Last night, while I was sleeping, I got a text from a friend. I won’t name this person, but he is a regular visitor to the Philippines, and generally spends a few months here whenever he comes. I guess he has only been here about 3 times or so, but since he stays for quite a long length of time, he could not be considered a newcomer, but rather a regular.
Here is the text message that he sent to me:
I am very worried now. My leg very big, swollen. Black mark on my foot. Bad infection. Doctors here stupid. I may need to go home b4 I die here. What 2 do now?
Well, firstly let me say that I don’t agree that the doctors here are stupid. But, what I will say is that as a foreigner we may present a situation to a doctor that he has not seen before. For example, if we get an infection from something, it may not be something that infects Filipinos. I mean, certain germs here are alien to our foreign bodies, while they are the normal germs that Filipinos are used to. The Filipino body has already developed immunity to certain common germs here, whereas our foreign bodies may be encountering this particular germ for the first time, thus having no defenses in store.
What did I advise my friend to do? Well, he is in a somewhat remote area. I advised him to start taking a strong antibiotic, and get himself to a good hospital. I recommended Davao Doctor’s Hospital, although it’s a little far from where he is. He is closer to Cagayan de Oro, but I don’t know the hospitals there, so I advised him to check those out too.
Back in the early 1990’s I had a similar incident happen to me. I was in General Santos City, and I slid and took a fall. In the process of falling, I scraped my leg on a piece of broken concrete. It was a very minor little scrape on the side of my calf, and I was not worried about it. I did wash it off, and although Feyma and her family suggested that I go to the doctor for a closer look at it, I shrugged it off. About 3 days later, my leg was a dark purple color from the knee down to the foot. I was in extreme pain too. I couldn’t even get out of bed.
The hotel where I was staying was right next door to a hospital, and a doctor from the hospital came to have a look at me. He was very concerned, and wanted me to go to the hospital, but I refused. He agreed to let me stay in my hotel room, and he would come and visit me regularly. He prescribed two drugs for me. One was for the pain, and the other was for the infection. When I took the drug for the pain, I would go into a very strange state! I had hallucinations and such, imagining all kinds of strange things! I saw dragons in my room, and such. The medication for the infection was not helping me either. I had to cancel my return flight to the States and reschedule it because I was too sick to fly.
After more than a week, I saw no improvement in my condition. I decided that I needed to fly back home to the USA for treatment. Remember, this happened in the early 90’s, before I lived here. I was only here for vacation at the time. When I flew back, it was a most uncomfortable journey, and I could barely walk at all. Upon landing in the USA, I went straight to the hospital. The doctor’s in the Emergency Room were stunned at the condition of my leg. I showed them the medication that I had been taking, and they never heard of it. Upon research in medical books, they still could not say what the medication was.
The doctors put me on an experimental antibiotic through an IV. I had to take that for 2 months, as I recall. They said that it was the strongest antibiotic that they had. Another thing that they told me was that if I had waited much longer before returning home, I probably would have lost my leg. To this day, even from that small scrape, I have a scar on my leg, and also some discoloration on my leg from that.
These days, I feel that the drugs and medical care here are much better, and they have my full confidence. Also, I am less susceptible to such infections, having lived here for over 8 years. My advice to you, though, if traveling, is to take good care of yourself. Don’t ignore any type of sore that you get. Seek medical attention early, don’t let it fester!
He should get to Cagayan University Medical Center (commonly calld CCC), although Polymedic and Mdical are also good. Yes, we are not immune to some of the bugs here until we have been here a while and had some infections. People who are overweight or have diabetes are especially vulnerable to cellulitis, a bad infection that usually begins with a small scratch or inflamed bug bite. You friend needs IV antibiotics and bedrest ASAP! He should not fly out with that infection if at all possible.
I sure hope he does this right away and gets the help he needs!
A note on prevention. Get a bottle of peroxide to clean any little scratches you may get, especially on the legs and feet. then, buy a tube of Fucidine ointment (made my Leo Pharma) and use that on the scratches and wounds you treated with the peroxide, and cover with a small band-aid. This simple proceedure you save you are LOT of misery and prevent any serious infections. If needed, do a nightly check for scratches and always treat them.
