Brazzil
February 2000
Health
When Maria de Lourdes Ferreira Gomes suffered a hysteria attack in a hospital in northeastern Brazil, a doctor hastily prescribed a tranquilizer pill and injection without an examination. "I spit the pill out," remembers Lourdes, "but couldn't do anything about the injection because they were holding me down."
Ferreira Gomes, who was suffering from the shock of a friend's heart attack, knew about tranquilizers. She had recently "been doped on pharmacy pills" after her mother's death. "I can't remember who came to the wake, and almost slept through the funeral," she says, "I resent that I wasn't fully present to mourn and say good-bye to my mom."
Brazil is the 4th largest consumer of sedatives in the world. The South American giant is addicted to these anxiety relief substances that are commonly known as remédios and easily available in almost any pharmacy without a prescription. Because their effects are short-lived, increasing dosages are necessary, leading to overuse and addiction. Long-term side effects may include memory and reason loss, diminished reflexes, stupor, and constant drowsiness.
Brazilian priest Aroldo Ramos, founder of the drug treatment program Amor-Exigente (Tough-Love) makes a link between systematic use of sedatives in families and the rise of illicit drug use by adolescents. He believes that many Brazilians today avoid suffering at all costs, which can lead to drug abuse. "If there are always tranquilizers at home, young people learn quickly to use drugs to lessen pain," he warns. "The problem begins with the medicine cabinet which is full of drugs."
The fever of "legalized" drugs principally attacks women who are responsible for 75 percent of the national consumption. A São Paulo School of Medicine study shows that 24.6 percent of women and 11,7 percent of men have mental health disturbances. Researchers caution, however, that results may mean that men are less likely to discuss mental problems, or more likely to seek escape through alcohol or marijuana use.
Homemakers are the most vulnerable, with 31.6 percent complaining of problems of nervousness. "The work of a homemaker is hardly recognized, not valued monetarily, rarely appreciated, and unending," analyzes Professor Josimar França, Director of the Faculty of Mental Health Sciences in Brasília, the capital.
Low-income women, especially in their 30s, show more signs of neurosis due to economic insecurity and endemic violence, both at home and on the streets. "With all the stress in daily life, some women are very nervous and rely heavily on tranquilizers in order to remain calm and in many cases sleep at night," comments Maria Madalena da Costa, a social worker who has accompanied women's groups in Paraíba for the last two years. The dismal state of the national health system fuels the tendency to self-medicate.
Quality of health care is often horrific with per capita annual government investment in health hovering at $91 compared to $385 in neighboring Argentina and over $2,200 in the majority of the northern European nations. Waiting lists in the public system are infamous with poor Brazilians queuing up before dawn for routine visits and specialized treatment delays typically stretching months.
This reality coupled with high unemployment makes self-medication at the corner pharmacy an attractive option. Brazil hosts more than 48,000 pharmacies, a 40 percent increase from 1998 figures. According to the World Health Organization, the country needs only 25,000 to adequately serve the needs of the population. Profits in the industry, twice those of the household appliance industry, doubled between 1994 and 1997.
Eighty million Brazilians, more than half the population, self-medicate regularly according to the Brazilian Pharmaceutical Industry Association. The government confirms that two out of three sedative sales occur without a medical prescription but on the recommendation, often inappropriately, of friends, family, magazines or the neighborhood pharmacist.
When Glícia Gerônimo Rangel was feeling depressed, her doctor prescribed a tranquilizer during a 10-minute office visit. Uncomfortable with the medicine's strength, she never touched the medication. Her fiancé, Juliano, was having trouble sleeping because of a new job. He quickly finished off the packet and easily refilled it at the pharmacy without a prescription.
Besides sedatives, Brazil's auto-medication spree includes the widespread use of "uppers" such as the anti-depressive Prozac and amphetamines, only 20 percent of which are prescribed by a psychiatrist. In a dramatic shift from past practice, general practitioners are liberally orientating their patients towards their use. "Anti-depressives are for depression, which has a clinical definition. But there is now an openness to using them to cure sadness, frustration, or exhaustion," says psychiatrist Artur Guerra, head of the Psychiatric Department of the Clínicas Hospital in São Paulo. Sales of Prozac jumped 43 percent between 1995 and 1997. It is so easy to obtain without a prescription that reports of socialites giving Prozac to their pets surfaced in 1997.
Brazilians ingest 20 tons of amphetamines annually, making the country the world's leader in consumption. China follows at a distant second with eight tons. Originally used by German soldiers in World War II to ward off hunger and exhaustion, today amphetamines are gulped down primarily by women to curb appetite for weight loss.
In general, the medical profession has contributed to this addiction. Researchers posing as patients seeking weight loss in Recife and São Paulo in 1997 visited 107 doctors. Less than a third required a medical exam before prescribing amphetamines. Only one doctor denied the patient's request by refusing to prescribe an "appetite moderator".
Pharmaceuticals industry tactics are also part of the problem. Drug companies offer monetary rewards to pharmacists and counter attendants for high sales. Some pharmacies offer price club discounts for frequent purchasers. Advertisements for drugs such as the worm medicine Zentel have at times promoted unnecessary treatments. Worms are not contagious but some Zentel campaigns encourage the treatment of the entire family of the patient. The drug companies also target doctors to boost sales. One physician received 69 ads, 452 free samples and 25 presents during a 21-day period.
Self-medication is not limited to sedatives and "uppers". Medical studies show that a healthy person needs between 3 or 4 prescription drugs a year. On average, Brazilians consume 11 prescription drugs with at least eight without any medical orientation. Experts agree that advances in medicine have played an important role in the prevention and treatment of tuberculosis, pneumonia, syphilis and countless other diseases that a century ago plagued humanity. The problem is that people need drugs only in rare situations but often seek them inappropriately for instant relief. "Nature resolves 90 percent of human health problems without intervention by a doctor" affirms Daniel Sigulem, Professor at the São Paulo School of Medicine.
Antibiotics are among most misused medications. "Some of our clients seek antibiotics for chronic back ailments," observes Efu Nyaki, co-director of AFYA, an alternative health center for women in João Pessoa. "The source of the pain is stress in 95 percent of the cases, but many women run to the pharmacy for quick relief. Antibiotics, of course, have no effect on back pain." But the inappropriate use of antibiotics and other drugs has detrimental consequences including intoxication. Over time repeated use, even in small doses, builds bacterial resistance making subsequent courses practically ineffective.
Brazil is not the only country with a self-medication habit. The types of drugs available for self-medication, however, vary greatly from country to country. In the US and most European nations, over-the-counter drugs are limited to aspirin, vitamins, and stomach ailment medication. Antibiotics, contraceptive pills and cortisone-based asthma medicine strictly require a medical prescription.
Alternative health centers are one response to Brazil's addiction to pharmacies. AFYA provides psychological counseling, as well as courses in therapeutic massage, mental health, sexuality, exercise, healthy cooking and plant medicine.
"Brazil's government fails to meet the health needs of the majority of the citizens. Self-healing gives women confidence, which can be a stepping stone to demanding their rights," Nyaki says, "Women who learn to heal themselves will also have healthier families and hopefully pass the gleanings on to their communities."
By Kathleen Bond, Maryknoll Mission Association of the Faithful. You can reach the author at katiaflavio@uol.com.br