Regional medical tourists: Looking North, talking East
Scores of patients from the Eastern Indian states (including the districts of West Bengal) give Kolkata the miss, reaching out for the other metros in the three corners of the country instead. It is not that nobody is aware of the trend. It is actually like the elephant in the room about whom nobody wishes to speak aloud. But in private, all the leading hospitals in Kolkata would grudgingly admit about this negative osmosis. The article tries to analyse this curious inclination of the ‘regional medical tourists’.
Kolkata being the biggest city and the only metro in the eastern region is supposed to be the highest point of summation for all regional needs, including healthcare. Despite having ‘good’ private healthcare infrastructure (including some of the biggest brands) the city is ‘leaking’ regional patients to the other metros.
Why the apprehension?
Kolkata is much closer to the eastern states compared to the other metros. Yet according to a presentation made to NRIs in 2008, yearly around 1.5 million OPD patients and 80,000 indoor patients at AIIMS are reportedly from Bihar (Delhi is about twice as far as Patna is from Kolkata).
In Chennai Apollo at one stage, as many as 30 per cent of the total out-patients and 35 per cent of in-patients every month were Bengalis. Bengali signboards, Bengali translators, Bengali books in the bookshop – Chennai Apollo has it all – even a Bengali restaurant called ‘Atithi’ within its premises to serve the Bengali cuisine. But when you find that people have actually travelled 1,676 km (distance between Kolkata and Chennai) for something as routine as a hernia or a cataract operation, you are entitled to be startled! It is no wonder that Coromandel Express remains choc-a-bloc with patients making a beeline for Chennai’s reputed hospitals. The Mumbai-bound trains from the East had on many occasions seen their entire emergency quota seats being used up by cancer patients, forcing the government to put a cap on berths allotted for such purposes. Even Vellore – which has assumed folklore status among the Bengali diaspora thanks to Christian Medical College (CMC) – has got a direct connect with Howrah through a new train (Aurobindo Express) as a direct fall out of this trend.
Everywhere but home
Domestic medical travel still has not received too much attention. The general perception is that it is pretty much unorganised (not yet fashionable?).
We would take a look at the score of the Eastern Indian states in the exhibit to understand the home truths in the table provided. The domestic travelers were estimated in the study by the movement of household members through the concept of ‘trip’-overnight as well as same-day. However in the provided table, only overnight trips were considered as a reasonable indicator of the domestic trend of travel for ‘health & medical’ (as the leading) purpose. Predictably rural people need to move around much more than the urban folk (with the exception of Manipur). Overall 47 lakh people in Bihar seem to need overnight trips for their medical needs in a year; for Orissa the number is more than 25 lakh, while for Assam & Jharkhand it is more than 15 lakh & 14 lakh, respectively; for the populous state of West Bengal the number is as high as 45 lakh!
Before drawing sweeping conclusions, however, it may be important to remember at this stage that not all overnight trips result in inter-state travel. With bus and train being the dominant mode of travel, it includes some amount of intra-state travel as well. Also people are often known to combine several activities along with the leading purpose, wherever possible (especially for elective and non-emergency medical treatment). Even after discounting the aforesaid factors, the sheer magnitude of domestic medical travel forces one to sit up and take notice of this phenomenon (to give you some perspective, India’s much touted position as an international medical tourism hub reportedly drew4.5 lakh foreign patients in 2007 and given an optimistic projection of 30 per cent annual growth).
Leap of faith
The major driver of international medical tourism is the cost differential, which the recipient country is able to offer. However, it is not the economy factor, but the lack of advanced treatment infrastructure, which is the chief driver of domestic medical travel. For the disadvantaged sections and rural patients from backward states the choice is often limited to traditional or questionable forms of local medicine. It is usually the moneyed class who make the hopeful travel for recovering their health. With different levels of ignorance, belief and gullibility these people take their decision suo motto or some form of ‘well-meaning advice’. The poor, especially if he is able to get the help of any benefactor, may also take a similar call giving him at least a fighting chance of survival.
Zero for conduct
Cultural aspects play a role in the health-seeking behaviour of patients. It is human tendency to show one’s best face to the neighbours. To cock a snook at the very people, who had once rubbed us the wrong way. Hardships on the way, language barrier, indifferent foods, etc, are okay as long as the bigger goal is met. If these people are asked to prepare a report card of the city’s (Kolkata) healthcare system, it is unlikely to get very flattering marks. What is disturbing is that these appraisal sheets would be populated with words like ‘apathy’, ‘insensitive’ ‘fleecing attitude,’ etc.
For people hardened through an evidently forgettable experience the challenge lies in finding a better tomorrow, a medical Mecca for salvation and vindication. While defeat and death may still be the final destination but at least the mind is at peace having not taken things lying down.
Make way for tomorrow
The time has come to reverse the patient traffic and woo them back. But that is easier said than done. It would mean burying the ghost of the past and removing the cobwebs of mistrust. If you are one of the stakeholders you can help in bucking the trend. By ensuring that the buck stops at your table! With infinite care and understanding you can recreate your city’s image, pixel by pixel, in the minds of the consumer.
Taking cognizance of the clinical pathway, the top management in the Kolkata hospitals can put in place a strategic plan (without taking things to jingoistic proportions, of course).
Ritz Carlton, the global luxury hotel chain, has a daily ritual worth emulating. It revolves around an iterative deliberation of a 16-component cultural piece (known as ‘the golden thread’). The private hospitals can develop their own ‘cultural thread of inclusiveness’ to win back the confidence of ‘the expendables’. At the organisational level, all the stakeholders (doctors, nurses, paramedics, administrators, frontline staff, etc) should inspire and encourage each other to work towards this common objective.