Do you really have to go to India? Set of new rules to curb medical pilgrimages
Kenyans are spending Sh8 billion annually to seek treatment abroad, and now the government wants to tame the do-or-die pilgrimage. GRAPHIC| MICHAEL MOSOTA
Nagged by an incessant running stomach six years ago, Anthony Maina decided to visit a hospital near his home. He had all along believed the nag would turn out to be a minor problem, but the physician informed him that he urgently needed a liver transplant. Even worse, he needed to seek treatment in India as Kenya lacked capacity to perform the surgery locally.
Maina, 28, had just been diagnosed with a rare disease of the liver that would see him spend months in hospital. The condition, known as primary sclerosing cholangitis (PSC), damages bile ducts by hindering the flow of bile from the liver to the gallbladder and the small intestines, where it helps digest fats and fatty vitamins.
Under the new regulations, a doctor will from now on only refer a patient abroad for treatment if there is evidence that hospitals in the country lack the capacity to take care of them.
“It has been six years since my life changed, my dreams of excelling in life almost cut short by a disease I never knew existed,” says Maina.
He had been initially diagnosed with pneumonia and put on medication, but when the treatment failed doctors started hunting for the real cause of his troubles.
By the time the right diagnosis was made the condition was at the advanced stage. He needed Sh8 million for treatment and a donor who would sacrifice a piece of their liver for him.
In June 2016 Maina and his parents, one of them being the donor, set out to travel to India, joining a long queue of Kenyans making the medical pilgrimage to New Delhi.
India is increasingly becoming popular with Africans seeking medical treatment overseas because of its relative affordability — compared to Europe or the Americas — modern equipment, and skilled personnel.
A huge number of Kenyans travel abroad for medical reasons, such as cancer treatment, transplant surgery, joint replacement and dental surgery.
Although Maina had the option of seeking treatment within the continent, in countries like Egypt and South Africa, he chose to travel to India because the treatment costs were comparatively affordable.
SEVERE SHORTAGE OF HEALTH PROFESSIONALS
Securing a visa to these African destinations was also a tedious process, unlike India, whose visas are issued within a week.
The Global Health Workforce Alliance, which advocates for solutions for countries that lack adequate health care systems, said in its 2015 report that sub-Saharan Africa is facing a severe shortage of health care professionals and lacks adequate health care coverage for those in need of medical treatment.
Since the 1990s India has been celebrated as a global leader in “medical tourism”, defined as the travel of people to a place other than where they normally reside for the purpose of obtaining medical treatment.
New Delhi boasts highly qualified doctors and state-of-the-art equipment, and its attractive medical procedures are approved by the World Health Organisation (WHO) and the US Food and Drug Administration.
But it is the cost of treatment and care that is the strongest pull factor. For example, a kidney transplant in India costs about Sh1.3 million ($13,000), while the same procedure will cost up to Sh30 million ($300,000) in the United States.
Because of these attractive prospects for patients, referrals to India have become a booming business in Nairobi. So much so that some health professionals have found an avenue to make a dirty killing by referring patients to the Asian country in exchange for kickbacks.
KICKBACKS
Last year a lobby claimed that rogue doctors were pocketing up to Sh100,000 for every patient they referred abroad, adding a huge financial burden on patients because the kickback is included in medical bills.
The Kenya Network of Cancer Organisations claimed that a number of foreign hospitals had established a cartel of unscrupulous medical practitioners to ensure a stable flow of patients.
“This is in the public domain and I can go on record saying that some healthcare providers are getting kickbacks of up to Sh102,000 ($1,000) per patient referred to hospitals in India for cancer treatment that Kenya has capacity to handle,” said chairman David Makumi, who is also a trained oncology nurse.
“Personally, I have been approached (by the agents of foreign hospitals) but when I threatened to report them to the anti-corruption agency, they took off,” he said.
Now, as Maina prepares to go back to India for check-up following a successful liver transplant, the medical tourism industry is just about to change as the Ministry of Health introduces stringent rules.
Under the new regulations, a doctor will from now on only refer a patient abroad for treatment if there is evidence that hospitals in the country lack the capacity to take care of them.
The new measures, published last month, are meant to control and monitor international referrals and protect patients from rogue doctors who misadvise them to seek treatment abroad in exchange for money.
Drawn by Health Cabinet Secretary Cleopa Mailu and the Kenya Medical Practitioners and Dentists Board (KMPDB), the guidelines also stipulate that patients will only be referred to foreign hospitals if there is evidence that the referral would be the most cost effective option.
However, a medical or dental practitioner may refer a patient abroad if the patient has opted for such and is willing to pay for the same without recourse to public funds.
Mr Daniel Yumbya, the chief executive of KMPDB, says the new guidelines will reign in rogue doctors and also ensure that referrals are only given in circumstances where the physician is convinced they are absolutely necessary.
“We have also noticed that non-specialists are making referrals, while in other cases specialists are referring patients for treatment that is not within their expertise,” he explained.
Mr Yumbya says the new rules are also meant to ensure that there are follow-up mechanisms for referred patients, either locally or abroad.
“If a patient is terminally ill and we are sure that referring him or her abroad will not do anything to save his or her life, then there is no need to refer,” he says, adding that these measures will also help the board and ministry scrutinise the type of hospital, treatment and cost a patient (especially one who is using public funds like the National Health Insurance Fund) will get. But even as these new regulations are effected, Mr Yumbya says, the board will not stop patients who choose to go to abroad for treatment.
“Some patients demand to go abroad, and when people lose faith in their country’s institutions, you cannot do anything to stop them from leaving.
“We opened up room for doctors and hospitals to advertise their services so that they are competitive enough, but if their charges are more than what is charged abroad, we will not stop patients from going.”
Although Mr Makumi accused the board of drafting rules without consulting the civil society, Mr Yumbya says stakeholders in the health sector were invited to participate in the workshop that approved the rules.
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Dangers of medical tourism
The specific risks of medical tourism depend on the area being visited and the procedures performed but some general issues have been identified:
Infection: Other parts of the world have different standards for sanitation, and medical facilities can be unsanitary.
Medication dangers: Medication may be counterfeit or of poor quality in some countries.
Communication: You may not be able to communicate your health issues or ask for help if something goes wrong.
Legalities: Foreign medical facilities may make it difficult for you to pursue a case as you may not have legal rights.
Credentials: Always check the qualifications of healthcare providers and the credentials of the facility you are visiting.
Costs: Make sure you have a written agreement defining what treatments, supplies and care are covered.
Drug resistance: Antibiotic resistance is a global problem, and resistant bacteria may be more common.
Travels: Flying after surgery can increase the risk of blood clots.
Ethical concerns: Has the organ you are receiving been obtained ethically? It could be from the destitute, teenagers, children or prisoners.
What you can do
Make sure that any current medical conditions you have are well controlled, and that your regular health care provider knows about your plans for travel and medical care overseas.
Have a written agreement with the health care facility or the group arranging the trip, defining what treatments, supplies, and care are covered by the costs of the trip.
If you go to a country where you do not speak the language, determine ahead of time how you will communicate with your doctor and other people who are taking care of you.
Take with you copies of your medical records that include the lab and other studies done related to the condition for which you are obtaining care and any allergies you may have.
Bring copies of all your prescriptions and a list of all the medicines you take, including their brand names, generic names, manufacturers, and dosages.
Arrange for follow-up care with your local health care provider before you leave.
Before planning vacation activities, find out if those activities are permitted after surgery.
Get copies of all your medical records before you return home.
