Vol.4 | Issue No.1 | Jul - Sep 2019
AVAILABLE IN PLENTY, BUT SCARCE FOR USE GO EARLY FOR
RENAL TRANSPLANTATION INDIA GOES UP IN
WORLD TOURISM RANKING
STRESS AND ANXIETY
MAY NOT BE AS HARMFUL AS YOU THOUGHT
A Complete Magazine on Healthcare in Asia
Medical Tourism Jul - Sep 2019
A Complete Magazine on Healthcare in Asia
LIVES LOST TO IGNORANCE Vol. 4 | Issue No. 1 |Jul - Sep 2019
An estimated half-a-million persons die every year in the country due to nonavailability of organs. Despite several official programmes to create awareness about organ donation among the people, the response has been at best lukewarm.
RNI No. KERBIL/2016/68979 Editor & Publisher BENNY THOMAS Group Editor C GOURIDASAN NAIR
About 1 lakh people die of liver diseases in India every year and only 1,000 are fortunate to have a liver transplant. A cadaver or deceased donor can save up to 9 lives but, despite this, organ donation is a neglected area in the country. Lack of knowledge, awareness and infrastructure are some of the reasons for the low level of organ donation in India.
Executive Editor* BYJU ARYAD Editorial Co-ordinator NINU SUSAN ABRAHAM Marketing & Promotion SUNIL NAIR (VICE PRESIDENT) SHIVAKUMAR VISWANATHAN (VP - GLOBAL) TIJO JOHNY (SENIOR EXECUTIVE)
There is a wide gap between the number of patients who need transplants and the organs that are available in India. An estimated 1.8 lakh persons suffer from renal failure every year, but the number of renal transplants done is only around 6000.
Layout & Design LAL JOSEPH
There is lack of awareness among the medical professionals too on issues relating to brain death. In 1994, the Government of India initiated a process to revamp legal framework for organ donation and, consequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted.
Legal Advisor Adv. BIJU HARIHARAN Arabic Translation Dr. A. ABOOBACKER BUSINESS ASSOCIATES Overseas USA : CHICAGO: Vincent Joseph Mob: 847 299 9954 USA : HOUSTON: Shaju Joseph Mob: 847 899 2232 USA : NEW YORK Vincent Sebastian Mob: 917 992 9629 USA : CALIFORNIA: Wilson Nechikat, Ph: 408 903 8997 Canada : Jose Sebastian, Ph: 416 - 509 – 6265 UK : Dileep Mathew, Ph: 044 787 743 2378 Switzerland : Dr. George Sebastian, Ph: 527204780 Ireland : Thomas Mathew Mob: 00353 87 123 6584 Middle East : Anil Nath, Ph: 506854500 Singapore : Mahesh A, Ph: +65 906 22828 Germany : Gayatri Puranik Ph: 0049 179 127 5002 Austria : Monichan Kalapurackal Ph: 0043 6991 9249829 Korea : Dr. A. Thomas, Ph: 0082 10 5822 5820 Australia : S. Mathew, Ph: 61247026086 Oman
Ignorance about the crucial importance of organ donation is vast and deep in Indian population. World Health Organisation (WHO) estimates that about 14.5 organs are transplanted every hour in the world. In 2016, there were 28,258 deceased organ donors in the world, contributing to 68.8% of the kidney transplants, 89.4% of liver transplants and all the heart, lung and pancreas transplants.
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BUSINESS ASSOCIATES India Mumbai : Mohan Iyer, Mob: +91 22 6450 5111 Eastern India : Sanjay D. Narwani, Mob: +91 983 120 7202 Hyderabad : Ephram Joseph, Mob: +91 939 131 5072 Bangalore : Shivakumar Vishwanathan, Mob: +91 829 618 0856 Tamil Nadu : Gurumurthy, Mob: +91 989 460 4804 Puducherry : K. Ramasubramanian, +91 989 497 7161 Trivandrum : Kuriyan K. Raju, Mob: +91 944 610 6644
Various innovations too have been introduced to minimise morbidity associated with organ donations. These include laparoscopic approach for left lateral segmentectomy and laparoscopic mobilisation of right lobes for hybrid laparoscopic and midline donor hepatectomies. These also include total robotic and robot assisted donor operations. All these innovations have helped in achieving better scar, lesser pain, low morbidity, and early discharge for the donors. Social attitude towards organ donation must change. There have been several instances of even persons declared brain dead being treated for days, wasting huge amounts of money. The cover story in this issue is about ‘Organ Transplantation’, which takes a look at the reasons for the low rate of organ donation, the legal frame work, attitude of the people, lack of awareness and poor rate of Brain Stem Death Certification by hospitals. Information regarding liver and kidney transplantations, knee replacement surgery are also included. In several countries, MICE (Meetings, Incentives, Conferences, and Exhibitions), the tourism segment has grown by around 20% year on year in recent times. MICE tourism is a niche segment in the tourism market, which has abundant potential and is gaining significance worldwide due to the growth of business tourism. This has also been given importance in this special issue. Medical Tourism magazine is the Official Magazine of Oman Health Exhibition and Conference since 2016. We wish you a happy reading. C Gouridasan Nair Group Editor
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Medical Tourism Jul - Sep 2019
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Disclaimer: The statements in this magazine have not been evaluated by the Food and Drug Administratin of USA or any other country. Information provided in this magazine are not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, consult your physician. All information is provided for research and education purpose only.
A Complete Magazine on Healthcare in Asia
08 Organs: Available in plenty,
but scarce for use
Go Early for Renal Transplantation
Challenges and innovations mark Liver Transplantation Watch Your Back! Get your disc prolapse diagnosed and treated early
20 Immunotherapy: A New
36 Mirror, mirror on the wallâ€Ś
Develop a happy mind for a shapely body
38 Stress and anxiety may not be
as harmful as you thought
40 Eat more plant- based food,
Weapon Against Cancer
22 AI revolutionises healthcare
improve heart health
24 Penile Prosthesis answer for
28 Healthcare? India! People of
Oman look towards India for quality healthcare at reasonable costs
42 News 51
60 Hospitals & Wellness Centers 30 MICE- a big boost for tourism
Medical Tourism Jul - Sep 2019
India Goes up in World Tourism Ranking CHENNAI A preferred city for Medical Value Travel
Stemcell Knee Cartilage Regeneration Revolutionary Technology To Fight Knee Arthritis Arthritis affects millions worldwide and 100 million people in India. Knee arthritis is very common and especially among the elderly. While knee replacement surgery is the gold standard treatment, TOSH Hospital offers an alternative, Stemcell Knee Cartilage Regeneration for knee arthritis. Knee cartilage regeneration is an emerging technique to treat knee arthritis and help preserve the natural knee joint. The single stage key-hole (Arthroscopy) procedure is done by harvesting stem cells from the patient’s bone marrow in the pelvic bone and injecting it into their knee joint. The worn-out knee cartilage causing discomfort and pain is first removed by a key-hole procedure. The stem cell mixed with clotting gel is injected into the knee joint. These stem cells help in the growth of new cartilage. The surgery takes about an hour and a half and the patient remains in the hospital less than 48 hours totally. Spinal anaesthesia is given to make both legs numb waist down, and the patient remains awake throughout the procedure. In rare cases, general anaesthesia is given. TOSH is at the forefront of introducing single stage stem cell knee procedures, and the highly proficient team has performed over 350 successful surgeries. As awareness of regenerative therapies increases, the number of patients undergoing knee cartilage regeneration is on the rise. This treatment will substitute at least 50% knee replacement surgeries globally in a decade. It can be performed at any age and a gap of 2-3 months needed between surgeries, for the other knee. While knee replacement surgeries require a revision surgery after 15-20 years and pose high risk of infection and other complications since a foreign material is implanted into the body, the major advantage of stem cell knee cartilage treatment is that it is a natural way to preserve one’s knee and avoids any artificial implant in the body. The minimally invasive procedure is not painful as there is no cutting of bone or muscle. The day care procedure ensures the patient moves the joint fully and allowed partial weight bearing walking on the operational leg on the same day. Mild pain relieving tablets are prescribed for 5 days. The sutures can be removed after 12 days. As the new cartilage forms, pain disappears. Post 6 weeks, the patient can get back to a normal lifestyle. Post-operative physiotherapy is not required and patients can do the advised exercises on their own. The success rate depends on the patient’s condition, age and level of knee damage. Even advanced cases are handled through this procedure after assessment of X-rays. For curved knees, a small alignment correction procedure is additionally needed.
