Tuesday, October 29, 2013

Droga! - São Paulo

And now it's on to one of my favorite complaints. The drugstores in Brazil. No, let me limit myself to São Paulo which is what I know best. I will try really hard not to do too many comparisons with the US, which has its own drawbacks (powerful pharmaceutical industry for one, lawsuits for another), but the drugstores themselves seem to work pretty well. My kingdom for a Walgreens. Oops, so much for fair comparisons.

This morning I was not feeling well and went to our giant box of medicines in the bathroom. It is a crate--drugs for kids, bandaids, Bang-Aid (what my husband calls Ben-Gay), tummy medicines, headache medicines, etc. Since I haven't been in the US for a while, my US supplies are running low-ish. The main reason for my buying my medicines in the US is that I know them--I have been around them most of my life. The second reason is it is easy to tell what they do for you. I'll get to that in a minute. Also they are less expensive there.

My kids are given US medicines almost exclusively, rather than Brazilian. Yes, acetaminophen is in fact paracetamol (Tylenol's formula in the US and Brazil, respectively) but I feel better when I can read the label well. Of course when they need a mega-blast of antibiotics, I give them the Brazilian versions. 

So, here is a random selection of what I found in the Crate o' Meds:

No, I haven't a clue what any of those do. Okay, the Imosec has got to fix up the tummy since there is actually a drawing on that one showing a tummy in lighter color. Yeah, and I do recognize the revectina as that is a lice preventative that I bought for the kids when a friend who spent the weekend was discovered to have them. So then I had to check if it was only me that had no clue on these meds. I asked the Brazilian husband what they did. He didn't know. He googled them. Sigh.

All medicines here (the ones you need prescriptions for) are in these white boxes with red stripes which say you need a doctor's prescription. In actuality, you don't. On these lighter meds, I have only rarely been asked for a prescription, and it is more to discover how many milligrams or pills are required (don't get me started on the number of pills thing--okay, do, but hold on a minute). For antibiotics, the rules changed about four years ago. It used to be that you could self-medicate on antibiotics. And people did. For any colds or fevers or whatever, people would just order up some antibiotics. Brazil was creating the superbug. I have to say that I find antibiotics prescribed way more frequently here than in the US, but I have no statistics to back me up. Just personal opinion. 

Now you need a doctor's prescription and "segunda-via" (second copy) for antibiotics. As in one copy for the drug store, and one for you to remember what you are supposed to be doing.  For a while there, phenobarbitol (taken by my epileptic dog) was a "blue copy" drug--you needed a special prescription with a blue copy that had even more rigid rules of stamps and duplicate and addresses etc. And ID. Fortunately it is no longer a blue drug--they were controlling it for a while because people were taking it as a calmant (why didn't I think of that? Cheap valium)--but is still a "segunda via" drug. 

Are you following me to here? I'm okay with all of the above. I have to learn the drugs here because I live here. If I am blind by the way, I am in a good place--all of these drugs have Braille on the boxes. Not sure it tells the people anything they need to know besides drug name, but there you have it.  No, there are two specific things that make me INSANE about the drugstores here (besides the fact that they don't stock doo-dads, and birthday cards, and candy and milk. Sigh. I love you Walgreen's). 

1. Quantities of pills. In the regular drugstores here (Droga Raia, Droga SP, etc), there is no manipulation. As in, if you have been prescribed 7 days of a drug, twice a day, you need 14 pills, right? But you cannot get 14 pills. You can get 20 pills or you can get 10 pills. Pills come in boxes with a set quantity only. You will have to buy two boxes of 10 pills, and then just chuck 6 pills. Or flush them into the Rio Pinheiros. Or give them to your maid who will probably actually take them for some reason or another.  What is the deal with that? What a waste. And why do people go to pharmacist school if they don't learn how to count pills into bottles, a la USA? Yes, it takes longer to get your drugs, but you get just what you need.

For example, here is bottle of Cipro I got last year from the US. It has exactly 10 pills in it. Well, okay, less than that now. Sorry, I am not showing the face of it with all the doctor info because of privacy. What I am showing is all the disclaimers about how it can make you sleepy, dizzy, crazy or sunburned. That is the bad part of the US--lawsuit city. In any case, I needed 10 pills, so I have 10 pills. No waste.

2. Lack of computerization. Here is where, I am sorry but it has to happen, I am going to compare with the US. Okay, so I am from the east coast of the US (NY/CT) but when I go back to visit, I may be anywhere from Boston to San Francisco. If I run out of a medicine that is prescribed for me, I can walk into any Walgreen's (where my prescription is registered) and get it filled. Any single one. It is in a computer.

