Africa and medical Tourism: Lessons from countries outside Africa

According to the Journal of Tourism & Hospitality, tourism is "traveling to and staying in places outside their usual environment for not more than one consecutive year for leisure, business and other purposes". Tourism is commonly associated with international travel as well as refers to travel to another place within the same country (Journal of Tourism & Hospitality). Medical tourism is one purpose why people travel, it is a reality and a worldwide market for international patient care at approximately $40 billion (Kelly Gooch. 2016). Traveling abroad to access medical treatment is increasing with countries like U.K. providing large numbers of exported patients (Hanefeld J, Horsfall D, Lunt N, Smith R 2013). Medical tourism comes in different forms ranging from skilled providers sharing skills and services during medical treatment safaris/camps, concierge services, affordable healthcare options in the global market to beneficiaries traveling from their home countries to other countries where they can get services. There are other reasons why medical tourism is booming and these are: avoiding long waiting lists; shifting priorities for healthcare; tightened eligibility criteria; financially empowered individuals making decisions to seek services; competitive quality and prices of health care in some countries being pocket friendly; low air fares and hotel stay fees; increased number of immigrants who are skilled in health care provision providing services in home countries; alternative medicine other than western medicine; partnerships between teaching hospitals and establishing green field ventures; and cutting edge care (Reenita Das). 

Dallol Salt Lakes, Ethiopia, Africa

Africa, you can learn from this scenario: medical tourism is a net importer/ exporter of patients in really big numbers. In U.S. alone in 2007, an estimated 750,000 Americans traveled abroad for medical care; the number is expected to increase to 6 million by the end of this year. It is increasingly becoming apparent that there are affordable healthcare options in the global market outside of U.S. with pocket-friendly costs. Most surgeries cost 50% to 90% less than the average cost of the same surgery at a U.S. hospital, e.g., stent placement for iliac artery stenosis, estimated bill: at approximately $35,000 in USA can cost $18,000 in Bumrungrad Hospital in Bangkok, Thailand. There are reasons why cost are much less at overseas hospitals, as compared with U.S. and these include: lower wages for providers; less expensive medical devices and pharmaceutical products; less involvement by third-party payers; and lower malpractice premium. The annual liability insurance premium for a surgeon in India is $4,000; the average cost of a New York City surgeon’s liability insurance premium is $100,000 (Rajiv N. Thakkar. 2010).

Africa tap into social media and showcase the good side of the hot springs, the herbal medicines and the fact that a tropical/equatorial climate is medicinal. Showcase places like Dallol Salt Lakes in Ethiopia or Buranga Hot Springs (Geysers of Africa). You are missing out! Social media is playing an important role as an advertisement platform and this makes it possible for beneficiaries to make comparisons in nature, quality, access and prices of health care services (Zheng Xianga & Ulrike Gretzel. 2010). Advisories from the U.S. embassies, missions , media coverage as well as presence of U. S. military inform destination risk perception (Grzegorz Kapuścińskia & Barry Richards. 2016). It is increasingly easier for Americans to travel around the world for life-changing procedures due to a powerful dollar at the exchange rate, the fact that it has become safer, more cost-effective and appealing for Americans than ever (Kevin Gray. 2013). 

Well, at the same time Africa, get your act together as far as organization goes. If you will want to be number one in the medical tourism market (yes you can), copy from say, the U.S. Talking about medical tourism without talking about how health care evolved into a quality service in say, the U.S. would be saying half the story. It is now a lifestyle and experiential activity(Constantine Constantinides. 2016). Aspects to talk about include the motivations put in place by employees for employers to stay longer at given jobs while at the same time they enjoy a quality life has in turn impacted on advances in the health care field. This as ensured medical and health services access by large employers through being self-insured; ensuring health benefit mandates are met; provision of benefits; provision of incentives in form of perks; and providing other forms of wage. A motivated employee is able to pay for health services. This kind of money invested in say, health care from services to infrastructure has made developed countries establish quality health care services. The technological advancement; economic growth; new market innovations; demand for services; and continued trainings and skills development in these countries have in turn improved technology; provided an understanding of demographics; and enabled the promotion of lifestyles that in turn protect people from risky health outcomes. Market conditions or regulations have made it possible for continued quality assurance. This is possible because of the specialized medical care provision; licensure laws; Intellectual property law; expansion/reduction of health government subsidized health care/insurance; and product safety, law or rules. 

