August 16, 2007

The Cost of Quality Filipino Healthcare
Cebu City (Cebu), Philippines

Having ferried over from Bohol for two final nights in the Philippines, I placed a four-month pregnant Tatiana and I in a hotel within two blocks of one of Cebu City's hospitals.

The recent priority on my mind, other than getting out of the country, has been to make sure Tatiana gets a proper prenatal checkup before flying to Indonesia. My guidebook reinforced the sentiment with a small blurb on the Islamic country's standard of healthcare:

Local medical care in general is not yet up to international standards. Foreign doctors are not allowed to work in Indonesia, but some catering to foreigners have 'international advisers'. Almost all Indonesian doctors work at government hospitals during the day and in private practices at night. This means that private hospitals often don't have their best staff available during the day. Serious cases are evacuated to Australia or Singapore.

Pleasantly Surprised, Impressed

First order of business last night was to see how much of a problem it was going to be to try and see a doctor, run some routine lab work, and have an ultrasound checkup without an appointment. A call to the Cebu Doctors Hospital a few days earlier was unproductive, and it was decided we would just deal with the issue after we switched islands.

We strolled into a clean and rather empty multi-story facility in the late evening. A clerk working at the information counter wasn't much help (English issues), incenting us to look for answers on our own.

Tatiana's last checkup was in Cairo two months ago, and her notes on the visit suggested that she continue to get her urine examined (for bad things like infection and protein).

Signs pointing to a lab near the entry proved themselves, and we slowly entered into the middle of a room full of blood samples, microscopes, and desktop centrifuges. A small nook contained a workstation that looked like a good place to start asking questions.

We were surprised to learn the lab was open 24 hours a day and accepted urinalysis requests without the need to see a doctor. Results would be back in two hours, and available at any time of the day or night.

I could hardly believe the price, thinking there was a communication issue between Filipino pesos and U.S. dollars, but Tatiana returned from the cashier with a smile. The lab work would be only 60 pesos—just US$1.32.

The ultrasound would have to wait until morning, as the offices were closed, but we both left rather pleased and hopeful for the next day.

Adventures in Healthcare

Having grown up in a country where hospital visits are for emergencies and routine doctor appointments are made weeks, if not months in advance, I was truly impressed with what Tatiana and I accomplished in two short hours.

In the United States I associate a hospital with the obligatory waiting room. There's an equation in my head that reads: "Hospital = Waiting for hours on end, bring a book". And the longer I travel in developing countries, the more irritated I become with the exorbitant costs and inconvenience of First World healthcare.

I want my medication cheap and available without a doctor's prescription, should I choose to self-medicate. I want on-demand appointments with low wait-times. I want my doctors to be competent, but more importantly to be cheap, so that I can visit several if I don't think one knows his/her head from their ass. And I don't ever want to question the sanitation of a needle that will go into my arm, or the arm of anyone I care about.

I fully acknowledge the price of healthcare in developing nations as it relates to cost of living there, and that a few dollars to me could easily be a day or week's wage for locals. But this doesn't stop me from comparing and contrasting services and quality—and from complaining about the zeros added to hospital and pharmaceutical price tags in North America.

There's a stigma out there about Second and Third World healthcare. I've visited a dentist, doctor, or pharmacy in enough developing nations to have formed a strong opinion on such things. I've seen the earlobe of a friend reattached in Brazil (torn during a hostile Carnival tussle), and hitched a ride in the back of a bloodied ambulance in the Caribbean. I've self-medicated more times than I can count, and know exactly how many doctors I'd like to slap because they wrote horribly off-target prescriptions for misdiagnosed ailments.

So when Tatiana and I got in to see a competent lady doctor for a 10-minute exam (and to authorize an ultrasound), waiting less than 20 minutes to do so, and paying US$15 for the visit, I was very pleased.

I was equally pleased at the price of Tatiana's ultrasound (just US$20), and with the patience, experience, and knowledge of the doctor operating the fancy, modern piece of machinery. Compare that with the multi-hundred dollar line item that Tatiana paid for the same exam in Miami—part of a US$1,500 bill.

The prenatal visit Tatiana had in Cairo last June was very positive. The doctor reported that the child was healthy and active, and was surprised by the degree of development in the baby's brain—although Tatiana laughs that he's probably use to seeing Egyptian babies (as Egyptian men are despised throughout the region as the worst of the Arabs). The doc also indicated that the gender was probably male, but couldn't tell for certain (as the kid wouldn't give an unobstructed view of the groin).

Today, Tatiana's suspicions were very much confirmed: She's baking a healthy baby boy in her ever-expanding belly. And while she was soaking up the imagery of the little fellow inside her on a ceiling mounted television, I was rather intrigued by the technology enabling it. This was my first time seeing this type of device—I really had no idea what such things looked or operated like—and found the entire process to be a fresh, new experience.

Cultural Nuances

I've really been enjoying recent talks with Tatiana about how various holidays were/are celebrated in her household, and sharing and comparing how childhood milestones are honored in Peru. For example, I asked about the loss of baby teeth, and if there's a Tooth Fairy that retrieves teeth lost from under a child's pillow at night.

I have wonderful memories of how my father—unbeknown to me at the time—would secretly replace my freshly lost teeth with either a Susan B. Anthony silver dollar or these massive half dollar coins (adorned with an engraving of JFK). Silver dollars are hardly ever used in the United States, and I've never seen a Kennedy half dollar outside of my own small collection. The obscurity of the currency made the act all that more special, and decades later I've still got the unspent coins tucked away with my few remaining belongings.

Tatiana recalls how, in her household, a mouse (Ratoncito PĂ©rez) takes lost teeth and replaces them with candy. We laugh as I playfully tease her about how the Peruvian Tooth Rat encourages tooth decay.

I'm thinking about amassing a small collection of interesting coins from various countries around the world that can be given to the little nomad for his lost teeth, continuing dad's tradition (with a slightly different spin). Yes, I like that idea quite a bit.

Tatiana has also shared with me some of the more interesting baby-related superstitions she knows of, such as in Peru, where a pregnant woman should avoid looking at ugly people (or things), least their child be born unattractive. In Egypt, she tells me an mother-to-be will pour sugar into the hand of someone she thinks is attractive, and then proceeds to eat it out of their palm—be it stranger or loved one—matching the expected gender of the child with that of the person with the sugary fingers. Bizarre.


Tom Heimburger

September 19th, 2007

What?? You think those Susan B. Anthonys were left by me?? …Dad


September 27th, 2007

HA! Your dad's comment really made me smile! I really enjoy that you are posting these types of thoughts and experiences on your site as well. It's great to see the little things that you can and will enjoy with your new child. It really puts a whole new perspective on things! Glad you are writing again! Wishing you both the best!

The Philippines


November 22nd, 2010

For someone from the USA, the health care in the Philippines is incredibly expensive!

On top of that, the medical staff have no education, and don't do anything for you at the hospital!

It's a shame this culture doesn't care at all about it's people, and has no laws or government regulations….



June 11th, 2011

I think nurses from phillipines and many other asian countries are generally known to be more lazy, even though they may appear to be quite educated in medical terminology. I even met one quite educated nurse from phillipine who worked with me in singapore complaint about having to do some menial task!

I agree that many asian or nonwhite run health care centres may have the latest technology but their medical and nursing care are mostly substandard and their standard of hygiene is very low and they tend to be very lazy. They are more interested in earning money and exploiting poorly paid slaves to do any work, that they considered as menial.

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