Here is a thought provoking article British Medical Journal article on
Medical Tourism, as practices by misguided doctors.
Sam Lanfranco, STRING ListHost/Mgt
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Source: BMJ 2000;320:1017 ( 8 April )
Title: Medical tourism can do harm
By: Rachel A Bishop and James A Litch, codirectors and physicians.
Kunde Hospital, Solukhumbu District, Nepal
We are expatriate doctors living at 3900 metres in the Mount Everest
region of Nepal and running a health care system serving a population of
10 000. The area is remote, mountainous, and roadless, with the villages
scattered along high valleys. Over the past 32 years a health system of
one hospital and eight health clinics has been established so that most
residents are within an hour's walk of a health clinic or hospital.
The area is popular with tourists. Last year 19 000 visitors came into the
Sagarmartha National Park where Mount Everest, the hospital, and five of
the eight health clinics are located. Inevitably, there are many doctors
and other healthcare professionals among them.
Can you realistically treat chronic disease after a single consultation?
Although the presence of the hospital is well publicised, many doctors
touring the area hold ad hoc clinics along the trail. They often conduct
these clinics just a 100 yards from the local village health clinic. At a
time when we are developing the skills of the local resident health
workers and increasing the confidence that the local people have in them
such misdirected good will undermine progress in the existing health
system.
Consider whether you are treating the patient for your own good or for
theirs
It is inappropriate arrogance to assume that anything that a Western
doctor has to offer his less developed neighbour is progress. These
tourists are often working outside their trained specialty or have little
concept of how that specialty applies to Nepal. They frequently don't
understand local illness presentation, culture, or language. They often
offer inappropriate treatment because they think they "must give
something." The consultations are often one off, with little possibility
for follow up and the local health providers are left to pick up the
pieces with no record of the consultation. If an unregistered Nepali
doctor on holiday in the United Kingdom offered general medical
consultations in a shopping centre there would be a public and
professional outcry. The problem is extended when applied to nurses,
paramedical staff, and medical students.
Furthermore, legally these doctors are on difficult ground. The Nepal
Medical Council is striving to develop and maintain a professional body
and requires all doctors who practise in Nepal to register with the
council. For certain services, such as family planning, practitioners are
required to have Nepali training certificates. This is setting a standard
of medical professionalism that is required and respected in the West so
it should be respected in Nepal.
We are seeing the development of medical tourismexotic travel to a
developing region with a brief opportunity to practise medicine on local
residents. This seems to occur on two levels. Firstly, doctors travel
independently to areas that seem to have no system of health care and
while there perform good acts. We see this regularly with trekking doctors
who give residents short courses of antibiotics, which is fine until you
consider tuberculosis control and resistance. Recently, a chest physician
gave one of our long term psychiatric patients an injection, but we don't
know what it was. On the other hand, the acts performed in a life or limb
threatening emergency are justified, but there should still be follow up
with the nearest local provider.
The second level, which is more alarming, is the development of adventure
holidays sold to groups of doctors specifically for the purposes of
research or providing health care. The most recent example was an American
group of two subspecialists and a selection of house officers and medical
students who actively sought out patients along the trail without making
any prior contact with the hospital and health posts along the way. They
brought an ultrasound machine and a microscope. Can you realistically
treat chronic disease after a single consultation? But working with the
senior doctors we might have used the equipment and instruction with
lasting benefit.
Medical work overseas can be constructive. It takes little effort to find
out what health care exists in an area and for doctors to work with or
refer to the local system. For more long term work there are numerous
agencies in the United Kingdom and in other countries which recruit
doctors to work in developing countries.
A fundamental principle of medical training is "first do no harm." If as a
doctor you cannot resist the lure of medical tourism and insist on the
casual or opportunistic treating of local residents, consider whether you
are treating the patient for your own good or for theirs, and whether your
actions may actually do more harm than good.
Rachel A Bishop and James A Litch, codirectors and physicians.
Kunde Hospital, Solukhumbu District, Nepal
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