So, medical tourism is a sustainable phenomenon and not simply a passing fad. Medical Tourism affects healthcare in developed countries (e.g., United States, England, and Canada), developing or underdeveloped countries in form of: established health care markets providing low cost quality concierge and medical services; mutual partnerships between air travel companies, hotels and hospitals; the higher exchange rate of the Dollar, Euro and Pound against currencies where people go for medical services; safe destinations; and the increasing success rate of medical procedures outside say, U.S.

References:

Constantine Constantinides. 2016. Making Health Tourism “Truly” Sustainable and Resilient-Fro All. Retrieved from: https://www.imtj.com/articles/making-health-tourism-%E2%80%9Ctruly%E2%80%9D-sustainable-and-resilient-%E2%80%93-all/. Retrieved on October 18th 2016. 

Geysers of Africa. Retrieved from: http://www.wondermondo.com/Best/Af/AfGeysers.htm. Retrieved on October 18th 2016.

Grzegorz Kapuścińskia & Barry Richards. 2016. News framing effects on destination risk perception. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0261517716301030. Retrieved on October 18th 2016. 

Greenfield Venture. Retrieved from: http://www.mbaskool.com/business-concepts/marketing-and-strategy-terms/8506-greenfield-venture.html. Retrieved on October 17th 2016.

Journal of Tourism & Hospitality. Retrieved from: http://www.omicsgroup.org/journals/tourism-hospitality.php. Retrieved on October 18th 2016. 

Hanefeld J, Horsfall D, Lunt N, Smith R 2013. Medical Tourism: A Cost or Benefit to the NHS?. Retrieved from: ournals.plos.org/plosone/article?id=10.1371/journal.pone.0070406. Retrieved on October 18th 2016. 

Kevin Gray. 2013. Medical Tourism: Overseas and under the knife. Retrieved from: http://www.mensjournal.com/health-fitness/health/medical-tourism-overseas-and-under-the-knife-20131122. Retrieved on October 18th 2016. 

Reenita Das. 2014. Medical Tourism Gets a Facelift... and Perhaps a Pacemaker. Retrieved from: http://www.forbes.com/sites/reenitadas/2014/08/19/medical-tourism-gets-a-facelift-and-perhaps-a-pacemaker/#7bac8796a185. Retrieved on October 17th 2016. 

Healthcare Marketplace. Carlson School Of Management. University of Minnesota Library.

Kelly Gooch. 2016. How Scripps and Baptist Health South Florida are responding to medical tourism growth Retrieved from: http://www.beckershospitalreview.com/finance/how-scripps-and-baptist-health-south-florida-are-responding-to-medical-tourism-growth.html. Retrieved on October 18th 2016. 

Rajiv N. Thakkar. 2010. Medical Tourism. Retrieved from: http://www.the-hospitalist.org/article/medical-tourism/?singlepage=1. Retrieved on October 18th 2016. 

Zheng Xianga and Ulrike Gretzel. 2010. Retrieved from: Role of social media in online travel information search. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0261517709000387. Retrieved on October 18th 2016. 

Aesthetics overriding healthy practices: One's meat is another's poison; Constructivist Paradigms in cultural competence

Did you know that skin cancer is the most common form of cancer in the United States (CDC, 2011), despite that it is, arguably, the most preventable? The dangers of overexposure to the sun are well-established scientific facts, yet 30 million people in the United States—approximately 10% of the population—still visit indoor tanning salons (JAAD, 2005, p. 1038). Popular culture has even coined a term for those than who tan despite the dangers: “tanorexics”. Why do you think some people are willing to take the risk associated with a tan?

There are other examples of aesthetics overriding healthy practices. Some ancient Asian cultures used to bind young girls’ feet as a status symbol, repeatedly breaking their toes and the arches of their feet in an attempt to prevent them from growing in proportion to the rest of their bodies (Lim, 2007).

An example of aesthetics overriding healthy practices of an ancient Asian cultures which used to bind young girls’ feet as a status symbol, is one of so many other practices which may be meat to some and poison to others. 

I know of two African examples. One is drinking the menstrual blood from cows and the other is growing large size testicles. I have visited two African tribes whose men are encouraged to grow testicles up to 70-80 centimeters in diameter are the Baganda and Bubal Tribe reached puberty. For the Bubal tribe, this happens on account of drinking the hormone-rich menstrual secretion of the cattle. Which causes irreversible hormone changes, and this is what causes the testicles to grow. Among the Baganda the hydrocele was a status symbol and many men who had big testicles would show them off. A hydrocele is a painless buildup of watery fluid around one or both testicles that causes the scrotum or groin area to swell. This swelling is usually not painful and generally not dangerous. However, with involvement of cultural leaders these practices are dying away. Unless is prepared for such scenarios, it may be impossible to practice effective health promoting services in such situations.

The medical model would call for dismissal of such practices perhaps with long jail sentences for culprits and ridicule in one or two journals. It can be filed away as indicating abnormal behavior, itself a result of physical problems and should be treated medically. A medical model set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment. The medical model is highly successful and even indispensable in many contexts. But, what can explain lack of or very low turn up by given demographies at health facilities even with medical insurance provided at the gate. Appealing to the health belief of given demographies is perhaps one way of motivating participation. This can come about when providers gain a linguistic and cultural competence.

Understanding or competence in asking why other cultures do what they do can help health care providers recruit people who will meaningfully engage in practices which promote better health outcomes. 

References:

African Bubal Tribe-`The Giant Testicles`. Retrieved from: http://mindsparker.com/cultures/african-bubal-tribe-the-giant-testicles/. Retrieved on July 18th 2016.

Centers for Disease Control and Prevention. (2011). Skin cancer. Retrieved from http://www.cdc.gov/cancer/skin/ [2005, 53(6):1038–44].

Levine, J., Sorace, M., Spencer, J., & Siegel, D. (2005). The indoor UV tanning industry: A review of skin cancer risk, health benefit claims, and regulation. Journal of the American Academy of Dermatology, 53(6), pp. 1038–1044. 

Lim, L. (2007). Painful memories for China's footbinding survivors. National Public Radio. Retrieved fromhttp://www.npr.org/templates/story/story.php?storyId=8966942

Maria Mies. 2005. Patriarchy and accumulation on a world scale – revisited (Keynote lecture at the Green Economics Institute, Reading, 29 October 2005). 

Roscoe, John. 1911. The Baganda : an account of their native customs and beliefs. Cornell University.

What is a hydrocele?. Retrieved from: http://www.webmd.com/parenting/baby/tc/hydrocele-topic-overview. Retrieved on July 18th 2016. 

Laing, Ronald. 1971. The Politics of the Family and Other Essays. Routledge.

Amélie Blanchet Garneau and Jacinthe Pepin. 2014. Cultural Competence: A Constructivist Definition. J Transcult Nurs January 2015 26: 9-15, first published on July 17, 2014 doi:10.1177/1043659614541294.

Hydrocele and Manhood among African men. Source: Wikimedia Commons

Hydrocele and Manhood among African men. Source: Wikimedia Commons

Occupations as I immerse into an American life.

There are certain activities in which I engaged for the past five, which define me now. I love America, I love my  anti HIV-AIDS work, I enjoy academic engagements, I love travel and I love giving back. The pictures here show my fav pastimes:

I believe in the work AHF is doing, especially mobilizing anti-HIV resources. Thank you AHF. 

I admire, respect and cherish what made USA what it is. Thank you America.

I wish to travel to all parts of USA to have a feel of what others are doing around HIV prevention

National HIV Testing Day.

HIV Testing for all.

Touring the Alcatraz in Pacific Ocean.

The tour to other destinations.

Enjoying.

San Francisco CA

Our San Francisco CA

Believe me the receding foam is where two big whales disappeared.

The Pacific. Is it about pacification?

I just feel so happy.

The Golden Gate Bridge.

The Golden Gate Bridge in the distance.

The foam in our wake.

Far away, the bridge receded.

Yes, you guessed right. The Alcatraz.

Most times the best route is not arrest, all the time the worst thing is shooting; Fix the Ghetto and the Police.

A community meeting event to "mix all shades of skin" as one of its goals as well as to demystify the idea of "not understanding a black person" turns out to be an eye opener for me too. I was the moderator and we explored what it meant to at least understand the people in our communities. We had to make two statements and describe what those statements meant to us through our eyes, ears, relations and reaching out.

The statements:

1. "I have made an effort to talk to another person of a different skin shade than mine."

2. " I have engaged in efforts to reach out to people of a skin shade different from mine as well as sharing my experiences with people of a skin shade like mine.

After the session where each of us were given 5 minutes to share, we had so many comments. But for me one stood out so well. We had a "white" young man comment that his parents had drummed it into him that he should avoid people of any other skin shade (especially..................yes, you guessed right). 

For me it was the first time I improved my engagement with 2 persons from Myanmar and Bhutan. We have been in this group for a year and we had not really engaged like this. Honestly, I had placed them as "Filipino."  I am so happy I talked to them and they also got to know about my origins as a Ugandan-born American. 

I remembered engaging in my first "popcorn and cookie" Friday in San Francisco City this year and everyone was excited about the day. Our own corner booth on Hyde st./Golden Gate Avenue (in the Tenderloin, for those familiar with SF) received over 1,000 people, between 10:00am to 12:00 noon, who passed by and we got to talk as well as pass out cookies and popcorn. So many other volunteers were stationed at different corners all over SF. 

In 2014, I went to Oakland Zoo, to engage in an anti-HIV community event. Oakland Zoo, is located in southeastern Oakland. It contains modern exhibits. Most of its animals are kept in relatively "natural" habitats. The zoo is nationally known for its excellent elephant exhibit and has been praised for allowing their elephants to roam freely. It is here we that we spent that particular day dancing, talking, moving about and generally talking about the need to engage in loving and not stigma or discrimination.

 I remembered the 2016 "Black Month and Martin Luther Day" in San Francisco. I made effort to find planned events that particularly caused engagement with people of other shades of skin. I wondered if this could be an opportunity to add more events during that month that are about eyeball to eyeball, handshaking, talking and when the evening passes we shall have called it a day. I plan to reach out to the organisers so that next year I try out the "White hug a black (WHAB)" and "White Police Officer Hug a Black (WOHAB)" booth on one of the corners in San Francisco. May be I should make this an ongoing project. The Black month is an opportunity I shall utilise.

Fix the Ghetto and the Police. Source: FaceBook friends of mine.

Fix the Ghetto and the Police. Source: FaceBook friends of mine.

Fix the Ghetto and the Police. Source: FaceBook friends of mine.

Fix the Ghetto and the Police. Source: FaceBook friends of mine.

Fix the Ghetto and the Police. Source: FaceBook friends of mine.

ADDENDUM:

A friend who is also interested in what works sent me a link out of which this material has been kindly borrowed:

Wichita Police and Black Lives Matter have come with a relations building initiative. Members of the Wichita, Kan., police department spent Sunday afternoon eating and talking with people from the community, at a cookout that was planned with the local Black Lives Matter group. The event was called the First Steps Community Cookout — a reference to its goal of bridging the gap between police and the community they serve. Taking place instead of a protest that had been planned for Sunday, the cookout came about after Wichita Police Chief Gordon Ramsay had a lengthy meeting with activist A.J. Bohannon and other members of the local Black Lives Matter movement. For more read: Police And Black Lives Matter Hold A Cookout, And Praise Rolls In. Retrieved from: http://www.npr.org/sections/thetwo-way/2016/07/19/486581466/police-and-black-lives-matter-hold-a-cookout-and-praise-rolls-in?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20160719. 

All pictures: Courtesy of Wichita Police.

All competition is good even in healthcare delivery. Or is it? From a Public Health Perspective

The Business Dictionary defines competition from an economics point of view as: rivalry in which every seller tries to get what other sellers are seeking at the same time: sales, profit, and market share by offering the best practicable combination of price, quality, and service. Where the market information flows freely, competition plays a regulatory function in balancing demand and supply.

The Merriam-Webster's Learner's Dictionary gives what it calls a simple Definition of competition: the act or process of trying to get or win something (such as a prize or a higher level of success) that someone else is also trying to get or win : the act or process of competing; actions that are done by people, companies, etc., that are competing against each other. The competition: a person or group that you are trying to succeed against : a person or group that you are competing with.

I would use the terms access, quality and price more instead of competition as far as public health and medicine go. Why? Because public health and medicine as services are different for  each individual. Public health is a science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases. Overall, public health is concerned with protecting the health of entire populations. According to CDC. Public health is about protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention.

fee-for-service.Source: Wikimedia

References:

Competition. Retrieved from: http://www.businessdictionary.com/definition/competition.html. Retrieved on July 9th 2016.

Simple Definition of competition. Retrieved from: http://www.merriam-webster.com/dictionary/competition. Retrieved on July 9th 2016. 

What is public health. Retrieved from: http://www.cdcfoundation.org/. Retrieved on July 9th 2016.

Barriers or quality assurance? From a Public Health Perspective

Technology, the patents surrounding breakthrough inventions and computer platforms that facilitate exchange of information have helped in the organization of healthcare delivery. The HIPAA Privacy Rule establishes national standards to protect individuals' medical records and other personal health information and applies to health plans, healthcare clearinghouses, and those health care providers that conduct certain health care transactions electronically.

The HIPAA Security Rule establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information. key elements of the Security Rule including who is covered, what information is protected, and what safeguards must be in place to ensure appropriate protection of electronic protected health information. 

The Security Rule, provides room for interfacing providers to negotiate measures that separate tradecraft  secrets from providing quality care to a given patient.

EMR/EHR. Source: Wikimedia

References:

Summary of the HIPAA Security Rule. Retrieved from: http://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/. Retrieved on July 9th 2016.

The Security Rule. Retrieved from: http://www.hhs.gov/hipaa/for-professionals/security/index.html. Retrieved on July 2016. 

Access, Care, Costs, Quality outcome-focused performance measures promote accountability; From a Public Health Perspective

I was tasked to reconcile the heavy load of health mobilization and promotion that I engage in with an inventory that can be used to measure performance. I want to see the clients I help go to hospitals smile again or I want to hear them talk about a plan to continue seeking professional health care.

The U.S. health care system today seeks to address broad themes such as: access, quality and affordability. Approximately 46 million Americans are uninsured, many who are insured face rapid increases in premiums and out-of-pocket costs. Congress and the Obama administration are seeking ways to invest new funds to reduce the number of Americans without insurance coverage. 

However, with price discrimination there is need to simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps — even for those with access to insurance coverage. 

Preventive care is underutilized, resulting in higher spending on complex, advanced diseases. Patients with chronic diseases such as hypertension, heart disease, and diabetes all too often do not receive proven and effective treatments such as drug therapies or self-management services to help them more effectively manage their conditions. There are variations in hospital inpatient lengths of stay, visits to specialists, procedures and testing, and costs — not only by different geographic areas of the United States, but also from hospital to hospital in the same town. Many patients often do not receive medically necessary care, others receive care that may be unnecessary, or even harmful. 

Encouraging efforts at the state and regional levels to enable public and private payers, including Medicaid and Medicare, to participate in private-public initiatives is aimed at using better, outcome-focused performance measures to support payment and benefit reforms that promote accountability for greater value.

patient care. Source: Wikimedia

Access to Health Services. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services. Retrieved on July 9th 2016.

Drug Registration and Listing System (DRLS & eDRLS). Retrieved from: http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/DrugRegistrationandListing/ucm2007058.htm. Retrieved on July 9th 2016. 

Jonathan Blum. 2011. Improving Quality, Lowering Costs: The Role of Health Care Delivery System; Committee on Homeland Health, Education, Labor and Pensions United States Senate. Retrieved from: http://www.hhs.gov/asl/testify/2011/11/t20111110a.html. Retrieved on July 9th 2016. 

Measuring Health Care Quality:An Overview of Quality Measures. 2014. Retrieved from: http://familiesusa.org/sites/default/files/product_documents/HSI%20Quality%20Measurement_Brief_final_web.pdf. Retrieved on July 9th 2016.

Niall Brennan, Nicole Cafarella, S. Lawrence Kocot, Aaron McKethan, Marisa Morrison, Nadia Nguyen, Mark Shepard & Reginald D. Williams II. 2009. Improving Quality and Value in the U.S. Health Care System. Retrieved from: http://www.brookings.edu/research/reports/2009/08/21-bpc-qualityreport. Retrieved on: July 9th 2016.