Thursday, 23 August 2012

MEDICAL TOURISM... WHO CARES?

As published in the Blueprint Newspaper on Thursday 23rd August 2012

 Nigerians who cannot afford medical tourism

In the news recently (Sunday Trust, 19th August), Ibrahim Mohammed, a patient, was refused carriage by airlines in his quest to travel abroad for treatment. Ostensibly, because he was spinal cord injured from a road traffic accident. He had been lying, paralysed, in a hospital bed in Kano for about a month. He was eventually treated at Primus Hospital in Abuja…. by an Indian doctor. Both the patient and the doctor are apparently happy.

Who cares?
We should care about the real story behind this story but as always, we do not have the full facts. The story says that the patient works for the Kano State Government and money was not a problem. The National Orthopaedic Hospital, Dala, is one of those labelled “centres of excellence” and one place he should have found succour. Why could he not have been offered treatment by the neurosurgeons and numerous orthopaedic surgeons in the North? Did he refuse treatment locally? Why was he desperate to fly out of the country for treatment?

Let us digress
It is an inalienable right of Nigerians to choose where they go for medical treatment. Patients have a choice and the right to seek the best medical treatment for themselves. This happen in all communities and the need to preserve life and limb means patients and their relatives will gravitate to the best medical care available. We (health care practitioners) could and should be involved in directing them to the appropriate places where they will get good care. One of the key components of care is confidence in your health care practitioner. If you are happy and feel you will get better, most times, you will. After all, we care and God heals. Should they decide to go outside the country, for whatever reason, we should be able to provide post medical tourism care for them. After all, they cannot afford to stay abroad forever.

Home support
In truth, the poor health care delivery in Nigeria and poor medical advice have contributed to the mass movement of our patients to ‘safer’ shores. It is not enough to say patients should not go to India, Egypt or elsewhere, we must give them a good reason not to go. The best reason is good medical practice and effective communication. More importantly, doctors must appreciate their professional and personal skill level and limitations in practice. If you cannot treat the patient, know who can, learn to refer early to preserve the life and limb of your patient. Working together and better communication between professionals are the prerequisites for good quality of care.

Minimum standards
Dr Azodoh, Consultant Urologist with Chivar Clinics, Abuja once said that we need to provide a better standard of care for Nigerians. At the minimum, hospitals must be equipped with the basics to ensure life and prevent death. For example, the presence of simple oxygen and monitoring equipment for use by the patient can actually make the difference between life and death in some situations. We must be able to provide a satisfactory level of care for patients in this country. It therefore means that everyone must be hands on deck to improve standard of care. Medical practice in Nigeria must return to the good old days when excellence of practice was the by word. Running away at the time of need does not help.

Health Care Practitioners
Health care practitioners are educated people who have left health policy decisions to be made by uneducated and unqualified people. A lot of our medical infrastructure and respect has been eroded because of this oversight. We have a responsibility of guiding and influencing policy change at all levels – making top government functionaries see the bigger picture of these issues. We have the potential and the capacity to do this and that is what we should strive to do. We dare say that the responsibility to bring back the faith and trust by the Nigerian populace in our healthcare systems in the long term rest with all of us collectively. This faith is being restored by the formation of the Health Care Practitioners Association of Nigeria (HC-PAN). The association is a collective umbrella body of all health care practitioners and is in prime position to provide a solid basis for improved health care delivery systems in Nigeria.

Medical tourism is big business
India’s National Health Policy declares that treatment of foreign patients is legally an “export” and deemed “eligible for all fiscal incentives extended to export earnings.” Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion USD into the country by 2012. Specifically, it has been reported that India earns about $260 million USD from medical tourism from Nigeria alone. So, this is big business for India and they are actively pushing this activity and generating huge revenue from Nigeria. This is truly appalling and we are losing significant revenue to India and other countries. Instead, we should encourage inward medical tourism- into Nigeria. There is no reason why we should not be earning this money for Nigeria instead. This is money that could be used, potentially, to develop our crumbling health infrastructure.

Support your local
The colossal sum of money spent abroad could be used to equip many local hospitals in Nigeria to provide equitable standard of facilities and care for all Nigerians. Sadly, Nigerians, and many politicians and government officials do not support their local hospitals both morally and financially. They forget that some illnesses are so acute requiring immediate medical attention that cannot wait for the flight to other countries. Supporting the local hospital and ensuring that it has both personnel and equipment may be the difference between life and death. Anyone proudly strutting off to India and other countries is truly a big fool. Develop your local hospital and help prepare them to be able to help you when it really matters. That you can afford to travel to other countries is simply not the issue. Many have gone to other countries and return dead despite colossal sums of money spent.

Demoralising local doctors
One other fact is that medical tourism is further demoralising local doctors and sapping the little energy and interest remaining. This is very important and should be of concern to every sane Nigerian. We recognise the fact that over time, Nigerian doctors and hospitals have lost the trust and respect of patients. Rather than seeing this as a reason to seek medical attention elsewhere, this should be a call and pressure applied to the government to optimise and improve our facilities and expertise. Patients are best served by medical treatment provided close to where they live; particularly in emergencies.

The key issues are that such medical tourism is eroding the fabric of our own health services and further depleting the nation of medical facilities and expertise. It demoralises local medical practitioners and increases the brain drain. It reduces training of medical students, further creating substandard and poorly trained doctors to look after us all in the future.

It simply creates a vicious circle we must break free of.

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