Note: This article will be written in Taglish. Doktora Undone believes she can better expound her points if the medium is Taglish. Add to that, she hopes to demolish the heavily flawed superstitious belief about Rabies and the things related thereof by writing in the “language of the masses”. And unless otherwise specified, all parentheses are her annotations and do not necessarily reflect the views and opinions of the hospital staffs.
If any case that there shall be a conflict between what is written here and what your doctor has told you, please listen to the latter. NO QUESTIONS ASKED.
Hello, mga ka-hombre! 🙂
Kakauwi ko lang galing ng San Lazaro, ‘yung pampublikong ospital du’n sa Tayuman. As usual, pabugso-bugso na naman ‘yung sakit ng ulo ko (PS 6-7/10). Nu’ng Sabado pa talaga naka-iskedyul ‘yung pangatlong tarak ko, kaya lang na-late ako ng gising kaya ngayon nalang. Sayang hindi ko tuloy nakita ‘yung mga klasmeyts ko. Wala na rin akong balita kay Tatay Nestor. Iyon na nga, Lunes Santo kaya napakaraming tao. At gurl, ang inettt! Nauurat na ‘yung mga gwardiya du’n dahil bukod sa napakainit na nga e hindi pa matapos-tapos sa katatanong ang mga pasyente kung paano ang proseso, kahit nakapaskil naman sa dingding, hindi lang talaga nagbabasa.
Kaya eto na, isusulat ko na. Ako nalang talaga! Mawalang-galang na po sa Kagawaran ng Pangkalusugan at San Lazaro Hospital, bakit ‘di man lang kayo mag-update ng website kung papaano ba ang proseso? E helloooo!!! Social Media era na po tayo. Panahon pa po kasi ni kopong-kopong ‘yung istayl niyong whiteboard at pentel pen. Kulang na kulang po kayo sa public information campaign! *end of rant*
How to get to San Lazaro Hospital
If you’re coming from Fairview or Commonwealth area:
- Take a bus, UV or jeepney bound to Quiapo or Buendia. Basically, anything that will pass along UST will do.
- Get down at Lacson Avenue. Transfer to a jeepney bound to SM San Lazaro.
- Walk along Tayuman St. passing by the Espiritu Santo Parochial School until you reach LRT Tayuman Station.
- Cross the road and walk along Rizal Avenue. There you’ll pass by the buildings of DOH and JRMMC. (Those are big buildings and are hard to miss.)
- Make a right turn at Quiricada St. until you see the sign that says “San Lazaro Hospital”.
If you’re coming from CaMaNaVa (North of Manila) area:
- From Roosevelt station, take an LRT Line 1 and get down at Tayuman Station.
- Walk along Rizal Avenue and make a right turn at Quiricada St. until you see the sign that says “San Lazaro Hospital”.
(Para sa mga taga-Manila o Antipolo area, I honestly don’t know how you’ll get here. But just get down at LRT Tayuman Station and you’ll get by.)
San Lazaro Hospital Out-Patient Department
San Lazaro Hospital is a referral facility for infectious/communicable diseases. OPD, particularly, is situated at the right-most area. Head to the triage near the entrance, there you will be asked several questions and fill-up forms re: the animal bite and be given a number corresponding to your # in line. After which, you’ll have to pay Php 50 at the cashier for the hospital card and wait for your name to be called. They usually start calling names around 7:30-8AM. But on Mondays, it starts around 8AM (or a bit later) secondary to their flag ceremony.
One thing about public hospitals is that you ALWAYS have to be early, unless you’re planning on staying there the whole day. Personally, I was in line at 6AM, #34th and finished at around 2:30PM. The first visit always takes the longest hours since you have to do a series of interviews. Follow-up checkups are easier and usually takes 1-2 hours depending on the influx of patients. Also, OPD tend to be crowded on Mondays and Saturdays. And when I say crowded, it’s REALLY crowded.
To sum it up, below is SIMPLIFIED procedure:
- Get a number at the triage. Fill up forms. Pay Php 50 at the cashier for the hospital card. (Follow-up patients need not to pay. You’ll only pay ONCE. And that is on your FIRST VISIT.)
- Wait for your name to be called at the waiting area. (Mainit, I swear. If you have a battery-operated pocket fan, be sure to bring it as it’ll save you from the distress.)
- Once called, you’ll be interviewed by a clerk (I suppose). After which, you’ll have to go inside the OPD to be interviewed again by a doctor. There you will be given prescription. (I will expound the possible prescriptions below.)
- After buying your meds at the hospital’s pharmacy, head to the injection area to get inoculated.
- And voila! You’re done! Easy-peasy, right? But the buying and sharing of meds are where things get a bit complicated.
