

    • John Miele says

      David: Thank you! Marinduque, I assume, probably is like most provincial hospitals. The best thing you can do is to periodically get checked for major problems.

      I still want to get down there for a weekend… Someday!

  12. says

    John what you did was the right thing to do.I have been put in your spot a few times but nothing that seriouse and costly.But my family and I are lucky to live close to de lassle medical college wich has all the eqipment if somthing bad like a heart attack did happen and close enough to manila we could drive there if need be.

    • John Miele says

      Jason: That’s a good thing… They are known as one of the best hospitals in the country. The Philippine Heart Center, where Geoff had his surgery, is on par with the US…

      Ironically, I’ve been told, its’ construction was one of Imelda Marcos’ last acts as first lady.

  13. dans says

    hi john,

    how about getting your own helicopter? that will at least increase your chance of survival, say.. 80%? hahaha. anyways, I can’t really understand why many foreigner wants to settle in an isolated places specially when they are old? , I can understand a cheap cost of living or the peace they really wanted from the province life, but if I were a 60 years old western guy, I would not dare to live in an isolated place, there are many nearby provinces around manila like batangas, cavite, bulacan where you can have a “provincial life” and still have the cost of living down to a minimum and still living very close to a good hospital that can perform a major surgery.

    • John Miele says

      Dans: I can understand to a point: Sense of adventure, no traffic, and so on. However, there is a serious need to think about these things first.

  14. Ken Lovell says

    Thought-provoking post John, thank you. I wonder what would happen if you were in the US and this happened – would you pay out hundreds of thousands for the operation? I’m guessing not, and nobody would have expected you to.

    My partner’s family here have no house. They used to own one years ago but they sold it to pay for an operation for one of their children (she died anyway). I have little doubt that if one of our immediate family members has a life-threatening illness, I’ll be expected to pay for treatment for as long as I have money in the bank. I hope I never have to face that situation, because I’m not sure how I’ll respond.

    You’re dead right that people need to understand this is how families here look out for each other. In developed countries the situation simply never arises – people have health insurance and/or health care is subsidised by the government. You are never faced with the agonising choice of letting a close relative die and staying comfortably off, or maybe saving their life but ending up penniless. Yet there is a real possibility that people who live here will have to make just that kind of decision.

    • queeniebee says

      On the topic of family obligations, I think that it’s so true Ken, that many Filipinos have had to make big sacrifices in order to help pay for a loved one’s illness or accident.
      Any foreigner who thinks that they will not be called upon at some time to help their family is kidding themselves. How you will react will depend on each individual and their circumstances, but it will come up, and more than once. I’m sure many of us have had to do the same that John has done for a family member, but most likely not to that large an amout financially. Even as a resident living on a budget, there will be times that you’ll have to decide, and possibly, hopefully contribute based on what you can afford.
      We’re not talking about handouts to “money grubbing Filipinos” as some might say, but to people in dire straits.

      From my perspective, being married to a Filipino who considers
      himself very blessed, I see that he truly sees himself as his “brothers Keeper” and feels a great sense of responsibility and pride in being able to be able to help his immediate and extended family in times of need, and I can only admire and love him more for that.

      • John Miele says

        Queenie: Rebecca and her brother (The baby’s father) ended up having to dispose of their assets in the UAE… The results of 20 years work each. There is nothing left. I took out a small loan, and made arrangements with the Dr. for payments on whatever the balance was. In the end, we had to come up with 80% in advance, the rest to be paid over a few months.

        Queenie, this was a life vs death situation. I honestly could not look my wife in the eye again would I have been stubborn. A moral obligation. (Again, I’m not complaining. I never thought of it as a choice)

        • queeniebee says

          Hi John, I can only imagine what was going through theirs and your’s and Rebecca’s mind too. What a sweet payback to see Geoff pull through…

      • queeniebee says

        Ken, I was not referring to “you” personally, but as in all of us in general who might be affected by this issue.

      • roy says

        Hello Queeniebee, you bring a very impt point on family obligations and in another topic here, social situations in the Phil where money could be the issue. I have pointed out to Jawz that there values system and life experiences of someone from western culture that would make it difficult for them to understand Filipino culture, and that’s fine. It’s just the way it is. It seems to me that through your husband you understood or “made peace” in matters like “family obligations.” This is really very hard for Filipinos to explain it to westerners.