Dr. S.H. Jaheer Hussain MBBS, M S Orth, M.Ch. Orth (UK) Joint Preservation & Reconstruction Surgeon
ADVANTAGES Day Care procedure Retain one’s own natural knee Safer alternative to total knee replacement No metal implants No restrictions of joint movements unlike knee replacement Squatting, jogging and sports activity allowed gradually
TESTIMONIALS “My wife Mrs. Azza Al Harthi has undergone this procedure for the left knee six months back. I was really apprehensive about the procedure and was wondering if it was actually possible. Now she is happy with the results and planning for other knee. I hope that more people are made aware about knee cartilage regeneration so they can benefit from the minimally invasive procedure that doesn’t use any artificial implants.”
“ Everybody wants to be mobile and enjoy free movement. Dr. Jaheer truly gives a boon for all patients suffering from unbearable knee pain. This revolutionary treatment helps preserve our own knee and offers so much relief. I hope that more people are made aware about Knee Cartilage Regeneration so they can also benefit from the minimally invasive procedure that doesn’t use any artificial implants. “
Mr. Mohammed Naseer Ammar Al Harthi Muscat, Oman
For more details contact
TOSH (Trauma & Orthopaedic Speciality Hospital) #72, Ormes Road, Kilpauk, Chennai
+91-44 4903 4903 | +91 989 446 7903 | Email : email@example.com | http://toshhospitals.com A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM COVER STORY
ORGANS AVAILABLE IN PLENTY, BUT SCARCE FOR USE
Deep-seated prejudices are hampering organ transplants in India Byju Aryad
There must be programmes to raise peopleâ€™s awareness about organ donation. This will dispel fear and inhibitions of the people at large. Modern technology, combined with medical expertise, has made organ donation painless, less morbidity prone and cosmetic with minimal hospital stay and early return to normal activity. 8
Medical Tourism Jul - Sep 2019
n a country as vast as India, human lives can hardly be lost due to the non-availability of organs. There is enough to be harvested for the greater common good but, unfortunately, ignorance about the crucial importance of organ donation is as vast and deep as the nation’s population. Even among the urbanites, the value of organ donation has not percolated sufficiently, with the result that most avoidable deaths happen in metros, cities and towns despite the presence of sufficient infrastructure for organ transplant. World Health Organisation (WHO) estimates that about 14.5 organs are transplanted every hour in the world. In 2016, there were 28,258 deceased organ donors in the world, contributing to 68.8% of the kidney transplants, 89.4% of liver transplants and all the heart, lung and pancreas transplants. However, in India, organ donation has remained at a low ebb despite several official programmes being launched to rev them up. An estimated half-a-million persons die every year in the country due to non-availability of organ. The list of those awaiting kidney transplant is long, estimated at 2.2 lakh. Of them, only about 15,000 stand the chance of getting a kidney to live on.
LOW TRANSPLANT RATES About 1 lakh people die of liver diseases in India every year and only 1,000 are fortunate to have a liver transplant. A cadaver or deceased donor can save up to 9 lives but, despite this, organ donation is a neglected area. Lack of knowledge, awareness, infrastructure are some of the reasons behind shortage of organ donation in India. Majority of transplant programmes depend on living donors. It is believed that India's organ deficiency is mainly due to the fact that families still do not consider organ donation as societal obligation owing to
various misconceptions or ignorance, although organ donations are legal by Indian law. The need for organ transplants in India is greater than ever. The fact that the rate of organ donation in India is only 0.26% per million persons can be attributed to the fact that not enough people are aware about the number of lives that each person has an opportunity to save. Organ transplantation is the process of using the healthy organs of an individual for the purpose of transplantation into another person’s body. For this, individuals must consent to donate their organs. Organ donations are of two types - living donations and cadaver deceased donations. Dr. Mathew Jacob, Consultant in Integrated Liver Care at Kochi’s premier hospital Aster Medcity, says that if organs of deceased persons become available in larger numbers, it would be possible to reduce live donations. Further, it is also not possible to have live organ donation of heart, lung and pancreas. An estimated 2 lakh patients die of liver failure or liver cancer annually in India, about 10- 15% of which can be saved with a timely liver transplant says Dr Sylesh Aikot, Chief of Gastrointestinal Surgery, Baby Memorial Hospital, Kozhikode. There is a wide gap between patients who need transplants and the organs
that are available in India. An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only, Dr Sylesh Aikot said. An estimated 2 lakh patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant. Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed. So going by the statistics, there is an urgent need to raise awareness among the public, he said.
“SOCIAL ATTITUDES MUST CHANGE” “Social attitude towards organ donation must change. There have been several instances of even persons declared brain dead being treated for days, wasting huge amounts of money. Instead, we should use the opportunity to harvest the organs to save lives that can last longer,” Dr. Mathew Jacob says. There is lack of awareness among doctors as to when to declare a patient brain dead. This lack of awareness is also another reason for the low rate of organ transplantation, he adds. Dr. R. Krishna Mohan, Senior Consultant Urologist and Renal Transplant Surgeon at Aster, points out that the message of organ transplantation A Complete Magazine on Healthcare in Asia
has not reached the masses as has happened with blood donation. Another major issue that hampers the organ donation programme in India is religious, the customs and beliefs that are widely prevalent among communities preventing people from donating organs of their deceased kin. “In addition, only a few hospitals exist in India that specialises in organ transplantations. We have organ retrieval centres only in major cities and this hampers the organ donation programme. There is no clarity about the concept of brain death among people, including medical personnel, and this leads to lower availability of organs in our country,” he says. There must be programmes to raise people’s awareness about organ donation. This will dispel fear and inhibitions of the people at large. Modern Technology, combined with medical expertise, has made organ donation painless, less morbidity prone and cosmetic with minimal hospital stay and early return to normal activity, Dr. Krishna Mohan adds. There is a lack of awareness among the medical professional on issues relating to brain death. Government of India initiated the process of amending and reforming the THOA 1994 and consequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted. According to this law, Constitution of Brain death certification board has been simplified- wherever Neurophysician or Neurosurgeon is not available, then an anaesthetist or intensivist can be a member of board in his place, subject to the condition that he is not a member of the transplant team, says Dr Sylesh Aikot.