Hi AmericanLola – Thanks for the tip on CCC. I have passed that along to my friend.
Bob. Your friend just need to consult with the right doctor. The standard of care in the Philippines is not the same everywhere. Davao Doctors has a lot of highly trained specialist. A swollen leg/foot with black marks could also be indicative of a cardiac condition. It could also be a complications of diabetes or a virus. Please tell your friend not to delay a visit to a doctor or a hospital with complete diagnostic equipment. A trip to Davao might be worth it.
Hi Bobby – Thanks for the tips! Actually, I passed on AmericanLola's advice, and my friend is already on his way to CCC in CdO. Hopefully, he can get some relief for his problem there.
To Bob and others,
It is a very good idea to always keep Activated Charcoal powder in your medicine cabinet. Charcoal powder adsorbs the poison from stings, insect bites, infections, vomiting, swelling, odours (including bad breath), diarrhoea and many other problems where poison is involved, by the way even snake bites. Now I don't know if it is available over the counter in the Philippines but I do know that it is available from the Adventist Hospital in Davao City.
In fact I understand that a Japanese comapay has begun producing charcoal from coconut shells and my understanding is the business is run from Davao City.
Charcoal is used in everything from gas masks to all sorts of filters and for medical mishaps. Once I treated an 83 year old man who had fallen on concrete and ripped a large patch of skin from his hand to his elbow.I mixed the powder with flaxseed oil to make a paste and applied to his arm and covered in a bandage. I myself was completely staggered when I saw him two days later to see the skin was already on the way to being healed with no sign of swelling or infection. The benefits of Activated Charcoal powder are unlimited. You can also buy charcoal as tablets and capsules. Have a toothache. . . chew a tablet. . . instant relief. Tummy ache. . . chew a tablet or swallow a capsule. Check out this website http://www.CharcoalRemedies.com for peoples stories or help and healing.
Bob it would not hurt your friend to seek charcoal out, to at least stop the poison from spreading until he can get to further medical attention.
Ho Bob and others,
Activated Charcoal powder can be used against infections, stings, insect bites, snake bites, diarrhoea, odors (including bad breath), swelling, vomiting and many other poisons.
Anyhow if your friend can obtain some charcoal powder it will help until he gets proper treatment. I know that Activated Charcoal powder is available at the Adventist Hospital in Davao but I'm not sure if its available over the counter in chemists/drugstores/pharmacies in the Philippines.
You can buy Activated Charcoal as powder, tablets or capsules and it is always advisable to keep some on hand, especially the powder. You can mix the powder as a paste with linseed oil or flaxseed oil and apply to cuts and even snake bites and as charcoal is an adsorbent it attracts the poison into the pits and grooves of its sphere and this is then passed out when going to the CR. The charcoal is normally made from coconut shells and so it is completely safe. Have a toothache . . . . chew a tablet. Have a tummy ache . . . chew a tablet or swallow a capsule or add powder to water and drink.
http://www.CharcoalRemedies.com has many further medical uses for charcoal.
Sorry. . . that should have said HI Bob and others.
Hi Bob, I hope your friend is getting well soon. Also having been submitted in a hospital I would recommend SAN PEDRO HOSPITAL here in Davao City as well as THE ALEXIAN BROTHERS (where I got excellent and professional treatment.
Hi Richard and Klaus – Thank you for your tips as well.
Dragons Bob, the list gets longer 😆
I agree of what have been said so far.
As usual ‘you get what you pay for’.
Doctors in the Philippines have several layers of expertise. Those who are in the rural areas ( e.g. municipal health officers) are usually graduates of medical schools who only have at least 2 years of clinical experience.
The specialists usually have additional clinical rotations i.e. residency training that is three to five years longer than those who just are graduates of medical schools and licensed to practise. These specialists are found in cities mainly: Manila, Cebu, Cagayan de Oro and Davao.
In terms of actual care, there are variety of choices.
