One of the world’s most popular medical tourism destinations is affected by a shocking terrorism attack. News footage of explosions and burning buildings quickly spreads across the globe; an atmosphere of fear and uncertainty is followed by tough new security measures and visa delays. Patients who had preferred the country’s top medical centers for advanced treatment and modern technology begin switching to hospitals in other countries.
India? Thailand? No, the country was the United States. Until September 11, 2001, it was a preferred destination for Middle Eastern patients going abroad for treatment. After 9/11 many of them chose a six-hour flight in the opposite direction, to Thailand and the hospital where I work, Bumrungrad International. Today we serve about 400,000 international patients each year, and 1 in 4 come from countries in the Gulf.
I reflected on this from my office last May 17. On that day we served 284 inpatients and 1,401 outpatients, far less than average. The campus felt quiet and secure, but around it the streets were strangely empty. In the distance, a black column of smoke rose from tires set fire by demonstrators in the heart of Bangkok. Would I recommend, on that day, that an American needing an affordable heart bypass come to my hospital? No. The hospital was safe. My wife and my home were safe. But it was not a good week to travel to Thailand. We posted a message to that effect on our website.
The past few years have been interesting. In April 2009, we vacationed in Mexico, ignoring concerns about murders and drug wars voiced by some family members. I returned to Bangkok the day before airports began H1N1 screenings and quarantines on anyone returning from Mexico. This past April, we were in Spain when volcanic ash closed most airports north and east of us. We were fortunate to get home – just in time for the Thai street protests.
Bangkok has been peaceful since May 20. CNN doesn’t give Thais much credit but I think there is something to be said for a Buddhist culture of accommodation and compromise that gave free speech and Thai lives priority over tourism and shopping convenience. Eighty deaths are still a tragedy, but in a country of 65 million, that many die in traffic accidents every three days. So I’m not packing my suitcases.
But the purpose of this article is not to make you feel better about visiting Thailand. Rather, it is to ask how patients and providers should act in a world rife with financial, political, and geological calamities. How should patients evaluate news from the destinations they are considering for treatment? And what is our duty as healthcare providers, as we seek to both protect our businesses and our patients from harm?
Patients, Not Tourists
The label “medical tourism” suggests that patients traveling overseas for treatment should evaluate their destinations like tourists do. Is the weather pleasant, are the beaches clean, the shops honest, and the streets safe? Such things may be relevant for people combining a vacation with teeth whitening or light cosmetic surgery. But traveling for serious treatment is a different experience.
In his book Patients Beyond Borders, Joe Woodman says he knows of no fatalities resulting from violence or hostility, out of the millions of medical tourists who traveled for treatment in the past five years. “In truth,” Woodman writes, “most health travelers are usually quite sheltered. They’re chauffeured from the airport to the hospital or hotel, personally driven to consultations, given their meals in their rooms, and chauffeured back to the airport when it’s time to go home.”
So medical tourists should do their homework, but spend the time researching hospitals, doctors, and procedure costs rather than sightseeing, shopping and entertainment. One thing both types of travelers can do more conveniently today, using the Internet, is to learn from the experiences of others. A good hospital or facilitator website will include plenty of patient testimonials. Medical travel experiences are also showing up more often in blogs and on travel sites like TripAdvisor.
Should you be scared away by those CNN headlines about drug wars, political demonstrations, terrorism, or a nearby volcano? Before you call your travel agent to cancel, consider your decision less emotionally, more rationally. And get more information.
Some of our biases are cultural. Americans are famously skittish about the dangers lurking over there. Even if you’re a seasoned world traveler who has overcome this tendency, you will have friends and family members who tell you you’re nuts.
You also need to understand something called the “Availability Heuristic.” It’s a fancy academic term that means our perception of risk is biased by things we more often hear and think about. Airplane accidents are a classic example: since they get disproportionate play in the media, people tend to overestimate the risks of air travel as a result. Should medical travelers have been concerned by the recent political unrest in Thailand?
How could you not be, reading the CNN headlines of troops clashing with protestors? And yet, the risks of dying in a car or plane accident on your drive to the airport and flight to Thailand were about nine times more than your risk of dying from political violence, if you were treated here during that time.
