Discovering Medical Tourism

Recently I visited a string of interesting spa in South East Asia:

• Tria integrative Wellness,
• Amezcua Wellness Centre, 
• San Carlos.

These spa are classified under the medical spa category. The concept of a medical spa consists in linking pampering to health benefits: you go to a medical spa to feel better under a precise Medical protocol. If you figure that a medical spa is a massage table with an electrocardiograph you re not very far. A medical spa will go beyond the word wellness and investigate your health conditions on the short term (medical analysis) and on the long term (preventive care), connecting a spa treatment to diet counselling and stress management.

In fact according to the preventive care theory, nutrition influences the health of your body and keeping tabs with it is a good way to avoid diseases in the long term (this theory still lacks precise documentation but is based on the belied that the synthetisation of amino acids brought by daily food intake affects the creation of neuro transmitters hence the perception of pain and mood).

Let’s take a look at the spa menus proposed by these different medical spa to better understand what it’s all about!

 First, when I arrived at TRIA (Bangkok) I was surprised because the taxi drove me to the Piyavate hospital. Then instead of turning right we took a small road alongside the massive hospital to discover a brand new faciity behind with golf cars and mercedes in the parking lot. Then inside it’s a real treat: wooden atmosphere, with top notch design. The medispa is organised in threee levels (four to come): the first one is hosting a small spa for men and for women, on the second floor you’ll find treatment rooms that are full of medical equipement and at the center a spa cuisine restaurant where you will be served vegetarian food accroding to your diet assesment. Then the second floor is composed by a pool and 4 isolated treatment pavillon

 

Getting an idea of TRIA: the spa Pavillon (3rd floor) + the food corner (2nd floor)

I really love their approach as it mainly focus on understanding how an alternative medicine can benefit to someone: they use reiki for fatigue, anxiety, hydrotherapy for arthritis, yoga for balance and market that under simple names such as sitting confortably for yoga, go the distance for fitness assesment. A really complete preventive care program in a spa envirronment. Hence a stay at Piyavate can be immediately followed by an experienmce at TRIA, a decisive competitive advantage that is increasingly considered by Asian hospital groups. TRIA did their soft opening last October, I m really impatient to see their operation up and running!

 Amezcua (Manilla, Philippines) has put  up a team of specialists to operate on three distinct fields: alternative medicine (acupuncture, healing touch…), recovery after surgery and aesthetics surgery. The program has an interesting twist as it converts alternative medicine treatments in preventive care screenings (for instance Meridian Stress Assessment (MSA) derived from traditional Chinese medicine that consists in measuring electrical energy throughout acupoints and meridians to estimate one’s level of Qi or the Korean Bu-Hang (where cups are placed in one’s back to see if an organ is reacting abnormally)). They also use innovative alternative medicine processes recently developped such as ozonotherapy (inhalation of pure oxygen to reinvigorate the tissues). As for TRIA it is a rather new concept, and there are eyeing to develop a facility in Koh Samui in the months to come.

 San Carlos, founded in 1993, is well known for its expertise in the field of weight control, insomnia treatment and stress management. Techniques used at St Carlos are mixing traditional Thai medicine and recent western technology. St Carlos both provides general medical care and check-ups, and wellness programs (slimming, rejuvenating, body cleansing), as well as cosmetic surgery.

Spa packages mix laser acupuncture, Ayurveda and herbal medicine… The St. Carlos Weight Loss treatment consists of a mixture of Asian herbs and pharmaceutical components combined to effectively cleanse the body and burn off unwanted fat. First, patients loose weight, then there is a time for weight stabilization

After their treatment, patients are provided with a complete individual health plan. Considering the background of the client’s health problems, spa doctors educate the clients on individual health management, including healthy dietary intake and exercise programs. St Carlos Medical centre also offers a wide range of facial care products, as well as hair treatment and food supplements, under their own brand name, St Carlos.