MINIMALLY INVASIVE The conventional approach of thoraco-abdomen incision to harvest the kidney has been replaced by Laparoscopic Donor Nephrectomy, where there is only a small incision. In some 10 Medical Tourism Jul - Sep 2019
centres, such as MIART in Kozhikode, the female donor nephrectomy is done using 3D laparoscope and harvested in sterile bag through the vagina avoiding any major incision in the body. It is highly cosmetic with very minimal morbidity. As the size of surgical wound is less, there are minimal wound related complications and post-operative discomfort. According to Dr Krishna Mohan, governments should promote organ transplantation programmes in its various medical centres. It should also increase the number of hospitals with organ transplantation facilities and give advanced training to medical personnel. Governments and the various regulatory agencies should play a very important role in making the procedure hassle-free for the hospitals and, more importantly, for the relatives of deceased persons, which will go a long way to make organ donation smoother. Unfortunately, there is a disturbing lack of awareness among doctors, which is the main roadblock to the a widespread Cadaver Transplant Programme in India, says Dr. Krishna Mohan. A small section of doctors also seems to have withdrawn from the programme afraid of the legal hassles of the process.
NEGATIVE MEDIA GLARE Public outbursts in the social media about ‘organ trading’ discourages the altruistic intentions of treating doctors. Educating the people about the legal aspects of the programme is the key to solving this. Establishment of nodal centres for education and training at district level, conducting regular workshops, etc. also will help. Dr. Krishna Mohan feels that there should be a national level organizational committee to regulate organ transplant. This committee can oversee four or five zonal committees that have jurisdiction over a few states. These committees should be
able to interact in a way that organs are shared across states according to severity of the disease. An efficient air ambulance service for transporting the organs should be present, which should be funded by the government, he says. When a person is declared brain dead it is difficult for the family to initially accept the reality as the body is warm and the heart continues to beat. Brain death is often confused with coma and the family harbours hope of the patient reviving. But the fact is that brain death is irreversible even if the organs continue to function. This is what drives doctors to urge the family of the deceased to donate the organs and save someone’s life.
LONG WAIT FOR ORGANS If a patient has registered to avail a kidney for transplantation, it takes nearly four years to get a consent for organ donation, says Dr Mathew Jacob. The delay in getting organs for transplant leads to the death of majority of patients. Government hospitals should take the initiative to conduct organ transplantation so that the financially poor patients will be benefitted. At present, only a limited number of government hospitals are into transplantation programme. In many hospitals, doctors lack knowledge about brain death and keep the patient on ventilator for as long as it is possible. Many of brain death cases occur in government
Storage time for organs Heart
: 4-6 hours
: 12-24 hours
: 48-72 hours
Heart-Lung : 4-6 hours Lung
: 4-6 hours
Why is organ availability a big problem? • High burden (Demand Versus Supply gap) • Poor infrastructure especially in Govt. sector hospitals • Lack of awareness of concept of Brain stem death among stakeholders • Poor rate of Brain stem seath certification by hospitals • Poor awareness and attitude towards organ donation--- Poor ceceased organ donation rate • Lack of organized systems for organ procurement from deceased donor • Maintenance of standards in transplantation, retrieval and tissue banking • Prevention and control of organ trading • High cost (especially for uninsured and poor patients)
hospitals where in brain death declaration is low or negligible.
LEGAL FRAMEWORK The primary legislation related to organ donation and transplantation in India, Transplantation of Human Organs Act, was passed in 1994 and is aimed at regulation of removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs. THOA has now been adopted by all states except Andhra and J&K, who have their own similar laws. Under THOA, source of the organ may be a near relative donor (mother, father, son, daughter, brother, sister, spouse) or a non-near-relative donor. Such a donor can donate only out of affection and attachment or for any other special reason and that too with the approval of the authorisation committee. A deceased donor is one who has suffered brain stem death (for eg. the victim of a road accident), who
cannot breathe on his/her own, but can be maintained with ventilator, oxygen, fluid support, to keep the heart and other organs working and functional. Other type of deceased donor could be donors after cardiac death. Like in many other countries, brain Stem death is recognized as legal death in India under the Transplan-
tation of Human Organs Act, and this has revolutionized the concept of organ donation after death. After natural cardiac death, only a few organs/ tissues can be donated (like cornea, bone, skin and blood vessels), whereas after brain stem death, almost 37 different organs and tissues can be donated, including vital organs such as kidneys, heart, liver and lungs.
Issues and challenges Poor awareness and attitude towards organ donation Poor deceased organ donation rate High burden (demand vs. supply gap) Poor infrastructure, especially in government hospitals Lack of awareness about brain stem death among stakeholders Poor rate of brain stem death certification by hospitals Lack of organised systems for organ procurement from deceased donors Challenges in maintenance of standards in transplantation, retrieval and tissue banking Challenges in prevention and control of organ trading High cost (especially for uninsured and poor patients) Challenges in regulation of non-government sector
A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM KIDNEY
GO EARLY FOR RENAL TRANSPLANTATION
Compared to dialysis, kidney transplant is associated with better quality of life, lower risk of death, fewer dietary restrictions and lower treatment cost, says Dr. Krishna Mohan R, Senior Consultant Urologist and Renal Transplant Surgeon. Director & Ceo Metromed Institute For Advanced Urology & Renal Transplant
12 Medical Tourism Jul - Sep 2019
kidney transplant is a surgical procedure to place a healthy kidney from a living or deceased donor in a person whose kidneys no longer function properly. The first truly successful transplant was performed on December 23, 1954, at Brigham Hospital, Boston, by Joseph Murray, J. Hartwell Harrison, John P. Merrill and others. The procedure was done between identical twins Ronald and Richard Herrick, which reduced problems of an immune reaction. For this and later work, Dr. Murray received the Nobel Prize for Medicine in 1990. The recipient, Richard Herrick, died eight years after the transplantation. Kidneys are two bean-shaped organs located on each side of the spine just below the rib cage, each about the size of a fist. Their main function is to filter and remove waste, minerals and fluid from the blood by producing urine. End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally. Common causes of end-stage kidney disease include diabetes, chronic uncontrolled high blood pressure, chronic glomerulonephritis, polycystic kidney disease and urinary stone disease. Only one donated kidney is needed to replace two failed kidneys, making living-donor kidney transplantation an option. A successful transplant involves working closely with the transplant team. Members of the transplant team would include the patient being an important part of the transplant team, family members of the patient, the transplant surgeons, nephrologist, transplant coordinator, social worker and dietitian. Of course, it involves doctors from various fields during the pre-operative work-up. Get a transplant before you need to start dialysis, which is called a pre-emptive transplant. It allows you to avoid dialysis altogether. Getting a transplant not long after kidneys fail (but with some time on dialysis) is referred to as an early transplant. Some research shows that a pre-emptive or early transplant, with little or no time spent on dialysis, can lead to better long-term health. It may also allow you to keep working, save time and money, and have a better quality of life. Kidney patients of all ages, from children to seniors can get a transplant done. The patient must be healthy enough to have the operation and must also be free from cancer and infection. A kidney donor can be living or deceased, related or unrelated to the patient. The transplant team will consider several factors when evaluating whether A Complete Magazine on Healthcare in Asia
a donor kidney will be a good match for the patient. Tests to determine whether a donated kidney may be suitable include blood typing, tissue typing and crossmatch. It is preferable to get a kidney from a donor whose blood type matches or is compatible. If blood type is compatible, the next step is a tissue typing test called Human Leukocyte Antigen (HLA) typing. The third and final matching test involves mixing a small sample of recipient’s blood with the donor’s blood in the lab. The test determines whether antibodies in recipient’s blood will react against specific antigens in the donor’s blood. A negative cross-match means they are compatible and it is less likely to reject the donor kidney.
