December Issue 2007

Mrs Yasmeen Asad often looks through her photo album and is taken back to the days when her husband was hospitalised for an angioplasty at the Bhagwan Mahaveer Jain Heart Centre in Bangalore, India, some four years ago. News of the Pakistani couple’s arrival had reached the prying Indian media, and journalists soon began to throng the hospital in a bid to get the inside scoop. Yasmeen not only harbours fond memories of their brief shot at fame, she is also full of praise for the Indian doctors and their healthcare system.

“Doctors at a reputed local hospital had told us there was no treatment and that his chances of survival were virtually nil,” recalls Yasmeen. Her husband Asadullah Khan had suffered two massive heart attacks owing to excessive smoking that had rendered “half his heart dead.” Amid such gloom, Khan’s cousin in the US heard about India’s world-class healthcare system. He researched over the Internet and found out about a Dr Mukundan in Bangalore. The doctor was soon contacted and Khan’s medical reports were promptly dispatched, after which the patient was flown to the hospital in India and treated successfully.

Earlier, the case of baby Noor Fatima, who had travelled with her parents to India in July 2003 in the Dosti Bus after a multi-year-long hiatus of people-to-people contact between the two countries, was, undoubtedly, the most highly publicised of all the cases referred to Indian hospitals from Pakistan. In 2006, five-month-old Maria was flown from Karachi to Narayana Hrudayalaya hospital in Bangalore to be operated upon by the same doctor, Rajesh Sharma, for a similar heart condition. She had a gaping hole in her tiny heart. “Doctors here categorically told us to come back when she was 12, as there were no paediatric cardiac surgeons in Pakistan,” her mother Rabia Akif tells Newsline. They told the nervous parents that her condition may start to yield symptoms by the third month, and this may very well stunt her growth. “It was ridiculous! Should they not treat a child before the deformity sets in?” asks Akif. That was when the option of seeking treatment in India became inevitable.

However, Maria did not quite receive the same reception as Noor Fatima. By then she was just one of the thousands of ‘medical tourists’ who are now flying into India from both the East and the West.

Medical tourism, a catchy phrase picked up by the Indians, is now a booming industry in the country, growing by 30% each year and generating 12-15 billion Indian rupees annually, according to estimates.

india-health-2-dec07Where the country promises to offer the best in healthcare and a guarantee of patient satisfaction, the term ‘medical tourism’ laces it up with an opportunity of fun and frolic in “Incredible India.” While the deal may sound like an attractive proposition to many, some in the Pakistani medical fraternity feel that the terminology and its accompanying connotation simply sound “distasteful.” But the fact remains that medical tourism has more to do with medical facilities than with holiday tours.

Indian hospitals are offering world-class, state-of-the-art medical treatments and care at a fraction of the costs incurred abroad. Whereas a heart bypass surgery costs only $6,500 at the Apollo Hospitals in India, it could cost from $30,000-80,000 in the US. Consequently, patients from Bangladesh, Sri Lanka, Nepal, Indonesia, the Middle East, Malaysia, Kenya and Nigeria are pouring into Indian hospitals, in addition to patients from the technologically developed West. “In Pakistan there is the issue of cost, and in the developed world there is the issue of waiting lists. Under the public healthcare system, people in the UK have to wait for 18 months for a hip replacement surgery. And if you need bypass surgery in the US in a state-run hospital, you need to wait for 12 months,” explains Medical Director Dr Saeed Hamid of the Aga Khan University Hospital (AKUH). Moreover, cheaper medical costs in India have made the country a haven for non-insured Americans.

The phenomenon of medical tourism is progressing full throttle, thanks to the slick marketing techniques of the Indians. You can now skim through a dozen plus websites to find the hospital of your choice in India, make your appointment with a doctor with the click of a mouse, and send your medical reports online to that doctor for perusal. You can arrange with the hospital to provide you with the airport pick-and-drop facilities. They will also furnish you a list of affiliated hotels, where you can obtain discounted rates. The doctors will also help out with the visa procedure and any visa extensions, if need be, by writing referrals for the patient.

When five-month-old Maria landed at the Bangalore hospital with her parents and grandmother, she was promptly taken care of by the doctor himself. Says Maria’s mother, Rabia, “A boy carrying a placard with my daughter’s name was waiting for us at the airport. He took us to the hospital straight away in his car. After completing the registration formalities, my mother and I were allowed to stay as attendants with my daughter, while my husband was taken to the hospital’s visitors’ room. It was better than a five-star hotel room!” exclaims Rabia. And all those conveniences came at a meagre cost: “The whole treatment, including the attendant’s stay and the cost of food, was paid in a bill of 1,65,000 Indian rupees.”

