Part 2, Low Cost of Medications in Peru–Ordering in Spanish

Yesterday I wrote about how inexpensive it is to buy medications in Peru and how you don’t need a prescription for most drugs (apart from narcotics and amphetamines). This system made it easier and more affordable for us to care for my dad with Alzheimer’s while we lived in Lima.

Today I’m going to share a few tips on how to purchase medicines at a Lima pharmacy. These tips are aimed at people who are not Peruvian, especially those whose first language is English.

You know, I’m starting to get more emails from Americans wanting to know how we cared for my father in Peru and wondering if such a move is right for them. Some people who query me have never been to Latin America and, more critically, don’t speak Spanish. They want to know if it’s “necessary” to learn the language in order to get good care there for their loved ones.

The bottom line is, yes, you must speak at least intermediate-level Spanish to be able to coordinate care south of the border. There is no way around that. You’ll need to communicate effectively with caregivers, doctors, and–here’s the point that I was coming to in this post–with pharmacists and people who work at pharmacies.

Peruvian society is very people-oriented and service-oriented, which means you must negotiate transactions face to face, not with a computer or automated check-out service.Continue Reading

Low-cost Medications Are a Bonus for Caregivers in Peru

A customer buys medications in Nortfarma, a Peruvian pharmacy; prices are fixed by a national ministry, and stores that overcharge are fined. (photo: Andina)

In other posts, I’ve written about how affordable home-health aides are in Lima, a benefit that greatly helped our family when caring for my American father in Peru.

Today I want to share another bonus of caregiving in Lima: how medications are sold and dispensed. The Latin American system is so different than the for-profit model used in the United States, it’s shocking–and I mean that in a good way.

Basically, consumers at a Peruvian pharmacy can get almost any medication they want for about 70% less than what it would cost in the United States–without a doctor’s prescription. This savings applies only drugs that are no longer under patent and which are currently manufactured by several companies or as generics. New medications under patent are still full price.

For instance, the memory drug Excelon was still under patent when my father was taking it in 2011, so we had to pay full price (more than US$100 a month) for it in Lima. However, the eight other medications he took daily (Omeprazol, Sertraline, etc.) were available in generic form, and we ended up spending about US$80 a month for all of them together.

The savings were considerable, so we didn’t need his US insurance to cover drug costs. (His prescription plan  didn’t work down in Peru anyway).

I know that some readers are still stuck on that phrase in the third paragraph–“without a doctor’s prescription.”

Yes, that’s right. With the exception of certain drugs (see below), medications are freely dispensed in pharmacies sin receta (without a prescription), and overall, this works to the consumer’s favor in Peru, apart from the hazards of self-medicating. People do go to doctors and get prescriptions, but they aren’t necessary for initial purchase. And this system makes it much easier when you are a caregiver to an elderly person and you have to keep up with lots of refills.

Here is how the ordering process works:

Continue Reading

Peruvian Cure for a Prickly World War II Vet: La Comunidad

One of the surprises of bringing my 86-year-old father to Peru was seeing how much he ultimately thrived on having lots of human contact. To be blunt, his being doted on by sweet-tempered Peruvian women helped transform him from a vain, self-absorbed, prickly old man into a calm person who was actually kind of nice to be around. (Getting him on antidepressants—which I suspect he had needed for years–also helped.) Being part of la comunidad (the Spanish word for “community”) was an integral part of his emotional care.

Never a physically demonstrative person, my father had lived a rather solitary life in the United States. Widowed at age seventy-seven, he lived alone in a four-bedroom house in northern Florida and resisted having me, Jorge and Sam come live with him when we proposed the idea. His interactions with other people were limited to weekly church services, monthly Masonic meetings and brief transactions with grocery clerks, bank tellers, doctors and nurses. This wasn’t really that big a change from the way he had lived when my mom was alive. For decades my mother had been the center of his emotional life; when she died of lung cancer in 2004, he bought a toy poodle and lavished his affections (and Krispy Kreme donuts) on that. He had no close friends to speak of, just people he had known up north long ago and with whom he exchanged annual Christmas cards.

Moving my father to live with us in Peru put us in a different, more humane, paradigm.

In contrast with the United States—which prizes, above all, independence and individualism—Peru is a country of collectivism. Continue Reading

Eldercare Is Easier in a Nonlitigious Society

This quote, by 17th-century French satirist Jean de la Bruyere, might be said to sum up the attitude of many Peruvians toward civil lawsuits.

I knew when we brought my father to Lima in 2011 that it would be cheaper to give him personalized care there. What I didn’t anticipate is how much easier it would be work with doctors, nurses, health aides and hospitals—in contrast with the bureaucracy and complications of the U.S.

After thinking it over, I’ve come to realize what, exactly, made these interactions easier: Peruvian culture is not very litigious. Unlike in the United States, people don’t generally sue others and institutions over civil matters. And when it comes to medical issues, people rarely take doctors or hospitals to court, even when things go very wrong. For instance, the whole seven years I lived in Lima, Continue Reading

How Lima’s Compassionate, Affordable Home Health Aides Saved My Father–And My Family

When my 86-year-old father was diagnosed with Alzheimer’s in early 2011, he was living in northern Florida, and my husband, son and I were working and studying in Lima, Peru. We didn’t have money to put my father in a dementia-care facility, and we knew he needed more than a few hours daily of at-home nursing care. My dad, like everyone with Alzheimer’s, needed help with everything from bathing, to making meals, to remembering to take his medications. Short of moving back to the States without employment there, what could we do, we wondered?

