Allure of India

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Several years ago someone told me that you do not go to “see” India, but you will “feel” India.  At that time, I did not know what that meant.  I always imagined that India was a land of historically and architecturally impressive buildings, colorful and elaborate saris and culturally rich people.  On a recent trip to this vast land, I was fortunate to experience the great mixture of cultural diversity and modern promise that far exceeded my expectations.  India has an allure that is captivating and sobering at the same time.

Flying in from Bombay on Jet Airways, one is definitely NOT reminded of any prior experience at an American airport.  Smiley, so her nametag read, greeted us at the gate and escorted me through the airport like a graceful goddess to the priority waiting area to await the Goa flight.  


Later at the Goa airport, Sushma would do the same task, greeting me with a large smile and escorting me to transportation that was waiting for my arrival.  This was only the beginning of the kindness and hospitality that I was to experience during my entire trip.

Goa

Goa, India is a tiny west coast state that was previously inhabited by the Portuguese who came to it looking for spices in about 1510 and lasted there for about four centuries.  Goa is known as a friendly vacation mecca, wooded with palm and mango trees and commonly the weekend or week long retreat for Indian people looking to escape the hectic car horns of the crowded major cities.  


Although Goa is renowned for its beach culture, I never did got a chance to see the public beach.  It was entertaining enough to drive through the countryside and to witness the exact paradox of what my impression of India was before I left the United States.  It was laid back, casual and tropical.

As I was scheduled to speak at a Medical Tourism Conference on legal issues surrounding medical tourism, it seemed like a good opportunity to relax and unwind before the conference began.  


The resort where the conference was being held was called the Taj Exotica, a waterfront resort with private villas and golf cart transportation with a beach front view.  The accommodations were very good and if you have a chance to relax while in India, this is the place to do it.

Hospital

After the conference, I embarked on a ten day tour of the major Indian hospitals promoting medical tourism to foreign patients.  The majority of patients that go to India for care are traveling to the larger cities of Delhi, Bangalore, Mumbai and Chennai, the location of the best private hospitals.  


For patients seeking care in the cardiovascular or orthopedic areas, Delhi is a hot spot for its super-specialty hospitals that boast JCI Accreditation such as Fortis, Max Healthcare, Escorts Heart Institute, Apollo and Indaprastha Apollo Hospital.

Launching a trip into Delhi is no picnic as the airports are crowded and the traffic is quite hectic by any comparison.  The streets are filled with rickshaws, auto rickshaws, taxis and normal rush hour streams of cars, motorcycles, bicycles and bike-drawn carts.  The roads in Delhi are not easy to navigate with no real definitive lanes and patterns of traffic that seem to have no rhyme or reason.  


Oddly, however, I felt extremely confident in our driver’s ability to honk his way to clear paths ahead and during my entire stay in India I saw not one car accident.  It seems there is some unspoken driving etiquette that is far more advanced than what you would experience in New York, Miami or any other capital city.

In Delhi, I opted to stay at a recovery resort located in Sainik Farms.  This area is a unique enclave of one hundred homes, or estates as they are called.  The residents here are among the more affluent and as a community, they care for their own roads and provide their own electric through generators and water through roof top reservoirs.  


The resort was an oasis with antique furniture and gardens that make you feel like you are some place in Western Europe.  Bed and breakfast style living is a great way to experience the culture and learn a little more about the history of India.  This area I would highly recommend because it is in the city, but far enough removed that you can relax after the sensual stimuli of the previous day.

For people planning a trip to India for healthcare, it is certainly very easy to set aside a day for touring.  India is a nation of at least six different types of people brought together though decades of influence by traders, nomads and colonizers.  The culture is even more complicated because of the religions, the caste system emphasizing the concepts of dharma and karma, and the levels of wealth that make for a truly unique melting pot.  The most likely place to experience this diversity is in the ancient city in the capital of New Delhi.

There are numerous historical sites to see in Delhi accessible by car to experience some of this diversity with very little walking required.  As you pass by the numerous holy cows walking slowing in the streets and, on occasion, an elephant waiting in traffic, one very quickly learns that your trip will be too short.

Your trip will not be complete without venturing to the ancient Mosque of the Qutb Minar.  Known as the Quwwatul-Islam (“Might of Islam”) the Masjid is the earliest Mosque in India, enclosed by cloisters that were erected by Qutbuddin Aibak in A.D.1193.  The elaborate carvings and massive stone structures gives insight into the Arab influence in this part of the world.

Nearby, the infamous Indian Gate was formed by the British in an area of trees and lawns, fountains and water channels that was built in 1941 to honor the Indian soldiers who died in World War I.  Rashtrapati Bhavan is the presidential residence and you can get pretty close for a better view of where the Ministries of Finance and Home Affairs and Foreign Affairs are situated.  Since I only had this one day, there was no time to visit Old Delhi, but  have been told it is the worth the trip to see some of the local bazaars and the Jama Majid, which is the focal point for the Muslims living in Delhi.

Following this quick tour, it was time to check out what I had come to India to see: the hospitals.

