Monday, October 19, 2009

Birth control pills in Chile

**DISCLAIMER: I am not a medical professional or anything close. The following are my personal opinions and should not be considered medical advice. **

While waiting at the pharmacy counter the other day, I heard the young woman next to me ask for "the cheapest birth control pills you have."

Birth control pills are available without a prescription here in Chile. This means you can simply walk into a pharmacy and ask for the pill you want -- or, in the case of my fellow customer, whichever costs less -- without having to set foot inside a doctor's office.*

I have mixed feelings about this. On the one hand, I believe contraception should be readily available to women and men who wish to use it. Selling birth control pills over the counter makes them more accessible to women without the means or the time to make a doctor's appointment. It also makes them much easier to obtain for girls and women who wish to keep their decision to go on birth control private. On a more symbolic level, there's a lot to be said for being able to take the pill without having to ask anyone's permission first.

On the other hand, I can't help but suspect that this system makes it easy for women and their partners to make important decisions about their reproductive health without being properly informed. At the risk of sounding like the condescending voiceover on a TV commercial, I'd like to remind everyone that every birth control pill is different. Different pills have different doses of hormones, different modes of use and different potiential side effects. A pill that works swimmingly for one woman may be detrimental to the health of another. That's why part of a gynecologist's job is -- or should be, in my opinion -- to help patients choose a birth control method that is right for them.

It strikes me that a woman who asks for "the cheapest birth control pills you have" is very likely not making an informed decision. Of course, she has the right to make a choice based on whatever criteria she wants. Certainly, cost is an important factor for many women, especially given the fact that Chile's public health insurance provider, FONASA, does not cover birth control pills purchased in pharmacies.** Still, I'd be willing to bet there's more than one low(er)-cost pill out there, meaning women and couples on limited budgets still have options to weigh. But it can be difficult to know what your options are when nobody tells you, especially when it comes to a specialized field like medicine.

Of course, one could make the argument that consumers have the responsibility to inform themselves. As long as information is freely and widely available and easy to understand, I would tend to agree. However, I don't think this is the case when it comes to medication. As anyone who's ever glanced at them knows, the informational pamphlets that come with medication aren't exactly easy reading for those of us without medical training. Searching for information on the internet -- which, it should be noted, not everyone is able to do -- presents its own problems. First off all, it can be difficult to separate reliable information from B.S. Plus, when you research a product on its own website, you're getting your information from a company that wants you to buy what it's selling.

This lack of access to reliable information is even more worrying to me when I consider the spotty reputation of sexual education in Chilean schools and the misinformation about reproductive health -- "But virgins can't use tampons!" -- that circulates here and in the world in general.

I'm not saying that selling birth control pills over the counter is necessarily a bad idea. Like I said before, I think it has a number of benefits. What I do think is a bad idea, however, is selling birth control pills over the counter without providing women and their partners every opportunity to make informed choices. I'm guessing that whoever sold my fellow customer her birth control pills didn't ask her about her medical history, other medications she may have been taking, or whether or not she smoked (which a lot of young Chilean women do) -- factors that, as far as I know, are generally thought to be important when a woman is considering hormonal contraception.

But what if the pharmacy employee had been required to ask her if she had any questions about the pill or how to use it? If the pharmacy had been required to have someone on hand who was qualified to give detailed answers to all these questions? If pharmacies, educational and medical facilities, government agencies and NGOs distributed accurate and user-friendly information about birth control options in multiple formats, including on the radio, the internet and TV? And what if --gasp! -- prices were low (or nonexistant) enough so that monetary considerations would never have to outweigh health-related ones? Maybe then the young woman at the pharmacy would have asked for whichever pill she considered right for her and not whichever one was cheapest.

Needless to say, this is a topic that requires more than one opinion. So please, share. What do you think of the birth control situation in Chile (or in whichever country you happen to inhabit)? Any suggestions as to how to improve things? Is there a Chilean health insurance provider that covers birth control? Obviously, I'm not going to demand that anyone share his or her personal experiences, but if you want to, please feel free to do so.

*To get the morning-after pill, however, you have to make an appointment with a doctor, get a prescription, and find a pharmacy that has the pill in stock.

**In theory, women who have public health insurance are able to get free birth control pills at their local public clinic (consultorio). However, I don't know what pills consultorios give out or how many options they offer. Also, many consultorios operate on a "first come, first served" basis when it comes to appointments, and not all women are able to get up at the break of dawn to stand in line.

