The Gatekeepers of Care

While clearing out one of my travel backpacks, I found a box of paracetamol 500mg from my time in Vienna. And it made me pause.

In Vienna, pharmacies are not convenience stores. You cannot walk in, grab a box off the shelf, and be on your way. You speak to a pharmacist. You explain your symptoms. They listen, and then they dispense what aligns with your need.

Even the front desk at my hotel, when I asked for something for a headache, politely told me they weren’t permitted to hand over medicine. “We’re so sorry you are in pain, but you must visit the pharmacy,” they said, “in Vienna this is highly restricted”.

I first experienced this when my son fell ill there, and I had to lean on a local contact from an earlier visit. The pharmacist didn’t just hand me medicine; they offered guidance. The final choice was mine, but it came with a moment of shared responsibility. Back in New York, I was struck by the contrast. Tylenol flows like tap water. Shelf after shelf, endless bottles. No questions asked. No pause. Just consumption on demand.

At first it felt inconvenient. But then - oddly comforting. There was a system of care in place. A safeguard, one human conversation at a time. I’m content my son experienced the Viennese model. Part of my purpose has been to imprint an international perspective on him young, the way it was imprinted on me. Travel taught me early that America is not the center of the universe - just one small part of it.

Other systems exist. Other logics, other values, other balances between freedom and responsibility. Carl Sagan once reminded us that Earth is a pale blue dot, suspended in a sunbeam.

And yet - systems are prone to flaws based on who is designing them. A model built on dialogue and discretion can just as easily backfire when bias enters the room. A pharmacist’s role as gatekeeper, in the wrong hands, risks becoming a barrier. Racial profiling, cultural prejudice, or assumptions about who is “trustworthy” enough to receive care can turn a safeguard into an instrument of exclusion. What feels like protection for some can feel like surveillance for others.

To see systems clearly is to notice how we ration care, how we gate access, how we build trust - or bypass it entirely. A box of paracetamol in Vienna is not just medicine; it’s a reflection of a worldview. A belief that access should come through dialogue, not automaticity.

It makes me wonder:
What do our systems communicate - about what we value, what we fear, and what we’re willing to entrust to one another?


sincerely,
amber eltaieb