|Year : 2018 | Volume
| Issue : 2 | Page : 117-120
Managing the sequelae of urology medical tourism: A single center experience
Muhammed Ahmed, Abdullahi Sudi, Ahmad Bello, Ahmad Tijjani Lawal, Mudi Awaisu, Hussaini Yusuf Maitama
Division of Urology, Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
|Date of Web Publication||19-Jul-2018|
Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
Background: Medical tourism is a fast-growing business worldwide with almost every country involved as either a provider and/or consumer. The degree of participation may vary depending on the status of health-care system in that country. This study aims to present our experience in the management of patients who sought urologic care abroad or returned from medical tourism with urologic complications. Methods: The method of study was based on the documentation of interaction with patients, patients' relations and their agents in a questionnaire between January 2010 and December 2015. The data obtained included, their demographics, indications/motivations for seeking treatment abroad, procedures performed and complications. We also documented the secondary procedures that were performed and complications managed in our center. The data were entered into Microsoft Excel and analysed using descriptive statistics, tables and figures. Results: A total of 113 have either indicated intention of going to seek for urological care abroad or had already had urologic procedures abroad but were attending our clinic for follow up or for management of complications. Only about 12% of these patients were found to have genuine indications for seeking care abroad. Most of the indications were not justifiably based on the current capabilities of our health facility but more due to a lack of trust in the system or at worst pretentious. Conclusion: Patients seek for treatment abroad for variable reasons but and most could not be justified based on available local options. India and some Middle-East countries were the favoured destinations, and the quality of care and relative lower cost are the major attractions. The rising trend in medical tourism is fuelled by the poor state of our health-care system, perceived dearth of expertise and a general apathy and lack of trust.
Keywords: Complications, indications, medical tourism, motivations, urological sequelae
|How to cite this article:|
Ahmed M, Sudi A, Bello A, Lawal AT, Awaisu M, Maitama HY. Managing the sequelae of urology medical tourism: A single center experience. Niger Postgrad Med J 2018;25:117-20
|How to cite this URL:|
Ahmed M, Sudi A, Bello A, Lawal AT, Awaisu M, Maitama HY. Managing the sequelae of urology medical tourism: A single center experience. Niger Postgrad Med J [serial online] 2018 [cited 2022 Jan 27];25:117-20. Available from: https://www.npmj.org/text.asp?2018/25/2/117/237088
| Introduction|| |
Medical tourism is a process by which patients travel to overseas countries to seek medical treatment. This is usually either because medical services are offered at considerably lower fees in the destination country or due to inadequate health-care system and lack of expertise in the home country. Medical tourism is associated with huge capital flight, and for an already impoverished country, it hinders the development of a robust health-care system of the consumer country. Medical tourism often includes an element of post-treatment tourism (recovery) for the patient. The benefits are thought to include getting the opportunity to travel to holiday destinations and reaping potentially big 'monetary savings'. This is particularly so for people from affluent Western countries travelling to the developing nations where cost is on average one-tenth of what is obtainable in their home countries, for instance in the United States of America.,
Conversely, the lures for medical tourism in the developing world are due to some fundamental factors, which include the poor state of healthcare, inadequate or absent advanced medical facilities and the dearth of expertise. There are however genuine indications for patients to seek medical care abroad for procedures requiring hi-tech equipment that are not readily available in their home countries or for reasons related to lack of expertise. Other legitimate reasons are incidental patients in foreign hospitals among those on official visits, vacation or religious visits to destinations such as Saudi Arabia and Israel, who often use the opportunity to access the healthcare of their host countries. There are though other motivations with dubious and often unjustifiable indications in which the ultimate goal is to reap financial gains, this is especially so among patients sponsored by the government or wealthy individuals. This is particularly seen among a significant number of patients from Nigeria who are sponsored with public funds or by corporate bodies. The brunt of medical tourism on the economy of consumer nations like Nigeria is enormous, besides the huge monetary loss, it stifles local health-care development. The home health-care system is left with the burden of attending to post-procedural patients care on follow-up or offering palliation in the terminally ill. The objective of this study was to share our experience in managing the fallout of urology medical tourism at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria.
| Methods|| |
The study was based on the documentation of interaction with patients and patient's relations or their agents, where available, seeking a referral for their clients for medical tourism abroad. The period of study was from January 2010 to December 2015. Patients who already had urological procedures abroad but presenting to the division of Urology of ABUTH for follow-up or due to the development of complications were also included in this study. We also reviewed folders and case notes of treatments received abroad (where available). Ethical approval was sought from the Health Research Ethics Committee of our institution and consent for participation was obtained from each patient. A structured questionnaire was used to obtain data from the participants. The data obtained included, the patients' demographics, indications and motivations for seeking treatment abroad, procedures performed and complications. Others are the outcome of their treatments, their overall experience and treatment satisfaction; we also documented the secondary procedures that were performed and complications managed in our center.
