I've lived in Brazil for two years now, sometimes severely depressed, but I had never sought a psychiatrist because I assumed the care here would be poor and medication hard to find. Because I was fantasizing about decapitating myself last week, [
http://www.dailykos.com/... ] I finally decided to go to a psychiatrist here. I invited my wife to go along so that she could support me in scrupulously observing whatever medication regimen the psychiatrist might recommend. (When it gets this bad, medication is often a good idea.) Now having gone, there is very much good news to report and very little bad.
Things went surprisingly well in this first visit. The psychiatrist works in a fancy clinic, new, well-lit and spotlessly clean. Although his fifty-five dollar fee for a one-hour initial psychiatric visit is a lot of money for me right now, it is still only half or a third what such a visit would cost in the United States. When I asked if the doctor offered sliding-scale fees, he informed me that although he doesn't, he always provides one follow-up visit for free after an initial consultation, to see how new patients are doing on their new medications.
Effectively, my first visit with this experienced private practice psychiatrist cost $27.50 USD. I was not able to negotiate a discount.
The doctor doubted my manic-depressive diagnosis, because "manics tend to seek help the manic phase", when their outrageous and excessive womanizing and spending and traveling finally make their lives intolerable. [ http://www.psycom.net/... ] But, here I was seeking help while depressed. So, the doctor suspects that I am dysthymic (perpetual "blahs") [ http://www.mentalhealth.com/... ], although he acknowledges that psychiatric diagnosis of mood disorders "hasn't progressed much in this area over the last 60 years." As the doctor said, "All we can do is try a medication and, if it works, then we'll know what illness you have based on what medication works to make it better." Hmmmmmmm.
Now, for more good news: The doctor prescribed for me a "mood stabilizer" drug called carbamazepina, known also as Tegretol. Although the generic version of this medication would cost $00.25 cents per tablet at Walgreens.com in the United States ($15.00 USD for a one-month supply of two tablets per day), [ http://www.walgreens.com/... ] here in Brazil this medication costs just $00.06 cents USD per tablet at Government-sponsored (or $3.60 USD for a one-month supply).
How can this medication cost four times as much in the United States as it does in Brazil? I also bought some of this medication at a normal free-market pharmacy here, for $00.12 per tablet, or half the price that Walgreen's charges online. But there is another way to get this medicine in Brazil, which is to go to the Government's free clinics, where reportedly the medication is provided at no charge whatsoever. At free clinics, the medication is reportedly available without charge even for foreigners, and regardless of immigration status. Whoever imagined that people from the United States would have to move to Brazil as "welfare tourists", rather than the other way around?
Somewhere, there is a pharmaceutical company employee thinking, "Isn't there some way to force Manic Lawyer to pay in Brazil the same price that he would pay if he were here in the United States? If this sounds paranoid,
Doctors Without Borders is calling upon the United States government to withdraw its request for a World Trade Organization (WTO) dispute settlement procedure on the Brazilian patent law. The US government's complaint requests measures that might handicap the successful Brazilian AIDS control program, which is largely based on Brazil's ability to manufacture affordable medicines. [ http://www.commondreams.org/... ]
Making medication expensive is the considered and deliberate policy of the United States Government.
After paying two hundred dollars for month for Prozac in the United States, and one hundred dollars per visit to a psychiatrist, I am really happy to live in Brazil, where I can pay for my medical needs (at least for the moment) with the money I have in my own pocket.
If I didn't already have immigration status here, I might apply for political asylum in Brazil. My legal theory would be,
If forced to return to the United States, I would have to start a revolution to obtain affordable medical care, and then I would be put in prison. I urgently request that I be allowed to remain in Brazil, where anti-depressant medication is free, and that I not be returned to the United States, where the denial of medical care and necessary anti-depressants is a brutal and heartless form of psychological torture, and because in the United States I might be driven to suicide by the lack of affordable access to psychiatric health care.