Earlier this month the Director General Health Services in a letter to the Director of the Post Graduate Institute of Medicine (PGIM) issued instructions to temporarily suspend the mandatory foreign training given to post-graduate trainees due to the limited foreign currency available. The Health Ministry which is already feeling the pangs of the forex crisis due to the shortage of funds to purchase pharmaceuticals and the prevailing fuel situation is now facing a future threat of a specialist shortage.
The medical specialists in the country may prove to be major dollar earners for the country as already there are those who arrive in the island from countries such as the Seychelles in search of medical treatment from private sector healthcare facilities.
Talking about Medical Tourism
While medical bodies such as the Sri Lanka Medical Association (SLMA) have been touching on the subject, the Government Medical Officers’ Association (GMOA) has also on regular intervals spoken of the possibilities of launching such a programme which would give a welcome tilt to the island’s tourism industry. Former President Gotabaya Rajapaksa in his manifesto spoke of the possibilities while the subject was also touched upon in the 2022 Budget proposals. Considering the dollar shortage in the country, Sri Lanka should not merely allow ‘Medical Tourism’ to be a subject which is only talked about but should look at opening new avenues to overcome the dollar crisis which is smothering the breathing ability of the country.
Medical Tourism (MT) is when people travel abroad to obtain medical treatment. There was a time when those from less-developed countries travelled to developed countries for treatment which was either unavailable or was not developed adequately so as to ensure their life safety in their own country. The countries which they travelled to possess the technology and treatment methods to facilitate the medical care that was needed to safeguard the lives of patients.
Member of the Medical Tourism Association (MTA), Dr. Prasad Herath observed that the situation had changed since even those from developed countries have commenced seeking medical attention from developing countries at low cost. The long-waiting lists in their home country, the low cost, the availability of technology and the trained staff drew those even from developed countries like in Europe to less developed countries. Also there were possibilities of performing treatment methods which were legally questionable according to their Constitution or difficult to perform in their home countries.
“Countries such as India, Thailand, Singapore, Dubai, Abu Dhabi and many countries surrounding our island were benefiting from Medical Tourism,” he said.
Countries and specialties they offer
Turkey and Brazil have earned a name for MT on the global map for hair transplant, buttocks enlargement, cosmetic and dental procedures. Dr. Herath observed that researchers and media publicity received by those countries had earned them the name.
Explaining, he said there was a demand for cosmetic surgery, dentistry, organ transplant, cardiac and orthopaedic surgery, reproductive tourism, traditional and alternative tourism, wellness tourism, Ayurvedic treatment methods and the concept of a healthy lifestyle in the global market.
Cost of Treatment
Dr. Herath said that Jordan charged between US Dollars (USD) 635 to 915, Mexico USD 975, South Korea USD 1,500 and Ukraine between USD 500 to 700 for Dental Transplant, while Colombia, USD 11,700, while India charges USD 5,000 to 6,200 for heart valve replacement. The United States charges a whopping USD 1, 70, 000 while Colombia and India charge USD 20, 000 and USD 11, 500 to perform heart bypass surgery for foreign nationals seeking their skills and technology. Enumerating on the dollars that were drawn by medical tourism, he said that while the USA charged USD 28, 200 for Angioplasty, India charged USD 5,500 to USD 6,200 for it. Thailand and Ukraine charged USD 10, 938 and USD 4,000 respectively for the procedure.
Getting MT off the ground
The question arises as to whether Sri Lanka could at least at this juncture wade through the turbulent waters to get ‘Medical Tourism,’ off the ground. The country already possesses a world class health service which should be put to use at this moment to drag it out of the roiling, turbid water. Dr. Herath also a member of the Government Medical Officers’ Association’s General Committee, said while the island had won a name for its free health service in the region owing to its low maternal and child deaths, high level of life expectancy, the standard programme of innoculation, a good blood bank service, foreign trained doctors and trained staff and technology available in hospitals. The country has also received accolades for Covid-19 control and vaccination against it.
Currently, Sri Lanka has four hospitals – in the private sector which have received Joint Commission International Accreditation (JCIA). In addition to all this the island is already a tourist destination. It is time to put the island’s conducive climate conditions, the hospitality of people, cultural background, and its indigenous treatment methods which also attract tourists to greater use, the IMTA Member observed. Unfortunately, we as a country have not explored the possibilities to open our doors to medical tourism.
Changes that need to be made
This cannot be done overnight or by waving a wand. As mentioned before, touching on the subject in a presidential manifesto alone is inadequate to launch such a vast programme. There are rules and regulations to be introduced and laws to be made. Day in and day out, time and money is wasted in Parliament with very little being focussed about the crisis the country is facing and the corrective action to be taken to prevent the country from going down the precipice.
Addressing grey areas vital
Dr. Herath said that Sri Lanka did not have the laws to provide for medical tourists starting from the visa system to notify the purpose of the visit to Sri Lanka. In addition a foreign patient coming into Sri Lanka to receive medical care also faces difficulties paying through his/her insurance scheme. Identifying more grey areas which need addressing, Dr. Herath said that there should be a patient portal through which a local doctor would be able to access the patient’s medical history or the diagnosis details and Sri Lanka should be able to provide a diagnosis card acceptable to their home country. He noted that there should be a method of communication in place between patient and doctor- a Tele-medicine method through which a dialogue could be built between the patient and his or her doctor before he or she left his or her country to arrive in Sri Lanka.
He said the country should also be able to support a relative or relatives who arrive with the patient. It is only acceptable that having made the difficult decision of being treated outside of his or her own country, a patient would want the presence of a relative. Therefore, Sri Lanka should be able to cater to this requirement as well. Certain countries have apartments prepared solely for this purpose while they even go to the extent of providing the patient and his/her relatives with prompt healthcare facilities and emotional support during the trying period.
The member of MTA, a global set-up said that in Dubai, the Tourism and Health Ministries collaborated to initiate MT in that country. They went into such detail that a medical staff member was placed on board the flight which was flying in the patient.
However, as to whether this could be achieved in Sri Lanka is another matter when considering the inability of the Ministries of Power and Energy and Transport and Ceypetco inability of collaborating with the Health Ministry to ensure that the health service had adequate fuel to function its ambulances and generators. Appeals from the Dengue Control Unit to the various Ministries and institutions most often than not fall on deaf ears because each of these institutions are only capable of thinking individually while collaboration and support are not included in their dictionaries.
Specialists and Doctors
“We have doctors who have received their Specialist Training in Australia, the UK, the US and Japan, China, India, Bangladesh, Russia and Europe who are also able to speak the language of those countries. It is an important asset in MT that the patient is made to feel comfortable so that he or she can ask questions and clarify procedures. It’s important to build a good rapport, Dr. Herath said.
In addition, there should also be a mechanism through which the success rate of doctors involved in MT are assessed which also helps increase the patient’s trust and confidence and those of his or her relatives. To have an index of 75% success in surgery can be a factor to draw a patient to the particular doctor.
After all is said and done, it is also a known fact that certain great ideas which are arrived at following endless discussions are unable to see some of the grand scale programmes the Sri Lankan Health Ministry drew out ending in success. Looking back, the country is still struggling to get its transplant surgery off the ground. Therefore, proposals and more proposals could be put forward. Manifestos can call for Medical Tourism but as to whether the Government would even consider the possibilities of inviting the dollars through MT, is another matter.
By Dilanthi Jayamanne