Exodus to India, Kenyan’s new medical Mecca

Daily Nation

Not even in her most horrific nightmares could Gladys Etemesi have imagined that the little pain bothering her left shoulder would turn into one of the biggest, most traumatising and most expensive battles of her life.

But that niggling pain did indeed do all that to her, and more. By the time she regained control of her body, Gladys had gone to hell and back, endured the agony of intrusive medical check-ups, and flown over oceans.

The little pain she had thought would go away, doctors advised her one day on a routine check-up, had all the hallmarks of cancer. She ran the risk of losing her arm, they informed her, if nothing was done to clear it. But this was just some little, irritating pain, she thought to herself. Surely it can’t lead to much.

Well, to much it did lead. The pain grew worse, almost rendering the whole of her left arm useless. She could not lift anything with it when she finally darkened the entrance to her doctor’s office and asked whether amputating it would help.

Why, the doctors asked, would she lose her arm instead of seeking help in India?

India? She thought to herself.

Ahaaa, India!

That carrot had been dangled to her severally, but she had never considered it a viable option. But now she had an arm that was, literally, killing her. She knew cutting it off would lessen, if not end, the pain; but doctors had refused to amputate it, and instead asked her to see whether their colleagues in India could help.

And so began Gladys’ eye-opening experience of medical tourism, a phenomenon which, though popularised by New Delhi in recent times, has been around since — hold your breath — 300BC!
Way before the age of e-mail and digital scanners and unobtrusive surgery, pilgrims would gather in ancient Greece to worship at the temples of the god of medicine and healing, Aslepius.

That is why, when the fathers of modern medicine crafted the Hippocratic oath, they decided to pay tribute to the god by mentioning him in the first line: “I swear by Apollo the Physician and by Asclepius and by Hygieia and Panacea and by all the gods…”

From those epic beginnings, medical tourism has morphed into the multi-billion dollar industry it is in the 21st century. A study by the Confederation of Indian Industry in 2005 put the annual number of medical tourists at 150,000, and projected that figure to rise by more than 15 per cent every year. Current estimates put the numbers at 500,000.

India, clearly, is determined to pull no punches as it races to cash in on the money maker. At the beginning of this year, for instance, Delhi offered Maldivian citizens free 90-day visas into the country as long as the visitors are flying in to access medical care. The only other countries that enjoy these waivers are Nepal and Bhutan.

BOOMING INDIA

In June 2013, Research and Markets projected that the Indian medical tourism industry would register a Compounded Annual Growth Rate of more than 20 per cent between 2013 and 2015.

The report, titled Booming Medical Tourism in India, stated that India had managed “to match up with the quality of healthcare services that are being provided in developed countries”, and that “qualified medical staff, adoption of advanced technology and improving healthcare infrastructure” had made the country an attractive destination for patients all over the world”.

This high-quality service is among the reasons India today is a popular medical destination, not just for countries in the Third World, but also for super economies such as the US. American medical giant Companion Global Healthcare, for instance, has 25 accredited hospitals in 12 countries under its wing, and India sits proudly at the top of the list with seven Companion hospitals.

To make medical treatment in India more appealing to snobbish Americans, Companion offers its patients an 80 per cent discount in health care charges for services procured in its hospitals in India.

The greatest selling point for India’s growing medical tourism industry, however, remains its drastically low costs compared to other countries that offer the same standard of care. For example, a heart transplant which would cost around $100,000 (about Sh8,620,000) in New York costs only $7,200 (Sh620,000) in Delhi.

For Africa, that is too interesting a figure to ignore. That is why a report by A&K Global Health reveals that of all the people in Africa who travel abroad seeking medical help, 95 per cent go to Asia; only four per cent go to Europe and a paltry one per cent to the Americas. Most of those that go to Asia ultimately end up in India.

This global reality is reflected in Kenya. While there are other Asian countries such as Thailand and Malaysia that offer competitive medical rates, India remains Kenya’s destination of choice. About 60 per cent of Kenyans who travel for medical care choose to go to India, with South Africa coming a distant second with just 15 per cent.

This is because India is perceived to offer the best care at the most attractive rates. In addition, most insurance companies do not offer cover against chronic illnesses such as cancer, which would make it very expensive to receive care locally. This forces patients to seek medical treatment elsewhere.

So big is this medical tourism that it has spawned related businesses due to the sheer numbers seeking medical care outside their countries. Nairobi’s Pathway Tour Company is one such firm as it exists solely to organise patient transfers outside the country. Chief Executive Officer Simon Karo told DN2 that, in any month, the company helps up to 100 patients go to India for treatment.

Most of those are people who require a level of care that is unavailable in the country, and so Karo’s company links them with hospitals in India, arranges their travel particulars, books them into hotels and sends them on their way. Pathway also handles the patient’s return to Kenya and ensures that they liaise with local doctors to receive the necessary follow up care.

The existence of medical travel companies like Pathway is what finally tipped the scales for Gladys Etemesi.

