As I travel to various parts of the world promoting Medical Value Travel (MVT) to India and Max Hospitals, in New Delhi, I am increasing becoming aware of a certain kind of resistance bordering on hostility in different quarters. The last time I was in Kenya I happened to meet a local parliamentarian in Nairobi. The parliamentarian articulated this phenomenon rather well. As per his world view MVT entails a significant leakage of foreign exchange from impoverished sub-Saharan African nations to wealthier nations with fancier (and not necessarily better) healthcare systems. He felt that hospitals chains from India and Thailand and elsewhere tend to ”lure” away gullible patients to their shores even though the patients can be treated locally as well. The MP was of the view that only those patients should be allowed to travel abroad, who cannot be treated in Kenya itself.
Sadly, a similar view is also being articulated by many local clinicians as well as various Medical Associations and regulatory bodies in several parts of the world. They are making it difficult for foreign clinicians to come and work in their countries by raising inappropriate barriers such as the requirements of multiple licenses and permissions from sundry agencies. Essentially, behind all this lies fundamental insecurities and an almost cavalier disregard for what might be the best for the patient.
People travel far away from their homes in search of quality medical care for three main reasons.
- The Services are not locally available or are scarce.
- The services are available but are too expensive.
- The services are available but are not easily accessible to patients.
Unless a nation addresses these issues, MVT is unlikely to go away.
By being mean spirited and denying foreign doctors and hospitals to collaborate with local medical establishments is clearly foolhardy. International medical collaboration leads to exchange of knowledge and transfer of skills. That is usually the quickest way to upgrade local expertise and instill confidence in local clinicians to take up difficult cases initially under the guidance of foreign experts and later, on their own. There is nothing shameful in learning from someone who has greater knowledge or expertise.
Moreover, such practices are against the best interests of the patients, which all doctors are under oath to protect. ”As a father of a sick child with a congenital heart problem, why should I be denied the opportunity of seeing a foreign expert if he is willing to travel and visit me in Nairobi? Why should I not have the opportunity to take his opinion and compare it with what is available locally and decide for myself, what might be the best for my son?” asked John Kutolo, whom I met in Nairobi in October 2018.
The argument that people should not be allowed to travel abroad if the clinical service is available locally is quite disingenuous. The availability of service is just one aspect of the decision to travel abroad for treatment. The big question really is the quality of the service available and more importantly the trust that one has in the local medical services. Thus, it is possible that Kidney Transplants may be happening in Nigeria, however if I, as a patient or a care-giver do not trust the local hospital, why should I be forced to get my transplant done there?
Often people travel abroad for treatment because healthcare costs in many countries are humongous and insurance coverage either non-existent or severely limited. If the patients and the care-givers have confidence in their decision of traveling abroad, where they can possibly afford good quality healthcare, they should certainly have no difficulties in accessing such services. Similarly, if one chooses to get treatment done at low costs in a foreign country rather than wait for months in some places like Canada, UK or Russia, they should be able to do so unhindered. False pride in one’s country’s medical systems should not come in the way of offering foreign treatment options to patients who can than decide what might be the best for them.
While, I do realize that most hospitals sending their doctors and medical teams to war ravaged countries like Iraq or under-developed nations like those in the Sub-Saharan Africa clearly have a profit motive in encouraging patients to travel, the fact is that patients travel only when their clinical needs are not satisfactorily met locally. No one really wants to be thousands of miles away from family and loved ones during a risky medical procedures.
Finally, it all boils down to a patient exercising a choice over who and where she gets treated. I believe that the patients should have complete access to information regarding all relevant options and they should be free to choose. If this means that they should get to interact with visiting clinical teams from foreign lands, than they must be able to do so without hindrance.
The only way to counter MVT is for the governments and private enterprises to invest in healthcare infrastructure, build world-class, technology led institutions and have a steady supply of trained and experienced clinicians. All this must also be easily accessible to most citizens and at competitive prices.
Unless that happens, MVT is here to stay.
The views expressed here are personal