Sources of Information to Help You Decide
When you’re concerned about the security and safety of a destination, you need to get good information to help you make a wise decision. Let me propose some sources of that information, along with the tendencies and biases of each.
International news organizations like CNN, BBC, Reuters, and the New York Times are easy to access sources of information about world events as they happen. Their reporting can be very good (as I found the Times to be during recent Thai events) or very superficial (I won’t name names). An official at the US Embassy in Bangkok told me many news organizations use “fly-in teams” to cover events like this.
Their assignment is to fly in, take pictures and interview some people and distill it into the kind of bite-sized capsule summaries modern audiences prefer. The editors seem to prefer headline language that’s muscular and visual. “Demand.” “Reject.” “Crush.” “Torch.” It doesn’t allow for the complexity and nuance that inhabit the real world. To people living through these events, some on-the-spot reports seem irresponsibly simplistic. If you want the more complete version, look at the end of the online story for comments posted by readers. Some of these will probably be people with first-hand experience.
Embassies themselves are a reliable source of travel advisories. Their people on the ground in your destination country actually live and work there, facing many of the same risks you might face if you travel for treatment. Embassies issue advice through websites such as www.travel.state.gov – advice such as “remember that even peaceful political demonstrations may turn violent” and “avoid for all but essential travel.”
Their job is to protect citizens from harm, so we can’t blame them for erring on the side of caution. But this advice is arrived at professionally and carefully, since travel warnings cut both ways: while protecting American citizens, they can also hurt American businesses and NGO’s.
Do you know someone living in the destination country? If so, he or she may be one of the best sources of information. Your friend has to decide if it’s safe to go to work…safe to drive to certain parts of the city…safe to go see the doctor about their aching back. What does he or she think of that flood, or the mad cow disease outbreak, or the serial killer who hasn’t been captured yet?
Can We Count on Our Providers to Give Us Good Advice?
As providers we have a duty to inform patients about the local situation before they arrive. We may also have to make special arrangements for patients far from home if that situation deteriorates. At Bumrungrad, from May 17 to 21, we asked prospective patients via our website, contact center, airport reception desk and representative offices to postpone their appointments.
The hospital remained fully operational and the campus was safe during that time. But we could not guarantee the safety of patients getting to and from the hospital because, for those few days, some of the nearby streets were not secure. We set up accommodations for our staff on the campus so that we could continue to care for inpatients already at the hospital, without asking our people to take risks commuting to and from home.
We are relieved that the situation only lasted a few days. But the experience taught us valuable lessons that may be useful for other world hospitals that promote themselves to medical tourists. Don’t think it only happens to providers in far-off places. The good people of London, Madrid, and New York will agree with those in Bangkok and Mumbai on this.
Planning For the Unplanned
Two final thoughts—one for patients and one for providers. If you’re a patient considering overseas treatment, but concerned about unforeseen circumstances affecting your trip, several companies now offer a special kind of travel insurance designed for the needs of medical tourists. Like conventional travel insurance, such policies protect against trip cancellation and accidents.
They add coverage for unexpected complications, so the patient does not have to return to the destination provider if they need unexpected follow-up treatment after they get home. We list two such insurers, Seven Corners and Global Protective Solutions, on our website (Bumrungrad does this as a service to our international patients and does not receive referral fees or other considerations for it).
Providers who want to attract international patients need to be in it for the long haul, and they need to have healthy local patient bases. Serving the healthcare and travel needs of diverse patients from different cultures is an enterprise with a steep learning curve. It takes years to train your people and build the systems required to do it successfully.
Along the way, external factors, difficult to imagine and beyond your control, will affect your business. Your local patient base can see you through tough times, if they perceive you as a hospital that is as interested in locals as it is in foreigners.
About the Author
Bumrungrad International was the first Joint Commission accredited hospital in Asia, and has served over 3 million international patients during the past decade. In 2008 it was recognized by the American Medical Directors of Iinformation Systems (AMDIS) in its annual awards for hospital information technology. Kenneth Mays is Bumrungrad’s head of Marketing and Business Development. Please visit their website for more information at www.bumrungrad.com.