28 June 2011

Greater Freedom of Choice in Armenia than in USA? (Part 1)

Let me begin by saying this is all purely anecdotal. And of course, being a foreigner skews my perspective significantly. But in many respects, it seems to me that people in Armenia (and other developing nations) enjoy greater freedom of choice than their friends and relatives in the US -- and probably don't even realize it. Let me show you what I mean.

Note: These are only the first few examples I've collected on this topic. I have a few more (and will probably come across additional ones in the future), but am having trouble putting them into words at the moment, so I'll save them for Part 2 and, if necessary, Part 3.

Health Care

Anecdote 1: Choosing a health care provider

What happens when you wish to see a doctor in Armenia? First, you call your doctor's mobile phone and schedule an appointment, which will usually be within 24 hours. Depending on your situation, the doctor may even offer to come to your house to examine the patient (like our pediatrician does, and like Jarred’s orthopedist did when he had his leg injury). If you need a specialist and don't know anyone, just ask your friends or coworkers, and they'll give you the mobile or home numbers of their doctors for you to call. After you see your doctor, you say, "How much?" She or he will reply "x dram." You pay the doctor in cash. End of story. No provider lists, no receptionists, no automated menus, no hold muzak, no "I'm sorry, we're fully booked until next month," NO PAPERWORK, no waiting for hours in a crowded lobby, and no referrals necessary.

What happens when you wish to see a doctor in the States? Ummmm...

Anecdote 2: Women's reproductive health

A couple years ago, after Nathan was no longer breastfeeding, I wanted to try ParaGard for contraception. My OB/GYN in Orlando said they don't offer it, and that they could give me Mirena instead. I said no, I wanted a non-hormone-based IUD. They said, in essence, "Too bad."

I couldn't find any other clinics or doctors in Central Florida offering copper-based IUDs, so I talked to some friends and doctors I know in Yerevan, and they informed me that I could purchase Nova-T 380 (another copper IUD similar to ParaGard) from any major pharmacy in town for about 3,000 dram (about US $7.50 at the time) and have it inserted by a local OB/GYN. After a preliminary exam, the doctor gave me the go-ahead to purchase the device (no prescription required), and so I finally got what I wanted, and I've been very happy with it ever since.

Do pharmaceutical companies in the US have that tight of a stranglehold on health care providers? Or are the doctors themselves unfamiliar with the myriad options available to women in terms of contraceptives, and therefore uncomfortable recommending/using anything not advertised on one of the pretty drug posters in their offices? Hold on, both those questions are the same!

When we first moved to Armenia, one of the first things our employer asked us was if we wanted help getting set up with a mobile phone. We declined, as Jarred and I had already made a firm decision to take a vacation from cellular service, at least for a while. We managed just fine for about 6 months; eventually, between the frustration expressed by friends and colleagues who had difficulty reaching us and the occasional times we got lost trying to find a place and had no way to call anyone, we chose to rejoin the masses.

But if we had known beforehand how incredibly simple it is to purchase and use mobile phones in Armenia, we would not have delayed at all. I simply took my US-locked phone to a stall in the metro station where a guy unlocked it for about $10, making use in other countries possible, then I purchased a new SIM card from VivaCell – a popular cellular service provider—with a local number for less than US $1.50. Like everyone else in Armenia, I now use prepaid VivaCell cards to buy service credit, which can be purchased practically anywhere. And if I decide at any time I wish to switch to another service provider (e.g. Orange or Beeline), I remove my VivaCell SIM card, buy the new one for another $1.50, and pop it into my phone. No contracts, no penalties, no having to buy a new phone just because I want to switch providers. I know, it sounds amazing, but it’s true.

This leads me to another point: in the States, if you want, say, an HTC Inspire 4G, you pretty much have to get it from AT&T. And if you want to be able to use it while traveling in another country, you have to make sure you sign up for a plan that includes international roaming (which you'll have to pay for every month, even if you travel only 2 weeks a year). And if you exceed your allotted minutes, texts, or data use, you’re gonna get slapped with a big, fat, ugly bill at the end of the month. And if you can’t pay it, AT&T will cut off your service. And if you don’t like it, tough – you already signed your soul over to AT&T for the next 2 years, and the only way to get it back is by paying an obscene amount of money, just so that you can then go get suckered into another 2-year contract with Verizon, purchase a new phone (which might not like as much as your old Inspire), and start all over again.

Not so in Armenia, where mobile phone merchants take regular trips to China to import every model of mobile device imaginable (both genuine and imposter brands), to be unlocked and sold at their street-side shops and metro station stalls for reasonable – and negotiable – prices. We have a friend who does this for a living. Last spring I bought an iPhone 3G from him for about US $70, transferred my SIM card from my old phone, and it works just fine. Since it’s a dual-SIM device, I was also able to buy a local SIM card in the Philippines – for about $1 – and insert it without having to remove the Armenian one. This made communication with friends and family in Manila infinitely easier and cheaper than if we had had a US-locked phone and a Cingluar-locked plan …like we used to, when we were still trapped under the rock that is corporate America. Luckily, we didn’t have to cut off a hand in order to escape.

Of course, if you come to Armenia and miss living in a cage, don’t worry. It is possible to pay full price for a phone and sign a contract with VivaCell, Orange, or Beeline.


dnavre said...

I agree that there are things which are easier to do when living in armenia :) for example everyone here uses pirated software and that makes the life a lot easier.
I also agree that being able to choose a physician yourself and not waiting in lines for hours is also a good thing, but usually people tend to have several bad encounters before they find a relatively good specialist. Also there are many uneducated doctors in the country who's recommendations can even be harmful. The field is not controlled by anyone here.

Regarding what you've wrote about the mobile phones and SIMs. Well, yeah, i agree with everything you've said but if i lived in US i would be able to buy a phone for me with a contract really cheap, here i need to pay the whole price of the phone which is usually several times more than what i would have paid in USA. Another thing which is very uncomfortable in armenia is that you can't change your provider without changing your phone number.

BTW when i was is US in 2007 i didn't sign any contracts, i was also using a prepaid SIM and the procedure of acquiring it took me about 5 minutes at AT&T. ( they even gave us 2 not so bad phones for free cause it turned out our phone were incompatible with the US cellular network.

Jarred, Angela, and Nathan said...

Thanks for reading, dnavre! You're absolutely right that medical care here -- in general -- is not up to international standards. I'm just making the point that it's a lot easier to see doctors here. But it can be a give and take kind of situation.

I know providers in the US have finally started offering more pre-paid options than they used to. What I remember was that when we were looking into it while living there, most places offered about 4 boring phones to choose from.

Yes, phones can be expensive in Armenia if you are trying to buy the real thing. Anything name-brand here costs loads more than it would in the US as a result of shipping costs, import taxes, etc. While I look for certain features in a phone, I don't care if it's a knock-off model. So I'm perfectly happy with my $75 fake iPhone. =)