When you talk about healthcare, the United States and India have a very close relationship and it is getting closer by the day.  The American Association of Physicians from India (AAPI) is the largest body of physicians located outside of India.  One of the Indian hospital’s mottos is appropriately, “Saving Lives and Rebuilding Lives.”  Indian American doctors make a great contribution in both America and in their homeland, which further works towards closing the geographical gap between the two countries.

It is said that medical travel is increasing at a rate of 25% per year and as part of this $2 billion industry, 150,000 people went to India in 2004.  No one really has exact figures for this trend as there is no unified method of reporting it.  However, we know the numbers are growing and India is rising up like a phoenix with its state of the art healthcare and surgeons that are second to none.  Hospital systems like Apollo are focused on “heart-tugging, boundary melting activity” that shows signs of incredible growth in its future.

India rises above many other countries in state of the art technology and advancements in healthcare.  Surgeons like Dr. Subramaniam at Apollo Hospital have been pioneers in keyhole cardiac surgery and robotic surgery.  Dr. Ramachandran, a neuroscientist who studied in San Diego, discovered the nature and developed a treatment for phantom pain.

Apollo Hospitals is the largest healthcare group in Asia with almost 700 beds in the Dehli hospital and 14 operating theaters, Indraprastha is known as the first JCI accredited Hospital in India.  Indeed it appears to be the oldest of the chain of new Apollo Hospitals with its train station semblance lobby and crowds of local people.  While I was there, the historical building was undergoing renovations, which may have added to the congestion.  


The treatment specialties offered at this hospital range from cardiac, orthopedics, oncology, and transplants, particularly kidney transplants and liver transplants all with fantastic success rates.  Overseas patients from the West can feel comfortable with the western influence imparted upon it through partnerships with well known American hospitals.

Fortis is a hospital system boasting twelve facilities plus the recently purchased chain of Escorts Hospitals.  The Delhi hospital is a combination of general, multi specialty and super specialty hospitals.  Super specialty physicians are full time employees of the hospital and the multi specialty physicians’ work as general contractors, sharing their expertise with other healthcare facilities.


Here you will find high tech video screens updating physicians schedules on the walls allowing patients to know when their turn is.  The highest technology is used throughout the hospital with numerous ICU units and a nurse to patient ration of one to one.  Nurse ratios in patients’ rooms are three to one.  When have you seen that in the U.S. or Europe?

Fortis takes pride in having an overall center of excellence, yet it is specifically targeting medical tourism in the areas of renal sciences, diabetes treatment, joints, pulmonary and cardiac care.  The English speaking international department does a very good job at managing foreign patients on their own, assisting in the areas of acquiring visas, airlines, hotels and transportation in addition to guiding patients from one physician appointment to another.  


Fortis Delhi has ninety private rooms, two deluxe patient rooms (cost around $500 per night) that can accommodate a companion and one presidential suite (cost around $800 per night) where the President of India has been treated.  


All international patients receive private rooms and receive personal treatment through the international department that arranges everything including airport pickup, hotel stay and interpreters when required.  The international patient center handles all foreign patients for the Escorts chain as well.  Cardiac care is a premium product of medical tourism.

Fortis La Femme is the only boutique hospital in India.  Now at about three years old, La Femme is a facility catering to women.  Here you will find plastic surgeons certified by the American Society for Plastic Surgeons and orthopedic surgeons who treat the Indian President’s wife.  All of the Directors of the Board to La Femme have been trained or spent time in the U.S., allowing for a good understanding of what a foreign patient looks for when traveling overseas for care.  


La Femme specializes in ob/gyn, neonatal care, laparoscopic, cosmetic and preventative care where patients can receive an annual health check, mammogram, ultrasound, pap test and bone density scan for only $125.  And if you would like to come here and really get it all done, the Med Spa offers a full line of cosmetic surgery, cellulite reduction treatment or a full body lift.  


Finally, worth noting if you have time to come to India to give birth to a child, La Femme is the place, with state of the art delivery rooms where all of the equipment is hidden behind cabinets and walls to create a natural home environment for the mother to be.  Moreover, the birthing beds themselves have lumbar support located in rooms with dimmed lighting and pastel colored walls to ensure a calming birthing environment.  For most women, I am sure this would be very tempting.

Escorts Heart Institute

Escorts Heart Institute has become world renowned for its unbeatable outcomes in cardiac procedures and surgery.  Known in the United States through Maggi Grace’s book State of the Heart and the magic hands of Dr Trehan, patients know they can seek the highest quality of cardiac care here at a much lower cost than in most parts of the world.  For patients planning a trip to Escorts, State of the Heart is a must read.


Since the five Escorts Hospitals were acquired by Fortis, the International Patients Center is seeing many more international patients particularly for heart surgery.  The Cardiac Scan Center is a state of the art imaging scans that can diagnose coronary conditions at a much earlier stage for treatment.

Bangalore is located in the southwestern state of Karnataka and is the hub for research and technology and other hi-tech industries.  Coming to Bangalore after the bustling Delhi was an awakening to the fact that India can combine industrial and transport with style.  


