Resisting the advance of Medical Value Travel is Futile

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.

  1. The Services are not locally available or are scarce.
  2. The services are available but are too expensive.
  3. 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

Medical Trafficking and Medical Value Travel are very Different

I was recently in Kenya and learnt about a new term called “medical trafficking”.

This came up in discussions with a member of the Kenyan parliament, who is also an eminent clinician of Indian origin. The MP is a prominent citizen of Kenya, owns a chain of hospitals and believes that what passes for medical travel in Kenya is mostly medical trafficking.

Well, I wouldn’t agree entirely but there is more than a grain of truth in what the lawmaker is talking about. Essentially, he defines medical trafficking as dubious agents persuading gullible and sometimes desperate Kenyan citizens looking for the medical treatment to countries like India. He believes that many of the problems for which the Kenyans are travelling can be treated in his own and other hospitals in Kenya. However, ordinary Kenyan citizens, when faced with a medical crisis are lured away by unscrupulous medical travel agents with promises of magical cures at jaw-dropping prices in faraway places. This is largely achieved through an unholy nexus between local clinicians, hospitals, medical travel agents and hospitals in India and other countries.

The Hon’ble MP believes that Kenyan government should take steps to prevent exploitation of Kenyan patients in this manner. He is sponsoring a private member’s bill in the Kenyan parliament, which will regulate medical travel from Kenya and allow only patients, who have serious medical conditions and for which treatment is currently not available in Kenya to travel abroad.

I believe this is good.

However, there are a few caveats.

More than restricting patient travel for better medical care, Kenya needs to invest a lot more in building capacity and appropriate skills enhancement in the medical centre. The hospitals in Kenya, while making progress are still far behind those in India and elsewhere. The government hospitals are overcrowded, filthy and struggling. The hospitals in the private sector, barring a few are at best secondary care centres equipped to handle only routine surgeries. There is an all-pervasive shortage of clinicians, nurses and para-medical staff. The problem is a lot more acute outside of Nairobi. Unless, Kenya bridges this gulf, patients will always seek to travel abroad in search of better care.

This cannot be done overnight. Building new hospitals and finding highly trained and experienced clinicians will take years. In the short run, some gains can be made through collaborations with foreign hospitals, who might be willing to share their expertise with local Kenyan hospitals. It might also be possible to import a team of highly trained clinicians and allied technicians to be able to work in Kenyan hospitals for short periods. This will help Kenyan patients get access to high-quality care closer home and the local clinicians will be able to learn while working together with foreign experts.

Sure enough, some clinical work, particularly for higher-end tertiary care specialities, may still not get done with-in Kenya. Patients for these conditions will still need to travel abroad. These patients must be guided through proper well-established medical travel operators governed by suitable rules and regulations. These need to be framed urgently.

The medical travel industry continues to be largely unorganized not only in Kenya but in almost all parts of the world. Small-time operators with very little understanding and knowledge of the patient’s needs or the capabilities of the hospitals that they are being referred to continue to thrive. This is the soft underbelly of medical travel that the Kenyan lawmaker referred to as ”medical trafficking”.  This, of course, needs to be rooted out. It will be possible only when well-established medical travel operators employing doctors and other experts come into play. The government of Kenya should establish guidelines on who can be a medical travel operator, give them incentives to set up their offices in Kenya and let them effectively collaborate with Kenyan Hospitals, the NHIF and other large public sector undertakings for patient referrals. Only authorized medical travel operators should be allowed to facilitate patients for treatment abroad.

Finally, I must make a point about patient choice. The fact that a particular treatment is available in Kenya should not mean that the patient must be treated in Kenya. This will be clearly wrong. Availability of treatment does not guarantee quality. If a patient prefers to go abroad for her own treatment, she must be allowed to do so. After all, it is a matter of her own health and if she has the necessary wherewithal to pay for the treatment at a place of her choice, she must be allowed to do so.

Medical Trafficking is a result of unorganized, mercenaries masquerading as medical travel operators being allowed to work unchecked in Kenya. It must be curbed through effective legislation. However, patients genuinely needing high-end medical care or those who wish to travel abroad for treatment must be allowed to do so. They should be guided to bonafide and licensed medical travel operators who may help them seek the best possible care anywhere in the world.

The Story of John and Omar – How Customer Advocacy Builds Brands

200308966-001I was in Nairobi earlier this month. The occasion was to inaugurate Max Healthcare’s information Center in the city. I was accompanied by our partner based in Dubai and the program consisted of the usual run of the mill stuff. We had a couple of doctors accompanying us for the almost obligatory OPD’s, which were being hosted by a local medical center in the Upper Hill area of Nairobi. In the evening was a small press interaction, where all of us were to make some noises about how we expected to partner with the local medical fraternity in improving healthcare services in Nairobi and other parts of Kenya.