SPECIAL PROGRAMMES FOR LIVING DONOR TRANSPLANTATION Many patients have relatives or non-relatives who wish to donate a kidney but are not able to because their blood type or tissue type does not match. In such cases, the donor and recipient are said to be ‘incompatible’.
LIVE DONOR AND DECEASED DONOR WAITING LIST EXCHANGE This program is a way for a living donor to benefit a loved one, even if their blood or tissue types do not match. The donor gives a kidney to another patient who has a compati-
14 Medical Tourism Jul - Sep 2019
ble blood type and is at the top of the kidney waiting list for a ‘deceased donor’; kidney. In exchange, that donor’s relative or friend would move to a higher position on the deceased donor waiting list, a position equal to that of the patient who received the donor’s kidney.
PAIRED EXCHANGE KIDNEY TRANSPLANT (‘FAMILY SWAP’) This program is another way for a living donor to benefit a loved one even if their blood or tissue types do not match. A ‘paired exchange’; allows patients who have willing but incompatible donors to ‘exchange’; kidneys with one another-the kidneys just go to different recipients than usually expected. That means that two kidney transplants and two donor surgeries will take place on the same day at the same time.
BLOOD TYPE INCOMPATIBLE KIDNEY TRANSPLANT This is a program that lets patients receive a kidney from a living donor who has an incompatible blood type. A special process called plasmapheresis, which is similar to dialysis, is used to remove these harmful antibodies from the patient’s blood.
POSITIVE CROSS-MATCH AND SENSITIZED PATIENT KIDNEY TRANSPLANT This program makes it possible to perform kidney transplants in patients who have developed antibod-
ies against their kidney donors--a situation known as ‘positive crossmatch’. Patients receive medications to reduce their antibody level or they may undergo plasmapheresis treatments to remove the harmful antibodies from their blood. Kidney donor can be a live donor or a deceased donor. Donor nephrectomy can be carried out by open procedure, laparoscopic, 3D laparoscopic, robotic or through single port procedure or by transvaginal retrieval of organ. Even the recipient surgery can be done in various ways such as open procedure, laparoscopic or robotic procedure. If the new kidney fails, dialysis can be resumed or even a second transplant can be considered. To prevent our body from rejecting the donor kidney, medications are needed to suppress the immune system which reduces the immunity making body more vulnerable to infection, for which anti-bacterial, anti-viral and anti-fungal medications need to be administered. Compared to dialysis, kidney transplant is associated with better quality of life, lower risk of death, fewer dietary restrictions and lower treatment cost. In addition, fertility (the ability to conceive children) tends to increase. Men who have had a kidney transplant have fathered healthy children, and women with kidney transplants have had successful pregnancies.
NEW TREATMENT SHOWS PROMISE TO CURE KIDNEY DISEASE Researchers have found a potential treatment for polycystic kidney disease, a genetic disorder that causes the kidneys to swell with multiple cysts and can eventually lead to organ failure. The study published in the journal Nature Communications shows an approximately 50 per cent reduction in kidney size in afflicted mice following treatment. The drug is now in early clinical trials on human subjects, the researchers said. Autosomal dominant polycystic kidney disease (ADPKD) affects about 12 million people worldwide, with half developing end-stage kidney disease by the age of 60, according to the study. "Once the kidneys have failed, the only options for survival are dialysis or a kidney transplant, a large percentage of ADPKD patients on dialysis die each year while waiting for a donated kidney," said Indian origin researcher and study senior author Vishal Patel, Associate Professor at the University of Texas Southwestern Medical Centre. According to the study, the new treatment showed no evidence of toxicity in animals or human cell tests. It is preferentially delivered to kidneys rather than the liver after being administered. "We earlier showed that levels of a tiny RNA fragment called microRNA-17 are increased in models of ADPKD. "MicroRNA-17 interferes with the normal function of other, beneficial RNAs, causing kidney cysts to grow. RGLS4326, as the new drug is called in development, works by blocking the harmful microRNA-17," Patel added. "Our current results relating to brain network indirectly support our previous findings by showing that the positive effects of regular tea drinking are the result of improved brain organisation brought about by preventing disruption to interregional connections," he added.
Dr. Krishna Mohan R. M.S. DNB (UROLOGY) FICS (UROLOGY) Senior Consultant Urologist & Renal Trasnplant Surgeon Fellow Of Robotic Surgery (Seoul) Director & Ceo Iart (Institute Of Advance Urology And Renal Transplant) Metromed Institute For Advanced Urology & Renal Transplant, Kozhikode, Kerala, India.
A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM LIVER
CHALLENGES AND INNOVATIONS MARK
LIVER TRANSPLANTATION At present the need for liver transplantation in India is estimated to be around 20/million population (or 25,000 LT per year) representing gross inadequacy, says Dr Sylesh Aikot, Chief of Gastrointestinal Surgery, Baby Memorial Hospital, Kozhikode.
ransplantation medicine is by far the most challenging and innovative aspect of modern era treatment of liver disorders for which we owe our gratitude to the likes of Dr. Thomas Starzl, who were responsible for sowing the early seeds of transplantation science. But the major issue plaguing the field is a universal donor shortage in the face of an ever increasing recipient pool. In a bid to reduce the donor recipient mismatch, a lot of innovations have come to the fore. These mainly pertain to
16 Medical Tourism Jul - Sep 2019
living related liver transplantation. The motto of any living related transplant is donor safety. To minimize the morbidity associated with donations, there are various innovations introduced. These include laparoscopic approach for left lateral segmentectomy, laparoscopic mobilization of right lobes for hybrid laparoscopic and midline donor hepatectomies. These also include total robotic and robot assisted donor operations. All these innovations have helped in achieving better scar, lesser pain, low morbidity, and early discharge for the donors.
