Playing catch up

It is not easy to get back into the swing of things, once you’ve been out of the loop for a while. I’ve neglected this blog and no one except my Facebook and CWD friends have any clue what life has been like for us here in the jungle over the past couple of months. Mostly, it’s because it’s been relatively uneventful. That’s not to say that nothing ever happened. Because this is type 1 diabetes we’re talking about, and something is always happening.

June 25, 2009: RIP OneTouch Ultra 2 Glucometer

This is Alexandra’s 1 year anniversary of her diagnosis. Her meter – her very first glucose meter 2 – up and died on us that evening. (Ralph Nader would have had a field day with that fact, I think.) Oh, we tried to revive it; we changed the batteries, opened up a package of new glucose strips, all to no avail. It just would not work. C’est la vie, right? But, I couldn’t let it RIP, no way. It seemed to me that after only a single year, it should still be in good working order. I mean, we spent nearly $100 on that meter (sans glucose strips, by the way) and while I had other meters we could use, it was the principle of the thing, ya know? So I emailed LifeScan (which is a Johnson & Johnson Company) and complained. And what do you know, within two days I had a response from a local distributor. Yes, my meter was still under warranty and would be replaced. Whoo hoo! The identical meter is now back on our headboard. Bonus discovery! We found out that the distributor (Palb in Kaneshie) sells glucose strips to the public at GHC 50 for 50 strips. That’s good to know… and waaay cheaper than you can buy it anywhere else in Ghana.

July 27, 2009: Lantus trouble

We buy 5 cartridges of 300 units at a time, and I had opened one up that day, given Alex her shot and then noticed that already nearly 80 units were missing. Went to go get another vial, and there was no other vial! We were going through these things at an astronomical rate! Alex uses a mere 13 units a day, and even given an extra 4 units for the pen priming, there’s no way we could have finished 4 (and been on our 5th!) in only three months. So, silly old me, I email the Lantus people (Sanofi-Aventis). They put me in touch with the local distributor who agrees to replace the “missing” Lantus. I head out to the pharmacy with Alex’s insulin pen and the Lantus cartridge, and the representative comes down. He’s a nice young man just aching to help. Within a relatively short while, I’ve got two replacement cartridges and a new insulin pen (which doesn’t work for Alex, but that’s another issue). The nice young man also told me where I could find Lantus is Tema, so I don’t have to drive so far.

So, two complaints solved to my satisfaction. I was happy about that. I am not so happy to think about all of the other local people who maybe have suffered the same sort of problem but didn’t know they had any recourse.

August 20, 2009: Barbara learns a lesson

I hate to be on the last cartridge of insulin before replacing it. You just never know. I had just opened the next to last cartridge and remembered my new friend from Sanofi-Aventis telling me about the local pharmacies that stock it, so I hightail it over to the first one. They don’t have it, but say they can order it for me. It’s a rinky-dink little place, and I’m not all that impressed. For what it’s worth, I am a pharmacy freak – I love looking at bottles and packages and drugs and wandering up and down the aisles. This had none of that.

Then I head over to the other pharmacy that was suggested. Now, this is more like it! Bigger, cleaner, brighter, lots of drugs and a very nice pharmacist dressed up like a pharmacist! But they don’t have the Lantus in stock either, but they can order it for next day delivery! “What’s the price?” I enquire (knowing, of course, how much it costs me if I go directly to the distributor). Oh, well, they’ll have to see if the price went up but last time it was GHC 90 (I know it’s now GHC 95).

So here I am, naïve little me, thinking okay, even with a mark-up, it’s probably not gonna cost more than GHC 110. GHC 130! How’s that for a mark-up? Alex and I walk in the next day to pick it up and I almost passed out when he told me the price. I sputtered, “Wow! That’s some serious mark-up you guys put on this.” And the pharmacist (different one than the day before) says, “Really? We only mark it up 33% -- other pharmacies mark up 40%!” Um, I don’t think so. “Well,” I tell him, “we’ve got a problem, because all I’ve got is GHC 110.” The guy looks at me and says, “So what do we do?” I’m thinking, “What do we do? How about I walk out of here leaving you with cold insulin in your hands and I go to the distributor and save myself GHC 35.” I say, quite frankly, “This is all I’ve got, take it or leave it. I wasn’t expecting a mark-up like that and I can’t afford it.” He’s clearly not happy, but he either sells it to me for that price or it sits in his fridge… I mean, what’s he gonna do, hold Alex for ransom?

Long story short, he calls the other pharmacist who agrees to mark it up only 10%. Barbara learns her lesson: Cheaper to buy directly from the wholesaler, all things considered.

October 12, 2009: The Humalog Dilemma

Alex also needs Humalog; it’s a fast acting insulin and is one of the primary weapons in the fight against high blood sugar. She was running low (I sheepishly admit it, she was down to her last cartridge), so I called up the pharmacy who distributes this and was told that they have it in stock. I draft a letter and pull the money out to buy it and send our taxi driver, Ekow, to the pharmacy in Accra.

An hour after he leaves me, I get a call from him. He’s at the pharmacy and they have the Humalog but it expires 10/09. Note to self: REMEMBER TO ASK ABOUT EXPIRY DATE NEXT TIME! I get the pharmacist on the phone, and he confirms they’re out because all of their supplies have been sent to Korle Bu Hospital, except for this package which is expiring in three weeks. “Do I want it?” the pharmacist wants to know. Of course, I don’t want it! It’s for an 8-year old girl; she’ll never finish it all before it expires. The next shipment isn’t coming in until next year, I’m told. I call my taxi driver and tell him to forget it.

A few days later, I decide to drive to the hospital to find the Humalog, and Ekow takes me there. Supposedly, you’re supposed to have a prescription at the pharmacy, so like a good consumer I head up to find a pediatrician who can write one out for me, since Alex’s main doctor isn’t around. I find no one I know, but do find a surly doctor who looks down her nose and tells me to have a seat in the waiting room till she can get around to me. I’ve got little patience for beaurocracy, so within minutes I’m out of there.

I tried the first main pharmacy, and they’re willing to help me (after all, the universal language in Ghana is cash!) but they’ve not got Humalog; they’ve got Regular and Lantus (good to know for later, but right now I don’t really care) but no Humalog… maybe one of the other pharmacies on the hospital grounds. Off I go in search… after the third pharmacy, I’m starting to get frantic that I’ll not find this stuff and have to rely on Regular insulin. I spot one of Alex’s doctors walking around and she directs me to the Diabetes Clinic. Saddest place (well, next to the children’s wing) that you ever want to see. They’ve got Humalog, but with the same expiration as the one from the wholesale distributor. I am sincerely frustrated at this point. I head back to pharmacy #1 and buy the Regular, just in case.

I go online looking for commiseration from my CWD friends, and learn that it’s alright to use the expired insulin, because the pharmaceutical companies are usually very liberal in their dating, so that they don’t run into lawsuits and such. It’s not like on October 31st that the insulin will instantly self-destruct, it may just degrade over time. That news comes as a major relief to me.

So I tell my husband to pick it up from the pharmacy, after I confirm again that they’ve got it in store. This time, without my even asking, they advise me that it will expire at the end of the month. I tell them it’s alright, I want it anyway and that my husband will be there to pick it up later in the day.

You can imagine my relief when Sly came home that night and handed me a box of Humalog 75/25 Mix!!!! What! They screwed up the package in the pharmacy, and Sly didn’t think to check the box (and to be honest, I’m not convinced he’d have known that it wasn’t what I really needed, anyway).

Here we go again.