I was quite apprehensive about this. It is a known fact that the local medical community does not much appreciate foreign doctors landing up on their shores under the guise of OPD’s and taking away ‘their’ patients to sundry hospitals abroad. Though, I have never really understood the cause of this antipathy, (after-all only those patients will choose to travel abroad whose medical condition is such that can not be treated locally) I have been told by our Kenyan hosts that this is for real. Thus, I was a little concerned about a media interaction, where I may have to respond to some sensitive questions.

Also, I was worried that we really didn’t have much to share. After all an information centre of an Indian hospital chain is not really the most interesting piece of news even from the point of view of the news starved media of the city. When we reached the venue in the late afternoon, I was relieved to see our guests trickling in, the PR guys were busy settling the media folks down, the atmosphere was convivial and relaxed.

We had lined up the doctors to talk about their specialities (cancer and neuro-surgery), I was to speak briefly about Max Healthcare and our reasons for landing in Nairobi and our partner from Dubai was to talk about their reasons for joining hands with Max in this venture. We also had two patients, who had been treated at our hospitals and had returned home safely with wonderful experiences in Delhi.

We were soon done with our respective spiels and I could feel a sense of disappointment in the room. The journalists had come with hopes of an interesting evening and our stories had hardly set the room on fire. The presentations from the doctors were also a little technical, which too added to the gloom. They had tried hard, however for doctors to speak in front of an audience and not to lapse into medical jargon is an herculean task. The only saving grace seemed to be the booze and the plentiful food.

As the evening wore on, we had John come up to address the media. John is a cancer survivor, full of life and vitality. Earlier in the day, when I had met him he had told me about his struggle with the big C and how he had fought desperately to beat it. He had been treated by Dr. Rudra Acharya, the cancer surgeon who had spoken a while earlier. “I am here to tell you all, that cancer can be beaten, I am a living proof of this” began John. He narrated his ordeal with a great deal of emotions, the hopelessness of a patient diagnosed with cancer, how it hits you and what extra-ordinary courage it takes to fight this uphill battle. John appeared to be a man with a great deal of conviction and perhaps driven by a mission to share his story widely. He spoke eloquently about how he was taken care of by a team of doctors drawn from various cancer sub-specialities, how did they collaborate to ensure he received the most effective treatment and how everything came together in the end to pull him out from a very difficult situation. He was effusive in thanking Dr. Acharya and the team of doctors, who saw him through this very difficult phase of his life and spoke very highly of his experiences in an Indian hospital so far away from Nairobi. Soon he had his wife join him on the podium, and the two held the audience completely enthralled while sharing even small incidents that touched their hearts. ” I am planning to be in Delhi once again in February for my check-ups and this time round my doctors have invited me to stay at their homes. We missed the Taj Mahal the last time round, I sure hope to see it now” said John. He than invited Dr. Acharya to join him and his wife and both of them warmly hugged Dr. Acharya, who seemed a little overwhelmed with all the attention.

The media loved John. They were now firing questions at him and were literally eating out of his hands.

Soon we had our other guest, Omar, on the podium. He wanted to talk about the treatment of his son at Max Hospital in Saket, New Delhi. His 12 year old son had met with a freak accident in school. The child had tried jumping across a barrier, had landed on the edge and ruptured his urinary pipe. Omar had taken his son to at-least half a dozen centres in various parts of Eastern Africa. Nothing had worked till he landed with Prof. Anant Kumar  in Delhi. Dr. Kumar took up the challenge and re-constructed the ruptured pipe. Omar had been delighted to see his son recover and for him his Indian sojourn had truly been one of the most rewarding experiences ever. I had met Omar for the first time in the office of Dr. Anant Kumar in Delhi, about two weeks before this press interaction.I had told him of my plans to travel to Kenya and he had volunteered to come and speak about his experiences with the local media. Omar is of Somali descent, not only did he come over to see us and share his story, he helped arrange many Somali TV stations based in Kenya to come for the press conference. He first narrated his story in English for the benefit of the Kenyan media and than for good measure he repeated everything in the local Somali dialect for the Somali audience both in Kenya and back home in Somalia.

John and Omar both did us a great turn, though all they wanted was to help others overcome similar obstacles in their lives. They volunteered to share their stories of difficult times and their struggles and how they found comfort and happiness with a couple of highly skilled doctors and their dedicated teams in a faraway, strange land.

Thank you John and Omar.