“I did not want to go to a strange country for treatment, and I did not have the money,” says the practising nurse. However, a friend recommended A&K Global Health. One look at what they had to offer the nurse was sold.

“They connected me with Narayana Hospital in India and made all the travel arrangements,” she narrates. “I was so relieved that when I landed in India, I found a representative from A&K Global waiting for me. Even better, when I got to the hospital, the doctor, too, was waiting for me, and treatment began immediately.”

Being a nurse, Gladys appreciates just how unusual it is for a patient to find a doctor waiting in the hospital. In most cases, local hospitals are so understaffed that a patient is forced to wait hours before they are attended to.

Dr Sultani Matendechere, secretary general of Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), paints a rather gory picture of the situation in Kenya.

“At Kenyatta National Hospital,” he begins, “there are cases of patients who have had to wait for more than six months for something as routine as radiotherapy treatment. By the time it is the patient’s turn at the machine, his or her condition has worsened. Some even die waiting.”

In addition, lack of medical equipment presents another challenge for public hospitals. In the rare instances where equipment is available, it is old and outdated, posing a danger to patients.

For example, the country has only two renal dialysis machines in its public hospitals: one at Kenyatta National Hospital and the other at Moi Teaching and Referral Hospital. This results in endless queues at these two institutions as kidney patients from all over the country make the trip to either Nairobi or Eldoret for treatment.

Worse still, even where equipment is available, there are no qualified personnel to operate it. According to the doctor, most trained specialists have left the country for better paying jobs abroad. This scarcity of resources, both in technology and personnel, is so crippling that Kenya falls horribly short of World Health Organisation standards.

In fact, Aga Khan University Hospital is the only facility in the region with the Joint Commission International (JCI) accreditation, a thorough audit of more than 1,200 quality elements, including factors such as infection control, standards of physician practice, medication management, safety of care, qualifications and competencies of staff and physicians, patient education and multi-disciplinary management of patients.

“The government has failed horribly at improving the quality of healthcare in the country, and as a result standards keep falling,” laments Dr Matendechere. His description of the situation points to a country run by a few well-heeled individuals who have buried their heads in the sand and refused to give public medical care the attention it deserves because they can afford private hospitals.

“For the rich people in government, the problems in public hospitals are not a priority because they are not the ones that use those hospitals,” he says.

And that, he argues, is the reason a crisis is always in the offing within the industry. In December last year, for instance, government doctors went on a strike that paralysed treatment in public hospitals as they protested delayed payments and the ineffectiveness of accessing pay via the devolved county government.

In the past, the government has also been accused of not paying trainee doctors at all, which makes it difficult for doctors to go back to school and specialise.

“There is just no incentive to specialise in Kenya,” complains Dr Matendechere. “And even after one specialises, there are no facilities available to enable one to practise one’s skills. So many doctors end up moving to the private sector or abroad.”

This low score in the health care report card may have made Nairobi a prime market for countries offering competitive medical care such as India, but, despite the many problems facing its health sector, Kenya is still ahead of its peers in the region. This explains why medical travel is not just outbound.

“Every month we get up to 2,000 patients coming to Kenyan hospitals from the greater East African region,” reveals Mr Karo, the Pathway CEO. “Most of these are from South Sudan, although there is quite a substantial number that comes from Tanzania, Uganda and Rwanda as well.”

In this regard, Dr Harun Otieno, a cardiologist at Aga Khan University Hospital, argues that Kenya can become a hub for medical tourism in the East Africa region.

“We have modern facilities and a growing number of specialists, so if we worked together and looked at reducing the cost of medical care, we would reach a large number of needy patients from within Kenya and outside the borders too,” says Dr Otieno.

And sending patients abroad in their thousands every year has a very detrimental effect on the development of local health care, he argues. “When everyone goes to India, our experts locally are left treating general conditions instead of dealing with these patients, and this further hampers our development of specialised medical services. Training opportunities are lost, revenue is lost and confidence in our own abilities reduced.”

The cardiologist asserts that it is only in very rare cases that he recommends treatment in India for his patients. “Most of the treatment for basic and advanced heart conditions is available locally,” he says. “Furthermore, the costs of travel, accommodation, and time off work may add up to what we are charging here.”

One of the biggest challenges associated with going abroad for medical care is difficulty in getting follow up care. Patients are often referred back to Kenya with instructions to go back to India in a few months. Furthermore, they are given drugs with Indian names or many that are not locally available. The costs may be cheaper for medications, but post-procedure care includes close patient monitoring for complications, laboratory testing, physical examination and treatment for conditions that may arise from treatment.

“Most recently,” Dr Otieno says, “we admitted a very sick patient from India who had been treated last year and sent back to Kenya only with his medical folder. No doctor-to-doctor information was shared and this complicated treatment when the patient came back.”

Dr Matendechere shares these sentiments, and is of the opinion that if the government engaged all stakeholders in the medical industry and made a commitment toward capacity building, then Kenyans would have no reason to seek medical care abroad.

Until then, people like Gladys Etemesi will continue boarding India-bound flights. Because, at least for the moment, the grass is truly greener across the ocean.