Sun, sea... and SURGERY!

Medical tourism – patients going to a different country for either urgent or elective medical procedures – is fast becoming a worldwide, multibillion-dollar industry. In fact, medical tourism is, actually, thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine in Bath, a practice that continued for 2,000 years. From the 18th century, wealthy Europeans from Germany travelled to spas in the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. While India is considered the leading country promoting medical tourism today, Sri Lanka is also making its mark as a medical tourism destination. The Nation took a look at this growing phenomenon

Sri Lankan officials are of the opinion that Sri Lanka could offer a service that is just as good, or even better, than that offered in India and capture a significant portion of the medical tourism market

By Marianne David and Kushali Atukorale
Tourism may be down in the backdrop of the escalating war, but Sri Lanka appears to be finally waking up and making strides in the field of medical tourism.

While many hospitals in the country, the Sri Lanka Tourist Board and the Tourism Ministry are now looking into this new avenue of income, sites such as Gorgeous Getaways are already actively promoting Sri Lanka, among other countries, as a place that is ideal for a surgery holiday.

In addition to the country’s location and vibrant atmosphere, Sri Lanka offers some of the most competitive packages in the market, making it one of the best choices for a surgery holiday.

Speaking to The Nation, Colombo National Hospital Director, Dr. Hector Weerasinghe asserted that Sri Lanka has all the facilities, equipment and experienced consultants and surgeons in government hospitals as well as private hospitals to provide all types of medical treatment. He pointed out that even Sri Lankan patients going abroad for medical treatment was pointless since Sri Lanka was capable of meeting every medical need.

Apart from being a medical tourism destination, Sri Lanka is also exploring the care-provider option. According to Tourism Ministry Additional Secretary George Michael, Sri Lanka is able to offer high-level medical facilities.

“We are looking at medical tourism very positively. There are two categories we are looking at in this regard – ayurveda and western medicine. We see that in time to come, half of the world’s population will be over 60. There is a huge opportunity to promote Sri Lanka as a medical service centre and care provider,” he pointed out. Towards this end, he said plans are in the offing to develop this sector and extend the care provider facility in new resorts.

“We have 1,000 acres of land in Deduwa and 4,000 acres of land in Kalpitiya, where we intend to expand the facilities for healthcare. There is a lot of potential to do this in Sri Lanka. Sri Lankan women could be trained to provide healthcare services and be given a higher salary instead of going to the Middle East for work,” he added.

Low cost and less waiting times are the two main reasons why people opt to go abroad for medical treatment.
Many medical tourists from countries such as the United States are seeking treatment in other countries since the prices are a quarter or sometimes even a tenth of the cost at home, while those in countries such as Canada are frustrated by long waiting times. And Sri Lanka is now gearing up to meet their needs.
According to Lanka Hospitals Corporation Limited (Apollo) Chairman Ajith Jayaratne, Apollo is well equipped to deliver any form of medical attention to patients from any where in the world.

“We can offer medical attention at a much more affordable price than most countries in Europe. As a group, which includes Sri Lanka Insurance Corporation and the Aitken Spence Hotels, this was the obvious thing to do – combine medical advice and attention with holidays,” he asserted.

Apollo, which offers packages for medical tourists, set up its medical tourism arm recently and it has received a good response despite the war situation in the country. As for the effect of the war on medical tourism, Jayaratne said, “People think twice before coming here – we have to live with that. However, we will continue in our efforts.”

Some patients seize the opportunity to combine a tropical vacation with elective or plastic surgery, while others are opting for medical tourism due to some treatments not being available in their own countries.

Sri Lankan officials are of the opinion that Sri Lanka could offer a service that is just as good, or even better, than that offered in India and capture a significant portion of the medical tourism market.

According to Dr. Aruna Rabel of Durdans Hospital, the hospital has received a good response from the UK, certain Arabic countries and the Maldives, which had contacted the hospital inquiring about the medical facilities that are available.
“We have tied up with a UK company as well as with some local and international travel agents. We have to look into factors such as packages and other requirements and accommodation as well as local and foreign follow up. We are expecting to carry out five to 10 major operations per month at Durdans,” he asserted.

Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Now, Belgium, Poland and Singapore are also entering the field. South Africa specialises in medical safaris, where tourists can visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants.