All in all three different approach:

• TRIA is the future of spa integration to hospital
• Amezcua is all about preventive care through alternative medicine
• San Carlos i s  a medical leader in alternative medicine

Hence if you ask me who is Medhi Spa I ll answer: “he’s the new kid on the block“

As stated in the previous article, Indian medicine has a great asset: its past. In fact, Ayurveda, the hollistic medicine principle derived from centuries of medical tradition, is an original medicine with a certain efficiency that can be built into a decisive competitive factor by Indian hospitals!

Previously, we talked about preventive care and diagnosis according to ayurvedic medicine. What about Disease management? there are four main methods by which and Ayurvedic physician manages disease:

• Cleansing and detoxifying (shodan)
• Palliation (shaman)
• Rejuvenation (rasayana)
• Mental Hygiene and Spiritual Healing (Satvajaya)

Cleansing and detoxifying (shodan)

This is the gore part of Ayurvedic medicine unfortunately and this can really scare off any person willing to discover ayurvedic medicine: pancha karma is all about vomiting, bowel purging, nasal douching to remove toxins from the body. The good part is that in preparation for cleansing an herbal oil massage may be performed (oil is well absorb by the skin and helps to eliminate toxins while passing through the body). herbs can also be introduced in certain parts of the body (especially the noze) to increase resistance to enzyme reaction. After the cleansing, the patient is given ghee (clarified butter) and yogurth to restore the intestinal flora.

Hi! Let me take care of your bowels

Palliation (shaman)

Shaman focuses more on the spiritual part of the healing and uses a combination of herbs, fasting, yoga streches, breathing exercices, meditation and lying under the sun (ah! that’s better than cleansing the body). in fact, the sun is not only a source of heat and light but according to ayurveda a way to better absorb vitamin D, to improve circulation and to strenghten the bones (the time of exposure required depends on your dosha type). Actually Shaman is often used as an alternative to pancha karma (see above ) for those who are mentally weak to undergo this kind of treatment (like me!). Shaman is really sweeter: one of the herbal therapies prescribed consists in consuming honey with certain herbs such as pippili (long pepper), ginger, cinnamon and black pepper…

Meditation as an alternative to cleansing

 Rejuvenation (rasayana)

Rasayana is a program of tonification which is similar to a physiologic tune up.  It is used to restore virility and vitality to the reproductive system, countering strterilirty and infertility, bringing forth healthier  progeny and improving sexual performance. Ayurvedic medicine uses three methods for rayasana: special herbs prepared as powder, pills, jellies and tablets; mineral preparations specific to a person’s condition and exercices (again yoga exercices).

Mental Hygiene and Spiritual Healing (Satvajaya)

Satvajaya is a method aiming at releasing psychological stress, emotional distress and unconscious negative beliefs. This is one of the precursors of stress management and operates in a very original and “modern” way. The categories of satvajaya include mantra or sound therapy to change vibraotry patterns of the mind, yantra or concentrating on geometric figures to take the mind out of ordinary modes of thinking and gems, metals and crystals for their vibratory healing powers.

Yantra: one type of the geometric figures to alleviate stress 

CONCLUSION 

All in all, Ayurvedic medicine is extremly original and should be put forward by Indian hospitals as an innovavtion in treatment. When people hear about Ayurveda they can barely figure out hwat it’s all about. My gut feeling is that some Indian HospitalGroups are being too conservative and too “un Indian” in their product offer for international patients. Again if the market is price driven today, I really think that it will all result to quality on a few years: ”MADE IN KOREA” used to be a problem but then Hyundai and Samsung surfaced with their different and new products to propell the cognitive perception  of Korea very high in people’s mind. To  me, the same can occur with the label ”OPERATED IN INDA“: nobody will feel confortable with it up until quality and differentiation  will be knitted to Indian medical providers

India has established itself as a prominent medical hub thanks to an important number of high tech medical facilityies and many seasoned cardiologists willing to treat international patients.

Still, as anylayman from Europe, for me India looks like a new country on the medical map trying to surf on the BPO (business process outsourcing) tidal wave.

HOW WRONG AM I!

