Self-medicating in Burma: pharmaceutical freedom in an outpost of tyranny.

Weeks before leaving for a year-long stint in Burma during the fall of 2003, I listened as a New York City travel doctor rattled off a list of sinister-sounding ailments. There was malaria to worry about; also typhoid, tetanus, tuberculosis, yellow fever, and something called Japanese encephalitis, not to mention the risk of rabies from wild monkeys. Eyes averted, I accepted vaccinations for no less than five diseases. I did no research, asked no questions, winced, and forked over $900.

Had she supplied vaccines for food poisoning, ear infections, and a dozen mystery illnesses I suffered while abroad, the story might end there. But living in a far-off country generally forces you to engage with its health care system, and Burma was no different. I was in a Rangoon doctor's office within a week of my arrival, asking for pharmaceuticals by name and being met with a blank stare from a Burmese physician.

It wasn't the language barrier. The doctor didn't understand what l was doing in his clinic. Because Burma has no prescription requirements, I didn't need his consent to self-medicate; I should have been at the supermarket asking for Cipro, an antibiotic, rather than wasting his time as others waited.

Freedoms are in short supply in Burma, a country run by a hardened military, yet the freedom to treat a bout of food poisoning with pharmaceuticals was new to me. The United States is the only country in the world that divides drugs into two rigid categories of prescription-only and over-the-counter. Most other developed nations allow for a third class of drugs to be dispensed by a pharmacist, and developing nations typically do not have prescription requirements or fail to enforce them.

My expatriate friends and I readily partook of Burma's open medicine cabinet, and in the process our relationship to health care changed dramatically. Our local grocery store stocked an array of antimalarial medications (prescription only, stateside), and the visible surfeit of options prompted us to question the recommendations of our Western and Burmese physicians. Why this one and not that? This one gives you nightmares; this one shreds your liver; this one causes nausea. Our doctors, with rosters of other patients and ailments to consider, could hardly have made the informed and personalized decisions we made with the benefit of their help. Nor would they have been more cautious than we, who had most to lose from an overdose or misdiagnosis.

The simple privilege of looking over our pharmaceutical options was revolutionary, but more so was the sense that our relationship to doctors had shifted from paternalism to partnership. We bookended every doctor's visit with our own research, Googled and re-Googled our symptoms, weighed differing opinions from Western and Burmese physicians. As the months wore on, we grew more confident of our ability to navigate our Asian maladies but continued to seek doctors--as consultants, not demigods--for advice.

In virtually all respects, Burma's health care system is not one to emulate. (I have an enduring memory of watching a stray dog lick blood off an emergency room floor.) But in the U.S., a country where self-care is often regarded with suspicion--the result of misplaced faith in crackpot herbal remedies, perhaps, or just manipulative marketing--it's worth noting that access to pharmaceuticals is not a prescription for social chaos. A doctor's advice is a valuable resource, but nothing encourages passivity like an overzealous, though quite possibly underinformed, gatekeeper.

As it turns out, most of the vaccinations I'd received in New York were unnecessary, the result of either ignorance or over-caution on the part of my physician. Had I had less faith in my doctor's expertise, I would have realized that a woman with a safe city job needn't worry about Japanese encephalitis, yellow fever, or even rabid monkeys. "Men mistake medicine for magic," the psychiatric critic Thomas Szasz has said, and it follows that we mistake doctors for magicians. If we were allowed to perform the tricks ourselves, we wouldn't be so easily fooled.

Assistant Editor Kerry Howley ([e-mail]) is a former correspondent for the Myanmar Times and Business Review.