It seems like these days many are feeling the bite of dengue fever. If not us, our neighbors are catching it. And we are sitting at home fearing we’ll be next. This malady, a tropical household disease not foreign to those of us living in Indonesia, is one of the reasons for round-the-clock doctor appointments and expeditious drug dispatch. It almost feels like we are experiencing an alien phenomenon unheard of before. Families and communities are panicking, rushing to equip their homes with fogging machines and pesticides for mosquito control. All this precaution and alarm is understandable and justifiable, except when it comes to the pile of pills we are consuming, or those the doctor makes us believe we need to consume.
I accompanied my boyfriend Kyle, who tested positive for NS1, to the doctor yesterday. His helper, Ben, who’s had the virus for about a week now and was almost fully recovered, also came along to get checked. The clinic, a private practice with an in-house pharmacy, is located in West Jakarta. We signed up at the counter where a staff member manually noted every registering patient’s name by hand on what was a piece of paper torn out of an A4 notepad. We sat in the waiting room for about 20 minutes before the nurse called us in. The nurse first examined Ben. Next, she checked Kyle’s blood pressure. On total we spent about 10 minutes in the room with the doctor before heading to the pharmacy to buy the prescribed drugs.
When it came to picking up the drugs, I was shocked to see the quantity (just for Kyle): 2 different kinds of antibiotics, 1 drug for nausea, 1 for acid reflux, and 1 for increasing white blood cells. I thought, what in the world? This is dengue fever, not cancer or cholera or something. So I asked the pharmacist if a patient would still need to keep taking the nausea medication even when he no longer felt nauseous. He said yes. I asked why, he just replied, “It’s for the gas in your stomach.” Twice. Enlightening. I was about to ask again but Kyle stopped me. So I asked yet again to explain the use of another drug he was holding in his hand for Kyle. And he wasn’t sure and told me to wait while he read the label on the drug. I turned to Kyle with a look—a how-does-a-pharmacist-not-know-the-drugs-he-is-prescribing kind of look. The pharmacist kept pointing out that all the drugs were to be taken completely, regardless of symptoms. God, let’s pray he didn’t prescribe the wrong medication for Kyle or anyone else. Besides the fact that the pharmacist couldn’t tell me what he was prescribing, there were other things I had issues with.
First of all, antibiotics are prescribed for illnesses caused by bacteria, not by viruses. Dengue fever is caused by the dengue virus, hence it is a viral illness. Antibiotics do not work against viruses. Second, antibiotics have side effects including allergies, stomachaches, diarrhea, infections, and other problems. Antibiotics work to kill bacteria (again, not viruses), including good bacteria. This destroys the bacterial balance in the body and as a result, antibiotics can have the aforementioned side effects. Third, taking antibiotics unnecessarily may cause the body to develop antibiotic resistance. This means that when you get sick and the bacteria are resistant to the prescribed antibiotic, your illness will last longer and you may have to find a different or more potent drug to kill the resistant bacteria. But while the resistant bacteria are still alive, you act as a carrier of these germs, and could pass them to people around you.
Within 40 minutes, Kyle had already spent close to 2 million rupiah, 30% of which was for the 10-minute doctor consultation (think back to the torn up sign-up sheet of paper at the reception desk). These days, computers come in handy. But okay, couldn’t they at least use a notebook with binding? It all slowly made sense to me. This apparently famed doctor not only owns the practice, but also the pharmacy. And he has been known to prescribe strong drugs, and a whole lot of them. So much so that when his patients go to another doctor and are prescribed other drugs, those drugs aren’t effective because the drugs this doctor has been prescribing are supposedly extremely potent. Kyle’s family, who’s been going to this doctor for years now, acknowledges that this is true and that even when all they have is the run-of-the-mill flu, they are given antibiotics on top of antibiotics. Here’s what I’m thinking. If you own a practice and you own the pharmacy, it makes sense to want to sell as many drugs as you can. After all, it’s all going into your pocket. Never mind whether the patient really needs them.
Now, I’m not against modern medicine or advanced healthcare; I am, however, against excessive and unnecessary consumption of drugs, especially when you don’t even need them in the first place. Needless to say, the whole situation was not sitting well with me. I consulted my uncle, a cardiologist, to ask if antibiotics were really needed for dengue fever. He says all that’s needed are plenty of water, plenty of rest, and possibly infusions of NaCl (sodium chloride or salt) if the body is very weak.
On the way home in the car, I was feeling even more agitated and uneasy about the whole situation, and talked to Kyle about it. He said he wasn’t sure what to do, didn’t know any better, and worried that if he didn’t take the antibiotics his condition might degenerate. He also added the reason the doctor prescribed antibiotics to dengue fever patients and in general, a crazy load of potent drugs, is that the doctor thinks because we live in a soiled country tainted with pollution and lacking in basic hygiene, therefore we need the extra “care” and precaution. Yes, this is neither Iceland nor Switzerland. But those of us who have grown up in and habituated this supposed polluted environment most our lives—our bodies—have adjusted to the filth and dirt over the years. If an Icelandic native suddenly moved to Jakarta, surely he’d have plenty to adjust to and it is very probable that, for example, the food he consumes here may cause stomach upsets, possibly leading to an infection and other problems. But an Indonesian body should and would be different. Over time and habit, our body auto-adjusts and auto-tunes to maintain its balance and keep healthy.
I am no doctor, no nurse, no med student, not even a dropout med student, heck I’ve never even once considered entering med school. But here’s what I think. We all ought to be critical thinkers. With Google, our smartphones, and information access at our fingertips, we should be responsible for our bodies and doing our own research. Having extra knowledge about the world, and in this case what a disease entails and its antidotes, is never a bad idea. Doctors are authority figures, yes. I respect them for what they do. I know my uncle is a passionate doctor who, for as long as I can remember, has dedicated his life to medicine, coming home never earlier than 1 or 2 in the morning everyday. Authority figures are authority figures. But it doesn’t mean we don’t question them. And after all, doctors make mistakes too (innocent or not), as do other humans.
It’s one foolish thing to spend the money on unnecessary medications. It’s another to consume them unnecessarily! My principle is that if I can ease any pain or symptom with natural remedies (a fruit, a nap, a jog), I always do. It’s only when I have no other option that I actually pop a pill. You don’t have agree with me or do what I do, but I think it’s worth thinking about the stuff that goes inside your body, especially those that you may be unnecessarily consuming.
So, what now? If you are concerned you may be taking drugs unnecessarily, make a list of all the drugs you consume on a daily basis. Think about what’s really necessarily, and eliminate those that aren’t. Sensibly. When visiting your doctor, don’t be afraid to ask him/her to explain and discuss the meds being prescribed—what they’re for and if there are any side effects. Get a second opinion. Get a third opinion. Most importantly, get the opinion of someone trustworthy whom you know genuinely cares for your wellbeing, irrespective of drug sales and consultation visits. And now that Google is just a click away, take advantage of it! Read, read, and read. Of course, you have to be aware and critical of the source. It would be naïve to trust everything you read on the internet. And lastly, it might be time to switch doctors.
Photo Credit: Google Images