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From sunny foreign shore

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Rags Methanol examines what holiday makers return with from abroad

There are some elegant consistencies associated with a British summer: strawberries and cream at Wimbledon, cricket and, of course, rain. The latter drives one particular British tradition — a summer holiday in a sunnier clime.

For pharmacists, those holidays may lead to one of our profession’s more quirky summer traditions — dealing with the random assortment of bizarre medicines that people return with from abroad.

Urinary tract infections are a common scourge for British travellers. Recently though, a patient came back from Eastern Europe having succumbed to a particularly bad attack. I presume her command of the local dialect was unable to communicate the fact that she was urinating blood — and that was why the local druggist felt a few mugs of marshmallow root tea would be sufficient treatment. Needless to say, it wasn’t — trimethoprim from the GP was, fortunately, more successful.

Others have received more hardcore treatments for their cystitis. One returned from Italy with co-trimoxazole. Perhaps, anecdotally, Tuscan urinary germs are particularly sensitive to sulfamethoxazole. Another foreign pharmacist subscribed to the “if in doubt, pee it out” school of thought — selling a box of furosemide to a British visitor with a UTI. Licensed uses aside, I consider this practice to be “iffy” at best.

Traveller’s diarrhoea is another affliction that sees many a British tourist testing the efficiency of their destination’s healthcare service. Many years ago, during an excursion to the Dominican Republic, I foolishly decided that the locals would excel in their preparation of Japanese fish dishes. The consequences started around 24 hours later and made sure I would not stray more than 20 metres from a bathroom for the remaining 10 days of my holiday. Despite this seemingly relentless diarrhoea being an obvious case of food poisoning, the medicines expert on the local high street assured me that a few doses of loperamide would sort me out. When I refused, a course of flucloxacillin was suggested. Clueless as to the logic behind these suggestions, and unable to locate the rehydration salts on the shelf, I gave up — opting instead to allow time to be my healer.

My customers appear to have had similar experiences. One returned from the Far East with a box of mesalazine that she’d been sold for a bout of the squits. That said, given its apparent success, I packed her off to the GP to determine whether the Oriental pharmacist had unwittingly treated an undiagnosed irritable bowel syndrome. I remain unconvinced though that it was judgement, rather than luck, that led to this diagnosis being made.

The seemingly unrestricted access to medicines that pharmacy customers have in other countries does, at times, yield favorable results. A friend of mine once suffered a particularly savage bout of conjunctivitis during a long weekend in Sardinia. Her previous experience — at the hands of a British pharmacist — had been akin to undergoing the Spanish Inquisition before she could get her hands on some chloramphenicol, so she was surprised at the ease in which she was sold a bottle of Tobradex. Credit where it’s due though — the infection was all but clear in just 24 hours.

Access to medicines is not just about sales regulations. Preventing patients from getting their hands on them is a useful method for allowing pharmacists to retain an element of control. Nonetheless, in Ho Chi Minh City, Vietnam, I ambled into a pharmacy that had original packs of gliclazide modified release, quetiapine and tadalafil all on a display stand just yards inside the front door. I reckon I could have swiped all three with one foot still outside on the pavement. This approach was the polar opposite of that exercised by a pharmacy in Basel, Switzerland, where even the effervescent vitamin C was kept behind perspex screens — seemingly only sold if the pharmacy staff judged that you deserved them.

In summary, I thank all pharmacists in overseas holiday destinations for the insights I receive of their alternative logic. While their approach to healthcare is sometimes overkill (Dermovate ointment for an insect bite) and at other times bizarre (using atenolol for a headache), their ability to apply outside-the-box thinking never fails to enliven my rainy summer days.

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