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Health

Health issues and the quality of medical facilities vary enormously depending on where and how you travel in the Philippines. Many of the major cities are very well developed – indeed Manila and Cebu are ‘medical tourism’ destinations where foreigners flock for affordable yet competent health care in modern hospitals. Travel in rural areas is a different story and carries a variety of health risks. For that matter, the average islander who practises small-scale farming and fishing can't afford modern medical care. As a result, some seek treatment from mananambals (folk healers) who are generally associated with Highlands people (the island of Siquijor is particularly well known for this).

Some travellers worry about contracting infectious diseases when in the tropics, but infections are a rare cause of serious illness or death in travellers. Pre-existing medical conditions and accidental injury (especially traffic accidents) account for most life-threatening problems.

Treat our advice as a general guide only; it does not replace the advice of a doctor trained in travel medicine.

Before You Go

  • Philippine pharmacies are usually well stocked with sterilised disposable syringes, bandages and antibiotics, but it doesn’t hurt to bring your own sterilised first-aid kit, especially if you’re going to be travelling off the beaten track. Contact-lens solution and spare contacts are readily available in cities.
  • Pack medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If you have a heart condition, bring a copy of your ECG taken just prior to travelling.
  • If you take any regular medication bring double your needs in case of loss or theft. Philippine pharmacies generally require a doctor’s prescription to issue medications. It can be difficult to find some of the newer drugs, particularly the latest anti-depressant drugs, contraceptive pills and blood-pressure medications.

Health Insurance

  • Even if you are fit and healthy, don’t travel without health insurance – accidents happen.
  • Declare any existing medical conditions you have (the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared).
  • You may require extra cover for adventure activities such as rock climbing or scuba diving.
  • If you’re uninsured, emergency evacuation is expensive; bills of more than US$100,000 are not uncommon.
  • Ensure you keep all documentation related to any medical expenses you incur.

Vaccinations

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking and underlying medical conditions.

  • Visit a doctor six to eight weeks before departure, as most vaccines don’t produce immunity until at least two weeks after they’re given.
  • Ask your doctor for an International Certificate of Vaccination (otherwise known as the ‘yellow booklet’), listing all vaccinations received.
  • The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Southeast Asia.

Recommended Vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia:

  • Adult diphtheria and tetanus Single booster recommended if none has been given in the previous 10 years. Side effects include a sore arm and fever.

  • Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and a sore arm occur in 5% to 10% of people.

  • Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with hepatitis A. Side effects are mild and uncommon, usually headache and a sore arm. Lifetime protection occurs in 95% of people.

  • Measles, mumps and rubella Two doses of MMR required unless you have had the diseases. Occasionally a rash and flu-like illness can develop a week after receiving the vaccine. Many young adults require a booster.

  • Polio Only one booster is required as an adult for lifetime protection.

  • Typhoid Recommended unless your trip is less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, however the injection is usually recommended as it has fewer side effects. A sore arm and fever may occur.

  • Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

These are recommended only for long-term travellers (more than one month):

  • Japanese B Encephalitis Three injections in all. Booster recommended after two years. A sore arm and headache are the most common side effects.

  • Meningitis Single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years’ protection; meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term travellers aged under 25.

  • Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally a headache and sore arm.

  • Tuberculosis A complex issue. Adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine is given in a lifetime.

Medical Checklist

Recommended items for a personal medical kit:

  • antibacterial cream, eg Mupirocin
  • antibiotics for diarrhoea, eg Norfloxacin, Ciprofloxacin and Azithromycin for bacterial diarrhoea; Tinidazole for giardiasis or amoebic dysentery
  • antibiotics for skin infections, eg Amoxicillin/Clavulanate or Cephalexin
  • antifungal cream, eg Clotrimazole
  • antihistamine for allergies, eg Cetirizine for daytime and Promethazine for night
  • anti-inflammatories, eg Ibuprofen
  • antiseptic, eg Betadine
  • antispasmodic for stomach cramps, eg Buscopan
  • contraceptives
  • a decongestant, eg Pseudoephedrine
  • DEET-based insect repellent
  • diarrhoea treatment – consider an oral rehydration solution, eg Gastrolyte; diarrhoea ‘stopper’, eg Loperamide; and anti-nausea medication, eg Prochlorperazine
  • first-aid items such as scissors, safety pins, Elastoplasts, bandages, gauze, thermometer (electronic, not mercury), tweezers, and sterile needles and syringes
  • indigestion medication, eg Quick-Eze or Mylanta
  • iodine tablets (unless you are pregnant or have a thyroid problem) to purify water
  • laxative, eg Coloxyl
  • migraine medication (your personal brand), if a migraine sufferer
  • paracetamol for pain
  • Permethrin (to impregnate clothing and mosquito nets) for repelling insects
  • steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone
  • sunscreen
  • throat lozenges
  • thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet
  • Ural or equivalent if you’re prone to urine infections

Websites

World Health Organization (WHO; www.who.int/ith) Publishes a superb book called International Travel & Health, which is revised annually and is available free online.

