Medical Tourism-Informed Decision Making

[Florida Native, BSN]

As everyone should be aware, Medical tourism is becoming a hot topic with the media. Most the articles are written by journalists with a limited medical background. Some have no medical background. Yet the media appears to be eager to publish what is written. Many articles appear to be more promotional in nature and not well balanced.

Currently India is the media darling because of rock bottom pricing. According to recent news articles, several US corporations are now considering adding Indian hospitals to their health plan and offering employees a discount for choosing them. There is no doubt India has some excellent physicians and nurses. India has several new state of the art hospitals built to try an attract patients from developed countries. What is lacking is proper sanitation and infrastructure outside the hospital. The Indian hospital corporations, the Indian government and the Confederation of Indian Industry don’t seem too concerned about the problem. They have elected to press forward without first fixing the sanitary and infrastructure problems. Crime is also a problem is also a problem beyond the hospital walls. None of the news articles address these problems nor do they provide guidelines for making an informed decision on medical travel.

The US State Department’s Consular Information Sheets provide valuable information to persons contemplating surgery abroad. The CIA World Factbook contains on environmental factors that should be considered. The Centers for Disease Control offers guidance to travelers on the medical risks posed by travel to other countries. As examples of the risks in India, the US Consular Information Sheets specifically warn travelers to India to take safe food and water precautions and to take steps to avoid malaria. There is a link to the CDC website later in the text. The CIA World Factbook states that, “Tap water is not potable throughout the country”. The US Embassy also advises travelers to India Travelers not to travel alone, particularly women. Women run the additional risk of “Eve teasing”. “Eve teasing” is a form of sexual harassment that can include unwanted touching and groping. The Embassy states such reports have increased recently.

A visit to the CDC website provides further information on the medical risks in India. Specific instructions are given regarding malaria. The instructions include,

“All travelers to malaria-risk areas in the South Asia region, including infants, children, and former residents of the Indian Subcontinent, should take one of the following anti-malarial drugs (listed alphabetically):

•atovaquone/proguanil,

•doxycycline,

•mefloquine,

•primaquine (in special circumstances).

Note: Chloroquine is NOT an effective antimalarial drug in South Asia and should not be taken to prevent malaria in this region.”

According to the CDC the malaria risk areas of India are, “All areas, including the cities of Delhi and Bombay. Risk in areas at altitudes

Travelers are advised to take the antibiotics before, during and after travel. A dosing schedule is provided.

There is substantial information on India public health risks on the internet. In a 2005 Power Point presentation, the head of the department of community medicine and epidemiology at an Indian medical school gives example after example of the risks to public health in India. The risks are related to the poor sanitary conditions in that country. The University of Pittsburgh School of Public Health has published the information on the internet.

The University of North Carolina School of Public Health has published on the internet a graduate thesis on India’s plague outbreak in 1994. It seems a majority of India’s population believes the rat is a god. In some parts of India including major cities, rats are fed in the public parks. According to a USA Today article last September, rat catchers in New Delhi haven’t caught a rat in years despite there being an abundance of the creatures in that city.

The lack of a national infection control policy for hospitals in India is still another problem. A 2004 graduate thesis from Australia also published on the internet states that several sources suspect the nosocomial infection rate in India to be approximately 30% vs approximately 5% in the United States. No one can say for certain because there are no reporting requirements. All hospitals in India decide what to track, what to report and who to report to on their own. One Indian newspaper article from February of this year quotes a physician at one of the tourist hospitals as saying India has no MRSA problem. The article claimed the few cases discovered probably came from medical tourists. The article was trying to encourage the medical tourism industry in India to play on the MRSA fears in the UK. A little research will reveal that MRSA has been well established in India for some time. Both community and nosocomial infections have been discovered. With the lack of mandatory reporting no one can say what infection problems exist in hospitals.

While people may choose to travel to India for treatment even if they are aware of the information, I feel they should at least be allowed to make an informed choice. At present this information is not provided and organizations like the Confederation of II Indian Industries as well as the Indian government and the hospital corporations themselves continue to work the international press to favorably spin medical tourism to India. Without complete information potential travelers cannot make informed decisions. I have been unable in my attempts to get the media to publish basic guidelines for potential medical tourists. Below is a copy of a short, simple set of guidelines I prepared. The information should help enable persons considering treatment abroad to find information on any country promoting medical tourism that would be helpful in making an informed decision.

When I suggested to several newspapers that they consider publishing my information of or something similar, the editors balked. Apparently the media still believes that one should never let the facts get in the way of a good story. The only response I received was from the LA Times. They did admit the information was useful but said they would not publish it. I contacted one travel writer who gave a glowing report on medical travel to India. She suggested the University of North Carolina School of Public Health did not know what they were talking about. She did not comment on the consular information sheet.