        • John Miele says

          Roy: This is something that outsiders only really get a feel for once they’ve been here a while…

        • queeniebee says

          Hi Roy, Coming from a very tight-knit family and community in New England, I’m pretty used to family helping family and neighbors looking out for each other. That has been a help. When my husband and I were first married and money was tight though, sometimes I resented the help here and there that we had to give to the Philippines.
          Through the years I’ve come to really know my Philippine family and community and totally understand and feel happy to be able to help them when they need it. I’ve come to realize that along with my husband, it’s very empowering to see what help can do to get someone out of a tough situation or raise their quality of life. It took time though…

    • John Miele says

      Ken: In the States, there are always options for those without income. Here, not so much. As I said, Phil Health covers 20%. What other options are there if you are poor here? In the States, you can always get treated first, then deal with the bill.

      • roy says

        That’s why John, I don’t think Americans are faced with these kinds of challenges. I can understand their shock if they are asked to pitch in. There, hospital bills are personal to the one who incurred and generally not enforceable to other family members. In another differences, I totally understand why there are nursing homes here in the states and so very few there in the Phil. Home set up between the two countries vary vastly. I read somewhere that it’s almost impossible for the Phil to breed serial killer because physical isolation is uncommon. There would always be nosy people watching your moves.

        • John Miele says

          Roy: The family structure here really cuts both ways… a good side and a bad side. One thing you can bet, though. Most Filipino families I’ve met really unite and come together in times of adversity… That is something I don’t see muh in the States.

  15. AlexB says

    Poor kid. Glad to know he made it. That’s tough to take.

    The list of questions you posed should be standard questionnaire for all wanna be expatriates. Paradise isn’t exactly all that free, just how much one is willin to pay. The idea of the Philippines as a paradise is stretching the truth. There are many pockets of paradise in the country but you know they will be far from “civilization” – like starbucks, malls, modern hospitals, wireless or cable tv, proper grocery, like usual comfort stuff. This is my 4th time in the last 10 years, twice working, twice visiting and I’m still not sure where and how.

    • John Miele says

      Alex: Thank you. Having just been up to Tuguegarao, you understand that even as a regional capitol, TUG would still be “in the sticks” to most Americans. Geoff’s medical needs exceeded anything they could provide there (Though, from what I understand, there is a trauma center there… 2.5 – 3 hours from Abulug.)

  16. says

    as a us trained md, we have the capabilties and experience to treat most known diseases to mankind. again, i see the sorry stste of most hospital in the phil. inspite of all the donations fron other countries, wher are alll this donations going? being stolen by these CRROK POLITICIANS AND MD. BY THE WAY, THE PROFESSIONAL FEES BY SURGEON AND ANESTHESIOLOGIST ARE WAY TOO MUCH COMPARED TO USA. AM AN ANESTHESIOLOGIST AND WE CAN ONLY CHARGE BY TIME IN USA. THAT HEART OPERATION IN USA, ANESTHESIA FEE WOULD HAVE BEEN ONLY 3000 DOLLLARS THE MOST.

    • John Miele says

      Rey: I lumped all of the costs together in general… Just like in the USA, the bill was around the size of a novel and no-one wants to read that… The actual anaesthesia fee was much lower. Again, I’m guessing that the cost in the end was 25% of the States, but still a substantial amount of money.

    • John Miele says

      Rey: He saw, in addition to Juanito’s regular pediatrician, three different doctors at the PHC, and one from LaSalle for a second opinion unaffiliated with the heart center. We were told by everyone that for the type of surgery he had, that was really the only place that could handle it. We were also repeatedly told he would not have survived a flight to Singapore or elsewhere. I will also say that the doctors and staff there were very professional. At the beginning, I kept away when the financial was being discussed to minimize any corruption, etc… We had no problems, and he is healthy and kicking.

  17. Bob New York says

    It is encouraging to read that the baby now has the potential for hopefully what will be a long and healthy lifetime. I agree John, under certain circumstances you just can’t say no. Thanks for this excellent article which along with the comments covers a multitude of topics. That $950 / month electric bill ? Must be a mansion with 24/7 central air and little or no insulation. For me here in New York, about $50 / month although I use oil for heat in the winter.

    My best wishes for a speedy and full recovery to little Geoff.

    • John Miele says

      Bob: Thank you… Just to clarify, my electric bill is nowhere near $950 per month (Averages $150 – $300… Higher end now with all the people in the house). That amount was what someone else stated… Must be a huge house with AC on constantly.

