The Saga of the Shots

Our Hep A vaccine shots

Four days ago, we decided to go to Thailand. We bought our tickets and began to do research - we knew we'd need some vaccines, diarrhea medicine (just in case), and something for malaria. We learned we needed typhoid, hepatitis A, and Japanese encephalitis vaccines.

So, Monday morning, we walked into the pharmacy around the corner from our hostel, and we asked where we could go to get vaccines. The pharmacist marked the location of the Civic Hospital on our tourist map, but told us that it might be a bit difficult for us to get vaccines since we were foreigners.

Off we went that afternoon to find the hospital. We walked about 2km (over a mile and a half), past crumbling apartment complexes, piles of garbage, and over the train tracks, where we walked through a parking lot and entered an adjacent building that was marked "Ospedale" (hospital). It was a plain-looking building, more like a school, and the bottom floor was empty. No receptionist. There was a sign that said something like administration, on the 2nd floor, so up we went. Still, no receptionist. So we walked down the hallway until we found somebody. The hallway was painted in bright yellow. It was eerily empty, except for a woman in the hallway, and voices nearby.

"Siamo americani, e andiamo subito a Thailandia. Ho bisogno di vaccini," I told the lady. "We are Americans, and we are going soon to Thailand. We need vaccines."

She looked confused and summoned a few other people from nearby rooms. After putting out a cigarette, one of them, a girl about our age, pointed out the window at a tree-lined street. "Go straight, to the end, then turn left," she said in English, pointing to the right.
"A destra?" we asked. "To the right?"
"Si, a destra." (Good thing we could speak a little Italian!)

Okay then. We left the building and headed down the street. We turned at the end and entered the last building at the corner. A sign said something like "medical" so we went up until we found someone. We accosted a doctor in a hallway, and repeated our question.

"Giù! Medico immigrazione è giù, giro," he said curtly. He gestured vaguely down and made a sweeping gesture. "Down! Medical immigration is down, around."

Alrighty. At least we knew what building name to ask for. We went back downstairs and headed around the corner. We went up the stairs in that building.

"Dov'è medico immigrazione?" I asked a medical-looking person in the hallway. "Where is medical immigration?"
"E' giù, e a sinistra," they said. "Ma può essere chiuso." "It's downstairs, and to the left. But it may be closed." (It was about 3:30pm.)

At last, we found the place - a door tucked out of sight of the street, with a faded printed sign that said "Medico Immigrazione." The door was open, so we went in, surprising two nurses who were cleaning up. "Domani! A le nove a tredici. E' chiuso," they told us. "Tomorrow! From 9 to 1. We're closed." and one asked the other, "Didn't you close the door?"

So back we went the next morning, arriving about 10am. The place was just a hallway, with two benches. Some people who looked like they were from India/Africa were already there. They stared at us. We stared back. No receptionist. We stood awkwardly, waiting to see what the process was. Soon, another woman (Indian?) arrived.

"Chi è l'ultima?" she asked. "Who is the last?"  Ahh, okay. This I could understand.
"Noi siamo l'ultimo," I said. "We're the last." The line was apparently self-regulating, and somewhat by honor system. We watched as the doors off the hallway opened - people came out, and the next people went in. At one point, new arrivals managed to sneak in the door ahead of the next people, prompting a small slightly heated discussion. "Non è giusto!" we heard. "That's not fair!"

At last, it was our turn. We waited outside the door, and when it opened, we repeated our question to the man in the white coat. He looked confused, but gestured us in, saying that we would repeat our question to the doctor. Okay then. The doctor came out, a balding older man in another white coat. We repeated our statements - we needed vaccines, since we were going to Thailand.

"Why you need vaccines? Where you read?" he asked us forcefully in English, but smiling.
I tried to explain that it was recommended, both on the embassy page and others.
"Ahh, internet," he said condescendingly. "But you no need vaccines for Thailandia! I have gone, I no need them!"
I tried to tell him that we needed Hepatitis A, and that mosquitoes liked to bite us.
"Ahh, hepatitis A is no problem. You catch, it is easy to correct. No problem!" We looked worried.

The entrance to "Medico Immagrazione e Viaggi"
 among other  unknown things

At last, a female nurse took pity on us, and wrote the name of something on a strip of paper. The doctor took us to the window, and pointed outside. "You need Medico Immigrazione e Viaggi. Medical immigration and travel. Go through the parking lot, to the silver wall, then go around to the left. It is very close." He drew a rough map on the paper.

