Thursday, September 10, 2009

Healing from Depression While Living in (Universal Public Option) Brazil

I had been feeling quite depressed much of last year and this one, after my 18 year-old step-son came to visit us for the Christmas before last and nonetheless stayed for ten months, all the while insisting that he couldn't and woudn't work, and I should find more money somewhere if I couldn't support him, his mother and two sisters on the income I had.

I finally decided that if living with my wife meant also living with my step-son, than I preferred to live alone. It
Free Pharmacy at Neighborhood Free Hospital

was a very hard decision for me, but first we separated houses and then I moved sixteen hours away by bus, and only returned a month ago, (aside from some shared vacations with my wife) when I learned that my 18 year-old step-son had moved decisively to a different region of Brazil.

This Christmas, if he comes, I'm leaving and only coming back when he's gone again. Let HIM pay the rent and other costs if he makes that decision.

Anyway, I'm feeling much better now, living with my wife and two step-daughters. I don't do very well living by myself. I get depressed more easily and more profoundly.

There is a whole different and chronic, lifelong level to my moods and personality. Unless I take a daily regime of medicines, I suffer the symptoms of clinical depression, e.g. feeling disinterested in everything and everyone around me, sleeplessness, feeling anguished with loneliness and directionlessness, and without the energy to do the things that others do to make their lives work from day to day. And when I feel like that, I become convinced that things can only get worse and the only solution is intentional and efficient self-destruction.

So, getting and taking daily anti-depressant and anti-anxiety ("anxiolytic") medication is fundamental to my feeling relief from those symptoms. The medications help me to take joy or at least pleasure in things around me, and to not so easily become angered, anxious and volatile.

This challenge is a big part of why I live in Brazil instead of in the United States. In Brazil, it's possible to get the medication I need, but in the United States it was so difficult as to be virtually impossible. For example, in the United States, when I was working as a managing attorney, but crying at my desk as I sank deeper into depression, I once called my HMO and told them I was suicidal and needed to see a psychiatrist.
Free Medicines at Free Public Clinic

They told me where to go and who to speak with and I did speak with that person for three or four sessions, before I discovered that he was NOT a psychiatrist and could NOT provide me with any medication, even though I had all the signs of clinical depression and should immediately have been referred to a psychiatrist. I felt like an idiot for not having asked him earlier, and yet I had made my needs plain to him and the HMO.

I was paying four hundred dollars a month for health "insurance" and they were playing with my health as if it were a rubber toy.

The only thing that the US's health insurance "insures" is that there will be a massive profit-centered bureaucracy between patients and the doctors and medicines that patients need. Once you're sick, if you die quickly then the insurance company avoids paying your claims.

So, how is it different in Brazil? Brazilians have medical care as a right guaranteed to them by the Brazilian constitution. Sometimes the situation at particular health clinics is precarious, but the right exists.

The pharmaceutical cocktail of nortryptaline ("Nortrip") and diazepam
works best for me.

In my case, there is a physician at a public clinic two blocks from here who will write a prescription for my antidepressants and anxiolytics, without insisting on charging me for a consultation and without insisting on charging me once again every time my medication runs out. In fact, it is illegal for anyone at these Brazilian neighborhood health clinics to charge anyone for anything. They have no cash registers and no credit card swipers. You never, ever see a dollar sign in a Brazilian health clinic. Not before, during or after. You receive no bills and there are no checks to determine if you are covered, because EVERYONE is covered to exactly the same extent - to the extent of the services that the Government is able to offer.

(In one city, health clinic workers were charging for places in line, but that was unusual enough to make the nightly national news. They were charging seven dollars to see an opthamologist.)

I've recently learned that that the effective way for me to get the medication I need is
(a) to see these doctors at the local clinc (for free) and then
(b) go to the public hospital in our neighborhood and get the medication that has been prescribed, also provided for free.
As with any bureaucracy, it takes a while to learn how the system works, what the parts are, and what each of them does. Sometimes break down and other resources have to be searched out.

My local health clinic, for example, used to have a pharmacy. But there's now a note on the door saying that the pharmacy is closed because the pharmacist has been fired. Thankfully, there are at least five other Government-sponsored pharmacies within a ten minute moto-taxi ride from here.

Today, I asked a pharmacist at a for profit how much my medication would cost if I bought it there. It would have cost seventy dollars. So, I continued walking until I found a free public clinic doctor to write a new prescription that would be honored at the free hospital's free pharmacy.

If you've read this far, you may know someone who has suffered from depression or another mental illness and who has had difficulty accessing medical care and medication. At the threshold level in this whole discussion is the willingness to take medication at all. Until I was twenty-eight years old, I insisted that all medications were inherently habit-forming and that they sapped individuals' desire to get to the bottom of their psychoanalytically treatable problems.

Then, one day during my first year of law school, I found myself crying uncontrollably on the floor of a friends house at three in the morning, repeating through desperate sobbing that I had realized that I had "always been depressed" and it wasn't going to go away because of even intense talk therapy. At that point, I was so anguished that I was willing to take virtually any medication that a doctor might prescribe, if it would bring me up and out from the pits of despair.

Since that day, eighteen years ago, I have had to try a variety of medications before finding a combination that, for the moment, takes the worst symptoms away with the least side effects, in a country where I can have access to medical care and medication even if my depression makes it impossible for me to work.

The United States was never the country for me, if only because it didn't have the good sense to understand that access to medical care can't be based on access to work. If it is, then as soon as a person gets sick and can't work, they lose their medical care as well. They only have medical care when the need it least, and when they need it most, it's gone. That only "insures" heartbreak, not medical care.

I knew I needed psychological or psychiatric care from the time I was a child, but my mother's medical insurance from the college where she taught only provided ten visits to a psychologist per year, and only covered less than half the actual cost. Here in Brazil, my step-daughter sees a speech therapist every Saturday morning, for free, at the public health clinic.

Lula Ignacio Lula da Silva is the president of Brazil and will soon have served his maximum two terms. Then the USA would do well to invite him to go to the USA and run the USA's public option medical care. Brazil knows how to do univeral free access AND medicine, but the USA has yet to prove its competence in this area, except perhaps at Veterans Administration hospitals.
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