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By David Haldane

July 12, 2018

It’s a scene that would be at home in most people’s nightmares. Your mother wakes up gasping for breath. It’s happened before because she’s asthmatic, and this is the sort of thing that happens to people with asthma. Frantically, you call the only number you have for such emergencies; the cell phone belonging to the local ambulance driver. He takes a while to answer because it’s 2 a.m. in the deep provinces of the Philippines and most people are sound asleep. When the driver finally does answer, he sounds groggy and irritated at having been awakened. “Sorry sir,” he snaps before hanging up, “but tonight I’m off duty.” This is the only number you have. Desperately, you consider your options. By the time you come up with one, however, it doesn’t matter because your choking mother has died in her bed.

As nightmarish as that sounds, it recently happened to someone closely related to my wife. I’m not disclosing the exact relationship or location here to avoid increasing the heat. But the horrific event made me seriously ponder what it means to live on the outskirts of a developing country.

In the United States, life is like a Sears catalogue; you simply open the pages and order what you want. Need a doctor? Fine, just make an appointment and come on in. Or, better, go to the nearest Urgent Care and you will find help. If it’s an emergency, of course, there’s another easy solution; dial 911 and someone will come. You may not know exactly who or where from but rest assured that they will possess the skills necessary to help if they can. And if there are any questions regarding your financial viability, well, they won’t be asked until long after you are saved, and the paramedics gone.

In the Philippines it’s different. While some big cities – such as Manila and Davao – have fairly advanced emergency systems, in the provinces you’re often on your own. And even if you can somehow get to a hospital, without a good amount of cash or credit you still could be left to die.

My wife’s mother, who worked for many years as a traveling midwife on Siargao Island, tells the story of a patient she once treated on the remote island of Suyangan, about two hours away. During a difficult delivery, the woman lost so much blood that she needed a transfusion. So, my mother-in-law, doing what the situation required, put her on a small pam boat and set out for General Luna, the nearest municipality with a hospital. To make a long story short, the boat was too slow, and the woman died in my mother-in-law’s arms.

Here’s the thing; being in the Philippines is like going back in time. You feel like you’re in California during the Gold Rush of 1849, or perhaps on the vast plains of middle America in the days of the Old Wild West. To some extent, you have to fend for yourself. To a large extent, I wouldn’t have it any other way.

Because being here is a choice we all make. And though there is much to lose, there is much more to gain. What it comes down to is the age-old balance of safety versus intensity. While I may not feel as safe in the Philippines, I somehow feel more alive. And, in the final analysis, for me, that’s more important.

The death of my wife’s asthmatic relative raised quite a hue and cry in the province where it happened. Angry accusations were tossed back and forth and lots of finger pointing went all around. In the end, the errant ambulance driver who seemed to value his own sleep over someone else’s life was pressured to resign. Does that mean that the victim of the next medical emergency will fare any better? Frankly, I fear, your guess is no better than mine.






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A former Los Angeles Times staff writer and winner of a 2018 Golden Mike award in radio broadcast journalism, David Haldane fell in love with the Philippines on his first visit there in 2003. A few visits later, he also fell in love with the beautiful young Filipina to whom he is now married and, with whom, he has returned many times. David has written extensively about his experiences in the Philippines for several publications including Orange Coast and Islands Magazine. Today he and Ivy, along with their eight-year-old son, Isaac, divide their time between homes in Joshua Tree, California, and Surigao City, Philippines. His award-winning memoir, Nazis & Nudists, recounts, among other things, the courtship of Ivy and finding a place to call home. For David that turned out to be at the tip of a peninsula marking the gateway to Mindanao where he and Ivy are building their dream home next to a lighthouse overlooking the sea. This blog is the ongoing chronicle of that adventure.






  1. Paul Thompson says:

    Your article put a light on facts that most people do not think about in their day to day life here, and thank you for pointing it out.
    I live in a rural Barangay in Bataan, the duty driver of the emergency truck normally can’t get the truck running is the normal excuse.
    Since 1999 we have lived here full time and we have always had our own transportation. There have been times when someone from my purok is at my gate (Never during the day, only at night LOL) needing a ride to a hospital. I cannot imagine a person that could refuse medical air to anyone, I know I couldn’t. A hidden benefit is the Hospital will render aid quickly when they see a Kano drove them there.