India has in fact one of the most documented medical tradition through ayurveda. Ayurveda is an ancient holistic medicine theory having its roots in Northern India - Nepal. What is so interesting beyond the cultural difference is that ayurvedic medicine is yielding very different results from traditional European medicine:

• In terms of Diagnosis
• in tems of Disease Management

First let’s explpain Ayurvedic Diagnosis:

An Ayurvedic diagnosis starts with determining you body type among three metabolic body types called doshas(vata, pitta, kapha). Your looking for a free membership card, ayurveda is there!

 

According to ayurveda I m a Vata and a little bit of pitta. What about you?

One’s doshas and the characteristics that reveal it clarify why one person will react to such product (milk, chili) or event (loud noise, humidity). Ayurvedic Physicians have traditionnaly relied on observation more than on medical equipment: they will question the patient on his medical history as well as his family medical history, listen to the heart, lungs and intestines, paying attention to the tongue, the nails, the eyes. Ayurvedic medicine distincts not one but three types of pulses (vaa, pitta, and kapha). The skills required are pretty impressive as a seasoned ayurvedic doctor can distinguish twelve different radial (or wrist) pulses!

The tongue is a major diagnostic site: the discoloation or sensitivity of the surface of the tongue can hint at the dysfunctionality of an internal organ. For instance, a whitish tongue indicates a disruption of kapha and accumulation od mucus; and a black to brown discoloration indicates a vata disturbance. A dehydrated tongue is symptomatic of a decrease in the plasma, while a pale tongue indicates a decrease in red blood cells.

In a tongue you can find your lungs, your heart, your intestines and even your spinal cord

Ayurvedic medicine has also introduced urine analysis way before the occidental medicine. the color can indicate dysfunctionalities (blackish borwn indicated an imbalance of vata, dark yellow for pitta, if it s cloudy it’s kapha) as well as the smell (a foul odor indicates toxins in the system, a sweet smell diabetic condition).

In a word, Ayurvdic diagnosis is a precursor to current prevemntive care diagnostics as well as an excellent complement to the western version of diagnosis as they go through their own path while yielding similar or additive results. I personally find it a great differentiation factor if explained well and done smoothly (people would be surprised to see no medical equipment involved). A tweener version between traditional ayurvedic diagnosis and western style would certainly help Indian hospitals dveloppinig a Best Practice that will help them gaining steam on the international medical market.

Indian Hospitals are now keeping track on the evolution of ayurvedic medicine and are increasingly opening dedicated clinics under the tutellage some medical teams. Disease prevention from ayurvedic medicine can tremendeously help pre and post operative care, yet there is a lack of integration today as indian practitionners a re carefully following wetserner guidelines. Yet, one could wonder how ayurveda would be factored in if Indian practionners were chosing to follow their own way and create an INDIAN model starting from preventive medicine and going up towards post surgery medical management.

Everyday, i have the chance of having at least 2 to 3 mails from the many entrepreneurs willing to make the jump towards medical tourism. We discuss several issues: what are the margins like, is the service fee enough to cover costs etc etc. At the end of the day I see many people with energy and hope willing to make a living helping out people to maje travel arrangements. Even though I always point ot at the lack of innovation of this sector, I genuinely think that one person will find the right formula at the end of the day.

Four Entrepreneurs on their way to relaxation…

Actually this is not my point. What is interesting with an entrepreneur is all the stress he is facing and the way he copes with it. How can he be creative under so much pressure? Poor people…. Actually, alternative medicine can help medical tourism prospective entreprneurs to simmer down and gather steam. Which methods are acknowledged as being efficient?

YOGA! Brace up entrepreneurs: Yoga thanks to its breathing techniques has proved through various studies  to be an efficient treatment furthermore if it is combined with aromatherapy (lavender is reputed to soothe anxiety but actually Kava and Passionflower (Passiflora incarnata) have proved to be more efficient. However, anxiety is a condition that can be tackled by many other treatments such as Tui Na (reflexology), balneotherapy or at a lesser degree massage. In fact, while people tend to privilege massage, scientists have proved that massage was providing short term relief (a feeling of being relaxed) but does not work durably on the body. Massage is just an erzatz of medical treatment for anxiety (Goffaux-Dogniez C, Vanfraechem-Raway R, Verbanck P. Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult: relationship with anxiety and stress adaptation strategies. Encephale 2003;Sep-Oct, 29(5):377-390).

