Tuesday, December 21, 2010

Let’s Call it…Insurance

It was inevitable that I was going to mess up somehow and run out of birth control without pre-warning my mom to send some over a month in advance. But I actually did consider this fact much ahead of time, and addressed it by picking up some “back-ups” – like Plan A.5 – some patches to use if my actual birth control ran out. Which, of course, happened.

It was only when I realized that I did not have another pack that I realized the patches I had gotten in the US expired in October. Guess they weren’t expecting me to keep them around for a year as Plan A.5.

No problem. We have a doctor on staff. And almost more out of laziness, I just wanted her to deal with this dilemma.

“NATHALIEEEE!” I went crying out of my room. “Marvin, earmuffs. Nathalie, my birth control has expired. What do I do?”

I don’t know what Nathalie thinks I do with my spare time, or maybe it’s just so engrained in her head that every woman must be on birth control unless she is married and has less than 2 children (this is a health metric in Rwanda), but her reaction was a lot more intense than I was expecting. …and before I knew it, I was handing her the pack of expired patches, which I had never actually used before, showing her the expiration – and not having the time/willpower to explain that I had actually been using different birth control.

Ultimately, my laziness of deferring to Nathalie did not work in my favor:

First, Nathalie did not handle it. She instead sent me to the District Pharmacy BY MYSELF to buy replacement pills. “But Nathalie, what if they don’t speak English?” “They won’t, but they will understand the active ingredient.” At the District Pharmacy, enough was communicated to learn that: (i) since I was white, I must have been sent by Dr. Nathalie, and (ii) they did not have the active ingredient I needed, so (iii) they were going to send me to the slightly more sketchy pharmacy down the street.

I had the joy of being accompanied to this pharmacy by a young gentlemen, up-and-coming pharmacist who wanted to work on his English, and his knowledge of pharmaceuticals. I know you should feel free talking to your doctor about anything, but he wasn’t my doctor, and I know that Rwanda doesn’t quite follow the same confidentiality standards as the US – so I just ignored him.

The next pharmacy first handed me a box that cost ~$40. Given that many NGOs essentially fly planes over developing countries, and let it rain birth control, I knew this was an outrageous price. I communicated as much. (Rough translation of what I was able to say: “No. How much two” [air-draw three zeros – to represent 2,000, ~$4.)

They came out with a box that said “Contraceptive Urgence.” Not caring if this was butchered English or French, I know that Emergency Contraception is illegal in Rwanda, so I wasn’t about to fall for that trick. Finally, I pulled out my “white girl insurance” and just called Nathalie, asking her to translate to the pharmacist. They handed the phone back to me, where Nathalie explained that they don’t have birth control with the same active ingredient as I “need”, so we’d have to go to Kigali. I asked why I couldn’t just buy the cheapest kind they had and call it a day.

I could practically feel her roll her eyes at me through the phone as she launched into an explanation about how I wouldn’t want to do that to my body as I was already in a foreign country and at altitude blah blah blah…and that it might not work if I switched active ingredients.

“Work”?? I’m just going to throw it out there that I only take the things to keep my boobs big and so I have some sense of when I will have my period.

Obviously, after this lecture, I was too intimidated to inform Nathalie that the box I showed her was not even the same active ingredient as the birth control I had actually been using…so I just stayed mum and let her do her doctor thing.

After this initial disaster, Nathalie called Jeanne d’Arc, who was in Kigali and explained “the situation” to her. As a good doctor would, Nathalie also texted JD the name AND concentration of the active ingredient in “my” birth control – so that my replacement could “match” as closely as possible.

JD called us when she was in PHARMACY NUMBER 5 to report that she had finally been able to find the proper active ingredient, but not the correct concentration. (Maybe that’s because the concentration in the patch is a lot higher than in a pill?)

“No worries,” said Nathalie, “we’re on our way to a health center now.”

When we arrived at the health center, Nathalie went straight to the pharmacy, where she did I-don’t-know-what-but-not-just-steal-a-box-of-pills-for-me and called JD to talk in Kinyrwanda some more. I do know that Nathalie became very concerned with the concentration. Apparently, the box I showed her has a much higher concentration than anything available in Kigali. This was not good because anything of lower concentration would not “work.” (WHAT DOES WORK MEAN?)

At the 7th pharmacy, JD finally found an acceptable replacement, for ~$20 for a one month supply. So I’ve effectively now paid more than I would have in the states, for birth control that very closely matches my back up, but in no way resembles that kind I had actually been using.

Let’s just add to the story, that this is what the packet looks like:

And HOW am I supposed to know where to start?!?

1 comment:

Jamie said...

"This was not good because anything of lower concentration would not 'work.' (WHAT DOES WORK MEAN?)"

If it doesn't work, your boobs will get smaller and you will have no clue when your period comes. Disaster, I know.