OPD Schedule and SLH ER
On Mondays to Fridays, OPD is open from 8AM until 3PM. As far as I’m aware, you can start getting number at the triage as early as 6AM. Again, it pays to be early. However on Saturdays, OPD is only open from 8AM-11AM, and closed on Sundays and official holidays. For the few unlucky ones who have been bitten on Sundays, official holidays or after clinic hours, you will given utmost attention at San Lazaro ER if you fall on the ff categories:
- Children ages 0-2 y/o
- 60 and above
- If the offending animal died
- If the offending animal is a stray and therefore cannot be observed
- If patient was bitten on dangerous areas (thorax up, including upper extremities)
- (+) multiple and deep wounds
Say you fall on any of above category, here’s the catch: YOU WILL HAVE TO PAY A COLOSSAL AMOUNT!!! When my dog bit my neighbor’s kid last December 2016 at around 3PM, we rushed the kid to SLH the same day and was told that I needed to pay five thousand for the post-bite prophylaxis. And that only covers the first cycle. Que horror!
I can’t help but ask: where does this leave the poor, the ones who had it rough all these years, the ones who barely survive on a single meal, the beggars and the homeless? What happens then if they fall on any of the above categories and has no means to pay for the insurmountable bills?
And the answer comes right along: they’d be dismissed. 😦
SLH-OPD Animal Bite Tips
- Wear facial mask at ALL TIMES. I cannot emphasize more on the need to wear facial mask at all times, most specially if the patient is a kid. In SLH, you will press flesh with people of different colors, statuses and medical histories. Keep in mind that SLH caters to INFECTIOUS/COMMUNICABLE diseases hence the need to observe proper protection. Facial masks can be bought outside the hospital (near the entrance) for Php 5.
- Bring alcohol. Like most public hospitals I know, SLH isn’t exactly clean. Same goes to its public CR. It’s a good thing that I always carry with me alcohol and wet wipes. Hindi po ako maarte pero iba pa rin ang nag-iingat. Health is wealth, ika nga.
- Bring something to keep you occupied. Some complained that the procedures are chaotic. Personally, I didn’t find the procedures chaotic at all, albeit tiring and painful. Only that there were lots and lots of waiting. My first visit took the longest waiting hours but I had Dennis Lehane’s Shutter Island which made the waiting somewhat bearable.
- Buy insulin syringe outside the hospital. Mas mura. Inside, it sells for about Php 12.50 / syringe. Sa labas, mabibili mo lang ng Php 5-10. Ingat ka lang kasi baka gamit na. Hahaha. Mercury Drugs sells this in bulk, usually by 10, costs Php 100. There is a Mercury Drug in Bambang St. ‘yung isa naman sa may bandang JRMMC.
Anti-Rabies Prophylaxis: Prices, Diskarte and Paawa
Eto na ‘yung nakakaiyak na parte: ang bayaran. Alam mo ‘yun? Nasaktan ka na nga, sasaktan ka naman ulit? Hahaha alangya! Anyway, below is the usual post-bite regimen:
Purified Chick Embryo Cell (PCEC). Eto ‘yung tinatawag nilang anti-rabies vaccine. I honestly have no idea how a purified (I wonder if it’s sterilized?) chick cell can kill rabies virus? Hahaha, that I leave to the experts. Another anti-rabies vac that they prescribe is called Purified Vero Cell Rabies Vaccine (PVRV). I don’t know the difference between the two but the nurse that I asked told me it’s just different brands. Ergo if you’ve been bitten, you are prescribed either with PCEC or PVRV. (Mine was PCEC. Rationale unknown.) For PCEC, they will ask you to find three other patients to share the vaccine with (1 vial= 4 patients). I shared mine with a carpenter, a vendor and a sexy mistress from Navotas (for realzZz). PCEC can be bought at the SLH Pharmacy for Php 1,170/vial, will be shared by 4, so that’s Php 292.50/patient. Hmm bearable naman— if you have a job that pays. Note however that they do not allow selling 1 vial to a single patient only. Perhaps it has something to do with the storage.
Kapag can’t afford ka naman at gusto mong mailibre nalang ‘yung PCEC, you have the option to make pila at the Medical Social Service located at the 2nd floor. It’s a rather long line so be extremely patient and kind. There you will be interviewed re: your occupation and your parents’. If you qualify, they will stamp the back of your hospital card indicating that your PCEC vaccine/s is/are free. Tip: if you plan on getting your PCEC free, have someone fall in line for you at social service while you wait for your name to be called.
Segue: May kwento ako. Kasi ano, nu’ng pangalawang follow-up ko, sabi sakin hindi daw ako pagbibilhan sa Pharmacy ng PCEC kapag walang tatak ‘yung hospital card ko. Hence I made pila pa at social service!!! Buti nalang kaunti pa lang ‘yung tao nu’n sa pila! We were 30 in line, I think. Aba’t sabi na naman ng katabi ko sa pila, “Baka hindi ka tatakan kasi mukha ka namang may pera.” Helloooo!!! Wala po akong pera! Naisip ko pwedeng pa lang mailibre with a little white lie. I mean, why pay for something you can get for free? And so I sat there, quietly, ever so quiet yet shaking (I’m bad with lying. I shake and stutter.), formulating the lie in my head.
Walang akong trabaho.
Walang trabaho ang tatay ko. Nasa probinsiya.
Walang trabaho ang nanay ko. Nasa probinsiya.