Liver transplantation in children under 10 kg poses special surgical, anaesthetic, and intensive care challenges. In particular, the left lateral segments (generally between 200 and 350 g) from adult donors may be too big for small babies <8 kg, causing potential problems with fitting in the small abdominal cavity and inadequate portal inflow. To reduce this issue, monosegmental and hyper-reduced grafts have been introduced for smaller recipients. To reduce the loss of valuable donor organs and reduce waiting list time, newer innovations in living related transplantations include swap liver transplantation, in which live-related donor of patient 1 donates his part of liver to blood group compatible patient 2 and live-related donor of patient 2 to patient 1 . Another innovation is transplantation between ABO incompatible donor and recipients by the use of plasmaphresis, immunoglobulins and newer immunosuppresants to prevent rejection. A very important challenge faced during liver transplantation is with organ preservation. In the current era we are moving from hypothermic preservation using static cold preservation solutions like UW solution or HTK solution to normothermic machine perfusion in which the procured organ is connected to the organox machine and the function of the graft is monitored real time. The main advantage of this process is in the deceased donor transplantation because this process also causes de-fatting of the graft by which steatotic donor livers become fit for transplantation as their functions can be monitored real time. Another recent method to overcome the problem of longer waiting list time is to introduce exception points. This has been introduced mainly for diseases like HCC and Cholangiocarcinoma to maximise organ availability by minimising waiting time. A way to expand the donor pool is by usage of marginal donor grafts including organs procured from donors after cardiac death. The main limiting factor has been to minimize the ischemia times because in these patients effective warm ischemia time starts when the patient becomes hypotensive (systolic BP<50). So this method of donation requires to happen in a controlled fashion with a tightly knit team of intensivists, hepatologists and surgeons. An important challenge facing transplantation surgery is the cost associated with transplantation. In India, the average cost has been about 2-2.5 million rupees. But this amount of spending has been beyond reach for majority of the people in need. In fact the total number of transplants in India is around 1.2/million population. Around 1200 and 1400 LT have been performed in India in the years 2013 and 2014, respectively. But at present the need for liver transplantation in India is estimated to be around 20/million population (or 25,000 LT per year) representing gross inadequacy.
In order to increase the public awareness regarding organ donation, there are numerous drives being organized by various NGOs. The National Organ and Tissue Transplantation Organisation, under the Ministry of Health and Family Welfare, Government of India, organises Organ Donation Day every year on 13th August. In a bid to increase the drive for donation, they have published facts about organ donation to allay the fears of the public. The idea is to spread the message that anybody can be an organ donor irrespective of their age, caste, religion, community, etc. There is no defined age for donating organs. The decision to donate organs is based on strict medical criteria, not age. Tissues such as cornea, heart valves, skin, and bone can be donated in case of natural death but vital organs such as heart, liver, kidneys, intestines, lungs, and pancreas can be donated only in the case of â€˜brain deathâ€™. Organs such as the heart, pancreas, liver, kidneys and lungs can be transplanted to those recipients whose organs are failing because it allows many recipients to return to a normal lifestyle. Anyone younger than age 18 needs to have the agreement of a parent or guardian to be a donor. Due to social media, there has been a boom in awareness drives, due to which the number of transplantations has been increasing. The aim should be to reach as many people as possible so that no organ goes waste and every patient in need of a liver transplant gets the organ on time.
Dr Sylesh Aikot MBBS, MS, DNB, FMAS, MCh (gastro) Specialist in bariatrics and advanced laparoscopic surgery, chief, gastrointestinal surgery, Baby Memorial Hospital, Kozhikode, Kerala, India. A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM SPINE
WATCH YOUR BACK!
GET YOUR DISC PROLAPSE DIAGNOSED AND TREATED EARLY
hen confronted with back pain and an MRI report that reads disc prolapse, every person feels a sinking feeling that he will never be quite normal again. Nothing can be further from the truth. Back pain is a fairly common complaint and forms the bulk of patients entering either an orthopaedics or spine outpatient clinic. Most back pains are simple muscle strains or mechanical back pains due to poor posture and poor core strength. These are self limiting but have a propensity to recur given the root cause which is lack of exercise and core strength. The problem arises when these patients are subjected to an MRI scan and come back with a detailed report on the status of their disc and poorly informed internet articles. To clarify, all back pains are not solely due to a disc prolapse. In fact, most back pains are not caused by disc prolapse. A simple examination, followed by medication and physiotherapy will relieve the pain in more than 90% of cases. This however must be followed up by a good rehabilitation and strengthening protocol. Disc prolapse when it does occur most commonly causes, sciatica which is pain running from the buttock down to the leg below the knee on one or both sides. This may be associated with numbness in the foot or weakness of the toes. Such symptoms require an immediate visit to your doctor to confirm
18 Medical Tourism Jul - Sep 2019
the diagnosis and initiate treatment. Here again, there is little cause to despair. The natural history of disc prolapse is one of resolution. That means the pain and symptoms are likely to settle down with medication and rest in a majority of the cases. The reason for intervention could either be persistent pain or weakness of the muscles supplied by that nerve root. If the complaint only remains pain then it can be treated by a selective nerve root block which is an outpatient procedure. The procedure entails a fine needle inserted into the spine under x-ray control to deliver medication near the affected nerve root. Usually the pain relief is immediate. In a few people, the pain recurs after a few weeks and they would benefit from a minimal invasive surgery. The surgery is quick and the patients operated at Dr. Rela Institute & Medical Centre generally walk the same day and go home the next day. Whatever the method that is successful in relieving the pain the patient must then go through a rehabilitation program. What is interesting to note is the volume of advice given on preventing disc prolapse including don't bend, don't lift weights, stop all physical sports and strenuous activities and be careful. There is no evidence to support these wild claims and the patient must get back to normal activity at the earliest. It is very common to see patients wearing belts and corsets for extended periods of time following a diagnosis of disc prolapse. Not only is this uncomfortable, it also causes wasting of core muscles and back pain associated with it. There are however a few danger signs to watch for
which include severe numbness with weakness of both feet, numbness around the perineal region and any alteration in the ability to pass urine or stools. All these indicate severe nerve compression and require immediate surgery. However, these account for less than 1% of cases.
MICROSCOPIC SPINE SURGERY Before you condemn yourself to a life of misery because of a diagnosis of disc prolapse, visit a spine surgeon. Get the right treatment and be back on your feet, doing the things you love at the earliest. Spine services at Dr Rela Institute & Medical Centre is fully equipped with high end technology to improve safety and accuracy in complex spine surgeries. It is driven by expert spine surgeons & fulling trained team with more than 10 year experience in dealing with complex spinal deformity correction, mini invasive fusion and deformity surgeries for accelerated recovery, microscopic disc surgeries, motion preserving disc replacement surgeries and complex fracture reconstructions.
