Where patients are going, and why

How to stop the trend

At just 35, Suraiya Begum had to have her left ovary removed as a diagnostic centre in Dhaka discovered a tumour in it back in 2001. Later on, she moved to Kolkata with critical gynecological problems and diabetes, where specialist doctors informed her that the surgery she had earlier undergone was unnecessary and she could have better medication. Another newly married couple Soniya Ahmed and Rajon Ahmed (not their real names), went to a government hospital, also in Dhaka, to have a discussion on their family planning options. The couple was shocked when a doctor suggested Soniya conceive as soon as she can. The doctor told her she might get affected with cancer because of her ovarian cysts. “After going through with my diagnosis report, the doctor advised me to get impregnated so they can remove both ovaries during my cesarean,” recounted Soniya. Shocked at the consultation, Soniya then visited a gynecological oncologist who skimmed over her medical reports and nonchalantly said she had nothing to worry about. Confused by the two divergent medical opinions, the couple is now planning to travel to Kolkata for a further diagnosis. These are among thousands of cases every month when overseas healthcare becomes the only option for Bangladeshis. A low confidence on local doctors and flawed diagnosis are forcing a large number of Bangladeshis to travel abroad for treatment of medical conditions such as cancer, cardiac ailment, autism, infertility, as well as medical check-ups, say stakeholders in the sector. Public health experts, health economists, agents of foreign specialised hospitals and patients say Bangladeshis seeking treatment abroad is on an upward trend since patients are unwilling to gamble with their life and health.When it comes to treatment abroad, Bangladeshi patients rely more on neighboring countries, said Professor Dr Syed Abdul Hamid, director of Institute of Health Economics at Dhaka University. India, Thailand, Singapore, and Malaysia are the most preferred countries while they are cost effective as well, he observed. Indian High Commission in Dhaka says it issued 130,000 medical visas until October this year, which is double the figure registered over the same period last year. In fiscal year 2015-16, India saw 460,000 inbound patients at its different hospitals, according to Export of Health Services survey conducted by Directorate-General of Commercial Intelligence and Statistics of India. Of them, 165,000 were from Bangladesh. Interestingly, only around 58,000 medical visas were issued to Bangladeshi nationals then, the survey reveals. Bangladesh then covered over 35% of the foreign patients and more than 50% of the total revenue from medical tourism, making it the largest contributor to medical and health tourism of India. Ahoy Bangladesh Limited, a medical value travel company based in India, informed that they receive 300 to 400 patients applying for Indian medical visas a month. Tata Memorial Hospital, Christian Medical College and Hospital, Apollo Hospitals, Indigo Women’s Center, Asian Heart Institute, Gleneagles Global Hospitals, Rabindranath Tagore International Institute Of Cardiac Sciences and Max Super Specialty Hospital are among the most preferred hospitals of Bangladeshi patients. A patient who has visited doctors in India or Thailand will never be satisfied with our local medical treatment, said Dr Hamid, adding that the little time local doctors spend on patients is contributing to the dissatisfaction. Some 63,000 patients went to Thailand in 2015, he further said. Dr Nilanjon Sen, managing director of Life and Health, a project affiliated with Bangkok Hospital Medical Centre, said around 400 patients go to Thailand every month. Other than Bangkok Hospital, a number of Bangladeshis chose Bumrungrad International Hospital and Samitivej Hospital among other medical centres in Thailand, he continued. Middle-income people plan for India, the higher middle class go to Thailand, and the rich prefer Singapore, he observed. Availability of affordable transportation, accommodation and halal food is the key to Bangladeshis flocking to Thailand, he said. Masfiqur Rahman Amit, area manager of Bangladesh office for Parkway Hospitals Singapore Pte Ltd, said they, on an average, have 25 patients a month. Mostafizur Rahman, managing director of Mediconsult Ltd, said: “A number of Bangladeshis have their medical check-ups done abroad even on a vacation.” Dr Hamid said: “Our laboratories lack efficient technicians and thus people lose their faith in domestic pathology reports.” “We have seen many cases of people being treated in a wrong manner, following flawed diagnosis reports, which has tarnished the image of local doctors,” he said. This lack of confidence is especially prevalent in terms of surgery, he said. Public health expert Dr Zafrullah Chowdhury attributed the growing trend of people thronging abroad for treatment to the absence of the government’s policy in this regard. Mentioning the cases of the president, the prime minister and opposition party leader, among others, receiving treatment abroad, he said: “If our political leaders continue in this manner, ordinary people are encouraged to do the same.”A recent estimate of Bangladesh Investment Development Authority, which was prepared using the data of Health Bulletin 2012, says Bangladeshis spend $2.04 billion annually on healthcare abroad. The amount is 1.94% of the country’s total GDP. Dr Sen said the treatment cost in Bangladesh is half one of that of India and one-third to one-tenth of the amount in Thailand and Singapore. “Considering the cost of critical surgeries, many find the overall hospital bills abroad similar to those estimated in local private clinics. Hence, numerous people prefer not to get treated at local hospitals,” he said. Dr Shagufa Anwar, chief of communication and business development of United Hospital, said it is not unusual that a certain number of people will prefer overseas treatment. But a change in mindset is key to increasing people’s confidence in local treatment, she said. She also said the practice of making doctors accountable in case of wrong treatment in Bangladesh was extremely important. Dr Hamid warned that Bangladesh is incurring losses in its health economy, gradually posing a great threat to the national economy. “In the case of referrals it is fine, or else there is no need to go abroad when we can cater to our patients with international standards treatment at home,” he said. “Millions of dollars are funneled abroad every year. If we fail to stop it right now, our entire medical service system and foreign currency reserve will collapse,” he feared. He recommended that the policymakers rethink this issue and work on its root cause to help restore the reputation of the health sector in Bangladesh.