If you were to hop onto the nearest vikram and go for a ride down one of the streets of a Dehradun you would find yourself driving past a chemist shop (pharmacy) on every corner, a mixture of doctors practicing homeopathic, Aryuvedic, and allopathic medicines, and countless billboards for imaging centers and health “checkups.” Every day that you see fliers that resemble a fast food menus offering “basic,” “deluxe,” and “super-deluxe” healthcare screenings. Turn down another street and you might come across a cluster of diagnostic centers with ultrasonography, CT scanners, and MRIs. Around the next corner will be a small hospital tucked in the mess of buildings sandwiched between a shoe shop and a gas station. In keeping with India’s general theme of “anything goes” the entire healthcare industry seems to have just popped up wherever there was space, with little rhyme or reason. I feel a bit overwhelmed looking at it all from the perspective of outsider…. I can’t even imagine what it would be like navigating the system as a patient.

The Chemist – your friendly neighborhood drug dealer. 

Seeing so many chemist shops naturally had me curious about prescriptions and how medication distribution works. The long and short of it is that if the U.S. employed a similar system it would be a complete and total disaster. According to the letter of the law, all medications dispensed require a prescription… however this is far from reality. All it really takes is to walk up to the chemist shop and tell them what you want and they’ll sell it to you as long as you have the money. While this is somewhat dangerous, it might not be all that bad when it comes to many medications for managing chronic conditions. However, when we asked about opiates, benzos, and barbiturates there wasn’t much of a difference. One attending told us that they are more regulated and harder to get while two others told us that they are as free flowing as all the other medications. The story for antibiotics and steroids is the same – ask/pay and you shall receive. From the individual’s perspective this system makes getting medicine and med refills very simple….  but the potential for abuse of the system is quite obvious.

Let’s take a moment to look at who owns and operates the chemist shops. One would assume that a pharmacist would be in charge of dispensing medications, much like in the U.S. Again, on paper this is how the system works but the reality is quite different. Many of the shops are actually owned by pharmacists however they are all staffed and operated by laypersons with no training or certifications. One pharmacist may own multiple shops and allow all the drugs to be dispensed in his authority without ever setting foot in the shops. Yet again, this is a far way removed from the system in the U.S. where even the pharm techs need certification and every prescription is reviewed by a licensed pharmacist. I hope the potential for abuse is becoming quite clear by this point because my next post about the “quacks” practicing “medicine” shows just how creative some persons can get for exploiting the system.

After learning more about how medications are handled in India we naturally wanted to know why the government wasn’t doing more to rectify the situation. The easy answer is that nobody in power really cares to do anything about it. The long answer is that there simply isn’t enough man power for a crack down and even if the government cared to. As soon as one illegitimate chemist is shut down two more will open right down the road. Here we again see the recurring theme with most problems in India – the country is too big and there are too many people to effectively manage them all. The story of the chemist shops (and the medical quacks too) reminds me of the story of Hercules fighting the Hydra – for every head removed two more grow back. It is going to take a tremendous effort to change the system in a meaningful way and judging by the opinions of the physicians we’ve been working with nothing is going to change any time soon.

The chemist shop just down the street from our home stay.

Medical Imaging

The number of medical imaging facilities makes for an interesting, brief aside. Similar to the U.S. there are many freestanding facilities for medical imaging. Initially I was amazed to see so many facilities and so much advertisement but then I’m easily able to recall myself driving down one of the roads back home and seeing the large billboards advertising “Lexington’s only 3T open-air MRI.” Perhaps what makes it so different is that there will be million dollar machines sitting inside a building whose facade is crumbling and whose front door is barely hanging on its hinges. Or perhaps it is the fact that in some areas of town there are literally 3 MRI companies in a 2 block area. Maybe it is the ease with which you can walk in and get a full body CT for less than $100. Honestly, I’ve been half tempted multiple times to walk into a facility and get an MRI just for the fun of it since it’d cost a fraction of what it would in the states. 

Another diagnostic center 1 block away from our clinical site….. which is also one block away from a near identical diagnostic center.
A diagnostic center just outside one of our clinical sites.