Visitors and residents of Ukraine are often amazed at how easy it is to buy medication in pharmacies and to self-prescribe. In contrast to this situation, Ukrainian visitors to some parts of Europe are surprised by the difficulties in obtaining simple remedies without seeing a doctor and obtaining a prescription.
The differences don’t stop there, however. Ukraine’s big cities also offer a choice of specialist pharmacies, for orthodox and psychotropic medicines, for hormonal preparations and also homeopathic and herbal remedies.
Indeed, many pharmacies offer a complete range of products.
Keeping a pharmacy at home is, of course, the answer to many problems and next time you are alone in a Ukrainian kitchen a quick view of the cupboards will show that pride of place is given to the medicine store.
These often contain a great deal of inappropriate and out-of-date medicines, but old habits die hard and keeping drugs and not wasting them was a one-time survival technique that now, in theory, should have been replaced by the hundreds of pharmacies in most cities.
Pharmacies also offer a range of different suppliers for the same medications, which are always labeled in Ukrainian, but often also in Russian, German or English – thus adding to the patients’ confusion. Sitting behind such parallel imports are complex licensing procedures and quality control standards for Ukrainian products.
Keeping a pharmacy at home is, of course, the answer to many problems and next time you are alone in a Ukrainian kitchen a quick view of the cupboards will show that pride of place is given to the medicine store.
There are, of course, also generic products that use the drugs’ chemical name and brand-name products that use a company product name. My advice is to source the best drug you can, usually brand named by a European or American manufacturer. Prices here are often less than in Europe.
In general in Ukraine there is a non-regulated climate which allows patients to self-prescribe. In terms of benefits, it’s much easier for patients to source regular drugs for blood pressure, thyroid disease and this means that patients are less likely to have breaks in treatment because they need to make an appointment to see a doctor.
Simple conditions such as conjunctivitis can be quickly treated, as can infections. There is also a decrease in demand on doctor’s time.
Perhaps greatest of all it keeps the patient as the person responsible for health care rather than creating a national dependence on doctors for every small problem, as can be seen in, say, the United Kingdom.
This is, of course, of greater importance in a country whose health care economy is already stretched. Indeed, Ukrainian patients, particularly the elderly, are often afraid of visiting doctors because of the large number of medicines prescribed and the consequent cost.
The downside is that patients can continue medications for years without proper control or tests to make sure the medications are really working and are not causing any side effects. A potential side effect of patients using antibiotics could be an increase in bacterial resistance, although studies comparing bacterial resistance throughout Europe have essentially failed to show this.
Many pharmacies in Ukraine offer a complete range of products. Unlike in the West, it is easy to buy medication in pharmacies and to self-prescribe.
(Kostyantyn Chernichkin)
More worrying are medicines that have potentially serious side effects, which may be unknown to the patient; or drugs that should only be used for limited periods of time.
In contrast to the apparent non-regulation of obtaining potentially dangerous remedies is the strict control of psychotropic medications that can often only be prescribed by licensed psychiatrists and are only obtainable in certain pharmacies.
Opiate-based drugs such as the morphine derivatives and even simple codeine are even more difficult to obtain which certainly causes problems for those with terminal illness.
But given the huge abuse of prescribed psychotropic drugs in Europe and even more so in America, this strict control has an overall benefit for society. Of course, this has to be balanced against the ability to secure good psychiatric treatment or for family doctors to diagnose and prescribe in psychiatric illness.
In general Ukraine needs to make its mental health services more accessible and less stigmatised but should be very much encouraged to maintain ways of effectively keeping dangerous drugs and addictive substances off the streets.
Personally, I like the idea of patients controlling their own health and only seeking professional advice when needed, and in the end it makes for a better exchange between doctors and patients.
What I love most of all about Kyiv is the City Information Service 559. Dialed from any mobile, an operator will tell you which pharmacy near you should have the drug you need and their phone number so you can check.
Now that is service and a huge time saver; what’s more they have an English-speaking operator. Yes, some things in this country really do work well.
Dr. Richard Styles is a physician with the American Medical Center in Kyiv.