MD Travel Health (www.mdtravelhealth.com) Provides complete travel health recommendations for every country and is updated daily.

Centers for Disease Control and Prevention (CDC; www.cdc.gov) Good general information and country-specific warnings.

Further Reading

  • Healthy Travel – Asia & India (Lonely Planet) Handy pocket size, packed with useful information.

  • Travellers' Health by Dr Richard Dawood.

  • Travelling Well (www.travellingwell.com.au) by Dr Deborah Mills; now in its 18th edition (2013).

In the Philippines

Environmental Hazards

Diving

Divers and surfers should seek specialised advice before they travel to ensure their medical kit contains treatment for coral cuts and tropical ear infections. Divers should ensure their insurance covers them for decompression illness – get specialised dive insurance through an organisation such as Divers Alert Network (DAN; www.diversalertnetwork.org). Have a dive medical before you leave your home country – there are certain medical conditions that are incompatible with diving, and economic considerations may override health considerations for some dive operators.

Diving Emergencies
Evacuation and Search & Rescue Services

The Philippine Air Force, the Coast Guard and private operators such as Subic Seaplanes can assist with evacuations. However, their range is limited and you can’t expect them to miraculously appear in the middle of places like the Sulu Sea.

Recompression Chambers

There are four stationary recompression chambers in the Philippines.

St Patrick's Hospital Medical Center The only privately owned recompression chamber in the Philippines.

Cebu Doctor's University Hospital Cebu's recompression chamber. Contact Memerto Ortega.

PCSSD Armed Forces Hyperbaric Unit In Quezon City, Manila.

Philippine Commission of Sports Scuba Diving A chamber in the Cebu area.

Snakes

Southeast Asia is home to many species of both poisonous and harmless snakes. Assume all snakes are poisonous and never try to catch one. Always wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snakebite involves pressure immobilisation via an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Do not use tourniquets or try to suck the venom out. Antivenene is available for most species.

Insect Bites & Stings

Bedbugs don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine. Lice inhabit various parts of your body but most commonly your head and pubic area. Transmission is via close contact with an infected person. Lice can be difficult to treat and you may need numerous applications of a lice shampoo such as Permethrin. Pubic lice are usually contracted from sexual contact.

Ticks are contracted after walking in rural areas. If you have had a tick bite and experience symptoms such as fever or muscle aches, a rash at the site of the bite or elsewhere, you should see a doctor. Doxycycline prevents tick-borne diseases.

Leeches are found in humid rainforest areas and are very common in the Philippines. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.

Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg EpiPen) for emergency treatment. For others, pain is the main problem – apply ice and take painkillers.

Most jellyfish in Southeast Asian waters are not dangerous, just irritating. An exception is box jellyfish, which are extremely dangerous and can be fatal. They are not common in Philippine waters but they do exist, so ask around to make sure there have been no recent sightings in areas where you’ll be swimming.

First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Do not rub sand or water onto the stings. Take painkillers, and anyone who feels ill in any way after being stung should seek medical advice.

Air Pollution

Air pollution, particularly vehicle pollution, is a major problem in the Philippines’ largest cities, especially Manila. If you have severe respiratory problems speak with your doctor before travelling to any heavily polluted urban centres. This pollution can also cause minor respiratory problems such as sinusitis, dry throat and irritated eyes. If troubled by the pollution, leave the city for a few days and get some fresh air.

Heat

For most people it takes at least two weeks to adapt to the hot climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat. Take it easy when you first arrive. Don’t eat salt tablets (they aggravate the gut), although drinking rehydration solution or eating salty food helps. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching.

Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits.

Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin so they should be avoided. Locally bought prickly-heat powder can be helpful.

Parasites

Numerous parasites are common in local populations in Southeast Asia, however, most of these are rare in travellers. The two rules to follow if you wish to avoid parasitic infections are to wear shoes and to avoid eating raw food, especially fish, pork and vegetables. A number of parasites, including strongyloides, hookworm and cutaneous larva migrans, are transmitted via the skin by walking barefoot.

Skin Problems

Fungal rashes are common in humid climates. There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air, such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. Tinea versicolor is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness) see a doctor. Divers and surfers should be particularly careful with coral cuts as they can become easily infected.

Infectious Diseases

Rabies

This uniformly fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. Having pre-travel vaccination means the post-bite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not pre-vaccinated you will need to receive rabies immunoglobulin as soon as possible.

Hepatitis A

A problem found throughout the region, this food- and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A; you just need to allow time for the liver to heal. All travellers to Southeast Asia should be vaccinated against hepatitis A.