I don’t know if anyone here has any contacts with the media. If you do, please consider passing the information on. As medical tourism continues to grow, and it is predicted that it will, we will likely start to see adverse outcomes related to the problems mentioned. If the patient chooses to go to a high risk area for treatment after they have the knowledge to make an informed decision there is nothing we can do. But at least they should be given the tools needed to make an informed decision.

http://www.cdc.gov/travel/regionalmalaria/indianrg.htm

http://www.ucis.unc.edu/resources/pubs/carolina/Plague.html

http://www.cdc.gov/rodents/diseases/index.htm

http://www.usatoday.com/news/offbeat/2005-09-13-rat-catchers_x.htm

http://72.14.203.104/search?q=cache:7NS-S20EEuYJ:www.publichealth.pitt.edu/supercourse/SupercoursePPT/18011-19001/18811.ppt+open+defecation+india&hl=en&gl=th&ct=clnk&cd=11

(Open Power Point presentation from link at top of page. HTML version is available but Power Point provides easier to read detail.)

http://travel.state.gov/travel/cis_pa_tw/cis/cis_1139.html

http://www.cia.gov/cia/publications/factbook/geos/in.html

http://adt.lib.uts.edu.au/public/adt-NTSM20040913.150110/index.html

Medical Tourism: How to be a Safe Consumer

By Neal R. Yerkes, RN

Medical tourism is a term seen more frequently in the news these days. Americans and others are traveling abroad in search of quality, low cost surgery and other medical treatment. Much of the travel is to locations in Asia. The number of medical tourists to is expected to grow by 30%-40% per year over the next few years. Already nearly two million people travel to Asia in search of search of surgery and other medical procedures. But how do you know if the offering by a medical tourism company is of the quality and safety you want? In addition to questions about the quality of the physician and hospital, there are other factors to consider.

Does the company employ people with a medical background to assist you in making wise choices about medical travel? Before you decide on a medical tourism company ask about the medical education of its staff. Know who you are talking to and know their qualifications. According to a recent book, only two of the several hundred medical tourism companies operating in the United States actually employ people with a medical background. Most are started by people wishing to cash in on the growing medical tourism boom. Ask yourself, would you call computer programmer for legal advice? Relying on the advice of someone whose only background in medicine is the promotional material they read from the overseas hospital is about as good as asking a programmer for legal advice. You might get good advice but more often you would not.

Other factors to consider are the level of development of the country where the medical services are offered and conditions outside the hospital. Medical tourism operators are in business to make money. What they tell you may not reflect the actual conditions in the country you will visit. If a hospital offers higher commissions to the medical tourism operator then the country where that hospital is located will likely be given top billing. Be a smart medical tourism consumer. Do a little research on your own.

The US State Department’s Consular Information Sheets on the countries you are considering for medical travel contain a wealth of information. General advice on the quality of the healthcare system in the country you are considering is included in this publication. The US Centers for Disease Control's website provides country and region specific information for persons traveling overseas. The CIA World Factbook contains valuable information on environmental factors such as water pollution that should be considered. Both sources are published on the internet. Internet searches using the country name and sanitation should also be conducted. Such searches can reveal what the promoter may not be telling you.

Conditions outside the hospital should be carefully considered. While the price of the treatment may be low and the hospital and staff of good quality, what awaits you after you are discharged from the hospital? Most patients will be discharged into the community while their surgical wounds are not yet completely healed. They will remain there for follow up care and rehabilitation. Are there sanitary problems that might place you at greater risk for infection? Are you at greater risk of being the victim of a crime? Is the food and water safe? Are there diseases endemic to the country that might pose an additional health risk? These are questions that should be considered before deciding on a medical tourism destination. The lowest priced location may not be the best bargain when other factors are considered.

What happens if there is malpractice? Legal systems in other countries especially developing countries are substantially different than those in the US. While it may be possible to seek redress in the local courts of the country, the amount of the award for damages will likely be based on the local economy. In many countries this will only be a few thousand dollars. The amount might not be an adequate to redress the damage done. It is also like the medical tourism operator will require you to sign a paper releasing them from any responsibility if things go wrong.

Medical tourism can offer a safe low cost alternative to expensive local hospitals or long waiting periods. Be safe. Check the credentials of those offering medical tourism services, the countries where those services are offered and the credentials of the physicians and hospital. With a little research you can become a smart medical traveler.

[Tweety, BSN, RN]

Very good information.

Thanks.