“Nangigitim siya kapag umiiyak. Kapag nasasaktan hinihimatay.” (He turns blue when he cries, and passes out when in pain)

This is how Cheradee describes her three-week old child when seizure strikes.

Cheradee, a native of Samar met her partner Jerome in a public market where she used to work as a vendor until they decided to live together and they were blessed with a son.

“When I gave birth, Jerome and I noticed that my son, CJ had bluish lips and fingernails which we pay no attention to,” recalls Cheradee. Two weeks after birth, CJ would have more frequent episodes of having bluish skin when crying or feeding (tet spell), prompting the couple to bring him to the doctor.

Worried about their son’s condition, they went to a nearby private clinic. Their doctor told them that CJ is suffering from Pneumonia and a whooshing sound can be heard from the child’s heart. Suspicious about the murmur, the doctor referred them to a hospital that is capable of providing the needed medical and laboratory services.

“Ni-refer kami ng doktor sa ospital para mas matingnan daw ang anak ko dahil may naririnig daw siyang kakaibang ugong sa puso bukod pa sa sakit na Pneumonia", Cheradee narrates.

CJ was admitted and given antibiotics for his Pneumonia. Various physical exams were also performed on the child’s frail body to verify the cause of the heart murmur. It was a long and stressful week for the couple, until they received the doctor’s advice that a major operation is needed for their son.

Life has not been very easy for the couple. The family only rents a small room for P800 per month in Barangay Palatiw, Pasig City. Cheradee chose to quit her job in the market to take care of CJ while Jerome earns P120 per day as a market vendor to make both ends meet. With this little amount of money, how can they possibly afford to survive a day and take care of a sick child that needs a major operation?

Although bothered by the doctor’s advice, the couple still decided to move to Samar after their son was discharged from a two-week stay in the hospital. But another severe episode of a tet spell occurred which prompted them to return to the city and see a doctor again.

It was in November 2013 when the doctor at the Philippine Heart Center broke the news which made their hearts sink. CJ was diagnosed with Tetralogy of Fallot or the Blue Baby Syndrome, a rare condition caused by a combination of four heart defects. Still shocked with the doctor’s findings, they were asked if they are willing to have their son undergo an operation. “Paano po ‘yan, wala kaming pera?,” uttered the teary-eyed Cheradee.

With luck still on their side, the doctor told them not to worry because they will be referred to the hospital’s Social Services and advised them to apply for the Z benefit package of PhilHealth. Unfortunately, Cheradee’s membership under the Indigent program of PhilHealth already expired. Despite being short of money, they were able to produce enough funds to pay for their PhilHealth premium contribution, this time under the PhilHealth’s Informal Economy with Jerome as the principal member.

“Kumuha kami ng mga requirements para makapasok sa Z benefits. Hindi namin inintindi ang hirap basta ang importante makakuha kami ng mga dokumento kahit pila kami ng pila. Kapag day-off ng asawa ko saka siya nag-aasikaso ng mga papel. Madali lang naman kung talagang interesado at pursigido ka,” said Cheradee.

On the 22nd day of July 2014, the operation was performed to then one year and four-month old CJ. After long hours of waiting, the doctor informed the couple that CJ is in a critical state and asked them to say prayers. “Sinabihan kami ng doktor na magdasal dahil hindi raw maganda ang lagay ng anak ko, 50/50 daw. Hindi kami pinayagan ng doktor na makita ang anak namin. Sinisilip lang namin sa maliit na butas ng kwarto at nakita ko na may mga tinuturok sa anak ko dahil nawalan daw ng pintig ang puso niya.”

At past midnight, they were finally allowed to see their son and were told that he’s getting better. “Sa awa ng Diyos, nakaraos ang anak ko.”

Thankful for CJ’s successful operation, the couple has yet to face another challenge, that is, how to pay their hospital bill. Although initially assured by the doctor, Cheradee couldn’t help but worry.

When CJ got the doctor’s clearance, the couple were surprised when they were told by the billing clerk that their hospital bill was already settled, no out-of-pocket expenses needed. Almost 70 percent was covered by PhilHealth and the rest by the social services. In disbelief, Cheradee was speechless and did not even bother to ask how much was the cost of the operation. “Hindi ko na alam kung magkano yung total bill, basta natuwa lang ako nung sinabi na wala daw babayaran.”

“Maraming salamat, wala kaming masabi sa sobra talagang tuwa. Kasi kung kami lang talaga, hindi maooperahan ang anak namin.” Mabuti nga meron pang PhilHealth para matustusan ang gastos namin sa pagpapaospital….laking tulong talaga sa mga mahihirap,” says the very delighted Cheradee.

Overwhelmed with their experience in availing of PhilHealth’s Z benefits, Cheradee has an advice to those who are not yet members, “Sa mga hindi pa member ng PhilHealth, magpa-member na kayo kasi malaking tulong talaga ang PhilHealth lalo na sa mga may sakit tulad ng anak ko.”

Cheradee did not consider poverty as a reason for not seeing a doctor especially if there is a social health insurance that can be counted on in times of illness. “Kaya sabi ko sa asawa ko, kung may pera, hulog lang ng hulog sa PhilHealth,” said Cheradee, adding that she will also ask help from their barangay if she can still be included in the “Listahanan” of the Department of Social Welfare and Development to continuously avail themselves of the PhilHealth benefits.

The smiling CJ, who is now one year and eight months shows continuous improvement, with no signs of a tet spell recurrence and plays like a normal child – indeed, a very good reason to smile about.

Tetralogy of Fallot is among the Z benefit packages being paid for by PhilHealth. The package rate for TOF is P320,000 which covers the total cost of treatment to ensure totality of care. Other cases under the Z benefits include Acute Lymphocytic Leukemia in children, Breast and Prostate Cancer, Kidney Transplant, Ventricular Septal Defect, Coronary Artery Bypass Graft, Mobility, Orthosis, Rehabilitation, Prosthesis Help (ZMORPH) for the lower limb, selected Orthopedic Implants and Peritoneal Dialysis for End-Stage Renal Disease (PD First).

To avail themselves of the Z benefit package, a PhilHealth member or a qualified dependent should pass the selections criteria and should be pre-athourized by the contracted hospitals before provision of services.

PhilHealth members who are not qualified under Z can still avail themselves of the PhilHealth benefits under the All Case Rates when confined in any of its accredited hospitals nationwide. (Michelle S. Nisperos)