    A valuable article for all to plan and think about.

  2. kathy french says:

    It is sad that it takes a person losing their life to get the ball rolling on such life and death matters. In the states we often hear of off duty police, or fire ,men and women helping in emergency situations. I am glad the person resigned because it was not the right response in such a situation. If someone wants a 9 to 5 job they need to not be in that line of work. Their expertise may be needed at inconvenient times as well.

  3. Steve Zoner says:

    Similar things still happen in the States too. Some medical conditions are such that you either move as close as possible to a care facility, or you know that every day can be your last. The incident I remember happened to a friend of mine, and it was so similar to this incident in so many ways.

    He was the oldest in the family. When he was younger, and the oldest of his sisters was 16 going on 17, she was dating a young man in his early 20s. Long story short, for similar reasons as in the original story, one day the young man bought a semi-expensive gift for my friend’s sister. Her mother and step-father kept trying to convince her to give back the gift because the young man simply could not afford such a gift. But she refused to give it back.

    Well the young man had a mother who ALSO had severe asthma, and, during attacks, there were times she barely made it to the hospital on time. Because of giving the girl the expensive gift, the young man’s telephone service was cut off. One day, his mother had another severe attack. She literally crawled to a neighbor’s house gasping for breath, and ended up dying in their car on the way to the hospital.

    Needless to say, the young man felt it was his fault, as did my friend’s sister. The Pastor of the church was certain this would drive a wedge between them and their relationship would break up. He told my friend and I the same thing when we visited him. I pointed out that his grasp of human psychology was incorrect, and that this shared tragedy would, instead, drive them even closer together because, anything else would have made his mother’s death in vain. They got married a few months later.

    This incident happened in a large city in the US, and, it was even 2 miles from one of the largest hospitals in that city. Both of the people involved blamed themselves for the woman’s untimely demise, but, in reality, she was already living on borrowed time, and almost died on the way to the hospital during previous incidents. So, the bottom line which is ALWAYS TRUE is that EVERYTHING IS ALWAYS IN THE HANDS OF GOD! It doesn’t matter who else yells “I GOT THIS!” because GOD ALWAYS DOES!

    Sure, it doesn’t eliminate the pain of losing someone, but, sometimes, it’s the ONLY way to deal with it, and find some sense of closure.

    • papaduck says:

      If the young man had a cell phone and even if his service was cut off, you can still call 911. But even doing that may not have saved her life.

  4. Cordillera Cowboy says:

    Hello David,

    You’ve sounded a wake up call for anyone hoping to live here. Many of us have decided to live in the “Provinces”, Conditions vary widely even within a 50 kilometer radius of our place in town. There is a large, state run hospital literally one minute away from where we live. A new, modern private hospital, is about 15 to 30 minutes away. As you pointed out, the key is to get there in a timely manner during a dire emergency. We have our own transportation, which could help us greatly in such an emergency. There are ambulance services. These are relatively new hereabouts. I have not seen any of them in the outlying barangays, such as where my mother-in-law’s farm is, or where our ranch property is.

    The most recent motorcycle accident I witnessed was out at mother-in-law’s place. No ambulance service there. Folks convinced a passing tricycle driver to take the injured person to the hospital.

    We each have to decide how much risk we are willing to take. As you stated, there is an added intensity to life here.

    Take care,

  5. Rob Ashley says:

    David: As always, a nicely told story about an important topic. In some ways we are lucky to be in Cebu City with a few hospitals nearby, but again, if you don’t have the ready cash, you’re in trouble and I am sans medical insurance besides Phil health and Medicare. If you can actually get to the hospital (not in the Provinces) most things are still cheap. A recent 3 hour trip to the Emergency Room for the baby we are caring for, all diagnostics and medicine was 950 pesos. Sad tale about your relative and as you said, living her has trade offs in both ways, good and not so good. -Rob