"I have
been waiting for over a year in Canada to have an abdominoplasty,
liposuction, and breast lift and reduction performed. I
am 55 years old and really want to get on with these surgeries
as soon as possible."
"We have no health insurance. My wife suffers constantly
with her back pain. We cannot even begin to think about
treatment here in the US because of the extremely high cost.
After seeing your operations on 60 Minutes, we both have
new hope. Please contact us."
"Can you tell me what I would have to do to get a referral
to your fine hospital and what it might cost to fix my problem?.
I have never been outside of the usa...I await your reply
with fingers crossed (for good luck)."
Shortly after it was featured in the American
TV programme 60 Minutes, e-mails began hitting the
inbox of Delhi's Indraprastha Apollo Hospital, seconds apart
from each other. From Illinois, Florida, Washington, Texas,
New Mexico, California, Oregon, Oklahoma, Tennessee, Virginia,
from British Columbia and Alberta, Canada. Curious, hopeful
or frankly desperate, they were all looking for deals, asking
prices, checking out packages: what will a new hip cost,
by itself, and with bigger breasts thrown in? What about
a package for two—a facelift for me, Lasik eye surgery for
my companion? How much for a bridge, a root canal, ivf,
angioplasty, gastric bypass surgery.... This is my budget,
what can I get for it?
It might sound discordant, this price-tagging of body parts,
but for Indian private hospitals, nothing is more musical
than these noises from a global healthcare bazaar. They
demonstrate that an idea that seemed absurd at the start
of this decade has entered the realm of reality: that people
from the West will travel thousands of miles, to so-called
cholera country, for medical treatment—if the price is right,
and the quality is right. It's an idea with big money attached
to it: medical tourism is forecast to become a $2.3 billion
business for India by 2012. Some analysts predict it could
be the next major driver of the Indian economy after information
technology—if the industry and the government play their
cards right.
If 2003 and 2004 saw a trickle of refugees from the healthcare
systems of western countries seeking medical treatment in
India, in 2005 it became a stream, much of it fuelled by
a blast of free publicity from programmes like 60 Minutes.
Western TV crews accompanied often elderly people to India,
filmed them hobbling out of Third World airports, with bhangra
on the soundtrack, and driving into First World tertiary
hospitals with the best technology money could buy. They
showed them being "swamped by staff" and "feeling
like kings", as one delighted patient described it,
and seen by western-qualified senior consultants within
an hour of arrival—which could be 2 am.
The crews tracked the pilgrims' progress, finding their
way into an operating theatre where a surgeon obligingly
delivered a tribute to the British system that trained him.
To complete the picture, they also took gruesome shots of
operations being performed at public hospitals and tell-tale
ones of a row of empty beds in a poor ward at the Apollo
Hospital. But the main message came through loud and clear:
white people getting knees replaced, hips resurfaced, and
dental work done at bargain-basement prices by experienced
doctors who knew their job. British tabloids went to town
on teenager Elliot Knott who successfully underwent spine
surgery here last August after being told to wait a year
for an operation by the National Health Service.
That the publicity was good for business shows in the numbers:
British-Gujaratis Jagdish and Dipa Jethua, who saw a business
opportunity in facilitating medical travel, could only send
four patients to India for major surgery in January 2005.
In December, however, thanks
to Elliot, and other high-profile visits arranged by their
start-up, Taj Medical Group, they were able to send 27.
Most private hospitals saw a marked upward trend in western
arrivals last year, most of them from the UK, US and Canada.
Vishal Bali, CEO of the Wockhardt Hospitals group, told
Outlook that from the second half of 2004 and through 2005,
the number of western patients went up to between 8 to 10
per cent, from the 1 to 2 per cent that it had been previously.
The Escorts Heart Institute and Research Centre (ehirc)
in Delhi said that of over 1,500 foreign patients received
last year, about 700 were from non-SAARC countries, including
the US, UK, CIS, and the Gulf, a significant change from
previous years.
Individual doctors are seeing
the difference, too. Dr Mohan Thomas, a Mumbai and Goa-based
cosmetic surgeon, says his practice got 1,200 international
patients last year, double the number from the previous
year.
The Apollo Group saw an
overall five per cent increase in the number of western
medical tourists, according to executive director (finance)
Sunita Reddy, despite no special effort to market to them.
But at Apollo's flagship Delhi hospital, which gets more
medical tourists than its other hospitals, the arrivals
from some countries seem to have doubled. For example, it
got around 80 American patients from April to November last
year, more than the entire number in the previous financial
year.