  18. joey says

    John, you made my day after I accidentally ran across your article, your inspiring story and all the helpful, positive feedbacks. Also want to add here how I sometimes decide when getting overwhelmed with choosing/ balancing between white and black with so many shades of grays in between. I think about the extremes. Like- do I want to be in a place where I can really live a life ’till I die, no matter how short it will be? Or be where I can’t really live a life and all the docs will keep me alive for as long as they could even if I don’t want to live anymore? Just some thoughts. Of course, there are lots of places that are not too far from a good medical facility, again depending on one’s priorities. But you and your wife have good, brave hearts for doing what you know you must do. More power to you! Thank you and everyone.

    • John Miele says

      Joey: Thank you… If it were just my wife and myself, living in the sticks would be an option. We have our son’s welfare to consider, though. The idea behind all this was just to get people to think…

  19. Michels5098 says

    Awesome John!!!
    What you and your wife did for your Godson and his family speaks volumes about your character. I was the right thing to do with out a doubt. We know that we say no or have our wives say no to many request from her family and that puts alot of pressure on her. But when you and other expates do this act of kindness or (obligation)you show her family that they do matter and you will be their for the important stuff not petty requests. This has gained your family great respect and acceptance into her family which is a good thing.
    About older retirees moving to the PI well, i believe they are making a life or death decision to say the least. First off my older filipino friends that migrate back and forth from J-ville and Manila tell me there are three things you need to concider when I move there a good hospital,an Airport and a national bank all within an hours drive. What they are telling me is that all three may sameday save my live via medical, goverment, and financial. Makes sense. So we are going to move to Subic Bay.
    You Know John I got to thinking about the saying Live Like A King In the Philippines. You know in a way to a westerner that would be false advertising. Maybe it should read Live Like a King in The Philippines Like a Filipino. Live like a westerner pay like a westerner + some. Just food for thought. Maybe you could do an article comparing the two.
    Happy that Geoff is going home:)
    Maybe we can get together next years when i’m on vacation.

    • Michels5098 says

      Had a rough night at work my spelling and grammer s&*k right know Sorry I’m Going to Bed :)

    • John Miele says

      Michels: Thank you!

      I think Subic would be a good location: Close, but not too close. I also think there’s a decent hospital there, if I remember correctly.

      Any time… send me a note when you are here.

  20. Neal in RI says

    Excellent story!
    Any one that does LIP or wants to in the future stories like this WILL be a reality check. This it in a total different class, to just saying “Hinday” to the street beggars and looking away.

    I just sent a link to this site/story to a few of my former Hardass Jarhead buddies that think they want to LIP and live there in the same style that they did when we were there in the 80’s.

    Thanks for the great story.

    • John Miele says

      Neal: I’ve known many Marines over the course of the years, and they really should take note. Most marines I know who were career all have health problems: I think it is largely due to the nature of the job. The physical strain eventually takes its’ toll.

  21. Phil R says

    food for thought John .. I live in the sticks – talasay ..but my family history has no major illnesses… no heart attacks an diabetes or cancer ..just everyday aches and pains and no stress …Phil n Jess

    • JohnM says

      Thank you! He’s doing much, much better now (And he’s not shy about being hungry… a good sign since he’s still only 2.2 kg at 2.5 months).

  22. says

    I’m late finding this. I like it that Bob has these old articles rotating through the front page. Lots of good information that is still timely. I am curious about how Geoff is faring now, 2-3 years later.

    One thing clearly stated in the article, but seemingly not picked up on in the comments was that this responsibility was incurred by becoming godparents to the newborn Geoff. I believe that John accepted the honor, knowing full well the responsibilities involved. That may not be the case for many westerners married in to a Filipino family. Those of us who come from a Protestant background may only know of godparents from hearing old fairy tales. If an expat accepts the request to become a godparent, they have to know that it is not just a quaint old honor. Most Filipinos I’ve met in the RP have no idea that westerners may not be familiar with the custom and the responsibilities involved.

    As the situation relates to us aging expats, I’m one who purposefully chooses a perhaps shorter, but peaceful life, away from crowds, traffic, and (at least some of) the noise of cities, suburbs, & family compounds. I’ve adopted the same attitude as Mr. Katague. I simply know, and accept the risks. It’s not something foreign to me. I’m one generation removed from similar circumstances in rural Southwestern Virginia. Granted, the ambulances and firetrucks were always there. But, the volunteers who drove them had to get to the station from work or home before they could respond. We lost a barn to fire when the fire truck showed up empty, thinking they could draw water from the pond on the farm next to ours. They didn’t realize that they had to backtrack a half mile, and drive another mile down a twisty dirt road to get to the pond.

    But to reinforce John’s point, know the risks, and make your choice.

    Take care,

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