Tomorrow's Pharmacist (2004)

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Costa Rica — where medicine-taking depends on divine intervention

By Nisha Thakrar

Costa Rica is a small but incredibly biodiverse country in Central America, bordered by Nicaragua and Panama. I was given the opportunity to travel there as part of the IPSF student exchange programme

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During the four weeks I spent in Costa Rica I worked part time in a community pharmacy and had the opportunity to see different methods of pharmacy practice. My work consisted both of general organisation of stock and helping customers. My attempts at over-the-counter counselling in Spanish kept my colleagues entertained but did improve during the course of the month.

The major difference which was obvious from the start was how few medicines required a prescription. It was also clear that the Costa Ricans, or Ticos as they are known, regard the pharmacy as a first port of call instead of the doctor.

The only drugs that required a prescription were similar to Controlled Drugs in the UK, eg, morphine. However, nearly all other prescription medicines, such as antibiotics, could freely be bought by any customer without the pharmacy providing written instructions or patient information leaflets. They were handed out in clear bags, often blister packs of different tablets together. There was no extra identification of each type of tablet within these bags. When prescriptions were used, the patient was asked if they required a label to be produced. In the majority of cases, the customers declined this service and the prescription was stamped to prevent the pharmacist from being culpable for misuse of the drugs.

The relaxed attitude to the sale of medicines was emphasised when a customer entered the shop and asked the pharmacist for a selection of antibiotics. The pharmacist produced five antibiotics and placed them on a surface. The customer then produced a stick, and proceeded to choose the antibiotic he required by feeling the “divine forces” surrounding each antibiotic. After he had one, the pharmacist advised him to take one tablet daily for seven days. The customer replied he would only take three tablets, since that was what the stick had told him!

The prescriptions that were used had similar legal requirements to the UK but although the pharmacy was required to keep the prescription after it was dispensed, this did not always occur. The pharmacist explained that the customers did not understand this concept. The customers appeared unwilling to relinquish the prescription to the pharmacist, on occasions reproducing the same prescription several years later. Ticos also expect pharmacists to be able to give injections, but this is not in the course content. I was told that many pharmacists give in to these expectations, injecting customers without having received any formal training.

Some of the pharmaceutical companies offer incentives to the pharmacies to promote a particular brand by paying the pharmacy for each empty box of tablets returned to them. The pharmacy I was working in did not agree with this policy, and believed good customer service should come first. However, all the pharmacies did not have similar standards and often let this payment influence their recommendation of drugs.

Social security

About 70 per cent of Ticos go to hospitals to obtain free medicines as part of the social security system, since the community pharmacies provide only medicines paid for privately. However, the free medicines are often of an inferior quality and do not always help the patients. Asthma and diabetes are common problems in Costa Rica and medicines for these complaints are seen more commonly in the hospital due to their high expense if bought privately. The medicines in the hospitals are often in short supply, and the Ticos I spoke to complained that the system was badly organised.

Free time

Buses serve most parts of Costa Rica and I was able to make the most of my free time by exploring the country. Areas of particular interest included the Arenal volcano where I was able to watch red lava erupt from the volcano while soaking in the hot springs. The beautiful canals of Tortuguero National Park situated on the Caribbean side of Costa Rica, were another attraction. A night visit to the beach here also gave the chance to observe nesting green sea turtles.

A visit to Drake Bay in the Osa Peninsula at the southern tip of the country, proved to be the highlight of my trip. Reaching Drake Bay was an adventure in itself, with a six-hour bus ride from San José followed by 90 minutes in a boat. The boat first travelled along the river and mangrove swamps before negotiating the rough surf at the river mouth. There was a slightly wet landing at the beach followed by a steep climb to reach my accommodation but the views were well worth it. A generator was used for a few hours each evening to provide electricity for the communal areas. Nearby attractions included Caño Island and Corcovado National Park.

Caño Island is famed for its marine life and I took advantage of the excellent snorkelling opportunities. In addition, we were greeted by the sight of a female humpback whale with her baby on arriving at the island. Corcovado National Park is considered the most biologically intense part of Costa Rica, and the day I spent hiking there was enough to convince me of this. The number of species of plants, trees and wildlife encountered was staggering. Among the animals were three types of monkeys, agouti (a type of rodent), coati and sloths to name just a few. Among the birds spotted were colourful toucans and beautiful scarlet macaws.

Overall impressions

The exchange provided me with a unique experience. I feel that the pharmacy knowledge and the life experience I gained from the trip will help me with the rest of my studies and in my future career.