In Guatemala, the concept of “over the counter” barely exists, because in practice, almost every medication is available without a prescription.

Morphine. Antibiotics. You name it, you can buy it.

At first, that might sound convenient. But the reality is far more complicated.

Because when everything is “over the counter,” the responsibility for safe use shifts entirely to the patient—and most people simply do not have the extent of the information they need to make those decisions.

The ripple effect of incomplete understanding

It starts with something small.

Someone hears that when their sister had a cough, the doctor prescribed amoxicillin. So now, when they cough, they go to the pharmacy and ask for the same thing.

They buy just three pills.

What they don’t know is that their sister had a bacterial infection, and they most likely have a viral illness.

They don’t know that antibiotics do nothing for viral infections.

They don’t know that taking antibiotics incorrectly, especially in short, incomplete courses, can contribute to antibiotic resistance—making the medication less effective when they truly need it.

And the issue is not just misunderstanding. It is the system that allows and reinforces this behavior.

So while a medication might have helped their uncle after a specific and known condition producing certain symptoms, this same medication will not help their similar symptoms, that are caused by another condition.

Further, the medication might even be harmful for them- interacting with what they already take, or not safe in pregnancy, but nobody is watching to make sure!

The role of the pharmacy

In the United States, pharmacists are highly trained professionals, often completing 6 to 8 years of education. They are experts in medication mechanisms, interactions, dosing, and safety.

They work alongside physicians, and the two systems—prescribing and dispensing—act as checks and balances to protect patients.

In Guatemala, that structure is very different.

Pharmacists do not have to hold a degree to operate a pharmacy. In many cases, a family can open one from their home. And because prescriptions are not required, people regularly go directly to the pharmacy to ask what they should take for a symptom.

The pharmacist, in turn, may suggest a medication based on experience, hearsay, or what worked for someone else. But without formal medical training, they may not fully understand disease processes, appropriate dosing, or drug interactions.

The result is a gap between perceived authority and actual expertise—and patients rarely realize the difference.

Real consequences in real lives

We see this very often in clinic.

When we ask patients how they have treated an illness before coming to us, they’ll describe taking some medication that didn’t help. When we dig deeper, they often cannot recall the name, or we discover that the medication was never appropriate for their condition in the first place.

But the most difficult situations are when someone who genuinely needs medical care has only been relying on the pharmacy.

One of our patients came to the clinic with symptoms consistent with a urinary tract infection. This is very common in pregnancy, and her diagnosis was confirmed both by us and the local health center that same day via urine tests.

We agreed with their doctor that she needed amoxicillin three times a day for one week. We added education about hydration, hygiene, and continuing the medication for it’s full course even after symptoms improved.

At her follow-up appointment, I asked how she was feeling.

I was so supposed when said she was actually worse.

When I asked about the antibiotics, she told me she had just finished them. That didn’t make sense, since it had been a whole month.

We asked how she had taken them.

She explained that the pharmacist had seen the prescription and told her to take one tablet a day for 30 days instead.

That instruction was not only incorrect, it was the opposite of what was needed.

As a result, her infection had not resolved. Worse, she had developed a fungal infection, a common complication after inappropriate antibiotic use.

She had been miserable for weeks.

We explained why antibiotic dosing matters, and why guidance from someone without medical training can be dangerous. She now needed additional treatment for both infections—something that could have been avoided entirely.

When management becomes misinformation

That same day, her elderly aunt came in asking us to check her blood sugar. While we do not manage diabetes care, we routinely screen patients and provide education- the components that they can’t get from the doctor.

Her blood sugar was high.

She mentioned she had been taking metformin, a standard medication for type 2 diabetes. We advised her to follow up with a doctor, as her dose was insufficient and she needed adjustment, and the same doctor who started her on the medicine should make such a change.

That’s when she said something that stopped us cold.

She had never seen a doctor.

She explained that the pharmacist had given her metformin and told her to take one pill a day for a month to “fix” her diabetes.

That’s it- simply “fix” such a complicated disease process in a month without any lifestyle changes or monitoring.

There was so much wrong with that statement that it was difficult to know where to start.

We explained that diabetes is a chronic condition. It does not disappear after a month of medication. It requires ongoing medical supervision, dose adjustments, and regular monitoring.

We talked about how uncontrolled diabetes affects nearly every system in the body—leading to complications like vision loss, heart disease, nerve damage, and shortened lifespan.

It is not an easy conversation to have, and it had to be heavy enough for serious contemplation. But sometimes, the weight is necessary for someone to understand why care matters.

Bridging the gap

The health center is often overwhelmed, and in the busyness, it is easy for patients to feel rushed or unheard. In contrast, a friendly conversation at the pharmacy can feel approachable and reassuring—even when the information is not accurate.

That is the gap we see every day.

And that is the gap we try to bridge.

We want to be both kind and clear. We want patients to feel comfortable asking questions, but also to understand when they truly need medical care. We want them to know that while pharmacies can be helpful for many things, they are not a substitute for medical evaluation.

Most of all, we want them to have access to trustworthy guidance—so that a simple illness does not become a preventable complication, and a chronic condition does not go untreated.

Because healthcare is not just about access to medications.

It is about access to understanding.