Dr Parthasarathy Srinivasan D Ortho DNB, Ortho FNB â€“ Spine Surgery Senior Consultant Rela Institute of orthopaedics Head â€“ Spine Service, Chennai
CONDITIONS WHICH WILL BE TREATED AT DR RELA INSTITUTE & MEDICAL CENTRE ♥ Structural problems ♥ Scoliosis ♥ Spinal stenosis ♥ Degenerative disc disease ♥ Spondylolysis ♥ Spondylolisthesis ♥ Disc herniation ♥ Myelopathy ♥ Bone fractures ♥ Bone infection ♥ Rheumatoid arthritis ♥ Pinched nerves ♥ Bone spurs ♥ Radiculopathy ♥ Cysts and tumors, both cancerous and benign ♥ Conditions caused by traumatic injury Treatments Offered On-site ♥ Physical Therapy Assessment ♥ Epidural Steroid Injection ♥ Nerve Root Injection ♥ Facet Joint Injection ♥ Medial Branch Block ♥ Sacroiliac (SI) Joint Injection ♥ Spinal Cord Simulator Trial ♥ Surgical consultation,evaluation and follow-up
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MEDICAL TOURISM ONCOLOGY
IMMUNOTHERAPY A NEW WEAPON AGAINST CANCER
ncidence of cancer is on the increase all over the world. However, survival of cancer patients has profoundly increased owing to availability of advanced treatment options, specialized medical care, sophistigated diagnostic technologies and improvement in supportive care. Surgery, radiotherapy,chemotherapy and hormone therapy are the main treatment modalities in the treatment of cancer. Chemotherapy is the use of medicines to kill or slow the growth of cancer cells. Conventional chemotherapy drugs damages normal cells also, due to the no-targeting mechanism of action of chemotherapy. Newer therapies have emerged that have promising potential in cancer treatment, like targeted chemotherapy and immunotherapy. In targeted therapy, the medicine targets specific types of cancer cells, sparing normal cells. This leads to lower risk of side effects to the patient. In immunotherapy, the treatment boosts bodyâ€™s immune system to fight against cancer cells. 20 Medical Tourism Jul - Sep 2019
Immunotherapy has gained considerable spotlight as an available treatment option for cancer due to its tumour-specific activity and related efficacy.
WHAT IS IMMUNOTHERAPY? Immunotherapy consists of drugs that when injected into the body, can stimulate bodyâ€™s immune system to fight and kill cancer cells. These drugs have been approved for treatment of cancer.
WHAT ARE DIFFERENT TYPES OF IMMUNOTHERAPY? There are different types of immunotherapy as described below 1. Naked Monoclonal antibodies: An antibody is a protein that attaches to an antigen (a foreign body or toxin) and initiates an immune response to destroy the antigen. Monoclonal antibodies kill cancer cells by identifying and attacking specific proteins present on the surface of cancer cells.
2. Immune checkpoint inhibitors: This is an advanced therapy, where the drug targets and kills certain ‘checkpoint’ proteins or ‘brakes’ on cancer cells that prevent the immune system from attacking them. Some immune checkpoint inhibitors are also monoclonal antibodies 3. CART- cell therapy: Chimeric Antigen Receptor T-cell or CART- cell therapy is a specific type of adoptive cell transfer where T cells are activated (against specific tumour antigens) and multiplied in a laboratory and injected back into the patient to trigger a strong immune response against the tumour.
side effects may be caused like autoimmune thyroid problems, lung problems or kidney damage. Most of these side effects can be managed by steroids. Certain side effects may also need discontinuation of treatment It is important that people become aware about these new treatment options for cancer and avail treatment from experienced Medical Oncologists. It is equally worthwhile to encourage people to adopt a healthy lifestyle and diet to reduce the risk of cancer.
VARIOUS CYTOKINES AND VACCINES ARE ALSO USED AS PART OF IMMUNOTHERAPY Newer cancer immunotherapy drugs are being tested and approved to treat many types of advanced or metastatic cancers where chemotherapy has failed. Currently, the treatment cost is high as the immunotherapy medicines are research molecules, have a complex manufacturing process and substantial research and development cost
WHAT ARE SIDE EFFECTS OF THIS TREATMENT? Immunotherapy does not have side effects of chemotherapy like hair loss, vomiting, diarrhoea etc. Immune related
Dr. VP Gangadharan.DM Medical & Pediatric Oncologist, VPS Lakeshore Global Lifecare, Kochi A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM TECHNOLOGY
REVOLUTIONISES HEALTHCARE 22 Medical Tourism Jul - Sep 2019
iabetic Retinopathy (DRP) is a diabetes complication that affects the eyes. It is caused by damage to the blood vessels of the light-sensitive tissues at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems. The incidence of diabetic retinopathy is projected to escalate. Regular DRP screening of patients with diabetes enables early intervention and reduces the risk of vision loss. Doctors normally diagnose the disease and treat it by doing a biometric process called â€˜retinal scanâ€™. Aravind Eye Hospital and Sankara Netralaya are famous eye hospitals in India and recently they recorded an amazing achievement in the retinal scan process. It turned out that by using the same retinal scans, they could predict 5-year risk of adverse cardio vascular events like strokes in the patients. They could do this thanks to the machine learning system known as Artificial Intelligence (AI), which offered newer insights from the normal eye scans. Artificial intelligence is the simulation of human intelligence processes by machines, especially computer systems. These processes include learning (acquisition of information and rules for using the information), reasoning (using rules to reach approximate or definite conclusions) and self-correction. We can categorize AI into three types. Artificial Narrow Intelligence (ANI), Artificial General intelligence (AGI) and Artificial Super Intelligence (ASI). ANI is a system that is designed and trained for a particular task. AGI is a system with generalized human cognitive abilities. ASI refers to the time that the computer takes to surpass the capabilities of humans. When presented with an unfamiliar task, a strong AI system will be able to find a solution without human intervention. Self-driving vehicles to robotics belong to this category. AI is bringing revolutionary transformations in all the spheres of life which we could not even imagine earlier. AI tools present a range of new functionalities for businesses. Not all business persons can afford
the costs of hardware, software and staffing as they are very expensive and there are AI service providers to help them. AI as a service allows individuals and companies to experiment with AI tools for various business purposes. Popular AI cloud offerings include Amazon AI Services, IBM Watson Assistant, Microsoft Cognitive Services, and Google AI Services The potential for AI and robotics in health care is vast. The new findings during the eye scanning at the Aravind Hospital and Sankara Netralaya were the outcome of an initiative undertaken by Google AI in the healthcare system. Google AI is a collection of teams and efforts to bring the benefits of AI to everyone, says Sundar Pichai, CEO of the company. The company has opened AI centres around the world and is cooperating with many hospitals, focusing on those areas where the service of trained doctors are scarce. Last year, Google AI announced a deep study on diabetic retinopathy, a leading cause of blindness to help the doctors to diagnose it earlier and field trials were going in India. In a routine retinal scanning, a doctor is not in a position to predict the risk of heart problems the patient may suffer in future. But the machines could do it as they collected and analyzed the data of the patient in a comprehensive manner, which shows that AI will contribute a lot in the prevention of diseases in the coming years.
the fields of radiology, imaging, telehealth, electronic health records, use of AI in healthcare is growing. Brain Computer Interfaces (BCI) are predicted to help those with trouble in moving, speaking or those with spinal cord injury. Already, there is evidence of that the use of chatbots leads to positive outcomes in the field of mental health. Large scale research is going on in the field. AI in health care system is becoming an industry having potential for growth. Tech giants such as IBM, Microsoft, Google, Intel are already in the field and more are coming. Many Startups are also there and a large part of the industry is focusing in the sector of clinical decision support systems. Not only developed nations, but developing nations also will benefit from the AI revolution in healthcare. Like many other fields, in the healthcare sector too, there is pervasive fear that robots would replace humans in jobs. Last year, an investor in Silicon Valley even predicted that 80% of the doctors would be replaced by AI in healthcare. But there are many factors that point in the opposite direction. Will the human being trust the intelligence of a machine? Even if the machine diagnose a disease, it is certain that the final would have to be that of a doctor, who is a human being and not a bot.
