In the course of a recent trip to India, I developed some minor health problems and found myself doing what many locals do: consulting with a pharmacist. India's cities are peppered with these modest little storefronts, some the size of a large closet, which sit along the street, the pharmacists stationed on a stool behind a counter awaiting customers.
The pharmacies are stocked floor-to-ceiling with a plethora of remedies for whatever ails the human body and spirit. My husband and I sought treatment for an affliction common both to travelers and local Indians, caused by contamination in food and water: diarrhea. Despite our best food precautions, we managed to contract a case of the runs after eating at a very elegant restaurant in Jaipur in the northern province of Rajasthan. When a dose of Lomotil did not prove entirely effective, we decided to turn to a pharmacist for advice, as my experience traveling abroad is that local practitioners often know best how to treat common local problems.
The pharmacist asked us several questions in perfect English: Did we have a fever? Any vomiting? Any stomach cramps? No to the first two, yes to the last. He radiated a sense of confidence. He then produced two sets of pills in silver and green packages. We were advised to take these twice a day. He also gave us an electrolyte replacement solution, to be mixed with purified water and consumed twice daily as well. The pills had names I did not recognize, so I largely took them on faith, explicitly following his directions. The total cost for both of us: the equivalent of $2.50.
"You actually behaved in many ways like a many locals would - like a person who doesn't have easy access to a health-care provider," Nomita Divi, program manager of the Stanford India Health Policy Initiative, told me recently when I related my experiences.
Divi took a group of Stanford students - one med student, one masters and two undergraduates - to India for 8 weeks this summer to study this very phenomenon: the role of pharmacists in healthcare delivery in India, where a dire shortage of physicians, particularly primary care physicians, severely limits access to care. These pharmacists often serve as first-line providers, she said. Some have formal training, but many do not and operate on the basis of experience, as the students observed this summer, she said.
They dispense a wide variety of drugs, some branded, some generic. There is a higher-level category - generic drugs branded by well-known companies - which consumers may pay a bit more for, as they view them as more reliable, she said. Often no prescription is required. And costs are a fraction of pharmaceutical costs here in the United States.
Within two days of treatment, I was cured of my gastrointestinal distress. On my return home, I did further research on the medications I'd taken and found they were part of a standard regimen for diarrhea: an antibiotic in the same class as Cipro, which is commonly dispensed here, and an anti-cramping agent.
Buoyed by that success, I visited a pharmacy in Udaipur on another occasion when I discovered that I had foolishly forgotten to bring enough medication to treat my thyroid condition. After a brief panic, I stopped by a pharmacy to see if, by chance, it might carry thyroid pills. The pharmacist asked me my dosage level, then handed over bottle of 100 pills, which cost me $2. In this country, I would have paid $57 for the same supply (had I not had health insurance).
Divi told me my experience seemed to be a "textbook example" of what the students documented on how Indians look to pharmacists for guidance on routine medical problems.
"It's great that you got [to experience] first hand what a lot of the population experiences," she told me.
Previously: Stanford journalist returns to old post in India - and finds health care still lagging and Stanford India Health Policy Initiative fellows are in Mumbai - come follow along
Photo by Beth Duff-Brown