Nevermind the Pharmacists

Part One on Health and Safety: Doctors, Medicines, and Vaccines (oh, my!)
People in the U.S. have strong opinions and culture around health and safety. I hesitate to post this, because even while I feel critical about my new adopted country, I also feel protective of it. I know that my critique could be used as more fodder for the kind of people who are already xenophobic, people who are hateful and/or fearful about Mexico, Mexicans, and/or other immigrants to the U.S. Of course, all I want is to share some anecdotes about our adjustment to this country, and probably those xenophobes are not reading my blog anyway. Nonetheless, other well intentioned folks, potentially some people who I love and who care about me, are liable to be just as appalled, just as worried and upset and condemning about this country- which, after all, is the country where my partner was raised, and the country where we are raising our daughter for now. It’s a country where my heart lives now, and one that I’m not leaving anytime soon.
It is hard to share some of the negative or difficult things about my life here. People sometimes feel bad for me, feel pity, feel dismay, want to save me from it somehow, or just can’t fathom it. But I want to share, so that someday, when I go visit my city again, someday, when potentially we move back, someday, when you and I chat on the phone, the bridge between our experiences won’t feel so vast. So I hope that people can read this, and all the other negative, critical, difficult, or just wildly different things that I post, and keep in mind that this is just where I am. Every place has serious flaws, including and especially the U.S. I am not sharing this so that people will worry, or be shocked, or feel sorry for me. Rather, I want to give you an idea of my landscape, so here goes.
Doctors
My first experience with a doctor here was fantastic, since I didn’t have to leave the bed. Conan called his cousin who’s a doctor, explained my symptoms, and the cousin prescribed an antibiotic for me. Brilliant.
However, the same informality makes me nervous in terms of my baby. When we took Lucia for her first check-up, I diligently took all the paperwork from the hospital and the doctor’s office in Louisville. But the doctor didn’t even start a file for her- not a single note was taken, except by me. He also didn’t do all the same routine stuff like they do in the U.S., although maybe not all of that’s necessary? This doctor is a general practitioner, not a pediatrician, so maybe that’s the difference? I’m not sure that check-ups are the norm, so maybe that’s it? I did find out recently that there is one pediatrician (and one gynecologist!) in this town, so we’re discussing the possibility of going to see him/her for Lucia’s four month check-up.
It’s not like we have an appointment for her check-up. That’s because there are no appointments here. You just go to the doctor when you need to see a doctor. You wait if they’re not available. They have longer working hours, although they also might not be there at all, randomly. This is because most people work out of an office attached to their home. It’s nice for everyone concerned, as far as I can tell. The doctor doesn’t have to be twiddling his/her thumbs in the office if there are no patients- they can be in their house doing whatever they need or want to do there, and just slip in when a patient comes. The patient has more access to the doctor since the doctor’s “office hours” are longer, since the doctor doesn’t have to be there the whole time. The patient decides what time and day to go in. And wait times don’t seem to be longer than in the U.S., where you wait despite having an appointment.
Medicine
Antibiotics and other medications don’t come with 3 pages of warnings and information, either. They come with as little information as possible, it seems. The one bit of information mine had on it said do not use while pregnant or lactating. Even though I heard Conan tell the doctor on the phone that I was breastfeeding. Even though Conan says the doctor says that he’s gonna prescribe me a not-so-strong antibiotic since I’m breastfeeding. Even though Conan says the pharmacy person looked in some textbook to make sure it was okay. So why does my package say it’s not okay?
I’m 3 days into it at this point, and almost decide to panic. I’m also in Oaxaca City, not Juquila, so I can’t just go ask the doctor. I decide to skip my dose for the night and go ask a pharmacist in the morning. So when we pass by a pharmacy the next day, I say, “Hold on. I’m just gonna go ask about the medicine real quick.” There’s a guy that looks like a teenager working behind the counter- I avoid him. Then there’s a woman who looks like she’s at least a little more in charge, and not a teenager (no offense teens, but I’m looking for medical advice).