The question I am asking myself is why medical tourism is not helping patients to cope with stress through alternative medecine prior to the operation? Three hours of  yoga can provide a placebo effect enough to trigger relaxation fromm the patient… Again, the vision on medical tourism is quaint… Medical Tourism Entrepreneurs should help themselves as they would help stressed patients facing uncertainty or a complicated surgery. or simply the feeling that they are 10000 miles from home, alone, without insurance, no acquaintances to confide in, etc etc. RELAX! YOGA!

Sources:

1. Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med 2005;Feb, 11(1):189-201. 2. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 2003;Jul-Aug, 65(4):571-581. 3.  Malathi A, Damodaran A. Stress due to exams in medical students: role of yoga. Indian J Physiol Pharmacol 1999;43(2):218-224.  

Alternative medecine (also called complementary medecine) are all the techniques that helps treating a specific health condition. Even though some are still lacking exposure many of us have heard about acupuncture, yoga, aromatherapy. In France, thalasso therapy started not as a relaxation opportunity for Paris city dwellers but more like an opportunity to treat several health conditions, most notably arthritis and lower back pain. Scores of studies have been brought up in recent years and today we have some ideas on the connection of alternative medicine with the management of a health condition. Again we don’t talk about curing but about pain relief.

In the case of medical operations there is an astute way of connecting surgery to local medical specialties giving teeth to the idea of medical tavel (you go to country X not only for surgery but also for post operative recovery). Unfortunately, no medical tourism company is dwelling upon post operative needs and no one is carying a precise offer. 

After acting as a bookworm I have come with a ranking of the best 4 alternative medicine for post operative pain:

1. Acupressure (shiatsu)

 Acupressure is the application of pressure to certain points along the flow of energy or “qi” in the body. Acupressure is mostly used to sooth postoperative nausea and vomiting as well as for pain management. Researches report that acupressure may be as effective as intravenous pain relievers but still further experiments have to be done to confirm such a stance. The use of acupressure would be particularly interseting after laparascopic surgery but it remains to be seen if acupressure is safe for cardiology rehabbing…

2. Hydrotherapy

 Hydrotherapy has been reported as efficient in patient rehabiliatation following knee prosthesis implantation but also in a more simple fashion for surgical wound healing. As a whole hydrotherapy in its balneotherapy form (aquagym notably) is used for orthopedic rehabbing: drills in pool, aqua balancing. Hydrotherapy proves also to be efficient for osteoarthritis and the rehabbing following herniated discs issues.

3. Acupuncture

 Acupuncture is a well famed traditional chinese medicine techniques treating a health issue by inserting needles in one’s body.  According to research, auricular acupuncture (needles in the ear) reduces pain during hip surgery - this meaning that acupuncture can actually help during surgery! in the same way other types of acupuncture have been used on patients woth cancer preceeding or folowing chemotherapy with quite positive results. Yet, acupuncture is more about managing pain than treating any specific health condition.

4. Reflexology

 Relflexology often known as foot massage or Tui Na is derivated from acupressure focusing exclusively on the foot. Tui Na helps in a more restricted fashion than acupressure but some studies have proved its efficiency most notably for knee arthroscopy or knee replacement 

Several people asked me what is the differenvce between ayurveda and massage therapy. Surfing on youtube I found this video. I must admit I am a big fan of the blond girl featured in the video!  

SORRY! But I am again going to talk today about the debate hovering around medical tourism in  France. It won’t be the last time but at least I promise in front of our approx 150 readers per day I will not quote France for at least … 10 days!

Going back to today’s topic… I previously had a long log about how we should redefine medical tourism. In France, the soil is fouled beyond expectations as even the word esthetical medicine bears a bad rep. Yet this is easily understandable, as many people and even specialists look at esthetical medicine (not surgery) as a con art. Procedures such as mesotherapy (injection of vitamins, homeopathic formulations, plant extracts) not only hasn’t yet produced certified results but can sometimes create huge skin disorders, not just a mere rash. Esthetical Medicine gathers all non implicating procedures from BOTOX surgery to Intense Pulsed Light that generated a positive esthetical improvement on one’s body.