If you believe in charcoal, then you may try tuba-tuba (jatropha), young abaca grilled/squeezed the juice and mix it with Efficascent oil and rub on the affected areas. You may want to consult a specialist in folk medicine (arbularyo, manghihilot). He may try some rituals like burning a piece of your hair or that of a cat or a dog and let you inhale the smoke. He may also try to spit his saliva on your forehead and throat. The whole kit and kaboodle will set you back at most 500 to 1000 pesos. You will feel better especially with the price. What you save in pesos though you may splurge on a first class coffin in Somo.
If western medicine is your thing though then American Lola is correct. If the infection is just in the skin then a 6-week course of intravenous antibiotics is the norm. If the infection has gone through muscle or deeper tissues then surgery (debridement/fasciotomy) is indicated also. The worse case of course will end up in amputation.
Now, where to go? If you are sick enough that you need hospitalization…I will bypass Cagayan de Oro and even Davao hospitals. There may be good specialists there but the facilities are just not as good as in Manila. There are only so much time a specialist can give you too and most of the care as everybody knows are given by nurses. Most hospitals and notoriously in Cagayan de Oro and Davao are staffed by fresh nursing graduates and student nurses (no salary). The experienced ones are either nursing school teachers or have left already to the ‘lands of milk and honey’. If you are in a hospital that are staffed by nurses that looked like teen-agers—-get out as fast as you can.
In Cebu…the choices are Cebu Doctor’s, Cebu (Velez) General Hospital, and Chong Hua. Avoid the others as you might as well stay in Mindanao.
In Manila in order of preference: Philippine General Hospital (PRIVATE WARD), Manila Doctors’, and St. Luke’s. Avoid the others as you might as well stay in Cebu. The three hospitals above are U.S. equivalents.
Which Doctors? Insist for somebody who is U.S. trained. Be careful on this. Some will say that they are U.S. trained even though they just went there for a seminar or a symposium. You want somebody who had their residency and fellowship in a University-affiliated residency training program. Better still, they are ‘board certified’.
If you can’t find a U.S. trained then look for somebody who is Philippine-General-Hospital trained.
Folk medicine will cost you a total of P1000.00.
An admission in a Manila hospital will set you back P30,000 to P50,000 PER DAY!
Hi Jack – I can only report what the truth is! 😆
Hi Dr. Long – I personally feel that Davao Doctors is an excellent hospital, and that there are other excellent facilities in Mindanao. I guess it's a personal choice.
Hi Bob
Besides the advice you gave eveybody make sure they are up to date on their immunizations especially tetanus
Hi Bob,Interesting post,even if its a repeat.Taking care of cuts and grazes is very important in a tropical climate as they can easily fester and induce blood poisoning if ignored.From what i have read,the biggest danger comes from Dengue Fever which currently appears to be on the increase,however cases of Malaria in Phils appear to be in decline(not that we should be complacent).For those seeking Health Travel advice there are 2 good sites worth researching http://www.who.int (world health organization) and http://www.traveldoctor.com.au regards Chas.
Hi Dan Mihaliak – that's always a good idea, no matter where in the world you live.
Hi CHAS – I'm sorry that the article is a repeat today. To be honest, the last couple of weeks I've been having some real problems with my wrist again. Yesterday I was in severe pain, and is just no way I could have written an article for today, so I chose a repeat instead.
Hi Bob,
This article brings up some issues I hadn't given much thought to other than the usual tropical immunizations.
If I may I'd like to direct a question to Dr. Long re: posting #12.
Dr Sponk Long,
What do you think about Silliman University Hospital in Dumaguete City? I understand Silliman University is associated with a U.S. university. Your comments would be appreciated.
Hi Bob,No problem,hope you get your wrist sorted successfully,regards Chas.
Hi Randall Jessup – hopefully Dr. Long will read this and give you a response. I'm not sure that he reads every day so you might have to check back for a while.
Hi CHAS – thanks for your understanding. Not much to sort out as far as the wrist goes. The doctors that I've seen have all informed me that my only choice is to live with it, frankly. The pain comes and goes. When he gets painful that can last for a few weeks, then I can go for a couple months with no pain. It's just a matter of making lifestyle changes to keep the pain as low as possible. Thank you again.
Worst case scenario go to thailand..they have state of the art hospitals..and their only 4 hrs away….BTW…do you remember the name of the pain killer you got Bob??? I would like to get some to …er…study the effects of.