India, which is considered the leading country promoting medical tourism, is moving into a new area of ‘medical outsourcing,’ where subcontractors provide services to the overburdened medical care systems in Western countries. Government and private sector studies in India estimate that medical tourism could bring between US$1 billion and US$2 billion into the country by 2012.
According to reports, medical tourism to India is growing by 30 percent a year. India’s top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year. Western patients usually get a package deal that includes flights, transfers, hotels, treatment and often a post-operative vacation.

According to United Holidays Chairman / Managing Director Afghar Mohideen, seven of the UK’s cardiologists and a cardiologist from Singapore were invited to attend a three day seminar at Cinnamon Grand in January, in collaboration with John Radcliffe Institute of the Cardio Care Hospital in Oxford and Durdans Hospital.

“During this time they checked the facilities and requirements for international cardio care in Sri Lanka. They were extremely satisfied with the knowledge of the local cardiologists and the facilities at Durdans Hospital. In January 2008 we are going to have programmes regarding cardio care and we intend to market it through Cardio Care, UK,” he added.

Medical tourists not only have operations done in the country of their choice; they also check into plush hotels for a relaxing holiday – sometimes with their families – and spend big money while they’re at it. Such tourists spend around US$362 a day — over three times the amount spent by a typical Sri Lankan traveller.

Given the growing interest in Sri Lanka as a medical tourism destination, especially in the backdrop of its many tourist attractions, it is high time that the authorities start promoting medical tourism in a big way and grab this opportunity before it passes us by.
The medical tourism industry is expected to be worth around US$ 4 billion per year, according to a 2006 report by the Singapore-based travel supplier and ticketing firm Abacus International.

Cashing in on this trend, Lanka Hospitals Corporation (Apollo) has formed a strategic link with tour operator Gorgeous Getaways and currently promotes a variety of plastic surgery options through the Gorgeous Getaways website. Gorgeous Getaways, which pioneers the ultimate ‘nip/tuck’ holidays for international tourists, is Australia’s first independent operator for cosmetic surgery and dentistry luxury holidays.


High standards, low prices

According to a press release issued by Gorgeous Getaways, the company has personal representatives in Sri Lanka who will assist with hospital and medical appointments and be there if patients require anything after the surgery. It even offers a ‘Beautiful Beach Recovery Package’ for those who ‘crave for more exoticism,’ at Ahungalle, describing it as the ultimate side getaway.

Louise Cogan, founder of Gorgeous Getaways, states that the demand for the service was unprecedented, but not surprising: “It is getting increasingly popular to combine holidays with medical treatment. Spiralling costs in the West together with the long waiting lists have made medical holidays the emerging market. High standards in major surgery and dental treatment are now available at a fraction of the cost, even after enjoying your well earned recuperation at a five star hotel.

“Medical tourism is rising each year and hospitals located in Bangkok, Sri Lanka, Goa and Kerala are just some examples of the destinations that cater to holidaymakers requiring medical treatment. Doctors, dentists and hospitals with high standards and low prices are what you get.”


Downsides of medical tourism

Experts have identified a number of problems with medical tourism:
• Government and basic medical insurance, and sometimes extended medical insurance, often does not pay for the medical procedure, meaning the patient has to pay cash.
• There is little follow-up care. The patient usually is in hospital for only a few days, and then goes on the vacation portion of the trip or returns home. Complications, side-effects and post-operative care are then the responsibility of the medical care system in the patients’ home country.
• Most of the countries that offer medical tourism have weak malpractice laws, so the patient has little recourse to local courts or medical boards if something goes wrong.
• There are growing accusations that profitable private-sector medical tourism is drawing medical resources and personnel away from the local population, although some medical organisations that market to outside tourists are taking steps to improve local service.


Case studies

Name: Helena
Profession: Radio Promotions and Broadcasting
Age: 28
Country: New Zealand
Procedures: Breast lift and augmentation, tummy tuck and liposuction to back, hips, abdominal and thighs
Cost of holiday: Approximately $18,500 inclusive of surgery, hospital stay, five-star accommodation for two weeks; all care and transfers on the ground in Sri Lanka
Cost of just the treatments at home: $35,000

Name: Joanne
Profession: IT Engineer
Age: 31
Country: United Kingdom
Procedures: Extended tummy tuck, liposuction to arms, back, thighs
Cost of holiday: Approximately £3,000, inclusive of surgery, hospital stay, five-star accommodation for two weeks; all care and transfers on the ground in Sri Lanka
Cost of just the treatments at home: £8,000 - 10,000
(Source: Gorgeous Getaways)


