Part 1 of 2
MAGSAYSAY, Davao del Sur (MindaNews / 5 May) — In Barangay Blocon of this municipality, far from urban centers where medical services are readily available, the decades-old practice of “tandok” persists.
Practitioners believe that tandok can remove the rabies from an infected person by forcing out the blood though an improvised suction apparatus like the horns of animals such as deer, goat, and carabao.
The magtatandok (tandok practitioner) creates small incisions on or near the wound of the animal bite for better bleeding. Horns are then placed over the incisions, and the magtatandok sucks out the air with his mouth, creating a vacuum, which in turn would extract the blood.
Tandok has been practiced by the Borja family for three generations. But most likely way beyond that from where it first originated, as the patriarch who first brought it here learned it in Luzon before he migrated to Mindanao.
The current practitioner is Romeo Piñonal, 55, who is married to a Borja.
The women in the family, however, are not allowed to practice tandok as the activity can be quite nerve-wracking, with the incisions and blood involved.
Piñonal learned the practice from the elder Borjas. “The father of my father-in-law started this, and then I learned this from my father-in-law,” he said in the vernacular.
Even the small white flat stone that he uses supposedly to detect how much the virus has spread in the body is inherited from his grandfather-in-law, who was originally from Luzon who learned tandok there.
Tandok process
During MindaNews’ visit on April 28, a patient (who refused to be named) sought the help of Piñonal. She reportedly had been bitten by a puppy a week earlier.
She was told to settle on a Monobloc plastic chair and placed her legs in another chair so it would be easier for Piñonal to check the bite, which is on the left heel.
Piñonal rolls over a smooth flat white stone, slightly larger than a 25-centavo coin, from the site of the bite up to the legs. He does that 2-3 times. Piñonal would then stop when the stone supposedly sticks to a specific area, giving him an idea where the virus has spread so far.
He then proceeds to create small incisions using a razor blade (bought for ₱5 from a neighborhood store) in three areas near the bite site. He covers the incisions with goat horns.
The number of the horns to be used, he said, largely depends on how the virus has spread so far, and the days passed after the patient was bitten.
It is advised that the patient seek tandok immediately after being bitten, but Piñonal said that as long as it is still within 14 days, it is still treatable.
The sharp part of the horn has a small opening where he would suck the air out. He then covers it with soft wax to create a vacuum, which would force the blood out.
Piñonal leaves the horns stuck to the skin for 10-15 minutes to get enough blood. He said it is during this process when the rabies virus is removed from the patient’s body.
“Fifteen minutes would be the most, because if you go more than half an hour, the skin will darken,” he added.
Piñonal said it is important to get the blood with the rabies virus out of the body through tandok before it spreads all over.
The patient is then informed of a few things to avoid after undergoing tandok, like not to take a bath until a day after because, Piñonal said, the patient will be prone to fever or worse, flu.
“You will have fever because water can get inside the incisions. But after a day, when the wound closes, the patient can already take a bath,” he said.
Consuming squid meat, carabao meat and mackerel fish (local name: pirit) and drinking soda and alcoholic beverages such as coconut wine (local name: tuba) and beer are also prohibited within three days after undergoing Tandok, as these can cause relapse (locally known as bughat), Piñonal said. Bughat is a combination of severe headache, muscle pains accompanied by body weakness, sore eyes and gums as if the teeth will fall.
Piñonal believes that tandok must be effective because none has come back to complain of illness, but returned with thank-you gifts and presents.
Continued patronage
The study “Influence of Traditional Medicine (Tandok and Tawak) on Marinduquenos’ Knowledge, Attitudes and Practices and Practices on Handling Animal Bites” by Benjamin O. Sosa III from the College of Medicine of the University of the Philippines Manila published in the Philippine Journal of Science in June 2016 revealed that the majority would opt for non-medical alternatives rather than consulting a medical facility for vaccines.
In the case of Marinduque, patronage of the services of a magtatandok is one of the most prevalent ways in handling animal bite, aside from promotion of profuse bleeding by adding pressure on the wound and the use of garlic to rub against the wound.
Tandok, according to the study, are perceived by Marinduquenos’ to be as effective as anti-rabies vaccines.
The presence of a magtatandok in the area also influences the health-seeking attitudes of residents, due to the practitioner’s proximity and easy accessibility. Residents would not care to visit a medical facility for a second opinion on their bites, content with the treatment from the traditional healers.
For Susan Lucero, 40, her continued patronage to tandok is due to its easy accessibility compared to seeking help from clinics.
Lucero is a barangay health worker of Blocon, while her husband, Marvin, 43, is also a magtatandok. But aside from handling animal bites, her husband also uses the horns for tandok to treat colds and spasms from muscle fatigue, a similar practice to ventosa except that there are incisions like tandok.
Even Lucero’s children, when bitten while playing with pet animals, would seek tandok from their father, and no longer avail of post-exposure vaccine.
“We have never tried anti-rabies vaccine—might be Lord’s mercy—as my husband grew up relying only on tandok,” she said.
However, Lucero said most of her husband’s clients consider tandok as “first aid” before going to the doctors. But a few would not anymore proceed to seek medical help. Lucero, however, said they would still continue to encourage the patients to go to the clinics and not rely solely on tandok.