Esthetical Medicine: shooting bullets in the back of people? (this is a mesotherapy gun)

The underlying problem pointed by people is that this kind of procedures plays on the psychological weaknesses of patients seeking for eternal youth. Yet, the main problem of esthetical medicine is its scope that incorporates too many heterogeneous elements (mesotherapy has nothing to do with proven methods such as IPL). The other problem was certification: in many countries most notably the UK and Australia, generalist doctors could devise esthetical medicine treatments to their patient and even perform them. This blatant lack of knowledge results in many accidents that hampers the development of this medicine.

The move done by the French Medical Order (to give 80 diplomas of  anti age Morphological doctor (200 others are in the pipeline)) is paving the way for a real regulation of esthetical medicine. As we have seen in a previous article, specialists use to think that this branch of medicine should be auto regulated as it follows the supply side effect. Yet, any botched procedure has to be fitted by the State in a country with a strong Welfare System such as france or Sweden. Regulation will only come when esthetical medicine will become expensive for young people, namely contributors!                 

Ayuveda is an ancestral series of medecinal techniques coming from

India. The term is coming from ayus meaning life and veda which points to knowledge, therefore ayurveda is the “knowledge of life”. This term couldn’t be as meaningful with the recent evolution of research two examples can be pointed out.

Many companies are rushing into the Ashwagandha business. Ashwagandha is an herb used in Ayurveda coming from the Indian medicinal plant withania somnifera. Researches have proved that is genuine effects on fertility troubles or to alleviate symptoms associated with arthritis or even to treat memory loss. There are many developments in

Japan in order to fully understand the causes of these effects on the human body, as researchers wonder how this medicinal mixture could have so many effects.

Ganesha is very knowledgable indeed

Triphala is also gathering a lot interest as studies have proved that this medical formulation could act like an anticancer agent (according to researcher it could target cells in tumors while sparing normal cells). Triphala even looks like a miracle cure as other research led to observe that it provides protection against both gastrointestinal and hemopoetic death Ayurveda is now a new found field of research for researchers: while studying Triphala, researchers have come with the observation that the cytocide effect could be due the action of gallic acid and that its induced anti stress effect is due to its anti oxidant properties.

These discoveries come as a relief as ayurveda use to be the object of many deviant practices due to the inability of certain practitioners to come out with well mastered dosing leading to a high level of metals and minerals in their mixtures causing toxicity. Auyurveda was heavily dented when the journal of the American Medical Association discovered that 20% of the Ayurvedic preparations made in

South Asia contained high levels of toxic heavy metal such as the famed arsenic. This sudden peak of interest should help to perfectly understand the underlying chemical effects of each component of the ayurvedic preparations and furthermore perhaps lead to normative practices.

Radioactive miracle cures… perhaps not a good idea after all

However, I really wonder if the toxic metals are not generating the positive medical effects also. We should remember in the history of mankind that one example of toxic cure was devised. After seeing that radium could cure some cancers some people tried to devise special cosmetic cures. The most famous one was called fontaine de jouvence: it was a water tank where radium was dissolved in water. This item was widely diffused in the thirties from a therapy invented at the Plombieres les bains spa in France. Some con man further digged into that breach by inventing some creams that could cure cancer (like the company Tho Radia whose motto was: “Stay old if you want”) or even weight losing belts. The short term effect was a skin rejuvenation indeed, the long term effect was a series of natural disasters (skin cancers among others)… Yet, radium was expensive hence its dosing was not that important.  However there is no official statistics on the consequences of he use of radioactive products

People use to be amazed by the fixtures some civilizations have found in order to tackle medical hazards. At an ealy age of civilization (back in 2000 BC according to paleontologists) The Chinese were extremely creative as they were able to classify all kind of foods and associate them with illness or symptoms. For instance, duck is causing hemorrhoids and mango can cause urinary burning. If some solutions prescribed can only consist in abstinence of the trouble-causing food, Chinese were very innovative when it came to finding effective medicines made out of natural components.