From the days of James Joyce to the surgeon’s scalpel

“Why not?” says renowned Plastic Surgeon Dr. Purnima Aiyer

By Jayashika Padmasiri
“The Far East. Lovely spot it must be: the garden of the world, big lazy leaves to float about on, cactuses, flowery meads, snaky lianas they call them. Wonder is it like that? Those Singhalese lobbing around in the sun, in dolce far niente. Not doing a hand’s turn all day. Sleep six months out of 12. Too hot to quarrel. Influence of the climate. Lethargy. Flowers of idleness. The air feeds most. Azotes. Hothouse in botanic gardens. Sensitive plants. Water lilies. Petals too tired to. Sleeping sickness in the air. Walk on roseleaves. Imagine trying to eat tripe and cowheel. Where was the chap I saw in that picture somewhere? Ah, in the Dead Sea, floating on his back, reading a book with a parasol open. Couldn’t sink if you tried: so thick with salt. Because the weight of the water, no, the weight of the body in the water is equal to the weight of the. Or is it the volume is equal of the weight? It’s a law something like that. What is weight really when you say the weight? Thirty-two feet per second, per second. Law of falling bodies: per second, per second. They all fall to the ground. The earth. It’s the force of gravity of the earth is the weight” – Ulysses by James Joyce)

Sri Lanka is a land known for sunshine throughout the entire year. Many foreigners consider Sri Lanka a land of beauty or a small, heavenly island. Perhaps that notion no longer exists; many years have passed since James Joyce’s time, when he wrote about Ceylon.
At present, whenever Sri Lanka is mentioned, the first thought that enters most minds is the ongoing war and raging ethnic conflict in the country. However, through it all, tourists still visit Sri Lanka, and medical tourism is fast becoming one of the reasons for them to do so.

According to renowned Plastic Surgeon Dr. Purnima Aiyer, many foreigners come to Sri Lanka from all over the world for plastic surgery.
“Medical tourism is when a person seeks medical treatment in another country. They come to foreign countries to obtain treatment for various reasons. Some come to Asian countries to save money as it costs less in countries such as India and Sri Lanka,” she pointed out.

According to Dr. Aiyer, tourists sometimes seek medical tourism because they want to keep the surgery a secret.
“Medical tourism is promoted for business and personal reasons, such as pleasure. Most tourists come to Sri Lanka with the intention of having a tropical vacation in mind,” she added.

Speaking about the variety of surgeries available in Sri Lanka that are most sought after by medical tourists, Dr. Aiyer said that many foreigners come to Sri Lanka to undergo surgeries such as breast enlargement, breast reduction, tummy tucks, face lifts, liposuction and the removal of unwanted moles and scars.
Plastic surgery is a word associated with a lot of emotions. It is not an easy thing to become a new person or change your natural outlook, with which you are gifted at birth, especially when the risk involved is that you cannot guarantee what would the end result would be. However, plastic surgery has become extremely popular today and is nothing new to most people in Western countries.

As for one’s suitability to undergo surgery, Dr. Aiyer emphasised that the patient should be completely healthy.
“Not only physically healthy, they should be psychologically healthy too, since the patients have to undergo anaesthesia and the surgery itself. You cannot sue a doctor in a foreign country, according to the law. That is another serious issue with regard to medical tourism. After having spent huge amounts of money for the surgery, if the patient is not happy with the result, a foreign patient still cannot sue a doctor in a land that is foreign to the patient,” explained Dr. Aiyer.

As a result, she is of the opinion that a good understanding should exist between the doctor and the patient from the very beginning, and that the doctor should explain all of the issues which are involved to the patient.
“All of the possibilities have to be discussed, including all the side effects and how soon the patient can fly back to his or her own country. If all the circumstances are favourable, then I believe that medical tourism is fine. We take every precaution to prevent complications. However, ultimately we have to realise that we have only have the right to act. We don’t have the right to the proof of our actions. Complications can take place at any time,” she pointed out.

Dr. Aiyer asserted that medical tourists who intend to undergo any type of surgery should first be fully aware of the procedures involved: “Do your homework properly, know everything about the procedure, including the shortcomings, limitations, and complications, and how long the procedure and the effect would last.”

As for the benefits of medical tourism, Dr. Aiyer averred, “If you intend to undergo a surgical procedure as a medical tourist, then I think it is a good thing. Not only will it save you money, it will also give you a very good, world class result as well. In that case, why not?”










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