13 January 2010

Prescriptions Usually Not Required in Russia

Taking a blood thinner in Russia...

After surgery five years ago, my cardiologists prescribed Coumodin to help me avoid a stroke.  In Russia we call Coumodin... Warfarin.  Many professionals say this drug is underutilized throughout the world, and this seems particularly true in Russia. 

A delicate balance...

To take Warfarin properly you have to be sensible and motivated.  It's fine to avoid blood clots, but if your blood gets too thin, you can invite hemoraging.  Besides watching for untoward bleeding, it's necessary to visit a clinic often to check the clotting rate.

An excellent British organization...

Anticoagulation Europe at http://www.anticoagulanteurope.org/ gives a good overview of the value of Warfarin and its dangers.

Our pharmacies are like no other !

The pharmacy sells 'prescription' drugs, along with  related items. Everything is behind glass, so the customer can see what is available without asking.  People line up at a window, much like that at a train station.  I used to bring Larissa's notes, but now I enunciate slowly.

Laissez faire pharmacies

The clerk is supposed to ask for a prescription for a narcotic or psychogenic drug.  Pharmacy clerks were trained in technical schools before the end of the Soviet Union.  Now just about anybody can fill this position.

No visit-to-visit records and no relationship...

You are just another face at the window.  The concept of customer loyalty and keeping customers is foreign to most Russian business, and for that matter, even the Church.

The store keeps no prescriptions and doesn't maintain individual records.  They have no interest in contraindications.  No registered pharmacist is present.  

As with most things in Russia, you are on your own. 

Packaged with no hocus pocus... 

Drugs come in cards of
10 to 20 bubble wrapped pills, packaged in small cardboard boxes, with manufacturer dosing information enclosed. 

Consumers do not have to go through the farce of pretending drugs are still compounded... meaning you do not have to wait for a pharmacist to count pills from a large bottle, put them in a small bottle, and place an instruction sticker on the side.


The comparative price of prescriptions...

Larissa purchased Warfarin in December from Azerkee Pharmacy, which has a branch near us in Komandanska.  It is packaged in a small plastic bottle.  As of December 2009  our cost was $5.97 (at 29.39 rubles/dollar) for 100 2.5 mg pills

The mail order from Canada to the USA, even at their 50 to 70% discount, has a net price of at least $36.71 on the Internet... an amazing difference!

A conscientious patient...

Every month or so, I am off to the clinic to see how warfarin is treating my blood.  A factor of 1.0 means no drug effect, 2.0 means your blood takes twice the normal time to coagulate, 3.0 signifies your blood is getting close to the consistency of water.

Warfarin has dangers and side effects.  Many ingredients in prescriptions come from China.  It 2008 around 100 people died in the USA from tainted Heperin, an unrelated type of blood thinner.  The FDA only inspects foreign drug firms every 13 years, so I am wary of everything I take now.

A typical blood clinic visit in SPB...

I catch a machutka, taxi van, along Parachutna to the clinic.  On entering I am gifted with baheely, plastic elasticized covers, for my shoes. 

I check my coat. in Russia, no one leaves a  tip... and stroll to the blood draw room entrance, where there may be a small group of people on chairs outside. 

At this moment it is very important to study faces and clothes so you know who was there before you... otherwise an unassuming old lady will steal your place.  I talk with the people and something about my accent gets people smiling... quite an accomplishment in Russia. 

A Helpful Nurse...

The nurse at the Heart Clinic in Udelnaya knows me well.  She asks after my wife, and I tell her she has
zoloteeya ruchky... golden skilled hands.  She takes the venous blood draw... a procedure that can really hurt done by an insensitive or clumsy technician.  I feel nothing.

She is an example of the friendly helpful people in St Petersburg who make the day more pleasant than it could have been.

Blood level testing in Pena impossible...

We spend June, July, and August in Zalozye, near Pena, Tverskaya Oblast.  It's lovely there but a sparsely populated vacation spot also brings a problem or two.  What to do about my Warfarin testing?

Larissa's cousins kept the farm after the
kalhoz... collective farm... was abolished in 1991.  Their daughter is a lead doctor at both the clinic and hospital in nearby Pena.   She has arranged hospitalization for me... and brought me hot food at night. 

We asked by cell phone about getting my Warfarin level checked.  She found the technician qualified to do a Warfarin check.  However, after taking the hour-long trip to Pena over some rough roads... an expensive trip... we found this nurse was on vacation.  An unheralded vacation is typical of how things sometimes operate.   We did some shopping, visiting, and travelled back to our village.

We try again...

We checked again as to when the uniquely qualified technician would definitely be back, and scheduled another trip. We arrived to be told by this uninspired nurse that Yes, she could do the test, but No, she did not have the supplies with which to do it. 

That no one else was trained to do the levels test, and that supplies were not ready are considered good excuses in much of Russia.

I spent all of summer 2009 in the dark about my blood levels.  Russians are fatalistic about such things.  My luck was good and I survived without trouble till our return to St Petersburg.


Russians complain about the recent large increases in drug prices. How are the drug prices where you live?  What do you think of Russian pharmacies?

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