Pagdating ko sa loob, tinanong na ko, “May trabaho ka ba? Anu’ng trabaho mo?” Ha! As expected! I’ve rehearsed my answer in my head several times! Victory! “Wala po.” *puppy eyes*
“Anong trabaho ng tatay mo?” – wala po nasa probinsiya. Ah, easy peasy! Did not even break a sweat!
“Anong trabaho ng nanay mo?” Toinks!!! Para akong nag-zone out at bigla akong kinabahan sa mga pinag-gagawa ko (perhaps ’twas the heavens telling that I shouldn’t lie, churi talaga) at ang bigla kong nasabi, “Nagtitinda po.”
“Nagtitinda ng?” Holy crap, why do you keep asking questions?! Will I be put into jail because I lied to get a free PCEC? Will my pictures be posted on the walls?! Mugshots?! I panicked na. I didn’t know what to answer but I want my PCEC free! I glanced at my seatmate hoping to find answers, and saw that he was wearing a dilapidated pair of tsinelas. So I turned my gaze at the woman interviewing me, let out a little pout and said, “Nagtitinda po ng tsinelas.”
And then voila! My 2nd dose of PCEC was free!!! *evil laugh* (To be fair, I’m really jobless but my parents aren’t. But I was the one shouldering the entire expenses so their jobs are irrelevant. Haha. Excuses.)
I’m pretty sure I’ve derailed quite significantly to what this article is about. Haha going back…
Equine Rabies Immunoglobulin (ERIG). This was probably the most expensive on the regimen and costs Php 1, 190 / vial (5mL). Dosage depends on the weight of the patient. For example, at 60kg, I needed 3 vials. That’s a whopping Php 3,570!!! I guessed this partially explained the headaches and fever I had the following day. (Kidding aside, according to CDC, 10-15% of patients experience fever, headaches and nausea after getting inoculated. Perfectly normal. Daw. Sabi ng CDC.)
If anatomically possible, ERIG will be injected around the bite wound. BUT, mine was at my lower lips! Man, I was terrified! I kid you not! I took comfort at the thought, that maybe, just maybe, ERIG will be like a lip filler and then I’ll end up having Kylie Jenner’s lips!!! Not bad, eh? But the nurse injected mine at my Quads. Fart. Ang sakit, bes! Ang sakit sakit!!! Muntik ko ng hawiin ‘yung kamay ng nurse! After that, my legs felt heavy and sore, even surpassed the sore I usually have after hours of treks. Fortunately though, ERIG will be only be given once. If out of stock sa SLH Pharmacy, wala kang choice kundi bumili sa labas. Sa Mercury Drugs along Bambang St., mabibili po ito ng Php 1,320/vial (5mL).
Oo nga pala. Nakalimutan kong banggitin na bago i-tarak ‘yung ERIG e kailangan mo munang magpa-skin test, to see if you’re allergic to it. So basically, skin test > wait 30 minutes > if (-), ita-tarak na ‘yung ERIG. Pray that the heavens allow your skin test to be negative otherwise you’d have to be injected with Human Rabies Immunoglobin (HRIG) instead and that sh*t costs a whopping Php 4,100 per vial!!! Mabuti sana kung isang vial lang! E paano kung more than two?! Nganga! Bigti kana, friend! (Please verify. A nurse told me that ERIG isn’t necessary as long as the offending animal is happy and healthy.)
Para malibre ang ERIG: magpapatak ng INDIGENOUS sa BARANGAY niyo. Tapos dalhin mo sa Social service. Bibigyan ka nila ng letter tapos ‘yun ang ipepresent mo sa Pharmacy. Voila! Libre na ERIG mo.
Anti-Tetanus Serum (ATS). Very cheap. Costs Php 78/shot. Kelangan ng skin test bago i-tarak. I don’t know what happens next if positive. (Mercury Drug’s price: Php 100)
Tetanus Toxoid. Cheap din. Costs Php 55/shot. (Mercury Drug’s price: Php 119)
Antibiotic. I was prescribed with Clindamycin, I think. There is a syrup for kids who still have trouble with taking tablet medicines, so need not worry. Sa follow-up checkups, PCEC nalang ang ita-tarak. At least for me. I don’t know if it’s the same for everyone.
Mag-mahal ka pa rin, kahit paulit-ulit kang masaktan. Charot. I mean mag-mahal ng hayop— as in dogs and cats and monkeys and exes. Hahaha joke. Pagod na po ako. I had an extremely exhausting day. To anyone who might be in need of this, I hoped this helped even for a bit. Now let me sleep in bliss.
*enter Liza Loeb’s Stay*
(will proofread this later)
UPDATE: There are food restrictions while you’re on the anti-rabies regimen. Bawal kumain ng malansa (chicken, itlog, seafoods, patis, etc) at bawal uminom ng alak (ehem, mga tomador diyan). Mine coincided with Holy week so I couldn’t eat meat. I do not believe in such profound belief, but I was on a holy week vacation with my lola so you know how it went. I ate a lot of seafoods. I ended up with pantal pantal all over my upper extremities at talagang makati, bes!