Incidentally, even government-run hospitals in India boast cutting-edge medical facilities. They are, however, very few in number, says the renowned Indian paediatric cardiac surgeon Dr Rajesh Sharma, who works at the Escorts Heart Institute and Research Centre in Delhi and has operated on no less than 200 Pakistani patients, including Noor Fatima. Higher salaries in private hospitals are now drawing most doctors away from the government-sector ones. “The quality of care in private hospitals has improved because of this flux of trained doctors from government hospitals.” And when 75-80% of the healthcare services and investments in India are private enterprises, the medical field is bound to grow.

Indian hospitals have, over the years, treated a myriad of Pakistani patients suffering from various health conditions. But mostly, it is patients in need of paediatric and adult heart care, liver and kidney transplants, cancer treatment and neurological therapies, who have travelled across the border and sought medical help. “Pakistan, as I can gather from my patients, has fewer qualified doctors than India,” says Dr Sharma. “In my field of paediatric cardiac surgery, for instance, I believe there are probably only two dedicated paediatric cardiac surgeons, one in Lahore and the other in Karachi for the entire country.”

Often patients who have been turned away in despair by Pakistani hospitals have found succour with Indian doctors. Rafi Munir was diagnosed with third-stage throat cancer at a reputable hospital in Karachi. His young specialist doctor, newly arrived from the US, suggested that he get his larynx removed, which meant he was never going to be able to speak again. “A friend of mine suggested that we go to India, and in no time got us connected to Dr Sultan Pradhan of the Prince Aly Khan Hospital in Mumbai.” When they arrived at the hospital in Mumbai, the doctor checked his CT scans and then proceeded to check Munir’s throat internally through endoscopy. That’s when he found out that the cancer had not reached his cartilages and that the removal of his voice box was not necessary. Munir could be treated with chemotherapy. “He was surprised that the doctors in Pakistan hadn’t gone through the trouble of checking his throat internally,” says Munir’s wife, Sarah. “It was only a half-hour procedure. They had quite clearly said, ‘Come tomorrow for a major surgery and we will throw your voice box into the dustbin.’”

“In some areas we lack the resources, both in terms of personnel and cutting-edge technology,” admits AKUH’s Dr Hamid. “But if you look globally, we have a number of Pakistanis who are extremely well-trained in some of the best centres in the world. Our difficulty is that we have been unable to attract them back home in considerable numbers which, to some extent, the Indians have succeeded in doing.” This may not only be on account of the poor pay packages offered to specialist doctors in Pakistan as compared to the West, but the deteriorating law and order situation in the country has made homecoming an undesirable prospect for most.

Where Pakistani healthcare lacks comparable expertise, the expense on a particular medical facility in Pakistan impedes the system even more. “I believe that international companies offer the same technology to other countries in the region at a much cheaper price than they do to Pakistan. Maybe, it’s just the negotiating skills of the Indians or it is the envisaged breadth of the market — India being a country of one billion people, while we are a country of 160 million. So there is the difference in quantum,” contends Dr Hamid.

But what has helped India the most in its healthcare are the indigenously produced drugs that are sold at extremely low prices. Frequent Pakistani visitors often bring their year’s supply of medicines from India. In addition to being self-sufficient in cheap medicines, the Indian pharmaceutical companies export their products to over 180 countries — a mighty feat for a developing country.

Oddly enough, in India international pharmaceutical brands sell for less as well. One reason could be that India has not paid heed to pharmaceutical patency laws. “Indian companies could duplicate medications pretty much in a year after their release in western countries. Any medicine available for Rs.50 here in Pakistan may be available for Rs.10 across the border,” says Dr Hamid. “Of course, one has to have a sound scientific background to be able to do that. The Indians have used such opportunities to build up their pharmaceutical industries.”

And that is not all. Patients returning from India rave about the bedside manners of the Indian doctors and the medical staff. Many of those interviewed described them as “warm,” “humble” and “cooperative” and, at the same time, criticised the local doctors for their high-handedness and lack of interest. Simple gestures like visiting the patient everyday instead of sending a junior doctor, easy accessibility over the phone and via email, and no airs of protocol all endeared the Indian doctors to the Pakistani patients, who insisted that the ‘VIP’ treatment was not extended to them alone. It was a courtesy extended to all — Indians and foreigners alike.

With hundreds of cured and contented patients, many of them Pakistanis, returning to their countries with positive stories and impressions, medical tourism in India is fast gaining momentum as a full-fledged industry, and the prospects of India emerging as a major medical destination on the world map seem brighter than ever. And now with the mending of fences between the two countries and a relaxation in the stringent visa regimen, the flux of ailing Pakistanis will only grow with time.

Is our medical fraternity bracing itself for the competition?

“We are aware of the competition. We have no deficiencies,” says AKUH’s medical director, Dr Hamid. “And competition will only make us better.”

One hopes so. It’s time Pakistan’s medical practitioners took a leaf out of India’s success story in the medical field.

(Names of some patients and their family members have been changed to maintain their confidentiality.)