We found treatment and a new lease of life in Indian hospitals

Saturday September 21 2013

Raphael King'ara (left) and Millicent Njeri

Raphael King'ara (left) and Millicent Njeri during the interview on September 20, 2013. JENNIFER MUIRURI (NAIROBI) story Joy Wanja 

By JOY WANJA MURAYA
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Millicent Njeri had been on the waiting list for a kidney transplant at a Nairobi hospital for six months, but the operation was postponed three times.

In desperation, Njeri and her husband Raphael King’ara turned to a herbalist in the hope that the kidney failure and enlarged heart would be cured. Nothing good came from it.

With no improvement to show for the Sh70,000 lost to the herbalist, the 24-year-old, then weighing a paltry 40kg, had to restart dialysis three times a week at a cost of Sh4,500 per session. This came to Sh54,000 a month.

Her health deteriorated as time went by. “She became weak and after consultation and online searches we were introduced to a company that helped us secure a hospital and doctor in India to treat my wife,” Mr King’ara told Lifestyle.

Medical tests picked her sister as a possible kidney donor and preparations were made to seek treatment in India.

After correspondence with a doctor at the Indraprastha Apollo Hospital in New Delhi, the mother of one took the flight to India this January in the company of her sister and husband.

Mr King’ara wishes they had known this earlier: “We spent Sh3.5 million on dialysis alone, money that would have comfortably paid for a transplant in India had we thought about it early.”

They then approached the National Hospital Insurance Fund (NHIF), which agreed to settle part of their Sh2.5 million bill. The Fund wired the money to the Indian hospital.

“NHIF catered for the hospital bill and we raised the air fare and accommodation charges during the follow-up period in India,” said Mr King’ara, a warder at Lang’ata Women’s Prison.

In New Delhi, Njeri was first placed on drugs to manage the Rheumatic Heart Disease before the transplant a week later. She is full of gratitude for the “remarkable personalised service” she received in the one and a half months she stayed in Indian. She now looks forward to sharing the joy of seeing her four-year-old daughter Marian grow, something she had almost given up hope on for the three years she battled the double organ problems.

She will, however, have to depend on anti-rejection drugs for the rest of her life. Also called immunosuppressants, anti-rejection drugs are daily medications taken by organ transplant patients to prevent organ rejection.

Njeri is among a growing number of Kenyans, who seek treatment abroad, with India emerging as a global healthcare destination.

Walter and Beatrice Kabitta too have been to India and back. They say travelling to India in December 2012 saved the life of Fyona, their eight-year-old daughter. Doctors in Kenya had said neither medication nor dialysis could save her.

MULTIPLE HARAMBEES

After online research, the family settled on Medanta-The Medicity Hospital in India, but had to raise the Sh3 million needed through multiple harambees.

“We wanted a cure for Fyona. Medanta had done the most and successful number of kidney transplants in the world so we settled on them,” Mr Kabitta told Lifestyle.

He donated the kidney that now sustains his daughter’s life, even though she has to be on daily medication for the rest of her life and which cost Sh30,000 per month. Fyona’s dream is to be an engineer.

Though there are relatively few patients from Africa that travel to the Asian giant, the numbers are expected to swell as populations age and health costs balloon in Kenya — unless urgent interventions are put in place.

Dr Harun A Otieno, an interventional cardiologist and a senior lecturer at the Aga Khan University Hospital in Nairobi, estimates that at least 7,000 Kenyans travel abroad in search of medical treatment each year.

“Seventy to 80 per cent of Kenyans travel to India whereas another 10 per cent go to South Africa. The rest settle for America and Europe,” said Dr Otieno, adding that treatment for cancer, kidney and heart problems are the most common. Others are bone and joint problems.
This trend, he says, does not augur well for Kenya, a country that hopes to streamline its healthcare system and become a leading destination for treatment in the region and in the continent.
“We lose about Sh7 billion annually from Kenyans who travel in search of medical interventions, yet facilities can be improved or made more accessible and affordable on our soil,” Dr Otieno told Lifestyle.

