#BiteSeries: A Complete Guide to San Lazaro Hospital Animal Bite Center

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! ūüôā

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

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Map to San Lazaro Hospital courtesy of Google Map.
If you’re coming from Fairview or Commonwealth area:

  1. Take a bus, UV or jeepney bound to Quiapo or Buendia. Basically, anything that will pass along UST will do.
  2. Get down at Lacson Avenue. Transfer to a jeepney bound to SM San Lazaro.
  3. Walk along Tayuman St. passing by the Espiritu Santo Parochial School until you reach LRT Tayuman Station.
  4. 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.)
  5. Make a right turn at Quiricada St. until you see the sign that says ‚ÄúSan Lazaro Hospital‚ÄĚ.

If you’re coming from CaMaNaVa (North of Manila) area:

  1. From Roosevelt station, take an LRT Line 1 and get down at Tayuman Station.
  2. Walk along Rizal Avenue and make a right turn at Quiricada St. until you see the sign that says ‚ÄúSan 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:

  1. 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.)
  2. 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.)
  3. 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.)
  4. After buying your meds at the hospital’s pharmacy, head to the injection area to get inoculated.
  5. 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
  • PWD

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. ūüė¶

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Hangdami! (Credits to: thefrequentvoyager.blogspot.com)

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.
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Credits to: http://www.thefrequentvoyager.blogspot.com

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‚ÄĒ 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.

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In conclusion

Mag-mahal ka pa rin, kahit paulit-ulit kang masaktan. Charot. I mean mag-mahal ng hayop‚ÄĒ 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! 

#BiteSeries: A Complete Guide to San Lazaro Hospital Animal Bite Center

Be Careful What You Wish For

 

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Randomly googled image to put emphasis on what I have to say. If this is offensive, please let me know. (credits to owners)

For days, I incessantly debated against myself on whether I should write about this. A part of me wanted to tell the whole story as it is. On the contrary, the other part of me wanted to fall silent and just move on with my life, for fear that others might perceive this as a grave attempt to aggrandize myself. P****** lang. Three days after and yet, I am still jaded as of this writing, and the last thing I wanna do is deal with any social media turmoil that could possibly erupt hereof. But for the sake of MY EQUANIMITY and PUBLIC INFORMATION, I am exterminating my reservations re: the matter and telling it all. My account is as follows:

March 12, 2017, 10AM: Event of a lifetime

Big brother’s last birthday as a bachelor.

The¬†family and I attended a joint birthday party held in a resort somewhere in Imus, Cavite. Prior to¬†this, my father and I were sorta having a discussion because of ¬†my defiance to come along. ¬†I am not a social butterfly, so my refusal was given whenever opportunity presents itself. Add to that, I was determined to finish the tagalized medical book I was writing that same day and I couldn’t afford any distraction‚ÄĒ no matter how grandiose and festive that was.

¬†In the end though, I succumbed to my father’s requisition.

We left home around at 8AM and arrived at Roselanie’s resort past 10AM. The place was serene, so much so that I regretted not bringing any swimwear. The catering service, however, was a flunk by itself. Granted that the foods were exquisite, but to have the guests wait around from 10AM until 1PM for something that SHOULD’VE BEEN¬†PREPARED all along, was unacceptable to say the least. Although¬†I will not go further into that, as I will completely adrift to what this entry is about.

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Turned out, ’twas a good thing that I had not eaten ANYTHING¬†the night before and¬†the morning of the event. I saved my calories enough to feast!
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“Breakfast” for the champions!
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The delay was worth it, after all.

March 12, 2017, 1PM

As shown above, I had a massive lunch that day which caused me to feel drowsy. I had not slept the night before, and so I fell asleep quite easy as soon as I hit the bed in one the rented rooms at the resort. Despite the scorching hot weather, I managed to sneak in a solid 2-hour sleep.

March 12, 2017, ~3PM: The unexpected happened

This is where everything started to go downhill.

In the middle of my deep sleep, I suddenly woke up. The suffocating atmosphere¬†of the room prompted me to go outside. I headed toward the veranda (see¬†picture below) and stood there while I watched my cousins playfully teasing each other in the pool.¬†Then all of a sudden, people started rushing to a¬†nearby pavilion¬†(see¬†picture below). I knew something was wrong. I then started scanning the surrounding to know what it was, until I saw my uncle sprinted like a lightning bolt¬†and grabbed a 4-year old boy out from the adults’ pool.

The boy had drowned. And NOBODY KNEW HOW LONG.

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Adult pool. I assumed it’s around 4-5ft. The boy, however, is barely 3ft tall.
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Randomly googled image. Credits to owners.

P*cha naman, why me?!

I rushed to the scene. And as soon as I got there, I had to step back, lest I do anything stupid.

“Ikki,¬†Kaya mo ‘ba?“, my balik bayan cousin asked. For a moment, his question bewildered me. Then it hit me. He¬†was asking if I knew how to do CPR!!! Of course, he knew (and everyone else in that place) that I am a pre-medical student! If anyone else can do it, I would be it.