The indications to seek treatment abroad were categorised as either genuine or not genuine. Genuine indication was defined as indications for procedures not readily obtainable or completely not obtainable in Nigeria: Including renal transplant surgery; laparoscopic/robotic-assisted radical prostatectomy, high-intensity focused ultrasound; upper urinary tract calculi (in patients declining open surgery) and requiring extracorporeal shock wave lithotripsy or laser lithotripsy; obstructive azoospermia requiring advanced-assisted reproductive techniques and penile prosthesis or reconstructive surgery. Data obtained were entered into Microsoft Excel and analysed using descriptive statistics and tables.
| Results/Observations|| |
A total of 113 patients were studied during the period of the study. Their indications for presentation, reasons to seek treatment abroad and the legitimacy of their indications (as defined in the methods) are shown in [Table 1]. We observed that majority of the patients, 82 (72.6%), presented to us to seek medical report necessary for their visa application for a planned medical trip abroad. The study also showed that only 12 (10.6%) of these patients had verifiable genuine indications for seeking treatment abroad [Table 1]. Some of the non-genuine indications were; advanced cancer prostate with paraplegia, castration-resistant prostate cancer, advanced renal cell carcinoma, urethral stricture, benign prostatic hyperplasia, hypospadias in children, advanced cancer cervix with obstructive uropathy requiring supravesical diversion of urine and teletherapy and/or brachytherapy to mention a few. Ignorance and lack of trust also played a significant role. The remaining 31 patients seen primarily came for follow-up, and were earlier referred abroad by a different physician or hospital and also included those pilgrims without a referral but incidentally had procedures during pilgrimage.
|Table 1: The indications for presentation to our hospital, their reason for seeking treatment abroad and the legitimacy of their indications|
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The complications of the surgical procedures the patients had abroad for which they presented to us and the secondary procedures we performed are shown in [Table 2] and [Table 3], respectively. Majority of the patients were satisfied with their treatments, but their main challenges were the cost of follow-up. Greater than 50% could not return to the primary managing hospital abroad for follow-up due to the cost. Language and other cultural differences made no much impact, due to good facilitation and the good reception accorded them.
|Table 3: The secondary procedures performed in our hospital for the patients on return from treatment abroad|
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| Discussion|| |
Medical tourism accords patients from developed nations less financial burdens due to lower costs of care in the developing provider countries. On the contrary, it is very expensive for patients emanating from less developed or impoverished countries like Nigeria to seek treatment in developed or developing nations. With rising cost of health-care globally more and more people will seek treatment in the developing world provided the treatments cost remains at competitive prices and the quality of care is of the highest standards. Over 2.2 million persons travelled to India and Thailand in 2004 seeking healthcare, and an estimated six million in 2010 which earn these countries about $4.4 billion in revenue, predominantly from surgical procedures.
In trade parlance, medical tourism has been equated to import commodities; therefore, the country of patients' origin is literally an importing country. The cost of the treatment is enormous and often borne by patients or their families, this may overwhelm their resources and tip them into debt. The private and public health facilities of consumer countries lose businesses to the overseas providers. Medical tourism that should ideally encourage economies to maximise their comparative advantage in labour cost, technology and capacity building, will indeed appear detrimental to the importing countries like ours.
According to the Indian High Commission in Nigeria about 38,000 Nigerians visited India in 2012, and 47% or 18,000 of these persons travelled to seek medical care. The total expenditure was N41.6 Billion Naira (260 Million US Dollars). The arguments remains that our medical systems are inefficient and face restraining barrier to entry into this industry.
The findings of this study in which only 113 patients were seen over a period of 5 years suggest that only an insignificant number of patients pass through the teaching hospitals or other tertiary health centres considering the number of travels for medical tourism each year as stated by the Indian High Commission. This could mean that other outlets like private hospitals or even some phantom settings might be involved in patients' referral. Ignorance and disdain for the content and expertise available in some Nigerian tertiary health centre were also likely contributing factors.
Majority of the patients we studied 82 (72.6%) only came to us to obtain a referral or medical report required to process their visa for a planned medical trip abroad. The significance of this is that the decision to travel abroad is made without seeking the opinion of the doctor or exploring local options adequately. Their motivations for going abroad were variable with the poor state of our health facilities accounting for the highest reason (30%). A few of the patients that were sponsored with either private or public funds felt it was an opportunity to obtain some 'financial gains'. The latter indication probably contributed to the large number of patients 70 (64%) with non-genuine reasons. Ignorance and lack of trust also played a significant role. A significant number of patients received treatments abroad similar to what was earlier planned for them in the local hospital in Nigeria. About a quarter of these patients also returned with post-operative complications and morbidities with 4 mortalities reported, albeit not all patients' returned to the referring hospital.
We noticed the overall outcome of similar urologic procedures carried out locally can perfectly measure up to what is obtains elsewhere abroad. A very glaring fact is the medico-legal issues, in the event of adverse outcome arising from negligence and incompetent practice, there is difficulty in seeking redress, given, there is no international regulation of medical tourism. Non-maleficence and beneficence issues are also common findings when commercial rather than professional promotion overrides decisions for treatment.
| Conclusion|| |
Patients seek for treatment abroad for variable reasons, but most could not be justified based on available local options. India and some Middle-East countries are the favoured destination, and the quality of care and relative lower cost are the major attraction. The rising trend in medical tourism is fuelled by the poor state of our health-care system, dearth of expertise and a general apathy and lack of trust.
There is a need for further research in medical tourism to explore sensitive aspects, which include the ethical and legal issues; the beneficial or detrimental impact on the sociocultural values of our people; and most importantly the economic implications of medical tourism on Nigeria's foreign exchange. Beneficial collaboration with developed health provider countries, in terms of technology and expertise transfer, may strengthen health care in consumer countries.
The untoward consequence of unregulated medical tourism to a developing economy are significant, therefore meaningful efforts to stem the tide would require deliberate efforts at improving the health-care systems, including the provision of modern facilities and workforce development. A vibrant private health-care system is likely to provide a long-term solution. There is also a need for proper regulations to guide medical tourism to protect patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]