Hi brian – the medications are actually quite simple. As an anti-inflammatory, i use Advil. For pain, I just use regular Tylenol, although it's only a mild pain reliever, it knocks it out pretty well. I also use a gel, which I can rub on my skin, which is called Fastum. This stuff is also an anti-inflammatory, and it works miracles.
Hi Bob, sounds like cellulities (or ecoli infection). Cellulities is no laughing matter – you have to combat it with strong antibiotics (preferably through IV). Staph or strep bacteria can get into the bloodstream through any cuts, even very small ones. Treat and cover all cuts – as what americanlola advised. There are lots of flies here, and I have seen how a wound gets festered by these pests!.
My husband had cellulities – and of course it had to happen in an atoll in Cook Islands where there was a population of only 2 people. We were able to contain the infection with whatever antibiotics we had or given to us by other cruisers. But it kept on recurring or his immunity is weak, and almost every 3 months for a whole year, he was on antibiotics (in NZ and in Norway). I think doctors in the tropics are best cuz this happens a lot here. I am just not sure in the rural areas as their facility/supply of medication may not be complete.
I suggest that he asks for a culture test done to see which antibiotics is best to fight the bacteria. REst and build up his immunity. In some cases, maybe where immunity is very low, some staph or strep bacteria can turn flesh eating. I haven't heard about this here but certainly in Canada, there were some cases.
I cannot stress that one should take prudent action to prevent infections here. It is hot and very humid – just the right formula. With bacterial infections, you can fight with antibiotics. With viral infection, you have nothing but your own immunity system to fight it.
Hi Ellen – thank you for sharing all about, you have some very good tips there. You're certainly correct that infections can be very serious in a tropical environment like the Philippines. As I said in my article, I went through that back in the 90s, and I can certainly attest that everything you say is true. This is valuable information for any readers who plan to come here. Thank you again Ellen.
By the way, Hydrogen Peroxide is called agua oxinada here. Pour it over the cut/wound. If possible, use antiseptic powder – if you can find them, it is amazing. Using ointments is not really good in a humid environment. It is okay for small paper cuts, but not for wounds. It just prevents the wound from drying out, sometimes makes it worst.
We use Medi Pulv antiseptic powder, available in NZ and Australia. I just cannot find this powder anywhere in North America. If you google it, looks like you can buy online from Australia.
Hi Ellen – thank you for the additional information. That's all good advice.
One thing that is good to keep around is a container of Cayenne Pepper Powder. The stuff works miracles from stopping bleeding on cuts, fighting infection (Especially with garlic), all the way up to stopping heart attacks and strokes. One time when I was working as a chef my knife slipped and I cut myself basically talking the tip of my finger off. It bled profusely and wouldn't stop so I put cayenne powder on the wound and took a tablespoon of cayenne mixed in warm water and drank it. Bleeding stopped within 2 minutes and it healed so well there isn't even a scar to show where it happened. Studies have shown that medications taken in conjunction with Cayenne Tea have their effectiveness increased by up to 60% because the tea evens the blood flow and promotes blood flow to congested areas (such as you would have with an infection).
As far as the infection goes I've seen old healing books call for cayenne tea of 1T Cayenne Powder to 1 cup warm water and mix in the juice of 4 cloves garlic. Garlic is also a wonderful herbal antibacterial/antiviral.
Now that being said, I would personally be running to the hospital as fast as I could go, but the natural cayenne remedies might help to keep things from getting worse until I got there.
Hi BrSpiritus – wow, I had no idea about the cayenne pepper, having medicinal value like that. I'll have to remember that, thanks for passing it along.
Bob:
In my youth, while working in a restaurant kitchen, I burned my hand. Didn't think much about it when it happened, but three days later, my thumb turned black and swelled 3 times its size. Staph infection. Surgery, Septicemia, two weeks in the hospital, massive antibiotics. Not fun, to put it mildly, and definitely not something to screw around with (almost lost my hand).
