The Advent of ‘Reverse Medical Value Travel’

Well, I don’t know what else to call it.

But this seems to be an emerging opportunity in the broader Medical Value Travel firmament. Last week, I learnt that my friend and former colleague Dr. Sunil Prakash, who is a well known nephrologist in New Delhi, was a part of a team that performed a kidney transplant at the Muhimbili Hospital in Dar es Salam, Tanzania. Dr. Prakash posted happy pictures with the patient and it appears the event generated excitement and a lot of publicity in Tanzania. Apparently, this was the first ever kidney transplant conducted in the country.

Essentially an Indian team of doctors carried out a complex surgery in a hospital in Eastern Sub Saharan Africa. Instead of the patient making the journey to a hospital in India, a team of doctors traveled and treated the patient in a foreign hospital.

I would call this ‘Reverse Medical Value Travel’ and I expect this to increase in the coming years.

This is certainly not new phenomenon. Many years ago Fortis Hospitals had tied up with the Talimi Hospital in Basra, Iraq. Fortis started conducting cardiac surgeries in the hospital in Basra. A team of surgeons, anaesthetists, perfusionists and a bunch of nurses would arrive in Basra and would go straight to the hospital and operate patients, who were pre-selected and already admitted in the hospital. A new team would arrive every week to replace the previous team and the teams would typically rotate every 6 weeks or so. This was a very successful program, ran for several years and I am told over 900 surgeries were conducted. I remember the initial problems we had in getting the clinical teams to travel to Basra but once the program started, it really took off.

I am sure there would be other examples of successful ‘Reverse Medical Value Travel’ elsewhere too.

The Reasons for the Emergence of Reverse Medical Value Travel

The primary reason for the inevitable rise of ‘Reverse Medical Value Travel’ is not difficult to understand. In many parts of the world, with healthy economic growth, are emerging exciting opportunities in the business of healthcare. Enterprising organisations and individuals are willing to invest in healthcare infrastructure such as hospital buildings and medical equipments, essentially things that money can easily buy. One can build a reasonably sized hospital in under 2 years but it is indeed difficult, well nigh impossible to develop a steady pipeline of clinical talent to work in the hospital. It takes several years if not decades for good medical teaching institutes to produce high quality medical talent. Thus, there is an emerging and deepening shortage of qualified and experienced medical teams who can sustain the new hospitals coming up at a frenetic pace.These hospitals are relying on importing medical talent from abroad. Successful clinicians with good patient base rarely uproot themselves and move to new pastures. Thus, we see clinical teams traveling for short durations and the emergence of “Reverse Medical Value Travel”.

The Advantages of Reverse Medical Value Travel

One of the key advantages of Reverse Medical Value Travel clearly is that it saves sick patients long distance travel. It allows patients to be treated closer to their homes, surrounded by family and friends and in a familiar environment. After being discharged from the hospital they can straightaway head home. I am sure this leads to faster healing and recovery.

The other advantage lies in sheer numbers. A single team of doctors can treat a large number of patients in one visit. Thus, a team of 5 can perhaps operate 25 patients over a a week. This implies that less number of people need to travel. Usually, when patients travel, they are also accompanied by family members and care-givers. The hassle is so much less.

Reverse Medical Value Travel brings the benefits of training and learning to the local clinical teams. They inevitably join in the surgeries and learn by working with experts from abroad operating in their hospitals. This is of immense value as the local teams learn and practice new skills with old masters. This transfer of skills and knowledge creates a ‘guru-shishya’ relationship with strong and long-lasting bonds. It also develops tremendous goodwill and bonding.

For the visiting clinicians operating in alien environments, often facing a language barrier and working in different cultural settings is also a tremendous learning. Most love the challenge and enjoy proving their mettle in these relatively difficult situations.

The local governments consider ‘Reverse Medical Value Travel’ as a boon. The precious foreign exchange outgo is much less, the skills enhancement and the goodwill generated in the local communities is tremendous, the media is very supportive – perfect for local politicians who welcome the foreign clinical teams with open arms.

This is a win-win for all.

The Pitfalls

While “Reverse Medical Value Travel” gradually takes wings, one has to carefully consider the risks as well. The clinicians operating in foreign hospitals have to be well protected with indemnity insurance and in some difficult places with blanket immunity. The hospital infrastructure has to be very good and the doctors should not be pressured into operating cases that they might not be comfortable with. The clinical protocols of the hospital, infection control measures and other critical medical parameters must be of a high order. The teams for post-operative care should be well trained to look after the patients once the foreign teams have departed.

In most countries, local hospitals or governments take care of most of these.

I believe that “Reverse Medical Value Travel is a great opportunity for Indian Hospitals. It can help them earn not only dollars but universal respect and tremendous goodwill.

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