MOSTLY OTC

by Ani Ivanova

The wildest and most dangerous free market in Bulgaria is when you go to your nearest apteka

Whether you have lived in Bulgaria for a while or are just visiting, you must have noticed them – small, big, shiny, old, part of a bigger chain or located in the proprietor's first floor flat - pharmacies can be found everywhere. You'll soon learn that a chemist's, or apteka is the only place to buy medicines in Bulgaria – from antibiotics to other prescription medicines to generic drugs such as Analgin, Paracetamol and vitamins.

If Bulgaria's notorious health care system, consisting of polyclinics, and mostly state-owned general and specialised hospitals, is largely a legacy of the Communist period, pharmacies were an upshot of the democratic changes. Up until 1991, the production and distribution of pharmaceuticals was highly centralised, but the transition to a market economy broke the monopoly. As a result, pharmacies mushroomed and even in small areas you have a choice of no less than a couple. In addition, at least one of them will be open around the clock.

Pharmacists in Bulgaria – graduates of specialised higher schools – are quite knowledgeable about treating minor ailments with both Western and herbal medicines. They also break the Bulgarian customer service norm by being surprisingly helpful. The drawback is that with the exception of larger cities, English will rarely be spoken. Nevertheless, if you try and speak a little Bulgarian or pantomime your symptoms, communication will ensue.

Although prescriptions brought from abroad are not accepted, if you show the chemist your original medication container, they will give you the same brand name or provide you with an equivalent.

Be warned that Bulgarian doctors will more often than not prescribe heavy-duty drugs. A person we know suffered bad withdrawal symptoms after taking tablets for her back pain for just five days. So before you buy anything like this, you may want to check them out online or with your local pharmacist who will be able to offer a milder or more natural remedy.

You will be shocked to find out you rarely need a prescription if you know what you need. If you've already had the flu or a severe headache during your stay in Bulgaria, you will have noticed that medicines that are strictly prescription-only in your home country – particularly antibiotics and painkillers - are sold over the counter here.

In theory, all medicines sold in pharmacies must be approved by the Bulgarian Ministry of Health. Both imported − most pharmacies are well-supplied, although you may not find all medications available in Western Europe and North America − and locally-produced generic drugs are reliable and cheap. Prices may vary from pharmacy to pharmacy, but generally you will pay less than in the West. Major credit cards are now accepted at big chains.

Even more shockingly, your pharmacist will almost always ask you whether you want just a couple of tablets and then give them to you out of an open box! Most Bulgarians buy medicines this way as they cannot afford to buy a whole box.

The most dangerous part, however, is to find out that some of the medicines on sale at Bulgarian pharmacies are fake, or mente. The uthorities regularly check pharmacies for fakes, but as with pirated DVDs and Abidas running shoes, there are no rules and no guarantees. Use your common sense.

If you contribute to the Bulgarian social security, NOI or the National Social Security Institute, you're entitled to free or cheaper medicines from the Bulgarian state health system along with free treatment from a GP and referrals to a specialist.

In case you don't contribute to social security, or are a retiree, or are not covered by a reciprocal agreement, check out the conditions for the validation of your private international health insurance policy or travel policy. If you pay for your medicines in Bulgaria and intent to claim reimbursement from an insurance company, it's always a good idea to check the company's policy on translating bills into English. Note that it can take several months before you receive your money.

Be aware that even though UK citizens are entitled to free medical, dental and hospital treatment in Bulgaria by virtue of a reciprocal healthcare agreement between the two countries, they must pay for prescribed medicines.

The same goes for holders of a European Health Insurance Card, or EHIC, formerly E111. It entitles them to emergency medical treatment on the same terms as Bulgarian nationals but they will not be covered for on-going medical treatment, treatment of a non-urgent nature or medical repatriation.

In addition to medicines, pharmacies sell nutrients, herbal products, cosmetics, toiletries, diet products, baby care products and feminine hygiene products. Pharmacies in rural areas may not be well stocked so use your visits to a neighbouring town or city to buy what you need.

BILKOVA APTEKA

Bulgaria has a long tradition of herbal remedies so if you have diarrhoea, your Bulgarian friends will advise you to drink mint tea, or take drops of peppermint, hawthorn and valerian to sleep sound. Wide varieties of herbs that have been dried, or made into potions, tablets, drops or teas, are to be found in a herbal pharmacy, or bilkova apteka. Even in these alternative clinics, the pharmacists are outstandingly outspoken and will not only give you whatever a doctor may have prescribed but offer remedies depending on your symptoms. For instance, they may ask you various seemingly unconnected questions to establish if your stomach or your nerves are to be blamed for a blinding headache, before they recommend a natural remedy. These pharmacies also sell imported herbs, including Chinese stuff.Homeopathic medicines have recently arrived in Bulgaria and sell at the regular pharmacies.

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