Before I started traveling extensively, I went to a doctor in Fountain Valley, CA, Dr. Mahmood Peshimam, who specializes in travel health, particularly tropical disease prevention. Dr. Peshimam updated all my "normal" immunizations, gave me around seven more for diseases common in the tropics, and I periodically visit him when I return to the States for a checkup since I travel to remote areas so frequently. Recommend a similar action for anyone who plans on moving here. Some tips he gave me:
Tetanus booster is an absolute must.
Rabies is endemic here… give stray dogs lots of space. If bitten, begin treatment immediately, whether or not you can find the dog. (If you are infected and not treated, you will die)
Mosquito-borne illnesses are the most scary. Malaria can be prevented with several options for treatment. Not so much a problem in Manila or the cities, but the provinces are a different story. Dengue can't be cured and prevention is limited to avoiding being bitten. Believe me: You do not want either of these. (I damn near bathe on "Off" up in Abulug) There are also immunizations for most types of Encephalitis.
Typhoid and Cholera are food and water borne and common in the Philippines. You can be immunized.
Get Hepatitis A & B immunizations. Both are very common here.
TB is also very common here (Rebecca just had a family member who caught it). Get immunized.
If you partake in activities with bar girls, I was told that over 50% of them here are infected with some form of STD. (Higher in Bangkok and some other notorious locales) Not practicing safe sex with them is absolutely stupid.
Your comment about local residents having immunity is also spot on. It doesn't take a rocket scientist to understand why locals eating from street vendors or drinking river water don't get sick, but your insides turn to liquid mush.
DENGUE – read up on the plant called Tawa Tawa (google it). Locals (and also regional hospitals) are using this plant. My sister in Manila has planted this weed in her garden to keep them handy.
Hi John Miele – You have some great advice there, and it is much appreciated. You have covered a wide range of possible health issues, with solutions. Thanks for that.
Hi Ellen – The guestblog on this site also has an article about Tawa Tawa and it's use in Dengue cases.
I would like to say that Philippines should be more socialist when it comes to matters like healthcare system just like do in Europe.
But unfortunately I'm aware corrupt my country is .
I understand your frustration and how doctors decisions can change your life and if they screwed up the patient is always the one who pays the highest price.
Hi reden – thanks for sharing your opinion.
You know I've been here almost 2 years now and I've had:
Dengue Fever
Cellulitis Infection in my leg
Measles
Plus several bad colds
I'm wondering if I'm a magnet for viruses or if some Aswang put a curse on me 😆
Bob your story is some scary S_ _ _ T
I once got cut when I was drunk and screwing around with a "Balisong" in RP, within 3 days my whole finger tip was discolored and swollen. Once I was back on Okinawa it 2 weeks of Meds to clear it up along with having to lance it to get the infection out
Seems to me the native people from RP have developed the Cockroach type of immune systems. No Offense!
I agree with Brian (post 14) and move as quickly as possible to Thailand. the best there is Bumingrad hospital off Sukimvit rd. or via Singapore to Royal Darwin hospital in Australia.
Hi Neal in RI – Yes, it is quite scary, and that's why everybody visiting here, or in other tropical areas should take good care of their health!
Hi Ian – There are also very good hospitals in the Philippines, I have no problems with them personally.
This blog goes along with a few of the Many health precautions given to me by a travel Doctor here before my first visit to The Philippines. AS I am planning a future visit, I shall visit the same travel Doctor again. I was given " several " vaccinations and boosters about 6 weeks prior to my last visit along with a near book size set of precautions specified for Americans visiting The Philippines which originated from such organizations as World Health Org., CDC , etc. After I read all of this stuff, especially about the food, I wondered if I could really have any fun there or not ( but I sure did ! ). One item that may pertain to this blog in those precautions was not to go around in bare feet or even the commonly worn in Philippines " flip Flops ", no barefoot walking on beaches etc.
I doused myself with " Off Brand " " Deep Woods " insect repellant with a 25% Deet content in a pump spray bottle ( no aerosols on aircraft I had some repellent for clothes but I think USA TSA removed it from my luggage ) . I was also told by travel Doctor here to take " Malerone " atovaquone and proguanil 250 / 100 mg daily starting a few days before I left home and a few days after I returned home.
Well, the one thing no one ever mentioned ( until now ) what could happen if you get a simple little scratch or other skin puncture that you might not even notice or think of. I will have to keep that in mind for my next visit.