I approach the woman and explain the situation. “Well,” she says in a school-teacher voice, “that’s right. Antibiotics are bad for babies. It damages them.” I just look at her for a minute. “Really? All antibiotics? So pregnant women and breastfeeding women can’t take any antibiotics?” I ask, catching myself before I raise my voice. “Correct. It’s dangerous.” She affirms. I want to channel my Nonna and ask her where the hell she learned that. I want to tell her that I know that’s not true, that there are different classes of antibiotics and they affect fetuses and babies in varying degrees. I want to tell her it would be insane and more dangerous if pregnant and breastfeeding women couldn’t take any antibiotics ever. I want to scream at her that she’s probably doing more damage to women telling them they can’t take antibiotics. Instead I stare at her again for a minute, controlling myself, and give her my best sarcastic “thank you,” and storm out of the pharmacy.
“How can she be a pharmacist?” I ask Conan irately. “She’s not a pharmacist, Julia. She’s just some woman who works in a pharmacy.” He explains. “Then where is the pharmacist?” There isn’t a pharmacist, he tells me. So imagine, it’s like there’s just the Walgreens clerk there doling out your medicine. Not someone who’s studied medicines. Someone who’s maybe graduated from high school. This is the norm. Fabulous.
Antibiotics also don’t come in the quantity that you need, for some reason. They’re prepackaged, so you might have to buy a couple of packages and then have some leftovers. I didn’t realize this until Conan got an antibiotic. He was prescribed to take it for 7 days but there were only enough pills for 5 days. Then when he went back to get some more they were out of it, so he went back to the doctor and got prescribed a different antibiotic to take for another 5 days. Not particularly efficient, to say the least, but surely there’s some reason for it? I guess so the non-pharmacists can’t mess it up? Any other ideas, anyone?
Vaccines
Before we arrived in Mexico, we researched vaccines fairly extensively. Mexico and the U.S. have pretty much the same vaccines, and more or less the same schedule, which made things a little easier. We had decided, however, to delay the Hepatitis B vaccine (routinely given at birth), and had delayed the rotavirus vaccine, and were discussing skipping it altogether. Then we arrived in Mexico, and were told by a doctor that you can’t opt out of or delay any of them. They’re obligatory- and supposedly more necessary than in the U.S., according to some.
Vaccines are also free, which is great, though it means the demand outweighs supply regularly. They are only given at hospitals and health centers, not at doctor’s offices. When we went to the hospital to get the 2 vaccines Lucia hadn’t had yet, they were out. The rotavirus vaccine can only be given within a certain time frame, and time was almost up. Since it’s slightly unpredictable when a new batch of vaccines would get to Juquila, we needed to get it elsewhere. While I wasn’t that worried about her not getting the rotavirus vaccine, I didn’t want them to make her get it outside of the time frame that’s been studied as the same time frame for the vaccine.
Luckily, Conan’s mom knows somebody- a key factor in any country, as we all know. So she called her nurse friend in the next town over and got the okay for us to go to the community health center there. I, of course, have to pee while we’re there. The bathroom looks relatively clean, but I go to wash my hands and there’s no soap.
Now, this is a situation that happens often, and I could do a whole post on the lack of public restrooms and lack of toilet paper and lack of this and that, thanks to my incredibly small bladder helping to over-inform me about these things. But we’re in a community health center! There’s a sign over the sink that explains how to wash your hands effectively and tells you about the importance of hand washing. And there’s no freaking soap. And while I’d already learned to carry hand sanitizer with me everywhere, the idea of all those sick people and no soap is enough to make me ill on the spot. (I will say that the nurse in the health center washed her hands with soap in the sink right in the exam room before giving Lucia the vaccine, for the record. Thank you, hygiene gods.)
To be continued…..

Tags: expat mama, health, mexico, oaxaca