There are many pubs and bars and good restaurants that give the illusion of being situated in any city anywhere else but India.  Bangalore evidently has a transient culture of people who come in during the week for work and return home on the weekends to various other locations.  Take time to see the Lalbagh Botanical Gardens, a 24 acre botanical park with India’s most vast representation of tropical and international flora and fauna.

Located in Bangalore, Wockhardt is another giant in healthcare.  It has two super specialty cardiac centers, one in Bangalore and one in Mumbai.  In Bangalore, there are two JCI accredited hospitals one showcasing its Harvard Medical International partnership on the exterior building, representing years of work in the area of quality of care.  


The Center of Cardiology performs almost 3000 cardiac procedures per year and the Center of Cardiovascular Surgery performs about 1400 cardiac surgeries annually with outcomes over 99%.

Wockhardt’s Super-Specialty Hospital opened in 2006 with 400 beds and a focus on the highest quality of care in cardiology, neurology, brain and spine, laparoscopic surgery, degenerative disc surgery, orthopedics and less-invasive surgery.  The expertise provided by Harvard Medical International on a regular basis provide opportunities for the directors and staff to discuss medical issues and continue to keep this hospital a top notch center of excellence.

Apollo Bangalore is Apollo’s flagship hospital.  JCI accredited and state of the art, this Apollo is picture perfect for foreign patients with its bright wide hallways and brand new private patient rooms.  The specialties and super specialties will make this hospital shine in anyone’s light.  


Apollo’s outcomes are top notch and any patient seeking the highest quality of care should look to Apollo as an “icon” and a force to be reckoned with.  Apollo is exporting this talent all over the world to exotic locations in Fiji and the Bahamas for those who really want to mix the highest quality of healthcare with a holiday.

Known at the economic hub of India, Mumbai is one of India’s most important revenue generators, surrounded by the Arabian sea.  Formerly known as Bombay, Mumbai is becoming as well known for healthcare as it is technology.  


Although the city has its share of slums, the rising numbers of wealthy and glamorous stars of “Bollywood,” India’s version of Hollywood, keeps bringing n the crowds. Wockhardt is located in Mumbai and is, of course, JCI accredited.  This Mumbai Wockhardt is home to the other specialty heart center with outcomes in heart surgeries above 99%.

Wockhardt

Although  I did not have the opportunity to visit it, Jaslok is JCI accredited and one of the oldest and most well known hospitals in Mumbai with over 37 specialties and its own International Patient Center.  It is worthwhile to look into their Neuroscience Division, cardiology and oncology departments.

Dr. L.H. Hiranandani Hospital opened here in 2004 excelling in areas such as cardiology, bariatric, hip resurfacing and replacement.  One of the big appeals to Hiranandani is their International Health Check Program attracting patients from Asia, Africa and the Middle East on a regular basis to take advantage of their silver, gold and platinum packages designed to enhance the one-stop experience.

As a medical tourist, it is a good idea to check out the political and economic backgrounds of any country you would like to travel to.  India is an example of a country that is taking great strides towards political promotion of medical tourism.  Here in India, there is a combined effort of the hospitals, state governments, hospitality industry and travel agencies to help spur the growth of tourism to India.  Medical Tourism is seen as one of the most lucrative industries that will attract patients from the U.S., Canada, U.K., and the Middle East, expecting to grow into a $1.5 billion industry in 2010 according to the Financial Express on May 4, 2007.

To promote medical tourism, the “Incredible India” motto has streamed out of the tourism department and encouraged the launching of the extended medical visa.  India put in place the medical visa, allowing patients to come to India with a companion for up to one year typically and even up to three years for certain medical conditions if the patient comes with a recommendation from an accredited medical authority.


Improving healthcare infrastructure will be a huge step in the right direction as corporate hospitals like Wockhardt, Apollo, and Fortis have found.  Low cost treatment, no waiting times, and alternative treatments such as Ayurveda are the main reasons people will flock to India for care over other countries.

Hopefully the U.S. health market will come to the same realization I did.  With spending in healthcare in the U.S surpassing the $2 billion range, the rising number of uninsured topping 50 million and the advent of the baby boomers swiftly merging into the medical necessity category, I believe you will see several hundreds of thousands Americans seeking overseas healthcare for life saving procedures in the next year.  


This is on top of the hundreds of thousands fleeing from Canada and the European Union.  Add to that the hundreds of thousands leaving home for dental care and cosmetics in order to improve their quality of life.  A large percentage of those will be traveling to India, Incredible India.

I know I would.  In the words of leader Jawahailal Nehru, “India, with all of her infinite charm and variety, began to grow upon me.”  And then it was time for me to go home.  I am looking forward to my return.”

Renée-Marie Stephano is General Counsel and a Director of the Medical Tourism Association, Inc., an international non-profit organization that serves international healthcare providers and medical travel facilitators in the global healthcare industry.  Renée-Marie is an attorney licensed to practice law in the states of Florida, Pennsylvania and New Jersey and has a background in litigation and health law.  She is also Editor of the Medical Tourism Magazine, a monthly journal serving the global healthcare industry by free subscription at www.medicaltravelauthority.com.  Renée-Marie may be reached at Renee@medicaltravelauthority.com.