r.i.c.e.

We know from work by people like my friend Jeff Hammer, a professor at Princeton, that there is a lot that isn’t working week about public health care in India. (On absenteeism, see here. On performance, see here.) I got a reminder of how bad things are when I was talking to a 17 year old girl from rural UP about her experience with a public dentist and doctor. Just as an FYI, the story in this blog post happened two months ago, and I am only now getting around to writing about it.

The girl had a fever, and pain in her teeth from several cavities. She was complaining other symptoms too, some swelling, and general malaise. I’m not surprised that she feels bad much of the time; although she is not very poor by UP standards, she lives in tough conditions, and her diet is quite poor.

To try to get some relief for her ailments, she first went to a public dentist, who wanted to pull out the offending teeth. Understandably, the young woman did not want her teeth pulled—she’s only 17 and she needs those teeth for a good long time. So, instead of filling her cavities, she told me, the dentist prescribed medicine. I asked to see the medicine that had been prescribed. Most of these drugs were given to her at the public hospital, some she purchased from the nearby medical store. Here is a list of things that the dentist prescribed:

1. amoxicillin (a common antibiotic)
2. aspirin (a pain killer)
3. alprazolam (a drug used to treat anxiety and panic disorder)
4. gentamicin injection (a serious antibiotic with potentially serious side effects)
5. diclofenac sodium injection (non-steroidal anti-inflammatory drug)

Thinking that the dentist had likely prescribed medicine only for her dental problems, she went next door to the public doctor, and told him about her other ailments. He did not ask any follow up questions, including what medicine she was already taking. Instead, he gave her a prescription for:

1. metronidazole (a drug which is antibiotic, amebocidal, and anti-protazoal)
2. alumina, magnesia & simethicone (anti-acid and anti-flatuent)
3. cetirizine hydrochloride (antihistamine, used to treat respiratory allergies)
4. amoxicillin (now she has a double dose of amoxicillin)

As before, she was able to get most of these drugs for free at the public hospital. But, since she can’t read very well in English, she did not know what the drugs are meant to treat, when to take them, and how much to take at a time.

The fact that the girl in this story was given so many medications, without any tests, verbal diagnoses, or counseling about how to take the drugs is quite worrisome. While it is true that the widespread availability and affordability of drugs in rural India, particularly antibiotics, has probably saved lives, this story suggests that health planners should also consider how overuse and abuse of drugs can have a negative impact on people’s lives. Many people likely experience negative side-effects of unnecessary medication, or of medication taken improperly, and evidence suggests that anti-biotic resistance is likely to be a big problem in the near future, if it is not already. And, of course, people like this girl probably don’t get as well as they could as fast as they could when they take medicines in a haphazard way.