Medications and Pharmacies

Typical pharmacy in Latin America. A few are twice this size and rarely much larger.

In all of the countries that we have been in so far (Costa Rica, Nicaragua, Panama, Colombia, and Ecuador), the pharmacies are similar. They are usually much smaller than a 7-11 store in the USA; often you just walk a step or two from the sidewalk to a counter. They tend to have medicines in a series of deep drawers behind the counter. The staff doesn’t wear any type of name tag or badge so I don’t know if they are “pharmacists” or not. They do tend to be pretty knowledgeable and able to recommend products for colds, coughs, bug bites, etc.

In Panama, Ecuador, and I think Costa Rica and Nicaragua as well, they are called farmacias but in Colombia they are usually called drogerias.

I know in Nicaragua, I could buy generic Xanax and Ambien with no problem, and no prescription. In fact, the generic Xanax was on the top shelf of the glass counter. No limits on how much I could buy either. And very cheap, under $0.30 each if  I remember correctly.

When I talked to the doctor who came to see Dan when he was under the weather in Popayan, he said that the only things that require a prescription in Colombia are antibiotics. I am glad that they require a prescription but it is amazing that you can buy anything else any time you want.

The farmacias tend to have a small selection of supplements, dental items, personal care items, etc. It will be interesting to see the differences in the future countries.

Blister pack of acetomenophen

You don’t generally see items in bulk. They are usually sold by a blister pack sheet, even something as common as acetaminophen is sold by a sheet of about 10 or 12 tablets. Selection is much smaller and options different from the US. For example, if you want a cream to stop itching from mosquito bites, you can’t get a benadryl type cream. And what you can get in one country you may not be able to get in another.

I take a large dose of Vitamin D3 every day so I like to get 5,000 unit gel caps but you are lucky if you can find 2,000 units caps and if you do, they are expensive where as in the US they are pretty cheap.

Smoking

On the boat I had an extensive talk with one of the passengers about her smoking. Susie is a medical doctor in England in her mid twenties. She is a delightful, intelligent, and insightful woman. She has a fear of dementia and feels that dying from the effects of smoking is a better way to go then to live longer with dementia.

Hmm, I’d never thought about it from that perspective. I tried to understand what she gets out of smoking and I know that you current and former smokers can understand the way the nicotine relaxes you and relieves stress far better than I will ever be able to.

After that discussion I felt very self-conscious when anything related to being the oldest person on the boat (other than Dan and I, the oldest person, including the captain was 31) came up (slow/more cautious than others moving about, trouble getting in or out of the dingy, climbing into the boat, etc.). I know she wasn’t referring directly to getting older but her concern about losing the ability mentally but it did make me more aware of the impact of aging on my body. And I am sure that the reason that I usually only pick up the last word in a sentence of fast Spanish is because my mind is a bit slower to process what I hear.

I don’t like that I can see myself slowing down but I do accept it. I do what I can to minimize that by staying active. I’m glad we are traveling now because I can see that it would be harder in a few years. Even now, if I stand too long or walk too far without breaks that my right leg complains quite loudly. I have decided to use a wheelchair when available when we are in places with a lot of standing like a museum. I did that at the Botera Museum in Bogotá. Didn’t like being in the chair and it was hard on my hands so Dan pushed me but it did allow me to view the exhibits without bothering my leg.

Like they say, aging beats the alternative (dying) so I’m glad to have that option.

Healthcare in Panama

Invoices from Clinic visit. Note the charge for the “consultation”, $5 to see the doctor.

We’ve had more occasion to check out the Panamanian healthcare system in our travels than we would have preferred. First Dan had allergies or a virus and saw a local doctor who was raised in the USA but got her medical training in Panama. I saw her to see if she had any different suggestions for the chronic insomnia that I have (some help).

Then last week when we went to Bocas Del Toro on the Caribbean coast I got “amoeba”. The water in Bocas is notorious but from what I can tell, the incubation period for amoeba is 1-2 weeks so I can’t blame it on Bocas. Amoeba seems to be the underlying problem causing dysentery. Gross bloody mucus stools, intense cramping. It came on quickly and I went to the Bocas clinic the next morning.

The clinic is in a large old building. Staff was professional but not overly friendly. The wait for care wasn’t long. I saw a doctor with a face mask on who asked me about symptoms and allergies. She ordered basic blood work, two IV antibiotics, and medications to take home.

It is obvious that sanitation is not a very high priority in this area. While we didn’t encounter mosquitoes in spite of some standing water in some ditches and the doctor wearing the mask, the rest was cursory. Not a single restroom was fully functioning with paper, soap, and flushing toilets. There was some combination of those things in the various restrooms but the only soap was in the treatment room.

The prep of my arm prior to the blood draw or IV insertion was a very quick swipe with a piece of cotton that had alcohol on it. It must have been adequate though.

I went home with two oral antibiotics, antacid, and probiotics. I was shocked (and grateful) that the doctor ordered the probiotics. The IV antibiotics started working within a couple of hours and I am now back to normal.

The entire cost of my test and treatment? $37 which included the medications. I would have gladly paid more to have more sanitary conditions but I know many of the locals couldn’t have afforded that.

Aside from these “adventures”, Dan has seen a skin doctor and will see her again this coming week. The office visit was $40 and the skin biopsies will be about $150 each. I plan to see a dentist locally in the next week or two for cleaning. My understanding is that the dentist himself/herself does the cleaning and that the cost is in the neighborhood of $50.

And in case you are wondering, I really have no idea how I got the amoeba. We have been really careful and use the reverse osmosis water to drink, brush our teeth, rinse many of the dishes, wash veggies/fruits. I had gotten a little lax and drank water in a restaurant in David but so did Dan and he didn’t get sick. We have gotten stricter again, just to be sure.