MEDICAL TOURISM: How Ugandan Medics Bag fat commissions for Shady Referrals abroad

By Richard Kintu

The surge in the incidence of non-communicable diseases as well as new infections has made health care a very dynamic aspect that necessitates constantly medical technological changes. Unfortunately, many African countries find themselves handicapped in the technological direction thus the need for parents to look elsewhere for such highly specialized treatment. This explains the growth of the medical tourism industry globally.  According to the Medical Tourism Association website, medical tourism is where people who live in one country travel to another country to receive medical, dental and surgical care. The association states that patients opt for medical tourism because of the high quality of healthcare, affordability, access of care or better availability. “At the same time they receive equal to or greater care than they would have in their own country,” the association adds.

In Uganda, medical tourism is equally a growing trend, with many patients— regardless of social status — considering treatment abroad as the only life-saving alternative.

The wealthy foot their expenses abroad while the poor resort to fundraising drives like car washes among others to afford the cost of treatment abroad.

Why medical tourism frenzy?

Speaking on condition of anonymity due to ethical requirements, a medic who has been part of the medical tourism dynamics in Uganda says that while some doctors do genuine referrals after exhausting all possible treatment regiments here in vain, there are patients who instigate these medical referrals. Many times they are driven by mistrust of the local health systems and the doctors while at times it is due to utter desperation for a cure,” the medic says. He adds: “The modern medical advancements and possibilities cause ordinary people to believe that ‘everything’ is possible; some almost forget human beings are mortal. And therefore, when faced with a life threatening condition, they want to try every ray of hope just like a drowning man will clutch at a straw. That’s why they believe going abroad can cause the much-needed cure,” he says. In his book titled Being Mortal, Dr. Atul Gawande cites a patient who told doctors “Don’t give up on me; you give me every change I’ve got.” As such the doctors had no option but to perform an operation which they knew didn’t stand any chance of giving him the benefit he hoped for. Dr. Atul states, “He was pursuing little more than fantasy at the risk of a prolonged and terrible death and though the operation was a technical success, it never really touched on the reality of his disease.” As a doctor involved in this operation, Atul admits that he feels that if this patient was pursuing a delusion, so were they as doctors involved. They had seen him through months of treatments for a problem they knew could not be cured but in the face of his determination to live on no matter what, they never got the courage to be honest with him about their capabilities and the choice before him. As a result he took a choice which they all knew was not the best for him.

Misdiagnosis to blame

In his soul-touching Facebook series titled ‘My death defying fight against a colon tumor’; Colon Cancer survivor Isaiah Jobs Rwanyekiro testifies on how a wrong diagnosis by Ugandan doctors nearly cost him his life. He writes thus: “Before my condition was finally pin pointed I had visited several respectable medical practitioners in Kampala. One told me I had a bacterial infection, another said I had helicobacter and another said I had inflammatory bowel syndrome. Inflammatory bowel syndrome is basically a term that generally describes having troublesome stool movement and painful lower abdomen. This misdiagnosis went on for almost two years even when I consistently had lower abdominal pain on and off… So be to honest I realized that most of our doctors here were operating with limited knowledge when it came to diagnosing or understanding early symptoms of colon tumor.

And in part 2 of his series, Isaiah highlights the case of a one Charles Musekura who had to undergo three surgical procedures to correct a misdiagnosis and mistreatment that had been accorded him by local doctors. “…For the record, (Maseruka) has undergone eight surgeries on account of mistakes made by Ugandan doctors. His first surgery was done in Kampala but it was not well done and even worsened his situation. The worst part was that the doctors who worked on him here refused to disclose to him that his surgery was for a cancerous colon tumor. He got to learn this when out of frustration his friends in Australia arranged for him to travel there for specialist treatment. Subsequently he travelled to Australia where he was to do a record seven more surgeries over a course of two years and the first three were to correct mistakes that had originally been made here,” Rwanyekiro writes.

The deals

Like every lucrative business, medical tourism has also been infiltrated by a cabal of conmen. These enable unnecessary referrals which then form the basis of hefty commissions that are shared between the fixers abroad and collaborating doctors here. Under normal circumstances however, the right referrals are channeled through a Medical Tourism Facilitator who works formally with a hospital. An according to the medical tourism association, a medical tourism facilitator is an independent company that helps coordinate a patient’s trip to another country for medical care.

Our source who was contacted for recruitment into the fake referrals ring noted thus: “Just as it is for pharmaceutical companies who give doctors incentives to prescribe particular brands of medicines, so it is by some medical tourism destination hospitals. They promise all types of incentives to the referring doctor or hospital and these range from sharing the proceeds of the medical bill to sponsored trips to a destination of choice,” he says.