Thursday, October 15, 2009

Overheard in Santiago, part 2

20-something guy: The classical composers were real musicians. Like Vivaldi and Paganini on the violin.
20-something guy's friend: Yeah, and the deaf guy.
20-something guy: The deaf guy had this thing with music. He would have no idea what it sounded like and it would come out incredible. You know why he went deaf?
20-something guy's friend: No, why?
20-something guy: Syphilis.

Overheard on the 506 bus

Wednesday, October 7, 2009

Gringo pesa'o

Many gringa bloggers have observed that santiaguinos can, at times, seem cold, brusque, or borderline surly. While I certainly don't see Santiago as a six-million-contender cage fight, I sometimes feel here like I did when I was living in a major city on the East Coast of the United States: Things move faster and people are more stressed out than I'm used to.

Because of this, I was a bit nervous when I started at my current job, which involves a lot of face-to-face interaction with the company's clients. I was worried that Santiago's stressed out, overworked and overcaffeinated would consider me the perfect dumpster for their accumulated tension. As it turns out, I've been pleasantly surprised by my clients, the vast majority of whom are patient, friendly and understanding.

Of course, there are exceptions. Like the delightful man who treated me to ten minutes of condescension and riddled me with orders like "move over." My boss later told me the charmer had been a member of Pinochet's cabinet.

The fact that people like him stand out in my memory goes to show that they are uncommon. Like I said before, most of the clients I deal with treat me with respect. Today, however, I found myself dealing with another exception to the norm.

When I saw him approaching, I immediately began to ponder, "Is he or isn't he?" -- gringo, that is. He was relatively tall, relatively blonde, and relatively light skinned -- but then again, so are a lot of Chileans.

I smiled and greeted him in Spanish. He did not greet me back, instead emphatically stating a single word: "English." Not "do you speak English?". Not "(Sorry,) I don't speak Spanish." Just "English."

Aside from resolving my uncertainty about his nationality, he'd started me wondering if I just might have another ass on my hands. I find it incredibly presumptuous when gringo travelers expect people in their host countries to understand English. Of course, I did understand the guy, but the point is that he had no reason to suspect I was a native English speaker. While I'm neither tall nor blonde, I would place my look solidly in the "is she or isn't she?" category, so I would have understood his assumption had we been in a hostel or a gringo bar. But we were in the Chilean work environment that I share with an exclusively Chilean team of coworkers. I wasn't wearing a "Kiss me, I'm bilingual!" pin or anything like that. In fact, most of the foreign clients I deal with don't even catch on that I'm not Chilean unless I tell them -- although they do ask me where I learned my wonderful English.

Still, I wasn't ready to peg Mr. English as a presumptuous prick just yet. If he thought I didn't speak English, I reasoned, he may be trying to simplify things for me by saying as few words as possible. So I pulled out my "Wow, where did you learn?" English and asked him what I could help him with.

He formulated a two- to three-word request, and I listed possible solutions -- none of which met his needs, apparently, which is fine. However, what I do not find fine is muttering "OK" and walking out of the room without bothering to thank the person who tried to help you.

My lips actually began forming the word as I watched him leave: "pesa'o." Literally: heavy. Figuratively: mean. That gringo had been mean to me.

I suppose coming across a rude gringo shouldn't have shocked me that much. After all, we foreigners are just as capable of being pesa'o as santiaguinos. I just hadn't come across a mean gringo at work yet. It may all boil down to simple mathematics: Since our Chilean clients vastly outnumber our foreign ones, it's much more probable that I'll encounter a Chilean meanie than a gringo one. Also, the gringo clients tend to be on vacation or business trips, so chances are that they're not as stressed out as their santiaguino counterparts. I'm not going to venture to say that people from the States generally act more respectfully than Chileans toward the people who provide them with customer service, because I simply haven't found that to be the case.

Maybe I was just expecting a little gringo solidarity, that superficial but real connection that tends to form between two people who find themselves together in a strange land. Of course, it would have been unfair of me to expect this from Mr. English, who had no way of knowing I was foreign, too -- at least before I switched to English. In any case, he was mean, and he caught me off guard.

Shortly after my run-in with Mr. English, I got on the Metro and headed home for the day. The universe was on my side, because I got a coveted seat. When the train arrived at my stop, I stood up and realized there was a pregnant woman standing standing beside me. I'd been so absorbed in my trashy magazine that I hadn't noticed her standing there, probably waiting for me to offer her my seat. As I exited onto the platform, I imagined my fellow passengers thinking to themselves, "Qué pesá."

I guess not everyone who comes across as mean intends to be. Maybe I should cut Mr. English some slack.