I have heard it mentioned many times that other parts of the world think USA and Americans are too " sanitary " and I think Bobs Blog here has brought some of that out.
One area that gave me a bit of concern was using PC keyboards in Internet Cafe's. I used them for keeping in touch with people there and back in the USA. Also I had never been in one before as we don't have them here where I live in the USA and I found it quite an interesting experience. Those cafe's that I went to had facilities for washing your hands although it might be a good idea to stuff a few brought from home paper towels in one of your pockets before going out somewhere. Some of the restaurants I went to had no paper towels or anything to dry your hands on.
It is not that I am a squeaky clean freak, I had read prior to going there about germs, virus, infection, etc. that living in the northeast USA all of my life, I may have never come into contact with. I survived my first visit with flying colors !
Here is a lonk on the USA Center for Disease Control ( CDC ) website for USA travelers going to The Philippines. There are many similar websites with these and other precautinns
http://wwwn.cdc.gov/travel/destinationPhilippines…
Thanks so much for this blog Bob, I hope your friend gets good medical attention fast and his condition can be cured.
I am going to try to get a small tube or container of antibiotic ointment or lotion and pack it with some band aids in my camera case, although i don't know if a USA formula will combat things found only in tropical climates and countries but at least it is a start.
Thanks for this info, I hope your friend finds the necessary medical care and has a fast and full recovery.
Hi BrSpiritus – that doesn't sound too good, maybe you do have a curse!
Hi Bob New York – what you mean there was no place to dry your hands in the restaurant? That's what your pants are for! 😆
Regarding the antibiotic ointment, you really don't have to bring it from the states it's readily available here.
Hi Bob New York – my friend did make it through that episode is doing fine. Thank you for your concern.
Hi Randall Jessup. I don't know much about Silliman. I know that the medical school there is pretty young (I think it started in the early 80's). Most of the practising doctors there were trained in Cebu and Manila. I will venture to say that the facilities should be one of the best in the country as you said there is an association with a U.S. university. I just can't say the robustness of the expertise of the medical community vis-a-vis Manila.
Another thing that I may add to the discussion is: there are now choices of air ambulances that can pick up patients from anywhere in the world with the nearest airstrip and bring them to the U.S., U.K or anywhere. The yearly insurance premium varies depending on which program one chooses. It can be really cheap or very expensive. These are basically flying intensive care units and man even with doctors with available continues communication with specialists in the ground at the receiving hospital. (Just google International Air Ambulances).
Cheers.
Hi Bob,In relation to Tawa Tawa for Dengue fever i once read somewhere, but since lost the link, about camote leaves (sweet potato)simmered up to have the same desired effect,has anyone else heard about this? In relation to Malaria prevention medication some treatments have severe side effects in some people,i tend to go for the older medication with less side effects although not as quite as effective.For anyone worried about Rabies i believe effective immunisation is available.Some very good info has come from this post,regards Chas.
Hi All,Just done some research as to why some people seem to attract Mossi bites more than others.Apparently Mossi's are attracted by high concentration of steroids or cholestrol on your skin,excess ammounts of acid in our sweat,carbon dioxide when we exhale.Avoid heavy exertion (especially at dawn and dusk when mossies most active) like playing sports as you emit more carbon doixide through heavy breathing and release more lactic acid through heavy sweating.Mossies can smell their meal up to 50 kilometres and can travel up to 40 miles.Most effective repellant is DEET based preferably at 50% DEET content.Source of info http://www.medicinenet.com regards Chas.
Hi CHAS – I had not heard about camote being useful for that.
Hi CHAS – That's good info on the mosquitoes!
Good advice here and I hope all will take heed. You must treat minor scrapes and bruises as if they were serious injuries, because they are. If the skin is broken, no matter how minor, at the very least Dial or Safeguard soap to get rid of the obvious dirt and then regular cleansing with Betadine and watch the wound like a hawk … very first sign of any infection means atrip to the doctor, then, not tomorrow. This is not the place to be a hero.
Hi Dave Starr – very good advice, soap doesn't always do the trick though, so it's good to use some kind of antiseptic as well. Thanks for your comment Dave.