I stared at him blankly before I give him my unintelligent reply,¬†“Hindi, kuya.” H-how can I say yes when all I have with me was mere book knowledge?! W-why should I say yes?! I haven’t done any of this! W-What if I ended up in jail for this?! My mind was playing tricks on me. Fearful. Always fearful.

At this point on, the scene was very chaotic, that even the word chaotic itself was an understatement. There were people screaming loudly, “Tisoy! Tisoy!”, adults¬†were¬†panicking, afraid to do anything,¬†¬†and on top of that was a dazed mother hysterically crying her lungs out. I knew I needed to do something. Time was running out and I had to act fast. So with no real life experience but the lessons I learned from my 5-year in pre-med and the tons¬†of Grey’s Anatomy episodes I had religiously watched over the years, I put my best foot forward.¬†I quickly recalled all the things I learned from the past and¬†took over the emergency response. Fearlessly.

It is now or never, I told myself

“Hayaan niyo na kay Ikki ‘yan!”, my uncle instructed the others to move away from the kid. My mind was clear. My hands weren’t shaking. I knew what I needed to do. Everything else in the background became a blur. My focus, directed to the boy, and to him only.

“How long has he been under?” No response.

I was not getting any response from the boy either. Pulse, negative Breathing, negative. Color, bluish. Tone, stiff. Stomach, bloated. Sh*t! The kid had been underwater for too long.  And as if the scene was not horrendous enough, there was water coming out of his ears, nose and eyes. The scenes in movies were protagonists look oh-so-beautiful even when drowned? Those were all BS. In reality, you have to be ready for EVERYTHING that the human body can possibly throw at you, that for sure was not emphasized in school.

I cleared the airway. Lifted his chin. Administered rescue breathes. Began CPR.

1001…

1002…

1003…

Still no pulse. Chest, not rising. I continued with chest compression, while instructing the others to prepare for the car. ¬†I admit though, that at this point, I didn’t think he’d survive. “He’s too far gone”, I told myself. ¬†While at it, I resorted to the best weapon I have, something that transcends even the most skillful doctors combined, I began praying. “Lord, this is not up to me. This is up to you. Please heed my prayers. Even one last time.”

All of a sudden, I had this surge of hope, that maybe, he’ll make it, even if ’twas against all odds.

YOU ARE NOT DYING. NOT ON MY WATCH.

1004…

1005…

1006…

After what seemed like forever, he gasped. He seemed to be exhibiting signs of life. I checked for his vitals. Pulse, faint but otherwise palpable. Chest, rising. I knew better, the fight wasn’t over yet. I cuddled him as we quickly drove to the nearest hospital. None of us knew the way to the nearest hospital, so we had to stop midway and ask for directions. The kid, on the other hand, was unstable. His VS were fluctuating. His mom, hysterical.

Mahal na mahal ‘yan ng papa niya.

“Anak, gising kana. Please. Please.

Anak, ‘wag kang matulog. Hinde… hinde…

Iniwan ko lang siya saglit. Katatapos lang namin mag-picture.

Anak, please. ‘Wag kang matulog.

Lord, please. Not today. Not on my watch.

I wasn’t ready to lose. NO, NOT THIS TIME. So, I began tilting the boy head down, squeezing him, tapping his back, hoping that he would soon vomit whatever water he ¬†had ingested. ¬†Then again, after what seemed like forever, he vomited, lots and lots, and began mumbling words I couldn’t comprehend.

Paki check ang bunganga. Paki siguradong walang nakabara.” I couldn’t see his mouth because I was holding him upside down, so I had his mom do it for me.

Deliberately, he faintly opened his eyes to gaze at his mom. Still lethargic, but otherwise responsive. At last, the critical part was over. I heaved a gigantic sigh of relief. When we arrived at the ER, the nurses and doctors on call were attentive to our needs. They began administering oxygen through a nasal canula, which irritated Genesis. I knew everything was going to be okay when the he finally screamed,

“P*tang-ina!”, and a nearby patient bursted out in laughter.

Haaay. Close call. Had I slept more that day, it would’ve been too late for Genesis. Buti nalang. When I got home that night, I locked myself inside my room and cried myself to sleep.

*****

Thank you father for a life well-saved. All glory belongs to you, and you alone.

Dearest Genesis,

Live up to your name. Live a new beginning. Fly high. Be brave. Paint beautiful portraits. Capture every moment. Have an awesome life. Soar high on mountains even if it scares you, because only then you will know that you had lived a full life .

I hope to meet a fine, young man should our paths cross again in the future.

Love,

Anna

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These pictures do not give justice on how much the kid had puked.
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After the storm, he gamely posed for a picture! Carrying him was his mom.

Now, you wonder why the title?

Because once upon a time, I asked ¬†for life to surprise me. And oh boy, how it did! At siniguro niyang ’twas a surprise of lifetime! Just when I thought my life couldn’t spiral any further, then this happened. A validation that perhaps my existence wasn’t so bad after all.

*insert cue music*

ūüé∂ Be careful what you wish for… because you might just get it all… you might just get it all. ūüé∂

Be Careful What You Wish For