A year ago, on a WhatsApp group, I read about a woman whose relatives were soliciting funds so that she could travel abroad for medical care. The sum required was quite much and did not tally with the diagnosis they painted. Curiously, I asked one of her children what her symptoms were and was told that their mother had hand tremors. She was finding it hard to dress and feed herself. The Neurologist who saw her diagnosed Parkinson’s disease. A Brain CT and MRI done showed normal findings, and this was not surprising as Imaging studies are not particularly helpful in diagnosing Parkinson’s disease. The doctor had placed her on drugs and for a while the symptoms reduced, but the children were insisting on a cure. They wanted a second opinion and a permanent cure which they believed could be found in India.
I tried to educate them that travelling was futile. Parkinson’s disease is not a disease that can be cured overnight. The goal of management anywhere in the world is to reduce the tremors and improve the quality of life of the patient as the disease is progressive. Surgical procedures (Deep Brain Stimulation), just like medication only reduce tremors, rigidity and improve slowing of movement. But did they listen? They sold what little property they had and together with contributions from relatives travelled to India.
Fast forward till last month- I heard from the patient’s sister that they had spent a month in New Delhi only to return with the same drugs that the Neurologist had prescribed. The patient’s tremors were still present and largely controlled only that this time, they had another crisis- the family was financially broke. I bit my tongue to prevent myself from saying ‘I told you so’.
I am not worried when the Otedolas or the Dangotes of Nigeria decide to embark on medical tourism for a mild headache or a boil under the armpit, it is the middle-class Nigerian struggling to eke out a living who baffles me. It pains me to see people trying so desperately to travel out of the country for conditions that can easily be managed here. Or in worse cases, for conditions that have reached end-stage. Whenever I hear of people running from pillar to post trying to get a visa for a patient with stage 4 cancer, my heart reaches out to them. Las, Las, it will all be in vain.
Medical tourism occurs when people travel across international boundaries for their health care and health need. According to Goodrich & Goodrich (1987), medical tourism is an attempt to attract tourists into a country by deliberately promoting its health care services and facilities in addition to the regular tourist amenities available in that country. In the past, people travelled from less-developed countries to seek health care in developed countries in Europe and America, but in recent years, more people now travel from developed countries to less developed countries for medical treatment as a result of lower-cost consideration. For example, a liver transplant that costs about $300,000 USD in the United States would generally cost about $91,000 USD in a country like Taiwan and $7500 in India.
Globally, medical tourism has contributed immensely to the growth and development of the health care system and the countries that engage in it because it attracts people from various parts of the world, thereby adding value to the countries involved. In Nigeria, the story is different, although the health care system in Nigeria is a blend of both public and private players, the recent mass exodus of Nigerians abroad for treatment is worrisome.
Affluent Africans are prime targets for medical tourism. In Nigeria alone, travel to India for healthcare generated more than US $260 million in spending in 2019. Patients also travel to countries other than India; notably South Africa, Dubai, China, and Malaysia, as well as the traditional destinations in the United Kingdom and the United States.
According to Price Waterhouse Coopers (2016) report, Nigerians spend $1 billion annually on medical tourism with 60% of it on four key specialities namely: oncology, orthopedics, nephrology and cardiology. This is nearly 20% of the total government spending on public health sector for the year, including salaries of all public sector doctors, nurses and other healthcare workers as well as other health programmes like malaria, tuberculosis, polio and HIV/AIDS prevention as total government expenditure on health sector for the year 2015 which stood at $5.85 billion.
However, the purpose of this article is not to bore us with facts and figures about how much Nigeria is losing to medical tourism (I will leave that to the economists), but to enlighten us (again, emphasis on the middle class) to the realities on ground before we wreck our selves financially while looking for a cure to ill-health.
The first thing I usually tell people is to first seek a second opinion here in Nigeria. It is important that both opinions come from doctors working in a public hospital. The keyword here is a public hospital, preferably a tertiary hospital. A doctor working in a public hospital will in most cases tell you the truth as they have nothing to gain by telling you otherwise. For example, if a patient has stage 3 or 4 cancer that has spread or a disease that is incurable, they will usually tell you as it is as opposed to a doctor in a private hospital that would want to coax you into doing a surgery that is of no benefit other than lining his pocket. It is a sad truth, but it must be told. My experience is that the doctors often tell the patients the truth, especially in terminal cases, however, it is the patients or their relatives that are in denial.
‘Cancer? God Forbid. Let us go to Dubai to confirm’. They always say.
The second thing after confirming the diagnosis is to know the reason for travel. This is paramount. A lot of people travel without a clear cut-out plan. Are you travelling for surgery? Maybe for a tumour? Is it chemotherapy? Is it for a cardiac bypass? Whatever the reason, make sure you have an idea of what you are travelling for. The reason for this is to avoid getting swindled. Yep, you heard that right. No be only for Naija, Yahoo Yahoo dey. When the hospital you travel to realise that you have no idea what you want, they will offer all manner of procedures using medical jargon and you will end up spending more than you bargained for. Nowadays, agents usually assist in securing a medical visa by linking you up with a doctor in the country of your choice who will peruse the patient’s medical records and then outline treatment and cost.
This leads me to the last and most important fact- Shine your eyes! In other words, do your homework. Read up on the condition and the hospital you are travelling to. Is it a good facility? What are their success rates with the disease? E.g. If you are going for a kidney transplant, how many transplants have they done successfully? Are they qualified urologists and nephrologists there? If travelling for an orthopaedic procedure- make sure the hospital is known for its state-of-the-art orthopaedic infrastructure. Do not just travel for the sake of it. Do you know how many botched-up surgeries have been carried out in India? Nigerians will travel blindly to some 3rd world country and when they reach there, these foreigners will smell our ignorance and go for the kill. So please, do your homework, go online or ask some to help you do the research.
It is an open secret that Nigerians have an insatiable appetite for anything foreign. The culture of Nigerians preferring anything foreign is what drives a lot of us into medical tourism. However, whatever the reason may be, only travel for healthcare when you can afford to or when absolutely necessary. Poverty and disease do not mix. Leave the medical travelling for Baba.