Another area AI can help is to enable the doctors to predict medical events. If the doctors are able to find that their patients would become very sick within the next 24-48 hours, the outcome would be tremendously different. Google will publish a report soon on the application of AI in healthcare system, says Pichai. AI and robotics are increasingly becoming a part of our healthcare system. The use of AI is predicted to decrease medical costs as there will be more accuracy in diagnosis and better predictions in the treatment plan as well as better prevention of diseases. AI tools play a great role in the treatment of cancer and heart and brain diseases. With the scientific and technological advancements in A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM SEX LIFE
PENILE PROSTHESIS ANSWER FOR ERECTILE DYSFUNCTION 24 Medical Tourism Jul - Sep 2019
Penile prosthesis implant has become a panacea for men with erectile dysfunction who do not respond to erectogenic drugs or cannot tolerate the side effects, says Dr. K. Promodu of Dr. Promodu’s Institute of Sexual & Marital Health Pvt. Ltd.
exuality represents one of the most important domains of human life and for a vast majority sexual act is the key bonding factor between partners. Erectile dysfunction (ED) is an important health concern significantly affects men's psychosocial well-being. This condition is projected to affect more than 320 million men worldwide by 2025. Many men consider ‘strong rigid erection’ as a sign of manliness. I have heard patients asking “When I can’t satisfy my partner why should I live?” or “If I don’t have erection, there is no point in living as a man!” etc. For majority of men erectile ability is very important. At least few get disappointed and even think of suicide when erection is affected.
HOW MANY ARE AFFECTED? ED affects approximately 50% of men older than 40 years with increasing prevalence as men age, and it often has a severe impact on their quality of life. As per the NIH Consensus Development program statistics in US, some degree of ED affects about 30 million Americans. Approximately 25000 inflatable penile prosthesis implant operations are performed annually in the US (Reported by Katherine et.al in an article published 2017 in Translational Andrology and Urology). When analysed the data of 24944 patients sought treatment for sexual problems at Dr. Promodu’s Institute of sexual & Marital Health Pvt. Ltd, Kochi, 64% male patients were found to have ED as their chief complaint.
THE ADVENT OF VIAGRA The advent of Viagra in late 1990 s gave a big boom to the treatment of erectile dysfunction. US Food and Drug Administration approved Viagra for the treatment of erectile dysfunction on 27 th March 1998. This gave a big relief to millions of men suffering from ED. But there are so many men who don’t respond to these magic pills or other mode of non invasive treatments. “....I don’t have any other option except suicide” In early days of August this year a 36 years old man visited our hospital for a penile implant operation. His first wife had left and filed a divorce petition as he couldn’t achieve an erection sufficient to consummate the marriage. Though he took treatment none of the medicines could help. Our evaluation showed a poor penile arterial inflow of blood which is the cause of inadequate erection and unlikely to respond to medication. He told me “Doc. Family court granted a divorce to my wife. Since then my parents and relatives have been compelling for a second marriage. But no one knows my real problem! Last month they fixed my marriage for next January. If the same situation repeats I don’t have any other option except suicide”. He was so particular to get the operation done before marriage.
PENILE PROSTHESIS IMPLANT: A PANACEA Penile prosthesis implant has become a panacea for men with erectile A Complete Magazine on Healthcare in Asia
$ Men don’t respond to medications and other forms of treatment $ Men cannot tolerate medicines due to severe side effects $ Men with ED and Peyronie’s disease or similar medical conditions not responding to other forms of treatment. $ Men with severe psychogenic ED doesn’t respond to all other forms of treatment $ Men who are physically and mentally healthy and capable of taking appropriate decisions A thorough evaluation and education of patient about his condition and a sufficient trial of medication is given before planning surgery. Understand that this treatment option is the last choice for those who could not succeed with other less invasive treatment methods.
dysfunction who do not respond to erectogenic drugs or cannot tolerate the side effects. And also for those who do not want to swallow a pill just before, and impatiently waste time to achieve an erection while his girl friend is eagerly waiting to make love with him. A penile implant is a malleable or inflatable device that can be placed inside the erection chambers of penis known as corpora cavernosa to achieve an erection. Malleable or bendable devices are simplest type of prosthesis consisting of a pair of flexible silicone rods surgically placed inside the penile shaft to get an erection. It is easily concealable due to its flexibility and nobody can make out externally. Inflatable devices are of two types, two and three piece depending on the location of the fluid used for inflation. Two piece devices consist of two cylinders and a pump filled with a fluid. Cylinders are placed inside the penile shaft and pump inside the scrotal sac. 26 Medical Tourism Jul - Sep 2019
Erection is being achieved by gently pressing the pump placed inside the scrotal sac and deflation can be done by gently bending the cylinders. The three piece prosthesis consists of two attached inflatable cylinders, a reservoir and a pump. Cylinders are surgically placed inside the penis, reservoir in the lower abdomen and pump inside the scrotum. When the man wish to have an erection he can gently activates the pump that transports fluid from the reservoir to the cylinders and gives an erection. It can be deflated by pressing a button. The most advanced and sophisticated version of penile prosthesis is the three piece type. Inflatable implants allow a man to have an erection whenever he chooses and it looks much more natural.
WHO SHOULD UNDERGO PENILE PROSTHESIS IMPLANT OPERATION? $ Men suffering from chronic ED alone
PenileP rosthesis implantation has emerged as a definitive, viable and effective treatment to restore erectile function to motivated men with erectile dysfunction provided the procedure is performed appropriately by an experienced surgeon or andrologist. But please remember that it will only help for an erection and neither helps to increase your sexual desire, satisfaction nor orgasmic pleasure.
Dr Promodu Dr. Promodu’s Institute of Sexual & Marital Health Pvt. Ltd Kochi, Kerala Email: firstname.lastname@example.org
Delivering innovative and trustworthy medical diagnostic solutions for over 34 years.
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MEDICAL TOURISM MEDICAL VALUE TRAVEL
PEOPLE OF OMAN LOOK TOWARDS INDIA FOR QUALITY HEALTHCARE AT REASONABLE COSTS
n the year of 2018, the total size of the global medical tourism industry was $36.9 billion. The healthcare industry is booming throughout the world due to introduction of advanced healthcare machineries, better hospitality and personalized care for the patients. The countries that have adopted innovation and technologies in healthcare sector are expected to earn more revenue through its medical tourism industry.
$ Organ Transplant
Medical tourism is not a fad rather it is a meticulous option to obtain better healthcare service. If the service comes at low cost, it will get even better for the medical travelers. In many countries, healthcare industry is regarded as costly. In some countries, healthcare service is not yet heavily modernized or revolutionized. Thus, people from these countries tend to travel countries where healthcare service is available at low cost. Nevertheless, people plan tour to countries where specialized healthcare services are also available.
$ Dental treatment
In most of the cases, it has been noted that medical tourism industry gets boost with following healthcare services.