Tuberculosis

Tuberculosis (TB) is rare in short-term travellers. Medical and aid workers, and long-term travellers who have significant contact with the local population, should take precautions. Vaccination is usually only given to children under the age of five, but adults at risk are recommended pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

Chikungunya Fever

This less common viral infection poses only a small risk to travellers in the Philippines, mainly in the Visayas. Sudden pain in one or more joints, fever, headache, nausea and rash are the main symptoms.

Cutaneous Larva Migrans

This disease is caused by dog hookworm; the rash starts as a small lump, then slowly spreads in a linear fashion. It is intensely itchy, especially at night. It is easily treated with medications and should not be cut out or frozen.

Malaria

For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.

According to the Centers for Disease Control and Prevention (CDC), in the Philippines there is no malaria risk in Bohol, Boracay, Catanduanes, Cebu, Manila or other urban areas. The risk of side effects from anti-malarial tablets probably outweighs the risk of getting the disease in these areas.

In general, malaria is only a concern if you plan to travel below 600m in extremely remote areas such as southern Palawan. Before you travel, seek medical advice on the right medication and dosage for you. Note that, according to the CDC, chloroquine is not an effective antimalarial drug in the Philippines.

Measles

Measles remains a problem in some parts of Southeast Asia. This highly contagious bacterial infection is spread via coughing and sneezing. Most people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash and can be complicated by pneumonia and brain disease. There is no specific treatment.

Filariasis

This is a mosquito-borne disease that is very common in the local population, yet very rare in travellers. Mosquito-avoidance measures are the best way to prevent this disease.

Typhus

Murine typhus is spread by the bite of a flea while scrub typhus is spread via a mite. These diseases are rare in travellers. Symptoms include fever, muscle pains and a rash. You can avoid these diseases by following general insect-avoidance measures. Doxycycline will also prevent them.

Dengue Fever

This mosquito-borne disease is by far the most prevalent of the diseases you have a chance of contracting in the Philippines. It’s especially common in cities, especially in metro Manila and it's the leading cause of hospitalisations of children in the country. While not usually fatal, dengue can kill; of more than 42,200 cases diagnosed in the first six months of 2013, 193 resulted in death. There is no vaccine available so it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue can bite day and night. Symptoms include high fever, severe headache and body ache (dengue was previously known as ‘breakbone fever’). Some people develop a rash and experience diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.

Travellers are advised to prevent mosquito bites by taking these steps:

  • Use a DEET-containing insect repellent on exposed skin. Wash this off at night, as long as you are sleeping under a mosquito net. Natural repellents such as citronella can be effective, but must be applied more frequently than products containing DEET.
  • Sleep under a mosquito net impregnated with Permethrin.
  • Choose accommodation with screens and fans (if not air-conditioned).
  • Impregnate clothing with Permethrin in high-risk areas.
  • Wear long sleeves and trousers in light colours.
  • Use mosquito coils.
  • Spray your room with insect repellent before going out for your evening meal.

Hepatitis B

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.

Hepatitis E

Hepatitis E is transmitted through contaminated food and water and has similar symptoms to hepatitis A, but is far less common. It is a severe problem in pregnant women and can result in the death of both mother and baby. There is currently no vaccine, and prevention is by following safe eating and drinking guidelines.

Japanese B Encephalitis

While a rare disease in travellers, at least 50,000 locals are infected each year in Southeast Asia. This viral disease is transmitted by mosquitoes. Most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die while another third will suffer permanent brain damage.

Schistosomiasis

Schistosomiasis is a tiny parasite that enters your skin after you’ve been swimming in contaminated water. Travellers usually only get a light infection and hence have no symptoms. Schistosomiasis exists in the Philippines but it’s not common and is confined to a few areas well off the tourist trail. On rare occasions, travellers may develop ‘Katayama fever’. This occurs some weeks after exposure, as the parasite passes through the lungs and causes an allergic reaction – symptoms are coughing and fever. Schistosomiasis is easily treated with medications.

Typhoid

This serious bacterial infection is spread via food and water. It gives a high and slowly progressive fever and headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for urban areas, not just smaller cities, villages or rural areas.

Traveller’s Diarrhoea

Traveller’s diarrhoea is by far the most common problem affecting travellers. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are etc.

Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell.

Treatment consists of staying well hydrated; rehydration solutions like Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools.

Amoebic Dysentery

Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut and then a second drug to kill the cysts. If left untreated complications such as liver or gut abscesses can occur.

Giardiasis

Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.

Availability & Cost of Health Care

Good medical care is available in most major cities in the Philippines. It is difficult to find reliable medical care in rural areas, although there will usually be some sort of clinic not too far away. Your embassy and insurance company are also good contacts.

If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention. It is always better to be assessed by a doctor than to rely on self-treatment.