The answer, it turned out, was right in front of our noses: Lima’s plentiful supply of professional home-health aides.

We had seen these young women in white or blue scrubs escorting elderly Limeños through the neighborhood parks—holding their hand as they walked slowly along the sidewalk or pushing them in wheelchairs. We’d also known two of these health aides personally. They had cared for my sister-in-law’s very sick mother for two years in her house. What had always struck me about the aides, or enfermeras técnicas [technical nurses], as they are called, was their patience, attentiveness, and positive outlook. They didn’t rush their patients, they didn’t ignore them to look at their cell phones; they did what had to be done—present, in the moment—and with kindness and good humor.

It clicked in our heads then: These aides would be perfect for caring for an Alzheimer’s patient. Even if they didn’t speak his language.

Cut to the chase: We moved my father to Lima, installed him in a room in the back of our house, and hired two licensed health aides to care for him 24/7.

That was March 2011. Cost for his round-the-clock care? US$670 per month for both aides, plus three meals a day. The two aides rotated shifts.

In future posts, I’ll explain how we found these aides and the legalities of hiring (and firing) domestic workers, as they are considered, in Peru. The important thing is that because my husband knew the city and the culture and spoke Spanish (he was born in Peru), it was easy for us to find excellent help and to arrange a good set-up for my father. We went through a personnel service that my sister-in-law had used, and it ensured that the aides were well trained and licensed, and had passed background and police checks. We had to go through a few ETs until we got the right fit for my dad, but within two months, we had found the ideal aides.

That’s my dad, above, with his enfermera tecnica Erika. Every afternoon they went for a walk in the park, or if he wasn’t up to it, for a ride in a wheelchair. My husband used to say that she had the patience of a saint.

The affordability of at-home care in Lima meant that my father was never alone as he battled Alzheimer’s.  These caring, capable women helped him in the tasks of daily living and stayed calm and upbeat in difficult situations that had me tearing my hair out.  It was brutal seeing my dad go on a hunger strike, as he did when he first came to Lima, and watching him succumb to hallucinations. I was overwhelmed witnessing my father’s suffering, but the health aides had seen it all. They knew that it was going to get better (with the doctor’s help), and they stayed strong in their faith.

His health aides not only saved him—they saved me and my family.

We were more fortunate than many caregivers in the United States, who have to hold down jobs and must patch together care strategies with hourly sitters and/or family members taking turns. My husband and I still spent many hours caring for my father in Lima, but we had the necessary luxury of being able to go up to our room at 10 p.m., shut the door, and sleep through the night without worries. The aides prevented him from wandering all over at 2 a.m. Just that fact alone let us keep a better grip on our sanity.

If there is one thing that caregivers of Alzheimer’s patients need, it’s this: Reliable, experienced help in overseeing the daily tasks of living. Alzheimer’s robs a person of the ability to do even the simplest of things—getting dressed, reading a book, remembering where one’s house is. Until there is a cure for this brutal disease, at-home help should be an affordable option for all Alzheimer’s patients, not just the very rich. Long-term care should be a right for all Americans.

My dad lived just a year and a half after his diagnosis. But that period was filled with caring and compassion. We have his health aides to thank for making those months—his Peruvian Alzheimer’s Adventure–a positive last chapter in his life.

How to Make Traditional Peruvian Apple Water (Recipe)

I explained in my last post the benefits of agua fresca [fresh water], an economical drink that is popular in many Peruvian households. You boil fruit and spices in water, strain it, and sip the liquid throughout the day to stay hydrated. The health aides who took care of my father in Lima used to make this for him daily, and he took to it immediately. He hadn’t been in the habit of drinking much water in the U.S., but I think that the mild flavoring of agua fresca was what made this drink so easy for him to consume.

There are many methods for making agua fresca. Here is a recipe for agua de manzana [apple water] that my husband’s family used back when he was a boy growing up in Miraflores. More often his mom would make apple juice, but this recipe served nicely when fruit was less plentiful.Continue Reading

“Fresh Water”: A Peruvian Tradition for Healthy Living and Eldercare

One of the healthiest habits that my father picked up when he was an Alzheimer’s patient in Lima (2011-2012) was drinking agua fresca throughout the day. Agua fresca, or “fresh water” as it is translated into English, is a popular drink throughout Latin America, but a bit of research on my part turned up an interesting fact: The Peruvian version that my father consumed day in, day out, differs in several ways from the agua fresca served elsewhere in Latin America. And those differences are what I’d like to explain for North American readers because this drink can benefit elders, their caregivers and people in general.Continue Reading

How We Got My Father Excellent Alzheimer’s Care for Less Than $1,400 a Month

If you’re reading this, you may be facing the terrifying predicament my husband and I found ourselves in in 2011: My elderly father had just been diagnosed with Alzheimer’s, and we had very little money to cover the gap between his monthly pension and what he would need for long-term care. To put it bluntly, we were scared out of our wits.

So we came up with an unorthodox solution: We moved my father from northern Florida to Lima, Peru, and cared for him there. Yes, Peru, South America.

He lived in Peru’s historic capital for sixteen months, until his death in July 2012, and he got excellent, personalized care that far surpassed anything he could have gotten in the United States.

In other posts, I’ll get into how and why we chose Lima (we were living there at the time). What most people want to know first are the numbers, so here they are.Continue Reading

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