Storing medicine through an Indian summer

The rules that matter

• Frozen means finished. A product that has frozen must be discarded, and it will look perfectly normal after it thaws. Do not use it because it looks fine. This is why a gel pack should never touch the pen directly, and why some hotel minibars are more dangerous than no fridge at all.
• Keep the fridge door shut during a power cut. A closed domestic fridge holds its temperature for several hours by itself. Opening it to check is the thing that costs you the medicine.
• Never the door shelf. It is the warmest part of the fridge and the temperature swings every time somebody opens it. Middle shelf, towards the back, not touching the back wall where things freeze.
• Never a car. Not for twenty minutes, not in the boot, not under the seat. A closed car in a Hyderabad summer exceeds 60 degrees, and this is by a wide margin the commonest way people ruin an expensive medicine.
• Once in use, most products live at room temperature for a defined number of days, commonly 21 or 28. Write the date of first use on the box in pen. Everyone thinks they will remember and nobody does.

Travelling with it

1. Hand baggage, always Never in checked luggage. The aircraft hold drops below freezing, and a frozen product has to be thrown away. Airport security in India is used to this; carry it in a clear pouch to make the conversation short.
2. Ask us for a letter On clinic letterhead, stating what you are carrying, that it is prescribed for you, and that it needs to stay cold. Take it for domestic flights too, not just international. We will write it while you wait.
3. Insulated pouch, gel pack, not loose ice A small insulated pouch with a frozen gel pack, with a layer of cloth between the pack and the medicine so it cannot freeze. These are widely sold as insulin travel pouches and any of them will do. Loose ice melts, wets the carton and can freeze what it touches.
4. On a long train journey An insulated pouch with two gel packs holds temperature for the length of most Indian routes. On a journey over about twenty hours, plan a swap: a hotel or a pharmacy at a halt will usually freeze a gel pack for you if you ask.
5. Haj, Umrah or any long trip Come and plan it with us at least a month before. There are questions about quantity, documentation and what to do in a hotel that are much easier to answer in advance than from Makkah.

Needles and disposal

India has no domestic sharps collection scheme, which leaves patients improvising, and used needles going into household waste is a real hazard for the people who sort it.

• Never recap a used needle. Recapping is how needlestick injuries happen.
• Collect used needles in a rigid, puncture-proof container with a lid. A hard plastic bottle with a narrow neck, taped shut when full, works.
• Never a plastic bag, never a soft bottle, never loose in the bin.
• Bring the full container to us and we will dispose of it through the clinic's biomedical waste route, which is the correct and legal channel. There is no charge for this. Please do not put it in your building's rubbish.