TOP CLASS TREATMENT

A Google search on medical treatment in India brings forth a long list of websites, each promising to deliver top-class treatment for various medical conditions at pocket-friendly cost.
The websites of the “medical facilitation” companies advertise various types of treatment offered by doctors in India, ranging from kidney, bone marrow, liver and hair transplants to hip and knee replacements.
The websites list doctors and their specialties in a bid to lure patients for treatment in India.
Lifestyle spoke to two medical travel facilitation companies that arrange treatment and care for foreign patients in India.
According to Mr Suhas MV of Treatment Assistance, the organisation provides step-by-step guidance to clients on travel, food, accommodation and other aspects during their stay in India.
A phone call to the company is answered on the second ring 24 hours a day, with information on medical needs and suitable budget provided promptly. The company uses online and offline marketing to advertise its services. Word of mouth provided by satisfied clients, who have travelled to India, is also a sure means of marketing.
“We get calls from different countries around the world. It is a 24-7 job so we have to work hard to support and help patients,” Mr Suhas said.
When a patient contacts such medical travel companies, the companies’ first obligation is to provide treatment options based on the doctors’ cost and hospital location among other factors.
“We then ask the patient to scan their medical reports and send them to us by mail, fax or courier then we provide expert medical opinion. We also give a cost estimate with all the inclusions and exclusions clearly mentioned,” said Mr Suhas, adding that there is usually a sustained exchange of communication until the patient makes the appropriate choice.
The company’s role does not end there as patients and those accompanying them, especially if they are first-time travellers, are provided with information on transport, acquiring medical visa, airline bookings and accommodation.

FEEL AT HOME

“Once they are in India, we visit them and keep in touch with them on regular basis just to make sure that they feel at home,” said Mr Suhas.

“Evaluation and testing are done on the first day and surgery is generally done on the second day. After the surgery, the patient stays in hospital for recovery as per the package,” one of the doctors in India told Lifestyle.

Mr Suhas, who said he handles 20 to 25 patients a month from different parts of the world, noted that the cost in India is nearly one tenth of other medical destinations like UK and US.

Once discharged from the hospital the patient is shifted to a nearby hotel or guest house for recovery and follow-up.

The cost of hotel stay is not included in hospital charges and the patient and accompanying attendant are required to pay directly. On the day of departure, the patient is taken to the airport free of charge.

Mr Allan Nyavuke, whose nine-year-old daughter Ivy was treated in India for liver cirrhosis in 2009 recalls their living arrangements after the surgery.

“The hotel accommodation cost is approximately Sh30,000 per month and after staying for two months in the hotel we discovered self-contained apartments, which were reasonably cheaper at Sh15,000 per month and we made our own meals,” he told Lifestyle, adding that Ivy is now a healthy, playful pupil.

CHEAPER THAN KENYA

Dr Neelam Mohan, a Pediatric Gastroenterologist, Hepatologist and child liver transplant specialist believes treatment in India is not only superior but is also far much cheaper than in Kenya.

“We have done 10 liver transplants from Africa. We also have an excellent system of follow-up with these patients,” said Dr Mohan, who is based at Medanta-The Medicity Hospital. She adds that the Indian doctors usually communicate with their Kenyan counterparts to get specific information on the patients seeking treatment.

In instances where patients in Kenya have access to advanced communication, Dr Mohan says teleconferencing is the best option to assess the patient’s health status.

“The advantage of teleconferencing is that you are able to see the patient and communicate with them,” Dr Mohan said.

Cure Med, another facilitation company in India, told Lifestyle it has handled at least 200 patients from Kenya.

Its director Nishant Gaur said the company provides services starting from basic consultation to full medical treatment with a post-operation follow-up at least twice a month after the patient returns home.

“We handle approximately 20 patients per month and over the years we have made networks with the best hospitals and highly updated hospital setup like robotic surgery and others that are run by highly qualified doctors,” Mr Nishant said.

Kenya is also looking at becoming a medical destination both regionally and continentally with Dr Otieno noting that some of the key health facilities already receive patients from Uganda, Tanzania, South Sudan, Somalia and the DRC.

Dr Otieno of Aga Khan, however, notes that hospitals in India have become so popular because they offer comprehensive pay packages.

“Their costs are perceived to be cheaper because they provide packages for the patients and the quality of care in some Indian hospitals is touted to be better,” he noted.

FOLLOW-UP TREATMENT

Of major concern, however, according to Dr Otieno, is the fragmentation of care for patients that seek treatment in India. He advises that it is important for them to seek follow-up treatment upon return to allow continuity of care.

But Dr Anthony Were, the Kenyatta National Hospital head of the renal unit told Lifestyle that all is not rosy for some kidney failure patients who have been to India.

“Some patients receive very poor counselling, especially after transplant, and some of them after returning discontinue their anti-rejection drugs and end up losing the new kidney. They then have to go back to dialysis,” Dr Were warned.
Some also return infected with Hepatitis B or C due to poor management, Dr Were noted.

However, Dr Otieno said that all is not lost despite the wave towards the East, with a team at the Vision 2030 looking at ways at bridging the gap and attracting the numbers to seek treatment within the borders.

“We seek to be the best healthcare delivery destination in the region, which will take time, resources and goodwill,” said Dr Otieno, who is also a fellow of American College of Cardiology.

“We aspire to keep Kenyan patients at home and bring Eastern Africans to Kenya,’ Dr Otieno concluded.