Regulation of pharmaceuticals is not something that has reached Cambodia yet & if you know what drugs you want or need, then you can pretty much buy any medication over the counter.
My Cambodian friend had a fever & cold symptoms so came around to my house asking for my advice about what medication to take, as well as subsequently passing it on to me - as I type I am experiencing both rigours & chills. She produced the above pick & mix bag of drugs that her local 'pharmacy' had given her & wanted to know what, if any, she should take.
This little bag was all she was given. No explanation of what drugs they are or what they are for and lets not worry about allergies, adverse effects & contraindications. Most importantly she was only given one dose of each type of drug, as that is all she had asked for. No need to wonder why there is 70% amoxicillin resistance in streptococcus bacteria here.
In her bag of tricks was;
- Big yellow round sealed tablet - Known by J & me as "yay's little helpers", contains Paracetamol 500mg, Phenylpropanolamine 25mg & Chlorpheniramine 2mg. Basically the Cambodian version of night nurse. Generally accepted as useful for cold & flu symptoms but the dose is 2 tablets taken up to 4 times a day.
- Red & yellow capsule - Amoxcillin 500mg. One dose is about as much use as a ashtray on a motorbike or a Cambodian pharmacist's advice. Have I mentioned drug resistant bacteria & over use of antibiotics here before?!
- White round tablet - according to pill identification wizard its Lorazepam - a sedative or sleeping tablet
- Large yellow oval tablet - multivitamin, although there is no evidence that it shortens cold symptoms it remains a common cold remedy, so I will give them this one.
- Yellow small tablet - either Ranitidine for excess stomach acid or Clarithromycin an antibiotic. Neither are indicated
- Pink small tablet - Dexamethasone. Because here you get a steroid for everything even if its been shown by evidence based medicine to increase mortality rates e.g. EV71
One common theme is if you go to a private clinic or pharmacy without knowing what it is exactly you want you will always leave with 6 different types of medication - its the rule. I have been told that in Cambodian culture odd numbers, particularly 3 is lucky - not so when it come to making money out of sick people it would appear.
Another friend (English) asked for my advice about his infected burn on his leg. He had attended the 'best' private clinic in town & had told them his concern about having an infection. He too received a booty bag, but of 3 days worth of medication, when after this his leg just was worse he then asked for my advice.
In his bag of wonders were;
- Enzyme tablets - for digestion
- Paracetamol
- Cox-2 Inhibitor - an anti-inflammatory drug
- Omeprazole - for excess acid in the stomach
- Multivitamins
- Antihistamine
When I informed him that no where in his smorgasbord of medications was there even one antibiotic he was genuinely surprised and understandably a little annoyed. After all why in a country where antibiotics are over used would you not get given antibiotics when suffering with an obviously bacterial infection of a large burn & resulting cellulitis of your entire lower leg.
After 30 months working in & witnessing the Cambodian health care system it takes an awful lot more than this to surprise or shock me now.
No comments:
Post a Comment