American Gringa Gweilo: Pharmacies

[This is the second part in a series of articles examining cultural differences between the United States, Brazil and Hong Kong, the three countries in which I've lived.]

I meant to post this a few weeks ago, when Hong Kong raised the avian flu alert from Code Tweety to Code Big Bird after infected chickens were found on a poultry farm. Since being hit with both SARS and bird flu, Hong Kong is rather paranoid about possible infectious diseases and seems to go into panic mode if even two elementary-school kids end up in the hospital with flu-like symptoms.

Elevators have signs on them to comfort riders that cooties are cleaned from the panels and doors every 2-4 hours, you can't wear a hat while going through customs at Hong Kong International Airport because there are automatic temperature readers to see if you're a bioterrorism attack waiting to happen, and people walk around with surgical masks on to not let the germs in (or the germs out, if they happen to have a run-of-the-mill cold and want to be considerate).

With the latest round of bird flu, my apartment building has posted warnings on precautions we should take, and the Korean fried chicken place wants to ensure customers that it's not using Chinese meat.






What does this have to do with pharmacies? Part of the problem in Hong Kong is that the smaller Chinese pharmacies (as opposed to the larger ones attached to a British-based drugstore) have no issues with doling out antibiotics without a prescription, leading to more drug-resistance strains. "I want Tamiflu!" Okay. "How about some Cipro?" Why the hell not?

They're not as regulated as in the United States, where you're treated as a common junkie or criminal and forced to hand over ID if you want an over-the-counter medication that will knock you unconscious for the duration of your illness. And when you need a basic medication, such as birth control pills or acne medication like Retin-A, you need to pay for an office visit to get a prescription (because everything requires a prescription) and cross your fingers that it's covered because if not, you'll be paying an amount far higher than the rest of the world.

Birth control pills are sold over-the-counter and at a cost of about US$15 for a month's supply in Hong Kong, and I routinely describe the symptoms of my latest illness to the local pharmacist at a chain drugstore and he helps me choose the appropriate medications, which cost considerably less than they do in the United States if you don't have a prescription drug plan.

Pharmacies in Brazil are similar to Hong Kong in how they operate. Most medications can be had without a prescription, more readily at some pharmacies than others, and birth control pills don't require one. When I was sick while living in Brazil, I'd go to the pharmacist as I do here, and she'd walk me through the store to find the appropriate over-the-counter medicines after giving me more potent ones from the pharmacy. Pharmacists in Hong Kong and in Brazil aren't pill counters, like ones are in the United States. They're viewed as legitimate experts in the health field and aren't beholden to god-like doctors for basic diagnoses.

So, while I might die of drug-resistant avian flu due to underregulated, lax pharmacies, at least I can get a real cold medication without being prejudged as a meth head and my name going in a database.