Just a few days ago a family came to my office after their daughter had been diagnosed with typhoid fever. They had been seen by a local doctor who had correctly made the diagnosis, but had then ensued to prescribe a myriad of medications, most of them completely unnecessary.
The treatment for typhoid fever is 14 days of specific antibiotic therapy as well as paracetamol (or other similar medication) for aches and fever. This young lady had been prescribed 14 days of Chloramphenicol (a relatively old fashioned antibiotic that can have undesirable side effects however it is still effective and cheap), paracetamol for pain and fever, dexamethasone (a steroid! for what?) as well as terbutaline (a potent asthma medication) and an antihistamine (anti-allergy / itching medication).
When I enquired with the parents as to why the child has so many medications they were as mystified as I was! Was the child asthmatic or did she have a cough? – No. Did she have a rash or itching? – No. So why all these remedies for symptoms that she did not even have?
It seems in this country that the more medication that you prescribe, the better. The first and most obvious reason is that the doctors usually get a kickback from the sale of prescription drugs. This is indeed a problem worldwide. Secondly many doctors believe that it is their duty to give as much medicine as possible for even the slightest symptom or potential symptom, and thirdly, many people are just not satisfied that they have been treated unless they go away with a handful of pills and lotions.
I once had a parent that was extremely angry that I had not recommended antibiotics for his child that clearly had a very simple upper respiratory tract infection that would certainly pass by it self.
I even knew a doctor once that prescribed antibiotic cream, antifungal cream, anti-itch cream and steroid cream for a rash. Why so may creams? He did not know what the rash was so he prescribed creams for every possible cause!
The most common over prescribed medication here are antibiotics. When antibiotics were discovered back in the 1940’s they were hailed as the wonder drug of the century. Certainly many people that once perished from simple infections were being saved. Even today antibiotics are the most valuable medicines known to man. However, as a society we are using them far too frequently. I don’t know about you, but every time a friend or relative comes from the doctors surgery here, they have at least one kind of antibiotic prescribed. Even more frustrating are the little packets of powder often dispensed for children. Who knows what these concoctions contain? My suspicion is they contain a potent mix of antibiotics, steroids, and vitamins; but it would be nice to know for sure!
Antibiotics used appropriately can stop infections and save lives. When used inappropriately they can do more harm than good.
So how does the average Joe know when medicines have been over prescribed, and when the drugs are really necessary?
First of all ask your doctor exactly what condition he thinks you have and how the medication that has been prescribed will treat it? This may make some doctors a little prickly as in this country they are generally not use to having their opinions and therapy questioned. Indonesians at large generally do not question doctors at all. It might be worth saying to him/her that you are not doubting their knowledge or suggestions, but that you are interested in your disease and treatment (indeed you have a right to know!).
Also make sure that the doctor tells you exactly what the medicine that he/she prescribes is for, and exactly what is in it? Generally medicines here are dispensed in a little clip-plastic with nothing but “3 x day” written on it. The original foil package that the drug is in also has little information on it. Often only the trade name for the drug is written on the package (eg “Claneksi” contains amoxicillin and clavulenic acid, but this does not appear on the package), so even if you try to research the medicine yourself, and the drug has been produced and “named” in Indonesia, the name of the drug does not appear on any website.
Make sure that you get complete prescribing information:
How should the medicine be taken? With or without food? Some medicines can be taken with food but not with milk.
How many times a day at what interval should I take the medicine?
How long should I take the medicine for and what will happen if I stop the medicine suddenly?
Will the medicine interact with other medicines? Some medicines will decrease the effectiveness of the oral contraceptive pill. This is worthwhile knowing!
Will the medicine make me sleepy and affect my ability to work or drive?
Will the medicine make me sun-sensitive and should I wear a sun block?
If you are pregnant are breast-feeding is the medicine safe?
Is the medicine safe for young children or babies?
What are the common side effects of the medicine? (Some commonly prescribed medicines can turn your urine bright orange or green which can be alarming if you are not forewarned!)
What are the side effects that should cause concern that need reporting to your doctor?
Fortunately in this day and age information on-line regarding medicines is freely available (at least in the English language anyway), and it is easy to research any medicines that you have been prescribed. Be wary of reading all the side effects of medication as it can be pretty frightening some times, however most severe reactions and side effects are rare, and just as many life threatening conditions are caused by eating peanuts as they are from taking some medications!
For those that are really keen on checking information on drugs prescribed in Indonesia, drug compendiums (MIM’s) are readily available at book stores like Gramedia, and they even have an English edition.
All in all most doctors prescribe medicines with good intent, and genuinely want to assist in your healing process, but the message here is be aware and don’t be afraid to ask “Do I REALLY need that medicine?”.
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com or
