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MedicalTourism in

The fast growing opportunity

By Aditya VijCEO, Fortis Healthcare Limited

The medical tourism business in India is amongst the fastest-growing market segments, estimated to grow at a compound

annual growth rate (CAGR) of 15.2 percent and expected to touch $2 billion by 2015. More than 1.5 lakh patients travel to India each year with a sizeable number coming from central and West Asia. The industry has an enormous potential for future growth. India is not just attracting patients from across the globe needing specialised surgeries but also from people looking for post-surgical recovery packages in the form health spas and wellness centres. India offers a huge patient pool, favorable regulatory environment and cost advantage for conducting clinical trials.

The low cost of medical services has resulted in a rise in the country’s medical tourism, attracting patients from across

the world. Over the last two decades, the economic boom in India has led to the building of medical facilities & infrastructure that rival the very best that western medical care has to offer. Many of the physicians that practice in these hospitals and clinics have returned to India from the U.S. and Europe, leaving behind successful practices resulting in having an influx of skilled physicians and nurse practitioners here. Medical tourists choose India as their favorable destination because India is the only mainstream option that offers a comprehensive solution for any and all medical needs, with the highest levels of

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Omani youth with rare ‘Brugada Syndrome’ treated in India at the Fortis Escorts Heart Institute. Device allows Doctors to monitor from India while he is in Oman.

service, facilities, and professional skills. The cost of some major surgical procedures in India is estimated to be 1/3rd to 1/10th of that in the United States or Western Europe. A heart-valve replacement that would cost $200,000 or more in the US, for example, costs around $10,000 at our hospital in India. India offers a unique high quality affordable healthcare proposition which is unmatched in the region. Indian hospital undertake complex cardiac procedures, orthopedic surgeries like joint replacements, complex neurosurgical procedures including spine surgery and gastro intestinal procedures in higher numbers.

Transplants for heart, liver and kidney are also performed with high success rates in India. Realizing the rich potential of Medical tourism, the Indian government has created medical Visa facilities for medical tourists as well as extended the Marketing Development Assistance (MDA) to accredited hospitals, under which financial support to approved medical and wellness tourism centers will be given for participation in approved Medical/tourism fairs, medical conferences, wellness conferences, wellness fairs

and its allied road shows. However, with nearly 80 per cent of spending on healthcare in the private sector, the private and public hospitals need to synergize their efforts to further promote India as the Healthcare destination worldwide. The Healthcare Industry will also have to focus on standardizing their processes and make its functioning more transparent and accountable.

Case StudyPM of Mauritius, Dr Navinchandra Ramgoolam with Dr. Aparna Jaswal

Dr. Aparna JaswalSenior Consultant Cardiologist and ElectrophysiologistFortis Escorts Heart Institute , New Delhi, India Holding 15 years of outstanding experience, Dr. Aparna Jaswal is a Senior Consultant Cardiologist at Fortis and Electrophysiologist Escort Heart Institute in Delhi. She was the first Indian resident cardiologist to have been certified by the IBHRE, USA as a Certified Cardiac Device Specialist and graduated as a Fellow of Heart Rhythm Society, USA. She holds an MBBS (Gold Medalist), MD (Medicine) and DNB Cardiology (Gold Medalist).

Having such an illustrious career supported by medical certifications from India and the US, Dr. Aparna Jaswal got her registeration to work in Fortis Clinique Darne, Mauritius. She is registered with the Medical Council of Mauritius since 2010 and to her credit has performed over 75 procedures successfully in the island of Mauritius. She has performed successful cardiac implants on many patients in India and abroad who have given testimonials for her accomplishments. She further got trained in Milwaukee, U.S.A , after her Cardiology training , to better her skills.

Abdulmajeed Ali al Siyabi is a 20-year-old Omani student from the Ibra College of Technology. He was detected with Brugada Syndrome (BS), a rare genetic disorder. He was taken to India for treatment and implanted with a device that allows doctors to monitor him from India while he is in Oman.

Dr Aparna Jaswal, senior consultant electrophysiologist at Fortis Escorts Heart Institute, New Delhi, who carried out the surgery said, “BS can be a cause of sudden cardiac death (SCD). It is a lethal disorder, especially among the youth.”

An implantable cardioverter defibrillator (ICD) was used to save Abdulmajeed.

“The device has been implanted under the collar bone. The challenge is to ensure that the device functions normally and there are no abnormal heart rhythms. We call such patients every three to four months. We have given him a Medtronic CareLink Monitor, which helps him check his heart beats and enables me to monitor his condition from Delhi while he is in Oman.”

Dr Aparna said that when the patient holds the antenna of the monitor over the implanted device, data is transferred from the implanted device to the monitor and sent to a secure server

via a standard telephone line/cellular network. We then review the patient’s data using the Medtronic CareLink Clinician website.”

Ali al Siyabi, the patient’s father, said, “My son’s problem began when he was ten years old. One day he fainted in school. We took him to a doctor who said that it was due to weakness from skipping breakfast. However, such occurrences kept increasing with age. It was only after one such episode in 2013 that we consulted experts

in Muscat who said that he was suffering from recurrent syncope and extreme care must be taken.”

Ali said that after consulting friends and experts, he

decided to take his son to India, where doctors diagnosed him with BS.