The most renowned of them all is the ginseng whose alleged effect is to accelerate the blood circulation and increase blood supply. It can simply be cooked in chicken soup. A funnier remedy is bird nest, coming from oral secretion of swiflets that helps beautify the skin of women or improve appetite. Its ingestion is delicate as it should not be associated with fruits that nullify the effects of bird nest if taken the same day. Bird nest can be cooked with pork soup or steamed as a dessert. In the same way apricot jernels are known to be an excellent remedy to cough (or even dried duck gizzards…). 

Even though these examples are quite extreme, I must admit I have always been fascinated by how early civilizations have studied fooding and tried to establish general principles. The nutrition philosophy created by cantonese is not an isolated example as we all know the famed Kosher principles (ruminant animals etc etc) or the Halal methods of slaughtering. All these dietetic traditions have proved to have coherent results and the beliefs exposed through the Chinese medicine have been scientifically validated in many cases.

The last days were extremely interesting for me. I was really wandering in the medical tourism jungle, checking which definitions people had in mind. I remember writing the ‘About this website’ page a week ago and I was so unsatisfied by this page that I decided to shelve it and rewrite it later. 

Every time I have a debate about medical tourism, people portray this industry as an unethical way of making money using the despair of people who can’t afford surgery in their country, plus a dangerous production system with all the infamous stories of botched mammoplasty or rhinoplasty.

Yesterday during a dinner, I tried to argue with a cardiologist that medical tourism is not boiling down to low cost procedures but is a wider access to unknown techniques perfectly mastered in Asia. These techniques range from ayurveda to tsubo chiatsu to Lasik surgery etc etc. I acknowledge the cost differential (we were talking about angioplasty) but for me, he was focusing on a non sustainable medical tourism. 

I am using the words ‘non sustainable’ because I feel that the existing business models of medical tourism are all one shot models:

+ heavy medical procedures motivated by a low cost effect or long waiting lists

+ no follow up stemming from the procedure + no customer relationship management approach. 

It is a run and gun approach that certainly has people smearing about the association of words ‘medical tourism’. But again there is hardly any tourism implied by this method> I have pinned this idea as medical travel. Let’s call it INDUSTRIAL medical tourism (as an input -output chained process)

 Yet, this is definitely not the vision I have about medical tourism. NOT AT ALL !

To me, medical tourism in Asia is an open window leading to the best healthcare procedures in the world, innovative techniques to solve rare condition techniques, the best preventive care solutions, unheard of manipulative therapies plus an opportunity to enjoy a tourism experience and so forth. Perhaps my definition is wrong but this is what medical tourism sounds to me. One could argue that I am speaking about health tourism…

 

Medical and Health Tourism as we define it as a longer life expectancy and a higher volume than the classical model

When considering biological methods such as herbalism or manipulative techniques such as psychotherapeutic postural integration or ayurveda are we only talking about health? These techniques are a genuine front end to medical procedures so how can they be restrained to mere health procedures… Medical tourism must be a sustainable experience and therefore must entice repeated visits: diversifying methods, proposing long term follow up (using tools such as the PRM we have previously reviewed) 

Here is my real first tentative definition of Medical Tourism, that we will call from now on Medical and Health Tourism: 

 ‘ an experience of medical and healthcare techniques culturally connected to a specific place or technically knitted to an hospital for preventive, aesthetic or curative needs ’ 

Experimenting these techniques boils to an exploratory approach that is tied up with traditional tourism (going from one place to another to try out a technique etc etc) but with the particularity of positively affecting our body  Talking about how angioplasty could cost only 10000 USD is definitely not the goal of this blog.   

Discovering medical tourism is going to take a major u turn. In order to carry out a clearer perspective on what we consider medical and health tourism is we will from now on stress upon THIS definition of medical tourism by digging into health and medical procedures specific to Asia and all the techniques that can make medical tourism a sustainable tourism.