Medical adventure in Sabang/PG

[WOODMAN]

My wife and I just got back from 2 1/2 weeks in the Sabang area, and I will be posting my usual insanely detailed trip report a little later. I wanted to comment on a rarely mentioned topic here, however, regarding a little medical adventure we encountered while there. The last night of the trip, (Easter night) we were out at a restaurant with our usual gang of thugs, when my wife (67 yrs old and having just completed about 35 dives) suddenly experienced a piercing pain in her lower chest and radiating back to her backbone. She also felt dizzy and slightly short of breath. OMG! The possibilities here were frightful, to say the least. The pain quickly dropped off to a low level, and my friends were calling around and found that both of Sabang's doctors were out of town for the Easter holiday. Just great. We managed to get her back to the resort and called our dive operator, who was Rick at Frontier Scuba. He came running over with a couple of O2 tanks (in case this was DCS) and we got her settled with O2 at high flow. She was smoothing out nicely, but we still needed an evaluation for obvious reasons. We could cart her down to Puerto Galera, which wouldn't be easy, or run her across the channel to Batangas, which would be murder also. Rick worked his magic, however, and actually got a doctor from a private clinic in PG to come out there for a house call. He arrived with a nurse in tow, and bringing a lot of emergency supplies. He checked her over and actually ran a portable EKG on her right there, which showed no cardiac involvement whatsoever. He thought this was probably a mixture of gastric reflux combined with a lot of diving and her age, and discounted the possibility of DCS completely. He gave her the green light to travel back to the states the next day, with appropriate followup when home, of course. So all ended well. And what did this adventure cost, you might ask? Remember that the doctor drove up from PG (bringing an ambulance) and brought a nurse with him. They had to walk about 1/4 mile in from the public dock to the resort, as there is no closer land route than that narrow alley walkway which runs behind all the resorts and dive shops and which is not navigable by cars, while carrying their equipment. For all this he charged me the princely sum of 3000 pesos, which is about 67 bucks US. Oh, I forgot. He added 250 pesos for the EKG, so that's another 5 bucks. 72 dollars for all this! I couldn't get my blood pressure checked for that at home. Imagine what this would have cost in the US! The important thing was that my wife turned out okay, and we traveled back with no further issues. Once again I would like to applaud Rick at Frontier Scuba for his unceasing assistance and commitment to his guests. We could not have had a finer friend during a scary time. I will be submitting the abovementioned trip report later, but I just wanted to get my heartfelt thanks on record for all who helped with this. Woody (and Judy)

 

[FT]

So glad to read that all is well. Filipino hospitality + skill = reassurance. Kudos to your host Rick.

 

[Kevrumbo]

Good that all worked out well. . . ! (Especially after that Typhoon which hit Chuuk & Yap rolling through Luzon, albeit weakened to Tropical Storm status when it made landfall).

Some info on JCI approved Hospitals in the Philippines:

St. Luke's Medical Center | Global City

Welcome to Chong Hua Hospital - An Accredited Institution of Joint Commission International

 

[descent]

Woodman, it's so good to hear that your wife is OK. Yikes! :wow:

 

[diverjen]

So glad she is ok! I having been meaning to put the DAN Asia number somewhere, is there a chamber close by in case?

 

[TSandM]

67 year old female, sudden onset chest pain radiating to the back, associated with shortness of breath and lightheadedness.

In the USA, if you present to an emergency department with these complaints, we are going to do quite a bit more than an EKG. Depending on risk factors and information from vital signs and clinical exam, that could include one or more troponin tests, a test for blood clots (a risk with a long recent air trip), or a CT scan to rule out aortic dissection (a painful and potentially lethal problem). I would guess the work up would run between 5 and 10K, and although I tend toward the risk-accepting and test-nihilist end of my profession, no way I would do less.

The EKG is only about 70% (or less) sensitive for heart attack. We don't accept a 2% risk of a missed MI in the States.

Maybe I should go practice in the Philippines, where they can clearly be more pragmatic.

 

[rob1967]

I have experience with the medical system in the Philippines and overall, I would agree that they are quite good. Actually an amazing bargain compared to the Western world! I think the doc you saw did quite good considering it was a house call in a remote area and not an ER visit, and 3000 pesos is an outstanding bargain!

When we travel and dive in remote areas, we have to accept the risk that medical care is not near at hand. Had you presented to a hospital in a larger city, you could have likely had the work-up that TSAndM recommends, and at a fraction of the cost of back home. His advice to seek appropriate follow-up once you are home seems ok to me. I guess we could debate whether it would have been more appropriate to go to the hospital in Manila the next day, but in hindsight, it looks like it turned out fine to simply go home. I am glad to hear your wife is doing well now.

In the Philippines, many locals have trouble accessing quality care due to lack of financial resources. But for those of us coming from western countries, the quality of care is generally quite good, and extremely cheap compared to the US!

 

[soccerrefjason]

Wow... I too am glad that your wife is well... Did she do the prescribed follow up? I took my son to the doctors office for a routine follow up and refill of ongoing meds request and was shocked to find that I had allowed his insurance to lapse at the end of last month. The doctor was in her own office and was willing to see him provided I paid the low consultation fee of $85. Sounds like you got a great deal monitarily speaking.

 

[WOODMAN]

So glad she is ok! I having been meaning to put the DAN Asia number somewhere, is there a chamber close by in case?

Closest chamber is Batangas, across the channel.

---------- Post added April 9th, 2015 at 05:07 PM ----------

We are of course following up on this, and as we are aware of the limitations of an EKG, we will get tropin levels checked also. She is completely asymptomatic now, except for the jet lag of course, but our doctor will see her soon and hammer this into the ground. All in all, I have to say we were extremely lucky to get this level of service at what amounts to a drop of the hat, and in such a remote place, figuratively speaking. Once again, thanks to everyone who was involved. Woody

 

[Kevrumbo]

67 year old female, sudden onset chest pain radiating to the back, associated with shortness of breath and lightheadedness.

In the USA, if you present to an emergency department with these complaints, we are going to do quite a bit more than an EKG. Depending on risk factors and information from vital signs and clinical exam, that could include one or more troponin tests, a test for blood clots (a risk with a long recent air trip), or a CT scan to rule out aortic dissection (a painful and potentially lethal problem). I would guess the work up would run between 5 and 10K, and although I tend toward the risk-accepting and test-nihilist end of my profession, no way I would do less.

The EKG is only about 70% (or less) sensitive for heart attack. We don't accept a 2% risk of a missed MI in the States.

Maybe I should go practice in the Philippines, where they can clearly be more pragmatic.

At St Luke's Hospitals in Metro Manila (or Chong Hua in Cebu City) -both JCI accredited medical facilities as noted above in post#3- you would get the same quality treatment and diagnostic work-up as in any US Hospital accredited by the American Joint Commission, but at a fraction of the cost (and still just as easily covered or reimbursed by most private or public US Health Insurance Providers like Medicare for example):

Cost Of Treatment Comparison | Medical Tourism Philippines