“Dr Aparna told us that the only treatment available for my son is

to insert an ICD, and we decided to go ahead with

the procedure. She said that this is the latest technology,

where a home monitor device sends data through wireless to

the doctors for evaluation. The surgery was conducted earlier this month.

ICD has a battery life of five to nine years and so the patient does not have to be taken to India for check-ups, unless an emergency arises. Abdulmajeed is no more under medication.

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Fortis Escorts Heart Institute, formerly known as Escorts Heart Institute and Research Centre, is a pioneer in the field of fully dedicated cardiac care in India. It is the largest free standing private cardiac hospital in Asia Pacific region, and a part of Fortis Healthcare which is the fastest growing hospital network in India. Fortis Healthcare, led by the vision of late Dr. Parvinder Singh of creating an integrated healthcare delivery system in India acquired Escorts Heart Institute and Research Centre Ltd. in 2005. Established in 1988, Escorts celebrated 25 years of Cardiac excellence in 2013.

Fortis Escorts Heart Institute (FEHI) has set benchmarks in cardiac care with path breaking work over the past 25 years. Today, it is recognised world over as a centre of excellence providing the latest technology in Cardiac Bypass Surgery, Interventional Cardiology, Non-invasive Cardiology, Paediatric Cardiology and Paediatric Cardiac Surgery and Department of Cardiac Pacing and Electrophysiology. The Department of Electrophysiology has some of the world’s best trained doctors and are pioneers in Electrophysiology in India for most procedures. The Department boasts of a dedicated Electrophysiology laboratory with cutting edge technology and state of the art laboratory. FEHI is proud to be doing the maximum number of complex electrophysiological procedures in a cardiology set up in India.

The hospital is backed by the most advanced laboratories performing complete range of investigative tests in the field of Nuclear Medicine, Radiology, Biochemistry, Haematology, Transfusion Medicine and Microbiology.

Fortis Escorts Heart Institute has a vast pool of talented and experienced team of doctors, who are further supported by a team of highly qualified, experienced & dedicated support staff & cutting edge technology like the recently installed Dual CT Scan. Currently, more than 200 cardiac doctors and 1600 employees work together to manage over 14,500 admissions and 7,200

emergency cases in a year. The hospital today has an infrastructure comprising of around 285 beds (it currently enjoys 100% occupancy rate), 5 Cath Labs besides a host of other world-class facilities.

The hospital also performed India’s first Trans Catheter Aortic Valve Implantation (TAVI) and Bioresorable Vascular Scaffold (BVS); Asia Pacific’s first Directional Atherectomy, Angioscopy, Drug Eluting Stenting, etc. Over the years, FEHI has cloned a Heart Care Network of 19 hospitals and Heart Command Centres in India and abroad. It has also launched the revolutionary e-ICU programme, enabling remote and timely access to critical care. Fortis Escorts Heart Institute has won numerous awards and accolades, the most recent among them being the ‘Best Cardiology Hospital’ at the ICICI Lombard & CNBC TV18 India Healthcare Awards for 2012 and 2013.

Before planning a vacation people should undergo pre-trip physical examination and a physician’s letter documenting the diagnosis and listing all required medications. They should also take into consideration competent medical personnel and facilities available at the destination they choose. People should carry a complete set of medical records with them -- two copies of medical reports, prescription records and insurance information; one in your luggage, and one to carry with you at all times. For those with pacemakers, always carry your pacemaker emergency card that outlines the type of equipment and date of implantation.

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People on vacations tend to indulge in unhealthy diet including cookies, crackers and chips which even labeled as “reduced fat” are made with oils containing trans-fats. So, these snacks should be completely avoided and replaced with vegetables and fruits which are good sources of vitamins and minerals and are low in calories and rich in dietary fiber. Fatty and processed meats, salty foods, and rich, creamy sauces and pastries that are probably high in saturated fat should be avoided.

Patients with a history or risk of heart disease should wear below-the-knee compression stockings if traveling on a flight of more than eight hours or further than 3,100 miles. This is especially important for travelers over age 50 and anyone with blood clot risk factors.

Avoid alcohol and keep yourself well hydrated to avoid blood clots. Drink plenty of water.

In-flight symptoms such as breathlessness, chest pain or confusion may signal that a person has dropping oxygen levels. In such cases, passengers with heart disease should ask the crew for additional oxygen.

Avoid extremely hot or cold destinations and high altitudes as it poses risks for heart patients.

Carry contact numbers and website addresses of pacemaker and ICD manufacturers and local representatives of the destination you are travelling.

If someone has had a heart attack and is not used to exercising, they should avoid a trek through the mountains.

Wear heart rate monitor to measure both heart rate and to understand the stress the body is under at any given time.

How To Take Care Of Your Heart While On Travel People with cardiovascular disease can also enjoy the pleasure of travelling as it’s completely safe for them, provided they stay within prescribed areas of activity, rest, medication and diet. Given below are some standard preparations as advised by Dr. Aparna Jaswal, Senior Consultant Cardiologist at Fortis and Electrophysiologist Escort Heart Institute in Delhi that must be kept in mind for anyone with chronic medical conditions.

If you are prepared with adequate knowledge relating to your condition and keep a few safety tips in mind then you can really make your vacations an unforgettable and pleasurable experience.

Fortis Escorts Heart Institutesetting new benchmarks in cardiologyBy Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute