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 Medical Challenges in Health Tourism

• DR. LEE MOON KEEN
• Consultant Neurologist
• Director, Alpha Specialist Centre
• Petaling Jaya, MALAYSIA

MALAYSIA MEDICAL TOURISM HEALTHCARE 29-30
March 2010, Kuala Lumpur, Malaysia
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Synopsis

• 1. The patient is not a tourist
• 2. Obtaining medical history - information gaps
• 3. Social history - a Black Hole
• 4. Time constraints and long term follow up
• 5. Cultural issues
• 6. Medicolegal implications

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The patient is not a tourist

• Co-ordinating the travel arrangements
• Expectations from medical treatment
• Needs / priorities of travel companions

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Obtaining medical history Information gaps

• Language - lost in translation
• Incomplete recall by patient
• Lack of background reports
• Non-disclosure - insurance considerations, etc.

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Social history - a Black Hole

• Catching the patient at one point in time
• Lack of prior rapport
• Cultural hurdles in understanding 

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Time constraints and long term follow up

• A consultation cant be rushed
• Medical tests need processing time
• Specialised investigations need pre-arrangement
• Patients need time to consider treatment options
  
• Recuperation after treatment
• Follow up review

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Cultural issues (1)Cultural sensitization

• Soft-skills training
• social and customer handling skills
• cultural sensitization of staff to other cultures
• Globalization
• much touted but less prevalent than it seems

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Cultural issues (2)Culturo-Religious Taboos and
Flashpoints

• Religious beliefs
• Belief systems in relation to ill-health -
  concepts of health and illness causation
• Fatalism
• Norms of modesty
• Cultural sensitivities
• Attitude of respect
• Forms of address 
• Taboo behaviours
• Patients interaction with Doctor
• Deference to authority figure
• Avoidance of confrontation

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Cultural issues (3)Impact on Treatment and
Hospitality

• Food
• Proscribed by religion
• Dietary preferences
• Medication 
• Proscribed by religion 
• Socially unacceptable 
• Belief systems
• Interference by home / homeopathic remedies

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Meshing with Alternative / Native Healing Systems
Unconventional healing practices taxonomy with
examples
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Winner of the National Book Critics Circle Award
for Nonfiction When three-month-old Lia Lee
arrived at the county hospital emergency room in
Merced, California, a chain of events was set in
motion from which neither she nor her parents nor
her doctors would ever recover. Lia's parents,
Foua and Nao Kao, were part of a large Hmong
community in Merced, refugees from the CIA-run
"Quiet War" in Laos. The Hmong, traditionally a
close-knit and fiercely people, have been less
amenable to assimilation than most immigrants,
adhering steadfastly to the rituals and beliefs
of their ancestors. Lia's pediatricians, Neil
Ernst and his wife, Peggy Philip, cleaved just as
strongly to another tradition that of Western
medicine. When Lia Lee Entered the American
medical system, diagnosed as an epileptic, her
story became a tragic case history of cultural
miscommunication. Parents and doctors both
wanted the best for Lia, but their ideas about
the causes of her illness and its treatment could
hardly have been more different. The Hmong see
illness and healing as spiritual matters linked
to virtually everything in the universe, while
medical community marks a division between body
and soul, and concerns itself almost exclusively
with the former. Lia's doctors ascribed her
seizures to the misfiring of her cerebral
neurons her parents called her illness, qaug dab
peg -- the spirit catches you and you fall
down--and ascribed it to the wandering of her
soul. The doctors prescribed anti-convulsants
her parents preferred animal sacrifices.

• Anne Fadiman (1997) The Spirit Catches You and
  You Fall Down
• A Hmong Child, Her American Doctors, and the
  Collision of Two Cultures

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Medicolegal implications

• Trans-national medico-legal statutes
• Indemnity coverage for doctor and hospital across
  borders
• Judicial rulings in different countries / regions
  
• Patient awareness of legal rights

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Factors impacting on Clinical Outcome and Patient
Satisfaction

• Work flow
• Culture-sensitive staff
• A Happy experience in the host country

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Conclusion

• Medical Tourism is not the same as Healthcare As
  Usual
• --- applied to a tourist