We have computers here in Brazil. In fact, most pharmacies have them. They are used primarily as a way of looking up discounts or seeing stock. There is no unified pharmacy network in any pharmacy chain. Even the big guys. The biggest chain, Droga Raia, which just sucked up Drogasil, has revenues of R$4 billion (US$1.8 billion) and has 9.5% of the pharmacy market. Yet cannot unify its computer system. I have to tell you that Droga Raia is my favorite of the drugstores--the queen of the pigs. Another drugstore chain once accused me of forging my doctor's signature, so I won't go there anymore. For the record, I did not.

I have a Droga Raia about a block away from me which is where I always get Caju's epilepsy medicine. And each month, for the last five years, I have to bring a new prescription with me. There is no record that my dog has been taking this drug for his whole life and will always be taking it. There is no annual prescription (Walgreen's still has record of it in the US from 5 years ago). I cannot go to Droga Raia in another neighborhood and have them look up the prescription and give it to me. Give me a break.

I know there must be historical reasons for all this. Perhaps the military dictatorship was involved. I am sitting here anticipating feedback from anyone who knows anything about this. In fact, I'd be willing to just have you make it up, but make some sense out of all this. Please!

And of course, I must add a Portuguese lesson to all of this. When you hear someone exclaim "Droga!", it doesn't actually mean that they are asking for some drugs. For example, if I miss my train by a half second, I would say "droga!" and it would mean "darn" or "shoot". It is not a swear word, but probably shouldn't be said in front of my 94-year old grandmother-in-law.  "Droga" can also be used to complain about something of low quality or little use (see last paragraph here). Perfect, don't you think?


  1. Keep calm - keep adapting. Little by little.

    You can use the Google machine to help you know what drugs are and what they are used for. Google the name and then translate the page(s) that come up.

    It is also important to compare prices among the numerous pharmacies. Prices for exactly the same med can vary wildly.

    Hang in there...

    1. Thanks for your comment, Jim. I feel like I'm pretty well adapted after living here 8 years but I don't think the length of time will make sense of certain things for me. Google is, as always, a lifesaver.

      You are absolutely right on the pricing. I had assumed that prices would be higher at some of the smaller "no-name" pharmacies in the neighborhood because they wouldn't get mass discounts, but that has not been the case. Usually I end up at Droga Raia because of its proximity to home. That also saves some costs.

  2. When Ifirst came here I learned a lot of Portuguese by watching tv shows in English and reading the subtitles to learn the Portuguese words and phrases. I initially thought 'droga' was a very rude word because it is used as a translation for practically every swear word going in English. It got a few laughs at a bar one night when I kept using it and, well you can imagine some of the phrases other people were coming out with.

    1. haahaha! That's true! It does get worked over as a synonym. It makes me laugh every time. I wonder what the origin of its usage is...will have to hunt that down. Where is Andrew Francis to keep me honest?

  3. Halloween is the time of year when I really miss U.S pharmacies (in my case, CVS). Walking into a drugstore and coming out with bags of decorations, candy, fake blood, and no medicine! Or stopping by right after Halloween and getting three bags of candy corn for the price of one because they´re trying to get rid of the leftovers. The only Halloween-related item that you can find in a Brazilian pharmacy would be stomach medicine for dealing with an upset stomach after eating too much candy or Engov (this deserves a separate blog entry!) if you drank a little too much at the costume party. Country roads take me home....

    Now on to some Brazilian pharmacy feedback (you asked for it!). A Brazilian pharmacist makes about US$ 15K per year versus US$ 117 K in the U.S. so I guess we can´t consider them health practitioners in Brazil. But the main reason why drugs aren´t dispensed in Brazil (pill by pill) is for fear of counterfeiting...at least the packaging would make it a little tougher for your neighborhood pharmacy to do a switcheroo. And as you mentioned, dispensing the exact number of pills takes time...what would you do in a Droga Raia without the aisles full of Halloween stuff to keep you busy while you wait?? Happy Halloween!!

    1. Thanks, West Virginia, for the commentary. Yes, I also grew up with CVS in Connecticut and you're right, Halloween is the best holiday there. Can't stand Christmas with all of its musical electronics and tinsel trees but Halloween, now that's a holiday!

      That salary difference is unbelievable! (and I should have gone into pharmacy in the US, darn). But the counterfeiting thing is crazy. I guess I'm glad I have to throw away pills rather than taking sugar pills....