Medical tourism is relatively cheaper in developing countries than in the developed countries. Going by the ‘McDonald index’, in India you get a burger for 40 cents at McDonalds, which would be more expensive in the US.
Similarly, the cost of other products and services are proportionately lower for people coming from developed countries like the US. Likewise, a surgery for obesity which costs about US$ 50,000 could be done in India for just US$ 10,000 in the best corporate hospital using the same kind of technology used in USA and done by surgeons trained in the West.
Due to the current favourable Rupee/Dollar/Pound/Euro exchange rate, foreign clients can take advantage of the weak Rupee and save up to 75 per cent over the same treatment in their own countries with no compromise on quality. For the average Indian, private medical care is very expensive, but for the visitors from other countries, it is a bargain price considering what they would pay back home for an elective procedure with a top specialist. In other words, cheapness is relative and does not mean that the standards are in any way lower.
While the globalisation of healthcare has given a sense of assurance to patients that they would get quality care, accreditations like that of the Joint Commission International (JCI) and presence of highly-trained doctors have added to the confidence.
Treating obese patients
To start with, when an obese person seeking surgery for his/her weight loss decides to come to India, he/she would have already tried all other alternatives and would be fed up and depressed. The first contact is usually through Internet.
What actually they need at that moment is simple straight talk. The medical tourism agency should understand that these patients have to be dealt with sympathy and attended in a proper way. And, repeated questions are normal for this category of patients.
The potential complications of obesity surgery and the hassles of travelling to a new country, which has a different culture, can stress any one out. It is important for the patient to have a tele / video conferencing with the surgeon who would be doing the surgery.
Patients have to be counselled about the tests that need to be done. They are often put on a high protein low carbohydrate diet that makes them and their liver more fit for the surgery. This generally starts 2-3 weeks prior to their travel to India.
Long travels and long waiting for transportation may create health troubles, the chief culprit being deep vein thrombosis. I usually ask my patients to start prophylaxis against this dreaded and common problem from the time they leave their home to the time they go back. One cannot do an ‘over’ prophylaxis.
Once the patient reaches India after enduring the long journey, which is extremely cumbersome for a patient weighing over 200 pounds, he / she needs rest and time to get over jet lag. Most of the patients suffering from morbid obesity are shy and have very little experience of taking long flights. Never plan to take them from airport to operation theatre. There should be a cooling off period of one to two days to ease out the exhaustion and also to get over the cultural shock (and of course the jet lag of travelling east).
All the staff in the hospital has to be geared to deal with these patients who are extremely sensitive to any kind of ridicule that may come from the ignorant. The problem of obesity is generally misunderstood in a developing country such as India as a self-inflicted problem of affluence and overindulgence. As a result, patients who come for the treatment are often ridiculed. However, the patients do not expect such insensitive behaviour from the staff of a professional hospital. For instance, a patient of mine was not upset hearing a snide remark from taxi driver about a possible flat tyre, but a ridicule from a ward boy, who was deliberately panting while taking her on a wheel chair, brought her to tears.
Not just buying a bariatric operation theatre table will be enough to perform the operation. There are many other facilities that need to be upgraded like wheel chairs, toilet seats, room chairs, beds and all other infrastructural amenities. The entire team of nurses, ward boys, staff of the food and beverages department, dietician, physiotherapists, receptionist and junior medical staff need training and workshops on how to deal with these patients. Only after this, comes the more difficult job of detecting complications which though serious, manifest in a very mild manner that can go undetected till it is too late.
Patients are sensitive to overcare. Various department in-charges have the habit of popping into patient’s room unannounced while he / she is trying to sleep. They tend to drop their cards and proudly say, “call me any time if you have a problem”. The biggest problem is disposal of these cards and trying to figure out who is who. This act of pampering is often seen as an invasion of privacy by the patients.
The members of the staff who deal with patients directly should ensure that there is proper communication between them. The nurse who checks the temperature should reassure the patient. She should not dash out of the room to complete the record. I once had a panic phone call from a patient, who thought that something was terribly wrong with his blood pressure as the nurse dashed out after recording it.
The right approach
- Adherence to predicted time and estimated cost are a few things at which Indians are extremely poor. This lapse is seen as unprofessional behaviour and can be very upsetting for the patient and also lead to loss of credibility. Do not create unrealistic expectations on these fronts. It is always better to make honest realistic statements.
- Admission and discharge procedures should not be time consuming. Transport from reception to room and within the hospital should be swift and comfortable.
- Food requirements should be special and good coordination is needed between the surgeon, endocrinologist and dietician. It is very confusing for a patient to hear different advices on one issue from these three departments. A standardised and mutually agreed diet chart should be formulated.
- Physical activity, breathing exercises, physiotherapy should be well agreed upon and appropriate to the medical needs of these patients. Junior doctors are totally untrained to deal with patients of another country especially with obese patients. They need to be sensitised to the needs of this special group of patients. Psychological care is as important as the medical care.
- Cleanliness and infection control is the biggest nightmare of all these patients. Repeated assurances about the equipment used, sterilisation and usage of gloves is necessary. The surgeon in charge is the best person to address this concern.
- Postoperative pain control, communication and reassurance is needed. If possible, video conferencing with a close relative back home can do wonders in boosting the morale of these patients. Avoid over cautious approach as this could raise suspicions of something being wrong and something being hidden.
- Billing and discharge procedures have to be smooth and reading material on postoperative care is very useful. Patients should not be abandoned at this stage and should be escorted to a hotel for recovery before they fly back. An email of good wishes and enquiry is always welcome.
Medical tourism for obesity surgery is still in its infancy and we need to realise that this infant has special needs that need to be catered to if we want it to be a healthy adult.
About the Author
Arun Prasad belongs to the first generation of laparoscopic surgeons from the time it started in the UK. Experience of over 5000 laparoscopic surgeries that include over 3500 cases of laparoscopic cholecystectomy, 1000 laparoscopic hernia surgery and rest advanced laparoscopic surgery including Thoracoscopic and Bariatric Surgery for weight loss including Gastric Banding, Roux en Y Gastric Bypass, Sleeve Gastrectomy and Mini Gastric Bypass.