Many of those mouse-clicking their way to a hospital bed
in India are escapees from western medical crises: whether
it's waiting lists for complicated elective surgeries in
the UK and Canada, which can't deliver the free healthcare
they promise; or the uninsured and under-insured in the
US, where medical treatment is extortionately expensive.
Any
international marketing executive—and every upmarket private
hospital now has one—can recite the numbers in her sleep:
8,50,000 waiting for a hospital bed in the UK, 45-million
plus uninsured in the US.
Medical value-travellers, as hospitals like
to call them, are also people looking for body shapes that
insurance companies won't pay for and dreams that even efficient
public healthcare systems won't deliver, like those of the
5 feet 4 tall Frenchman who recently came to India for a
leg-lengthening operation. Many are also in quest of treatments
not available at home, like hip resurfacing, less radical
than hip replacement, but yet to be approved by the US Food
and Drug Administration.
Marlene
and Paul Smith; Canadian Treatment: Spinal fusion surgery "Much
of Marlene’s pre-operative pain has gone. We’re 100 per
cent satisfied. We paid $19,000, including airfare. In the
US, the metal alone for her back would have cost $40,000."
EHIRC's
chief surgeon Dr Naresh Trehan recently operated on an 83-year
old Canadian cardiac patient who needed a valve replacement
with a bypass, but had been turned down by doctors back
home. "No doctor was willing to do it for him. It's
my specialisation, patients with 10 or 20 per cent heart
function. I told him the risk was less than five per cent,"
said Trehan.
Contrary to the popular stereotype, not every medical tourist
is dying to see the Taj. He could be someone for whom a
hospital room is the only piece of India he can handle.
In a month's stay at Apollo Hospital for complicated surgery
to correct his wife Marlene's curved spine, Paul Smith,
from Barrie, a small picture-postcard town in Ontario, left
the hospital only once, on a trip to the airport to sort
out ticketing. "With Marlene in bed, why would I want
to sightsee?" he said.
It was
desperation that drove Paul to type "surgery in India"
into a search engine after reading a story about successful
treatment in India in The Barrie Examiner. Agonising
pain kept his wife in bed for 16 to 20 hours a day, and
the wait for an appointment with the right kind of doctor—leave
alone surgery—was no less painful. Google took Smith to
the Jethuas in Warwickshire and they found him spinal surgeon
Dr Yash Gulati in Delhi The Smiths e-mailed him 15 questions
through Taj Medical Services, covering the range from AIDS
to aftercare, and booked their seats after they got his
answers.
They are going home in a few hours and they won't be returning.
One
giant leap into the unknown was probably enough. And yet,
they couldn't be more grateful, raving about their doctor,
dreaming about a better life for Marlene, determined to
spread the word about India.
Fortunately for the tourism ministry
not all medical
tourists confine themselves to hospital rooms. Amitabh Kant,
the bureaucrat who helped successfully reinvent Kerala as
God's own Ayurvedic paradise, is leading the ministry's
initiative to promote India as a "global healthcare
destination". So, after incredible temples, incredible
tigers and incredible yoga, it's now going to be incredible
doctors backed by incredible technology. Glossy brochures,
prepared with the help of ad agency Ogilvy and Mather, feature
men and women in spotless white coats bending over patients
against backdrops of sleek medical hardware.
Sheryl Weidner; American
Treatment : Plastic surgery "There is a different energy
here, a different mood...a lot of nurturing. It’s much more
personal than in the States," says Sheryl, a teacher
from Oregon. Seen here with friend Serena Taylor who made
a snap decision to buy herself an eyelift.
The
patients in the brochure seem mostly white and middle-aged,
for a reason: Kant is aiming way beyond the harried middle
classes from SAARC countries, Afghanistan and poorer African
countries who have been flocking to India for specialised
medical care which their countries lack. They, too, are
coming in rising numbers, especially from Afghanistan and
Africa, and sure, hospitals want their custom. But for reasons
of both prestige and money, what really excites both government
and industry is the fatter wallets in western countries
with ageing populations and rising healthcare costs—and
the Gulf, where seekers are finding it harder to access
medical treatment in the West, post 9/11.
It's definitely not the titled rich that are showing up
here. Cosmetic surgeon Mohan Thomas's upcoming patients
include a pair of London cabbies, husband and wife, coming
for facelifts. But even a schoolteacher from Bognor Regis
can book a nice room when a hip replacement costs less than
half of what it does back home. If they like the main course,
western patients will also splurge on side dishes. Like
Briton Barry Peters, who came to get a hip replaced, and
got his teeth done as well, paying less for the whole treatment,
including airfares, than just the dental would have cost
him in London. Or Serena Taylor from California, who came
to look after her friend seeking plastic surgery, and decided
to buy an eyelift. It must be like eyeing a pricey handbag
for several weeks and suddenly finding it at 80 per cent
off. What else can you say but, "I'll have that"?
Hospitals, hotels and spas are serving up more temptations.
The Apollo Group, which already offers its patients a post-op
package, including the services of paramedics, at Fisherman's
Cove, a beach resort outside Chennai, is tying up with the
Taj group of hotels for transfers to 38 leisure hotels.
A hospital
cannot replace a hotel. We should not keep these patients
in hospital a minute more than required, we must send them
to a place where they can recuperate," says Apollo
group chairman Dr Prathap Reddy.
In Bangalore, patients can check out of leading private
hospitals, and convalesce in places like Soukya, a sprawling
health farm on the outskirts of the city. With an in-house
team of ayurvedic physicians and allopathic doctors on call,
when needed, its medical director, homeopath Dr Isaac Mathai,
claims to have the "lowest doctor-patient ratio in
the world". It's the detox destination for Indian software
and media tycoons, and its international guests range from
spiritual gurus (Deepak Chopra) to Nobel laureates (Archbishop
Desmond Tutu) and Eurotrash (Sarah Ferguson).
Last
year they also included Ellen Parry, who runs a garage in
Wales. She moved there after back surgery at the city's
MS Ramaiah hospital. Back home in Wales, Ellen is still
ecstatic. "Amazing!", she said on the phone from
Wales when asked to describe her India experience
in one word. She
is exactly the kind of medical tourist Kant wants multiplied.
"Forward integration with hospitals, backward integration
with holistic Indian systems of medicine," is his mantra,
and it's clear why: ayurveda and the rest are products that
Thailand and Singapore don't bring to the healthcare supermarket.
They are uniquely ours, and already contribute significantly
to India's rapidly growing tourism sector. "Integration"
is a favourite word in the healthcare industry, too. If
at one end of the spectrum there's Soukya, which is both
spa and medical centre, and other places like it studding
the lush greenery of Kerala, at the other, it's mainstream
hospitals discovering "wellness" with a vengeance.
Judging
by the talk on the hospital circuit, it won't be long before
every upmarket private hospital offers ayurvedic massages,
aromatherapy, mudbaths, pranic healing, yoga, the works.
And full-fledged departments of alternative medicine, with
homeopaths, naturopaths, and unani medicine specialists
on board to deliver that authentic
dose of India.
Scot
Johnson; American Treatment: Cervical disc replacement "I
heard about medical treatment in India from the TV show
60 Minutes. Big American hospitals are full of Indian doctors,
that’s how I knew they’d be good."
Top
private hospitals are also vying with each other in other
ways to attract an international clientele. As in an accelerated
race for the latest hardware—you can't miss the giant boards
advertising the latest scanner—and for that prized certificate
by the Joint Commission International (JCI) in the United
States, a non-governmental body that accredits international
hospitals meeting exacting American standards. The early
birds who have it, such as Apollo in Delhi and Wockhardt
in Mumbai, display it big, and other hospitals are in the
queue. "The fact that we are JCI-accredited is a symbol
of quality assurance for patients in the western world.
To them, quality is foremost, even over cost," declares
Bali of Wockhardt.
The hospital room is changing too, with globalisation clearly
the spur, though all CEOs maintain that demanding Indian
patients are driving the changes, too. John Connell, a primary
school teacher from Southampton in the UK, who came to Wockhardt
in Mumbai earlier this month for a new minimally invasive
procedure to treat a hole in his heart, had the following
in his hospital room: a computer, internet, a DVD player
with regional compatibility that could play British DVDs,
a mini-bar, a coffee-maker, a cellphone. The hospital also
offered him and wife Amanda "virtual family visits"—that
is, a video of them shot in the room and uploaded for their
families back home.A hospital car was made available for
them to move around in the neighbourhood. John's room still
managed to look like a hospital room, but at new hospitals
like the Max Devki Devi Heart and Vascular Institute in
Delhi, it's all blonde wood, expensive blinds, and leather
sofas, the work of a British designer hired by the company
to get the look right. And prices? Ashmeena Ghei, international
marketing head, who is already facilitating visits by a
stream of international patients, quotes them in dollars:
$150 for a room, $300 for a suite.
But the 2.3 billion dollar question is: Will the stream
turn into a flood? And when?
(Anjali
Puri With Payal Kapadia with John Mary in Kochi) Article
Source: Outlook India