The continued patronage of tandok could be attributed to the cost of the anti-rabies vaccine. While a tandok session only costs ₱15 to 30 per horn, a single dose of post-exposure prophylaxis can be costly, from ₱1,250 to ₱P1,800, depending on the severity, category, and the type of vaccine used, according to Jeanalyn Monticillo, a nurse who is the coordinator of the municipal Animal Bite Treatment Center in Magsaysay.
Mary Jean Quinto, 37, also a barangay health worker, admitted that she, too, had sought tandok from Piñonal after getting bitten by their pet cat. She did not anymore seek medical help as she did not feel unwell after getting tandok.
Quinto agreed with Lucero, saying tandok is common to residents considering the high cost of the anti-rabies vaccine.
“We seek alternatives because of the lack of finances. But when we do have money, it is really advisable to get the vaccine,” Quinto added.
Caution versus tandok
Animal bite treatment centers, however, caution against relying on tandok as a treatment for rabies as it is almost universally fatal once symptoms appear.
Monticillo told MindaNews that tandok can sometimes complicate the rabies treatment and does nothing to eliminate it.
The availability of tandok in the community also hinders the monitoring and surveillance of animal bites as some patients, after getting tandok, will no longer seek rabies treatment from the facility, she added.
In Magsaysay, there have been increasing cases of animal bites—from 1,080 cases in 2023 to 1,800 in 2024. As of April 2025, the ABTC already recorded 600 cases.
Monticello noted that while Magsaysay residents’ health-seeking behavior is high, usually consulting medical experts for health concerns, they tend to seek tandok before going to the animal bite center simply because tandok is readily available.
“We always tell them they do not need to seek tandok because it will never give them protection against rabies,” Monticillo stressed.
Rather than eliminating the virus, patients might suffer from tetanus due to the open wounds from the tandok, she said. Suctioning a wound may remove some superficial blood but does nothing to eliminate the virus, which quickly travels through the nervous system, Monticillo explained.
This was also reiterated by Mary Divene Hilario, rabies control program coordinator at the Department of Health-Davao Region.
She said that creating small incisions on or near the bite site poses great risk. She pointed out that although the rabies virus passes not through the bloodstream but the tissues or nerves, so if an incision is created, it is just like helping the rabies virus to enter the human body.
Hilario said that patients may believe they have been treated and feel alright after a tandok session, but it is most likely that the animal is not rabid in the first place, and not that tandok is an effective treatment against rabies.
“Not all biting animals are rabid, especially those who got vaccinated. They might just be provoked, that’s why they bite,” she said.
Dr. Jasper Mijares, a veterinarian, noted that rabies has an incubation period and is not detected in humans before the onset of the disease. He pointed out that only when the biting animal is tested in a laboratory that it can be confirmed to be rabid. But only after the animal is killed and its head submitted for testing.
“The danger is when the animal is rabid, and the patient feels like tandok already treated him, he will no longer take extra precaution,” Mijares said.
He added that the practice only gives a “false sense of security” to the patient. And since there are no diagnostic tools for detecting rabies infection before symptoms show, the patient would claim tandok is effective.
“If you go beyond a certain period and the virus has invaded your nervous system, there is no medication for that. So why risk going to tandok?” Mijares stressed.
He emphasized that if the patient does not know the biting animal, or where it came from, and will never see it again, it is better to get the post-exposure prophylaxis for extra precaution.
The World Health Organization reported that once the virus infects the central nervous system and clinical symptoms appear, rabies is fatal in 100% of cases. The incubation period for rabies is typically 2-3 months but may vary from one week to one year, depending on the virus entry and the viral load.
Initial symptoms include generic signs like fever, pain and unusual or unexplained tingling, pricking, or burning sensations at the wound site. As the virus moves to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.
Clinical diagnosis of rabies is difficult without a reliable history of contact with a rabid animal or specific symptoms of hydrophobia (fear of water) or aerophobia (fear of drafts or of fresh air).
Monticillo reported the existence of tandok in four barangays in Magsaysay, with only two remaining in operation, namely, in Blocon and San Isidro. The magtatandoks from Barangays Barayong and Dalawinon have already ceased operations.
However, Monticillo noted there are only a very few reported deaths due to rabies in the municipality—only one for 2022 from Barangay Maibo, one each from Glamang and New Ilocos for 2023. There were no reported rabies deaths in Magsaysay in 2024 even though Davao del Sur had five deaths.
She recognized that changing the health-seeking behavior of the people is difficult, especially when services to help them fall short and tandok is easily accessible and readily available.
Rabies treatment requires three doses of post-exposure prophylaxis (depending on the category). In the Rural Health Unit of Magsaysay, Monticillo said, only the first dose is free of charge while for the remaining doses, patients will have to spend out of their own pocket.
Hilario, however, reported there are no tandok-related deaths in the region. But she believes that the patients may not be divulging it to health workers during investigation of history tracking.
Every patient that seeks assistance from animal bite treatment centers is required to fill out a form answering the history of the animal bite, whether they performed wound washing, and if they sought other treatment methods, including tandok.
While Hilario recognized the existence of tandok as a deeply rooted tradition, she urged practitioners to still convince their clients to seek assistance from animal bite treatment centers to ensure protection. (Nova Mae Francas for MindaNews)
This story is published with the support of Canal France International under the Media for One Health program.
Tomorrow: Rabies treatment and prevention underfunded
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