“It all starts with a call from a strange international number. The caller introduces him/herself and the prestigious hospital (commonly Indian). This is followed by quick profile of the Hospital as regards the kind of successful operations and medical advances it has pioneered. Next is a quick question about you and your practice and inquiry about your willingness to partner with them by referring all ‘complicated’ cases to the mentioned hospital- with a quick addition of the percentage commission that will come your way and an array of many other benefits that come with the partnership. If you are not the type that subscribe strongly to your values and ethics, you may be compromised. Follow up calls will be coming in nearly on a monthly basis. If you don’t give in, they will give up. But soon or later, you will get another call or an e-mail in the same regard.”

India success story

The Joint Commission International (JCI) which is an international hospital accreditation body, lists countries such as Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey and United States as the world’s top medical tourism destinations.

For many Ugandans, however, India is the preferred destination.

Muhereza Kyamutetera, one of the Ugandans heavily engaged in medical tourism in the country says Ugandans flock to India simply because of its cheap costs compared to other countries.

A 2009 report by the UK’s Daily mail revealed that India deliberately stepped up efforts to grow the country’s medical tourism sector. As part of the strategy, India’s tourism ministry went in talks with the country’s major hospitals to offer medical tourists deals as part of a ‘Visit India’ campaign. The Indian government hoped to boost the numbers of foreign tourists including Britons following the economic downturn and the Mumbai terror attacks of 2008. Airlines, tour operators and hotels were also asked to offer bargains including free travel for spouses or an extra night’s stay at hotels as part of the campaign. Consequently, the Tourism Ministry held discussions with leading hospitals like Wockhardt, Apollo, Lakeshore, Moolchand, Manipal and Sevenhills, the Times of India reported.

Statistics show that over 150,000 medical tourists travelled to India in 2002 but following the 2009 campaign, the number of travelers has been increasing by at least 25% every year since then. For instance, in 2014, the Indian Tourism Ministry reported that the number of foreign tourist arrivals for medical treatment in India rose from 184,298 in 2014 to 361,060 in 2016; representing a steep rise by 45% in the number of Indian medical visas issued in 2016.

Projections however show that the country’s medical tourism sector will grow to $7-8 billion by 2020.

Conversely, data from our Health Ministry shows that Uganda loses more than Shs200bn (about USD 70m) through medical tourism. Incidentally, figures show that most of this money is spent on treatment in India to treat disease like heart defects and leukemia. It is on the basis of this realization that government upgraded Mulago hospital and most recently, mooted the construction of an international super specialized hospital at Lubowa. President Museveni revealed that once completed, the hospital will make Uganda a regional medical tourism hub while at the same time save the dollars the country loses to treat Ugandans abroad.

Kyamutetera argues that as government builds capacity, India may for now still be the run-to country for medical tourism. His argument is supported by a Planning Commission Report which reveals that India provides the cheapest specialized treatment world over. For instance, a heart bypass surgery costing £5,300 in Thailand, £7,000 in Singapore, £16,000 in the US and £13,200 in the UK, would cost only £4,000 in India.

Prashant Kumar Naik, manager of international patients’ services at Apollo Hospital, told the Press Association: “The cost of treatment for surgeries in the US and the UK is very high. In some cases, India offers the same for one tenth or one eighth the total price.

“We have many patients coming here. As a destination, Bangalore provides an all-round experience since the climate suits all nationalities. As far as connectivity is concerned, we now have direct flights to the US and the UK.

“For countries in Africa, the medical infrastructure is not so good and they have to go abroad. India costs less than other countries, so people come here. Though there are no direct flights between Bangalore and any African nation, they can come via Dubai, which is not too much trouble.”

Cutting out the crooks

And while Kyamutetera admits that the medical tourism industry may be infiltrated by conmen, he says the success stories from it outweigh the few cases of disappointment.

The truth is that the quality of our healthcare and diagnostics is still low yet you cannot have the right treatment. I for instance know of a person who left with a kidney diagnosis here and end up with a heart diagnosis and operation in India,” Kyamutetera says., he believes that such cases of misdiagnosis may at times blame the medics of connivance with local doctors the moment they get different diagnoses in India.

The Indian hospitals are internationally accredited and operate at a very high level. That’s why you see the moment you reach there they can use your local diagnosis as a guide but they check you fully afresh and many times they come up with differing diagnosis,” he says.

He also defends the attempts by Indian medics to contact and seek collaborations in Uganda, saying many hospitals that offer medical tourism services are for-profit entities that must market their services to maximize their revenues and profits.

He thus urges government to get heavily involved and play a regulatory, guidance and linkage role.

“Many times the few conmen can explain the information gap in the system. But if government out of bilateral relations arrangement came out and profiled the right hospitals for Ugandans then we shall have no problems really. You should however accept that conmen can infiltrate any righteous systems; even in Mulago conmen keep being arrested from the corridors where they operate from,” he says.