Your health is your most precious capital

Most travelers do know the "Big Five": Malaria, Dengue, Cholera, Typhoid and Hepatitis and do have all routine immunizations. But there are lots of "small" diseases and injuries that can make your holiday trip a trip to hell.

For example, this skin infection started as small red dots itching a bit but was not taken too serious. A first self diagnosis came to the result that it might be a fungal infection. A fungicide lotion was applied.

But the infection grew serious and the help of a doctor was needed. Local doctors know local diseases best. A short visit at a doctor's in the next barangay showed up with an alarming result: Bacterial infection. The 7 days antibiotics treatment made completely disappear the infection. No traces can be found on the skin.

Recommendation:

Do not wait longer than 2 days when you catch a "small" disease. Ask for a local doctor and immediately look for a consultation.

Also this skin infection could be treated with antibiotics.

CAUTION: Philippines doctors often prescribe a minimal treatment duration of 7 days because of the cost. This could be too short.

This infection came back 3 times in different parts of the body (belly, finger and armpit). If you encounter a secondary infection, ask your doctor to prescribe you a longer (10 to 12 days treatment). 12 days are the maximum duration allowed for a antibiotics treatment.

This infection (Erysipel-Risipella) had been very bad. It's origins were a streptococcal infection and led to a necrotic wound. The doctors even considered an amputation of the leg. Fortunately a months long treatment did save the leg but did leave ugly scars.

So, we repeat:

Do not wait longer than 2 days when you catch a "small" disease. Ask for a local doctor and immediately look for a consultation.

Nizoral

For fungal skin infections we recommend Nizoral Cream. It treats all common fungal skin infections, including: Tinea infection (An-an), Ringworm (Buni), Athlete's Foot (Alipunga) and Jock Itch (Hadhad o hulas).

Nizoral Cream can be found in Mercury Drug stores. Mercury is the nations leading drug retailer and shops can be found in nearly any town. For a list of stores please see here: Mercury Drug.

How to find a doctor

If you are in town, simply ask the next taxi or tricycle driver. If you are in a remote location ask a barangay official.

Language hint:
Where is the doctor? Nasaan ho ang doktor?
I need a doctor who speaks English. Kailangan ko ho ng doktor na marunong mag-Inggles.

The second phrase can be necessary in regions where lots of natural-healers are considered to be a doctor, for example in Siguijor.

List of hospitals by region

REGION
ARMM	Autonomous Region of Muslim Mindanao
CAR	Cordillera Administrative Region
NCR	National Capital Region
REGION I	Ilocos Region
REGION II	Cagayan Valley
REGION III	Central Luzon
REGION IV	Southern Tagalog
REGION V	Bicol Region
REGION VI	Western Visayas
REGION VII	Central Visayas
REGION VIII	Eastern Visayas
REGION IX	Western Mindanao
REGION X	Northern Mindanao
REGION XI	Southern Mindanao
REGION XII	Central Mindanao
REGION XIII	Caraga

How to get a medicine

There is an excellent nationwide network of "Mercury" drugstores and pharmacies. The stores can be found in any town or city. Simply ask for the next Mercury store. The prices are relatively high but the products are of good quality.

Never buy a pill in a sari-sari! It could be your last pill.

Insect repellent

Insect repellents are your best protection against insect bites and therefore insect transmitted diseases.

Forget all the products you can buy back home, because they only make laugh Philppine insects.

Everywhere in the Philippines - supermarkets and drugstores - you can buy "OFF!". It exists in two forms: a creamy lotion and a spray. Both forms provide you with an excellent protection.

Price (2011): PHP 150.00 (approx. depends on the place where you buy)

Our Prevention Recommendations

DO:

Do always drink directly from the bottle or can (straws are relatively clean, glasses are potentially dirty)

Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission.

In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.

Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.)

To prevent fungal and parasitic infections, keep your skin clean and dry.

Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.

DO NOT:

Do not drink from glasses. and if you do so, never drink from a shared glass. (It is so kind to share a glass, but it is not fine to share hepatitis)

Do not go barefoot, even on beaches.

Do not eat food purchased from street vendors unless you are sure that it is well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever).

Do not eat food in an eatery with a too great choice. They cannot sell all in a day and the next day it is infected.

Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis.

Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas.

Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B.

Avoid poultry farms, bird markets, and other places where live poultry is raised or kept.

Official sources

For up to date information we recommend to visit these 3 sites:
Philippines Department of Health (DOH)
World Health Organization (WHO)
Swiss Tropical Institute (STI)

[Update 17/01/2011]

Rabies

The Department of Health (DOH) writes: Rabies remains a public health problem in the Philippines. Approximately 300 to 600 Filipinos die of rabies every year. Our country ranked third worldwide in rabies incidence in 2000. Dogs remain the principal reservoir of rabies in the country.

The World Health Organization (WHO) describes the key facts:
- Rabies occurs in more than 150 countries and territories.
- Worldwide, more than 55 000 people die of rabies every year.
- 40% of people who are bitten are children under 15 years of age.
- Dogs are the source of 99% of human rabies deaths.
- Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death.
- Every year, more than 15 million people worldwide receive a post-exposure preventive regimen to avert the disease.

If a dog bites you, wash the wound immediately with water and soap.
Then go to the nearest hospital, medical doctor, veterinarian or barangay health center.

Most hospitals in the Philippines, even in remote provinces, do have a stock of Anti-Rabies vaccine.

A post-exposure vaccination consists of at least 4 repeated injections.

Most hospitals give you the vaccine record form shown on the left, this allows you to continue your journey and to get the next scheduled injection in another hospital or clinic.

The vaccin is free of charge (a donation to the hospital is always welcome)
But you will have to buy the needed syringes in the next pharmacy

The Big Five in the Philippines

Malaria

Malaria symptoms appear about 9 to 14 days after the infectious mosquito bite, although this varies with different plasmodium species. Typically, malaria produces fever, headache, vomiting and other flu-like symptoms. If drugs are not available for treatment or the parasites are resistant to them, the infection can progress rapidly to become life-threatening. Malaria can kill by infecting and destroying red blood cells (anaemia) and by clogging the capillaries that carry blood to the brain (cerebral malaria) or other vital organs.

In the Philippines Malaria is known in the Mindanao, the Sulu and the Palawan archipelagos. But be aware that mosquitoes can be infected everywhere in the country. Mosquitoes do not only fly they also do use public transports such as airliners and ferries.

Dengue

Dengue fever is an acute febrile viral disease characterized by sudden onset, fever of 3-5 days, intense headache, myalgia, anthralgic retro-orbital pain, anorexia, GI disturbances and rash. Dengue viruses are flaviviruses. These viruses are also responsible for Dengue Haemorrhagic Fever (DHF). The viruses are transmitted to man by the bite of infective mosquitoes, mainly Aedesaegypti. The incubation period is 4-7 days (range 3-14 days). This disease is now endemic in most parts of the Philippines.

[Update 08/11/2008]

The Philippines Department of Health reported: 18,705 Dengue cases all over the country, from January 1, 2007 to September 1, 2007. 119 deaths with a case mortality rate of 196. 77% of cases were children ages 1-20 years old.
Dengue Source:	The Dengue virus is transmitted by an infected Aedes mosquito
Dengue Prevention	Protect against mosquito bites. Use insectizide to clean-up rooms, use mosquito nets to protect your bed
Dengue Immunity:	There are 4 serotypes of Dengue virus, so immunity only occurs when you already had been infected by all 4 serotypes
Dengue First Aid:	Drink as much as possible and fight fever with PARACETAMOL. Avoid Aspirine and Ibuprofen should be avoided because these could aggravate bleeding.

Cholera

Cholera is an acute diarrhoeal disease caused by the bacterium Vibrio cholerae. A person can become infected by drinking contaminated water or eating food contaminated by the bacterium. Common sources of infection are raw or poorly cooked seafood, raw fruit and vegetables, and other foods that have been contaminated during preparation or storage.

Most episodes of cholera are mild. Persons who have been infected may have no symptoms or only mild diarrhoea. Others, however, develop very severe watery diarrhoea and vomiting. The loss of large amounts of fluids can rapidly lead to severe dehydration causing death - sometimes within three to four hours - if the patient is not adequately treated.

Between 1988 and 1998, outbreak of food and waterborne diseases in the Philippines ranks first (typhoid fever), second (cholera), fourth (food poisoning), sixth (hepatitis A) and eight (diarrhea).

Typhoid fever

Typhoid and paratyphoid fevers are caused by the bacteria Salmonella typhi and Salmonella paratyphi respectively. Typhoid and paratyphoid germs are passed in the faeces and urine of infected people. People become infected after eating food or drinking beverages that have been handled by a person who is infected or by drinking water that has been contaminated by sewage containing the bacteria. Once the bacteria enter the person’s body they multiply and spread from the intestines, into the bloodstream.

Even after recovery from typhoid or paratyphoid, a small number of individuals (called carriers) continue to carry the bacteria. These people can be a source of infection for others. The transmission of typhoid and paratyphoid in less-industrialized countries may be due to contaminated food or water. In some countries, shellfish taken from sewage-contaminated beds is an important route of infection. Where water quality is high, and chlorinated water piped into the house is widely available, transmission is more likely to occur via food contaminated by carriers handling food.

Typhoid fever is endemic in the Philippines.

Hepatitis

Hepatitis is a liver disease caused by the hepatitis virus. Hepatitis can affect anyone. Hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics.

Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines are also available for long-term prevention of hepatitis A virus infection in persons 12 months of age and older. Immune globulin is available for short-term prevention of hepatitis A virus infection in individuals of all ages.

All 5 types of Hepatitis (A through E) are endemic in the Philippines.

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