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“

In my previous two articles, I have been talking about the possibility for Indian Hospital  to utilize Ayurveda in their healing and medical offers to gain a differentiating asset. Yet there are two hollistic medical system in Asia: ayurveda and traditional Chinese medicine that I ll call TCM to save some time.

Traditional Medicine is an ancient method of health care that combines the use of medicinal herbs, acupuncture, food therapy, massage and therapeutic exercise… Even though the concept yin yang is becoming a cliche of the occidental popular culture, TCM is really based upon this system: the interrelationship between organs is exactly depicting the yin yang theory.

This system, called the Five Phase theory, is based on the  premise that each organ either nourishes or inhibits the proper functionning of another organ (the yin against the yang). TCM aims at stabilizing the whole system for it to operate. Let’s illustrate this idea with the actual five phases

So let’s understand the whole system: for instance, deficiency in EARTH (stomach) leads to deficiency in both METAL organs (large intestine and lungs). Defficiency in METAL generates an imbalance in WATER (kidney and bladder) and in turn affects WOOD that will then affect FIRE. Any imbalance breaks down the whole chain…

Diagnosis in TCM is all about understanding if there is an imbalance of one of these five elements. Hence no x rays, no blood tests, no endoscopy… TCM diagnosis consists of four non invasive methods:

• Inspection of the general demeanor, body. language and tongue

• Question the patient about medical history, diet, lifestyle

• Listen to the tone and strenght of the voice

• Smell any body excretion, the breath or the body odor

• Palpation of the pulse of radial arteries, the abdomen and the meridian

This is actually not a far cry from ayurvedic techniques (even for the gore part), yet, the main difference resides in the meridian analysis and the will to get rid of all symptoms, even the hidden ones (as all elements are affected by the imbalance of one of them). TCM techniques are pretty obscur as they are practiced among the Chinese community in low profile places (in Singapore it is often practiced in a tiny room inside an appartement of a 16 storey building bar…)

I definitely need some guidance to find my way in this TCM shop!!

Many medical spa has taken into account the TCM approach to appeal to international custmers, but some Asian hospitals are trying to fill up the void. The Raffles Hospital hospital has just opened Raffles Chinese Medicine a clinic that emphasize TCM as a complementary medicine for a series of condition most notably stroke recovery and hypertension. Yet, the mysticism of the discipline plus the proven efficiency of TCM should entice Asian Hospitals with an important Chinese Community as their potential customers to develop such services:

• To find best practices to deliver TCM

• To propose an end to end medical follow up (post op recovery through TCM)

• To be DIFFERENT 

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

This morning I’ve had the surprise of testing a brand new website: MXS ! Medical experts Services is a  … french…. company (this was totally not compulsory) whose purpose is to dig into eating habits. They have hence created a software that helps you to manage your nutrition through several questionnaires.

We first have to get at odds with the classical size - weight - sports related questions. But then the software really impressed me. In fact, MXS tries to understand your eating habits by probing into one typical week of breakfirst, lunch and dinners. The software then treats you to depict all these meals through a series of screens where you can precisely elect all the elements of your meal with simple tools. For instance, let’s imagin that this morning I took white bread and nutella, the software will propose me a series of bread (including white bread) and then ask me what did I put on this bread. I elected chocolate and indicated I took what looked to be one regular spoon of nutella. The interactivity of their system is great, and honestly you go through the screens quickly. When finished, the software will then analyse your meals and give a series of comments on your eating habits. Even though this is only a sampled week, the conceivers of the software supposed that a typical week of eating could be significant enough as eating habits only sightly change from one week to another.

 Another interesting application was the relative adjustement of your suppers. Let’s say I depict my breakfirst: a bowl of hot chocolate, two croissants and a banana. The software will process this information, evaluate the current nutritive elements that were ingested and propose a lunch and a dinner that suits me in order to comply to the minimal daily nutritive needs (enough vitamines of all categories namely).

On the left side, our advised menu, on the right side, the predicted nutritional ripoffs…  

Honestly, it is very simple to use, the ergonomy of the website is well studied. Thumbs up. Yet, I am confused as I don’t understand how they are making money. In their demo all the features of their offer is for free and I wonder how they are going to commercialize this product and to whom?? Perhaps another great idea with no market. Readers? What do you think?

PIPS (Personalised information Platerform for Life and Health Services) is another european medical project we would like to dwell upon. I really loved this project when told about it while visiting Brussels a few weeks ago. Why? Because this project perfectly encompasses the Hypocrate oath by trying to diffuse the best medical services available for all.

PIPS is one the major projects in the European Commission PIPEline

The project is an holistic approach opf medical services as it joins Healthcare suppliers, citizens, Public Organisations, drug suppliers, food industry, health policy makers etc etc. How is it working. Let me reproduce an exemple quoted from their brochure:

“Mary Johnson is a diabetic/infracted and her GP suggest to contact a specialist dor an appointement. Mary goes to Dr Brown who uses the PIPS system and prescribes Mary a therapy and a set of tests to be done at ho,e. At home PIPS reminds Mary to take her test and after having done it recognizes an abnormal state. The system may change the prescription following t he doctor’s indication and asking for approval or will alert Dr Brown who, looking at her vital signs and the results  of the questionnaire will suggest Mary to fix an appointement to review the therapy”

Simply put wow! We here have  all rolled in a dime:

+ an appointement manager

+ a knowledge manager (convening heterogeneous information into an intelligible flow)

+ an at home medical care manager with high user interaction

+ a follow up system with an active warning system able to fix a prescription (decision support system)

The sustainability of the system in the mind of the PIPS creators relies upon the involvement of all healthcare actors to create a fluid delivery value chain that can generate valuable information. PIPS has been conceived to be always auto sufficient. The preventive care generated by PIPS is for instance doubled: a primary prevenetion after a disease to reduce side effects and a secondary prevention to reduce the risk of relapse or other collateral disease. Another interesting contribution made by PIPS is the help it provides to act over the prevalent cuases of non compliance such as abandoning treatment before completion.

PIPS is a great project because it is a societal project where everybody is involved in order to help everybody. It is a great vision of medical practices where all forces are garnered in order to help all three kinds of actors involved in medical care namely experts, medical professionals such as GP looking to tie up with qualified experts on rtare condition disease and the end-user at the other end of the delivery value chain that can use this system to assist him in his everyday life according to his IT litteracy (which is simplified to the extreme..)

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.