November 2006
At first it seemed that I wouldn't have a lot to write about for
November, considering that my major activities - a trip to Leyte and
one to Palawan - would fall under Plants & Field Trips.
However, plans have a way of changing. The Palawan trip has
been postponed, and instead I get to write about my first encounter
with the Philippine medical system, courtesy of the souvenir I picked
up in Leyte - Salmonella typhi.
One of the first responses people had upon hearing that I got typhoid
fever was, "But didn't she get vaccinated?" The short answer is
yes, I did, twice, most recently in August 2006. The longer
answer is that as with any bacterium that causes infection in humans,
there's more than one strain of typhoid. In fact, there are
something like 400 strains of typhoid, and I happened to get one that
wasn't covered by the vaccine. I may get typhoid again before I
leave the country - it's certainly possible.
A little about typhoid - it's not a disease that people worry about in
the US. You can check the CDC's website for statistics, but
almost everyone who gets typhoid in the US picked it up while traveling
in another country. Typhoid is one of those lovely fecal-oral
bugs that's spread in contaminated food and water in places where
sanitation and hygiene are inadequate. People here don't
necessarily wash their hands after the using the bathroom or before
eating, and in some places bathrooms and sewage disposal facilities are
probably lacking. Some people (like me) get quite sick when
they're infected, but others remain asymptomatic and help spread the
disease. Typhoid Mary is probably the most infamous example in US
history.
In the US, the CDC tracks typhoid infections and works hard to identify
the source of an outbreak. Here, it's pointless to try to figure
out how I got infected. It could have been from ice at the
restaurants, dishes that were washed in contaminated water, water that
wasn't treated or boiled long enough, contaminated food that wasn't
cooked thoroughly, or a carrier who prepared food that I ate.
I'll admit that I could have been a little more diligent when it
came to refusing drinks with ice or securing enough bottled water for
my personal daily consumption. But if the source was food or
dishes, there wasn't much I could have done to prevent getting
infected.
So what is typhoid fever like? I had most of the symptoms listed
in the popular medical reference books I have with me. First I
noticed that my knees ached, and I was more tired than usual.
Then I developed a fever, headache, and more aching joints.
On the third day with fever, I went to the hospital and was
tested and diagnosed. The treatment is Ciprofloxacin,
antipyretics, and pain medication. The fever continued for a
couple more days, and I also got to experience a minor nosebleed,
nausea and vomiting, dehydration, abdominal bloating, constipation, and
more joint pain. A week after starting treatment, I was basically
back to normal, if a few pounds lighter and more tired than usual.
I do not recommend getting typhoid fever. It's no fun being
in bed for a week, and the headache and aching joints make any sort of
movement very unpleasant.
And now for my first experience with doctors and hospitals in the
Philippines. Marilyn tried taking me to a clinic first, but no
doctor was in on Sunday, so we ended up going to Los Baños
Doctors Hospital. The emergency room desk was just inside the
front door, and it was just that - a small desk with a receptionist
under a hanging sign. Marilyn filled out a slip of paper with my
name, birth date, and complaint, and after saying they didn't accept my
insurance, the receptionist called a doctor. He directed us to
the lab, where the technicians printed out a pay slip. Marilyn
went to the admitting desk to pay while I had my finger pricked.
The technician filled three small glass pipettes with blood and
then taped a cotton ball onto my finger. She cleaned my finger
before pricking it, and I assume the needle in the pricker was a new
sterile one, but no one in the lab was wearing gloves. I waited
half an hour for the results of the complete blood count, and was very
surprised when the doctor told me my IgM had tested positive for
typhoid. He asked if I was willing to be confined, and it took me
a moment to figure out that he meant admitted, and several more moments
to realize that confinement wasn't mandatory. If confined, I
would have stayed in the hospital for 3 days and received antibiotics
through an IV. I chose instead to take oral antibiotics and go
home, understanding that if I didn't respond to the Cipro I'd have to
come back for the IV. But who wants to be in the hospital,
especially when you have to pay for everything out-of-pocket? The
doctor filled in parts of my insurance claim form (though not
everything he needed to do), wrote prescriptions, and gave me the bill
for his consultation fee. After I paid, Marilyn and I made our
way to Mercury Drugstore, where I was able to fill my prescriptions
with generic drugs instead of the more expensive brands. Here,
you can buy one pill at a time and accordingly, the pharmacist told me
what the cost was for one pill for each prescription. I filled
the whole prescriptions, but the pills didn't come in a vial with
directions printed on the outside. They came individually wrapped
in sheets, and where I didn't need a whole sheet, the pharmacist took
scissors and cut between the pills to get the right amount. The
directions for taking the pills were on the original prescription
sheet. The cost for everything - blood work, consultation fee,
and medication - came to about $40.
So all in all, it was a positive experience. It wasn't expensive,
I didn't have to wait long, and I got a diagnosis and treatment.
However, part of the reason I didn't want to be admitted was the
lack of gloves in the lab. The doctor also didn't ask if I had
any drug allergies or if I was taking any medications before he wrote
the prescriptions, and he didn't say anything about a follow-up visit,
which is necessary to make sure that I'm not still harboring the
bacterium. In the US, we take these kinds of things for granted,
and in an American hospital, they would probably also culture the Salmonella
to see if it was resistant to Cipro. I decided that by staying
home, I would expose myself to fewer additional health risks than if I
were in the hospital.
Typhoid update:
Two weeks after I was diagnosed with typhoid, I returned to the
hospital for a follow-up visit. Unlike my first visit, the
hospital was crowded, mostly with parents and small children waiting to
see a doctor. I wasn't sure whether the doctor who was in also
serves as a pediatrician for routine visits like check-ups and
vaccinations, but none of the children seemed acutely ill so that was
my best guess. Grace and I waited about an hour to see the
doctor, and in the end we'd have been better off not visiting.
The doctor spent about 15 minutes painting a worst-case scenario
of what could happen to me if the bacteria settled in my gall bladder
and made me a typhoid carrier. All I wanted to know was when I
could be tested to see if I was negative for typhoid. His answer
was two to three months after I was ill. They do a blood test
first, but the test (which was used to diagnose my illness) is for IgM
antibodies, which can also be produced in response to other pathogens,
not just typhoid. The antibodies persist in the blood for a
couple of months. If they are present after that, the lab does a
stool culture to see if Salmonella typhi
is being shed. The doctor talked for a bit about how a culture is
the gold standard for diagnosing typhoid, but he said a culture has to
be specifically requested at the time of diagnosis because it's not a
standard practice yet. I mentioned that I might have been exposed
to schistosomiasis in Leyte as well, and the doctor said I would
definitely need to be tested for that as well because the worms will
harbor the typhoid bacteria. I got the impression that the doctor
was enjoying himself at that point - maybe I just made a refreshing
change from tending to babies and toddlers. The one good thing he
said was that as long as I wash my hands thoroughly, there's no reason
I can't cook, so I proceeded to make spaghetti and sauce and squash pie
for dinner. It wasn't a proper Thanksgiving celebration, but it
was my best attempt in a country that doesn't celebrate the holiday or
sell turkey and pumpkin.
Last updated: November 30, 2006