Tuesday, February 23, 2016

Visiting the Clinic

Experiences will vary from clinic to clinic and I have to add a disclaimer that my sister-in-law works here and we're acquainted with the doctors. So my experience may be slightly more favorable than others. I should also add that I think it's well in our favor that we're extremely polite, patient, and gracious for the free health care we receive. When I hear Brazilians complain about the wait times (when I had Zika I waited two hours from seeing the nurse to seeing the doctor - kids, pregnant, elderly, disabled, and the very, very sick all take precedence), I like to tell them about the time I waited in my OBGYNs for 1 1/2 hours before anyone came to my room. And then I like to add how much I'm pay for the privledge of speaking to a doctor and the additional cost of tests, exams, and medications.

So with that out of the way, it goes like this: I enter the clinic and go to a little window where I present my SUS (Sistema Unico de Saude) card and tell the attendant why I'm visiting the clinic. For this trip, I'm trying to obtain a prescription for the two migraine medicines I normally take in the United States. Before moving here, I received a six month supply of my medicine, but I'm almost out. The attendant gives my information to another person who brings it to a nurse. I wait in the waiting room until the nurse calls me.



The nurse asks me again why I'm there, my symptoms, and takes my blood pressure and weight. We discuss my migraine medicine and I explain that the bottles I've brought with me have generic names and offer the manufacturer names plus the names of the medicines here in Brazil. Thankfully Topamax is still Topamax and Imitrex is Imigran so it's not too hard to convince her of the translation. She tells me my blood pressure is really low, which I've been told all my life. I really like the nurse here. She doesn't make me feel like an idiot and helps me with my mangled Portuguese.

I'm all done and she gives my information to the doctor and I wait again in the waiting room. This is the longest part. This is where I get bumped further and further down the line. But I don't complain about it, because I remember spending hours in the US, waiting in a room by myself, wondering when my doctor would appear. And paying for it. Since this is free, I'm going to sit quietly and happily. 

Like everywhere in Brazil, the waiting room is loud and bustling. A man comes in selling round flour treats called biscotto de polvilhos in clear plastic bags. They're cheap, kids love them, and every time I've been here someone buys a couple bags and passes them around to everyone. The kids will all play together and the adults will chat because everyone knows everyone. The clinics are set up by neighborhood, so you have to live in this neighborhood to go to this clinic. In the US, I didn't see a lot of people interacting in waiting rooms. Maybe they tried to prevent the spread of illness by keeping their space. Maybe it's the cultural attitude of Brazilians - no space is personal space. Whatever the reason, it feels much more like hanging out at a friend of a friend's place rather than a sterile environment. I don't know if that's good or bad, merely an observation.

Biscotto de povilhos

When I see the doctor, a Cuban named Ariel who is working here with his wife (their two young kids are still in Cuba), I try to be quick. Nothing is quick in Brazil because it's culturally rude for any interaction, including a business interaction, to be in and out. You have to sit and chat and ask about the families. It takes time. But I know other people are waiting and it's something that's been very difficult for me to become accustomed to. I'm from the Northeast after all. I walk and talk faster than everyone here. Anyway, we muddle through information about my medicine and he issues me a new prescription that's valid for three months. This is a huge sigh of relief for me because I can't function properly without my migraine medicine.

Hallelujah!

If I were getting something like fever medicine, I could pick it up right here at the clinic's pharmacy for free. But because I'm getting specialized medicine, I'll have to purchase it at the commercial pharmacy down the street. It's about R$14/bottle or US$3.50. In the States, I paid $10 and up per bottle, AFTER also paying for health insurance. Without health insurance, the medicine is US$100 per pill. It would have been completely out of my price range if I had to purchase it out of pocket.

Overall, I've been very happy with our experiences with the Brazilian health care system, although I fully understand that we have been very lucky and that not all cities or even neighborhoods in our city are as well staffed and efficient as ours. 


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