Navigating Ecuadorian Pharmacies

When I first walked in to a pharmacy in Ecuador I was greeted by a sight very similar to one in a U.S. pharmacy. All the regular items were available: personal hygiene products, snacks, bug sprays, and first aid kits. Quickly I realized that something was missing and that something was all the medications. They were all kept behind the counter, including non-prescription ones. In Ecuador, and many countries south of our border, they are more cautious about crime, so I didn’t think much of it. I’ve traveled through all five of the climate zones in Ecuador this semester, so I wasn’t surprised when I got bad seasonal allergy symptoms. After four trips to the pharmacy for one illness, I learned pharmacies and medical laws here differ greatly from the U.S., despite appearances.

In Ecuador there is a problem with people with lower incomes self-medicating, rather than going to the doctor. Despite there being free government hospitals open to everyone, many people don’t like going to them. They aren’t the nicest and sometimes have longer lines. Many of the poorer citizens don’t understand the doctor or feel they are looked down upon. Traditional healing is also more embedded into the culture here. All these reasons make sense, but occasionally I’ve seen someone put off treatment for far too long for any of these reasons to be logically understandable. On a bus I was on a man begged for money to treat a tumor that looked to be the size of several apples. I’ve been told that there are some cultures in Ecuador that simply don’t go to the doctor unless there is no other option. All this is part of the reason why everything is kept behind the counter. People are then forced to speak with a pharmacist about even minor issues and, hopefully, this will protect them from making easily preventable mistakes.

This is a solution for a very Ecuadorian problem and every country must do things differently because of their own unique needs. However, this system is difficult for foreigners and in some cases maybe even dangerous. Discussing names of medications and chemicals can be a challenge in one’s native language, let alone a second language. I very quickly missed the system back home and thought of how much easier it would be to translate words and choose the best medication and strength if I could only look at the box.

Eventually, I started to get the hang of the system and learned how to explain my systems and ask if they had anything to help. I also made it a habit to double check the directions and dose with the pharmacist, as the information sheet is purposefully removed from the box to help the self-medication problem. It was annoying at first, but I was proud for learning how to do something so intimidating in my second language. Then I realized everything I didn’t know.

The first big difference I learned about was that pharmacists here do not have the same level of education as those in the states. This whole semester I had been trusting them just like I do at home when, out of curiosity, I asked my host mom and was told they only go to school for three years. I did some research on pharmacy schools in Ecuador. Some programs last five or six years with courses like those taken in the states. Shorter programs can be completed in two to three years and mostly cover the business side, with only a few modules in science. In the United States it takes six to eight years to receive a PharmD.

Something else that was odd is that it is possible to buy prescription medications without proof of a prescription. Last night I went to the pharmacy and bought steroids without a doctor sending any paperwork to the pharmacy or even telling me to buy them. What distinguishes prescription drugs from non-prescription drugs here is that the prescription drugs come with absolutely no instructions, forcing patients to go see their doctor. To clarify, no medications come with the instruction sheet that is in every box of medicine in the U.S. Pharmacists give directions on how to use the non-prescription products and tell you to ask your doctor about prescriptions. I’m sure you can see some flaws in this system.

Navigating such a strange system, while sick no less, was an experience. I am thankful I have my aunt, who went to pharmacy school in the U.S., to help me out. I am glad to go back to a system I understand soon, but don’t want to only be negative about what’s going on here. Ecuador’s health care system has different needs and weaknesses, so it can’t go about things the same way we do. Also, their prescription system isn’t as easy to work around as one would think. Many brands of drugs that are only sold in this area don’t have dosing or other information online, probably because of these laws. Some Ecuadorians have mixed opinions on the laws here or question their effectiveness. No law is perfect and I sincerely hope this system that drove my sick-self crazy does what it was designed to. I don’t know this system well enough to suggest improvements, so I’ll hold back on criticisms and stick to helping future exchange students and travelers figure it out. I believe I have a right to critique and push for change in my own culture, but not necessarily others. I will always be sooner to suggest switching things up than elsewhere.

Tips

If there is something you are likely to need, buy it before coming. I’m really wishing I had brought my favorite allergy medications; I can’t find any products with the active ingredients of either one, so I’ve been suffering. The selling of Tylenol is illegal here, so stock up before coming. Don’t worry, having it isn’t illegal and, even if it was, the cops have better things to do. I also recommend bringing Tums and keeping some in all your bags. Stomach issues are a traveling norm and having Tums was a big help my first three weeks.

Double check everything with the pharmacist. The information sheet that they pull out of the box before selling here includes doses, side effects, and known interactions. As this information can’t always be found online, tell the pharmacist anything they might need to be aware of and double check to make sure you understand them.

If you are looking for a specific drug use the Spanish chemical name. To do this lookup the active ingredient, then type that ingredient and “Spanish” into google. If a Spanish version exists it will pop up at the top, if not it’s still possible to find the drug under the English name. I now know the active ingredients of Claritin and Zyrtec in two languages, so you should all be very impressed. Another thing I do in advance is look up the doses or concentrations available for sale. Since I can’t look at the boxes here to choose between regular and extra strength I like to have an idea for when they ask me what strength I want. The pharmacists can also help you choose. Also, keep your browser tabs open and show the pharmacist what you want to avoid miscommunication.

Go to the doctor sooner here. Between the different education levels of the pharmacists, how difficult it is to tell the education level of the employee you’re speaking to, the difficulty of adjusting to a new system, and the fact that your immune system is weaker when traveling, this is a good idea. I had a friend go from a little warm and nauseous to not being able to walk on her own in just a few hours. Be more careful while abroad! If you want to read about that story check out a post she wrote for our Spanish class’ blog. (It's in Spanish.)