So off we went once more. We walked through the parking lot in front of the building, then turned to the right at a bent corrugated metal fence. At the street, we had clearly left the hospital campus grounds - we turned left, and 100 meters further, we saw a sign that said Medico Immigrazione on it. We turned - the entrance was a long hallway, much busier than the other places we had been. Learning from experience, we accosted the first doctor-looking person, and repeated our Thailand statements, and showed him our paper. He nodded, took the paper, and led us to a door off the hallway.

Inside was a tiny office, with one desk and a couple chairs. A lady doctor sat behind the desk, clearly in charge. The doctor who had our paper went inside, talked to her, and then went inside an adjoining room, which looked large and had a number of people in white coats standing around. Occasionally the lady at the desk would yell something in Italian towards the adjoining room.

At last, after waiting 30 minutes, we were allowed inside the inner sanctum. Three doctors and at least four student interns, all in white coats, turned their eyes to us. Needless to say, it was a bit intimidating. We told them we were going to Thailand for two months. This time, there was no arguing about needing vaccines. "You need them," they told us.

The door and hallway

Eventually, here's what we learned: they couldn't give us malaria pills, as we were going for too long a time. One type of malaria pills had to be taken daily, and caused liver damage; the second type was taken weekly, but both types caused side effects of hallucinations and depression. "Not good for travel," they said. They were going to give us an emergency type - if we had a fever, we must take 3 the first day, 2 the next, and 1 the final day. But, we only got one box, with 8 pills. (I guess only one of us will survive.) They stressed we should go to the hospital if we had any fever. "Attenzione, e vai subito." "Pay attention, and go soon if you feel any fever."

As to the other vaccines, they wrote us a prescription to get Hepatitis A, but dismissed the typhoid and Japanese encephalitis. "As long as you drink bottled water, and wash well your fruits and vegetables, you are ok," they said. Okay then.

So we returned to our neighborhood pharmacy, precious prescription in hand. The vaccines were shipped in the next day. We went back this morning - the pharmacist put the vaccines - a needle shot - into a bag.
"Come fare?" we asked. "How do we do the shot?"
"E' normale, non è una problema," he said. "It's normal, not a problem."
"Si, ma dove per fare?" we asked. "Yes, but where do we put the shot?" We gestured at a vein. Was he really going to just hand us a box with a shot and tell us to do it ourselves?
He gestured at his butt, vaguely, then pulled out the instructions in the box. He scrutinized them for several minutes, then concluded, "Deltoidi" - the shoulder region.
We tried to explain it wasn't normal to be handed a shot to do yourself in the United States - we weren't used to to this type of thing. He told us that the law didn't allow the pharmacy to administer the shot, but we could go back to the hospital where we got the prescription, and they would do it.

Okay then. There was no way we were going to give ourselves the shots. But, as luck would have it, our hostel owner has many family members who are doctors. Tomorrow, one of them will come to do the shot for us. We told him how strange it was to be handed a shot to do yourself. He said, "They'll let you have guns, but not needles in the US?" In Italy, it is nearly impossible to get a firearm legally.
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Update on Friday:

So, we found out this morning that we would have to go back to the hospital to get the shot administered (our hostel owner's family was too busy at the hospital to have time, unfortunately). So back we went - and giro e giro (around and around, in what is becoming for us, the normal Italian way) we were pointed to "Pronto Soccorso" - emergency help. First it was 500 meters, then after 500m, it was 200m, then 150 m.... One kilometer later, we eventually ended up at the same exact set of buildings where we'd received our prescription. At the Emergency, they told us....guess what - we had to go back to the same long hallway to ask for a specific doctor...but guess what, it was closed (3 pm again), and....likely, the office was closed on Saturday.

The entrance to...the emergency room???

So back we went to the hostel - to look up on YouTube the correct procedure for administering a vaccine via intramuscular injection. With some trepidation, and after scrutinizing the video closely, we each did the vaccine for the other. And so far, four hours later, we are both alive. :P

Conclusion: the American health system may be royally screwed up, and incredibly over-priced, but the rest of the world is not necessarily that much better. The grass is always greener, eh?