28 Medical Tourism Jul - Sep 2019
$ Orthopedics treatment $ Cardiovascular treatment $ Nephrology treatment $ Oncology $ Cosmetic surgery
$ Hair transplant $ Laser tattoo removal $ Alternative medicines
MEDICAL TOURISM INDUSTRY IN OMAN Oman, which is official known as the Sultanate of Oman, has more than 4.6 million population. In terms of its nominal GDP, the country stands at the 64th rank. The countryâ€™s economy is majorly dependent upon its oil export, though it has also made immense progress in the field of technology.
Also, India having a number of JCI (Joint Commission International) accredited hospitals and enables it to stand out in the global market.
CHALLENGES FOR HEALTHCARE IN OMAN High cost of living in Oman is a challenge for people seeking medical tourism opportunity in this country. Besides high cost of living, high cost of healthcare in private hospitals is also an area of concern. Thus, people opt for medical tourism for two basic reasons - First of all, they expect quality healthcare service. Secondly, they expect low cost service.
RAPID HEALTHCARE INFRASTRUCTURE DEVELOPMENT
India’s growing medical tourism sector is attracting dozens of medical tourists from Oman and the Middle East and their most preferred location is Kerala, as per some fresh reports. With India holding around 18 per cent of the global US$19.7 billion medical tourism market, those figures are expected to rise by the year 2020, as more people choose India for their medical needs. Some of the few procedures that are constantly becoming the most popular amongst those travelling from Oman are: • Knee Replacement • Spine Surgery • Cardiac Surgery
OPPORTUNITIES FOR MEDICAL TOURISM IN INDIA Apart from that, the presence of world-class medical facilities, coupled with skilled doctors, pocket friendly rates for complex procedures, makes India a key player and an integral destination for medical tourists who are looking for medical care outside their home country. To add on to this, there is also good connectivity between Oman and India with hundreds of flights every week connecting Muscat and Salalah to 11 destinations in India.
India as a country has the largest pool of doctors and paramedics in South Asia, comprising of Doctors, Surgeons, Dentists, Nurses and support staff. Many of them have established their credentials as leaders around the world. India’s medical history spans thousands of years through Ayurvedic and alternate medicine which is also a most sought after mode of treatment
THE MAJOR ADVANTAGE Oman nationals travelling to India for medical treatment can save anywhere between 30% -70%, including the cost of ticket expenses and accommodation all combined. Besides, things made easier for Oman Nationals, since while travelling to India for short visits, especially for medical consultations, can apply for an e-visa where the whole process of applying for a visa can be completed online without requiring a visit to the Embassy. India’s fast-growing presence as a global leader in medical tourism is a great opportunity for those in Oman seeking medical treatment to visit the country for a wide number of specialized treatments.
Amit Ranjan Founder & CEO, Medtravels Kozhikode, Kerala A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM TOURISM
MICE A BIG BOOST FOR
In recent years, India has emerged as one of the most sought-after MICE destinations. India provides an impressive combination of accommodation and other conference support facilities to hold a successful conference.
ICE (Meetings, Incentives, Conferences, and Exhibitions) is proving a game changer in the tourism industry across the globe with several countries logging growth at the rate of 20% year on year. MICE tourism is a niche segment in the tourism market, which has abundant potential and is gaining significance worldwide due to the growth of business tourism. It targets business clients travelling for various types of meetings. People gather together to attend meetings, conventions and expositions adding to the 30 Medical Tourism Jul - Sep 2019
social, sporting, political or religious dimensions of tourism. The MICE segment is a very profitable industry and statistics point to the fact that the average MICE tourist spends double the amount when compared to a normal tourist. With cities becoming regional hubs for mass gathering for various purposes, various groups and associations are leading herds of tourists to these places, mixing business with leisure. MICE continues to experience rapid growth as meeting planners and
travel agents organise corporate incentive travel programmes to reward employees for reaching specific targets. Incentive trips generally vary from three to six days in length and can range from a moderate trip to an extremely lavish vacation for the employee and his/her partner.
panies, incentive houses, professional trade organizations, tourism boards, tourism trade associations, and travel-selling professionals.
MICE events have direct implications on a countryâ€™s tourism. The attendees of the events from other countries or maybe just Personnel and businesses other states not only involved in the MICE marparticipate in the event but ket include corporate meet- also indulge into tourism. ing planners, meetings and Since MICE events are convention departments of aimed at mixing business hotels, conference cenand leisure, a city which tres or cruise ships, food isnâ€™t known for its tourism, and beverage managers, cannot be a preferred MICE logistics firms, private tour destination. operators and transfer com-
MICE TOURISM IN INDIA MICE tourism in India is continuously growing and increasing its meetings, incentive, conference and exhibition facilities. The Union Government has set an ambitious target for MICE INDIA to achieve 2% of the global MICE market share by 2025, from an insignificant current share of 0.5%. A conference traveller, on an average, spends $1511 a day for a four-day stay compared to $600 spent by an inbound leisure traveller staying for the same duration. As per industry estimates the global MICE market supports 4,00,000 conferences and exhibitions worldwide, making it an annual US $280 â€“ 300 billion market. In recent years, India has emerged as one of the most sought-after MICE destinations. India provides an impressive combination of accommodation and other conference support facilities to hold a successful conference. High-tech facilities matching global standards are offered at conference and meeting venues in India. Tourism Industry plays a vital role in supporting economy of the country as well as generates foreign currency. Today, hotels and major tourist resorts are venues for meetings, gatherings, planning, conferences and
other activities that involve a large number of people. India is a late entrant in the MICE segment with little share on the global scale. Of the total 12,563 international meetings a year, it hosts only 175 - or just 1.4 per cent to rank 24th worldwide, according to a FICCI-Yes Bank report. In 2018, MICE tourism in India was pegged at Rs 25,000 crore with 8 per cent growth year-on-year, said the report titled 'India Inbound Tourism: Unlocking the Opportunity'. The industry is estimated to have a space of 5 lakh square metres, which is expected to cross 15 lakh square metres over the next two to three years. India ranks fifth in the Asia Pacific region behind Japan, China, South Korea and Australia. However, it has a variety of destinations which can be clubbed with diverse tourism offerings to enhance MICE. With more investment by leading tourism agencies and coordination of Indian companies, Indiaâ€™s role in the MICE tourism circuit is growing steadily. Better connectivity with the world because of its physiographic location provides India abundant opportunities to become a MICE hub.
India has signed several treaties with developed countries to cooperate and develop its tourism sector, which is boon for MICE Tourism. Expansion of leading hotel chains in India has created a new space for development of the MICE segment in India. With the growing infrastructure and profitable business policies, it is possible that the Indian MICE will surpass other countries to occupy a higher position globally in the next 10 years. The coming years will see use of a lot more technology in organising and managing the MICE events.
MICE TOURISM IN KERALA Kerala recognises the potential of the MICE industry and is fast emerging as a preferred MICE destination. With a fine concoction of culture and natural settings, Kerala also offers state-ofthe-art technology for business meetings, conferences and exhibitions to match global standards. Amidst ravishing backwater settings, series of breathtaking tropical beaches, mist-laden, plantation hills and cities that host leading names in star hotel business; all provide some of the best venues for fabulous MICE experience in Kerala. After the stagnation following the recent floods, Kerala tourism industry is gaining momentum. Kerala has its own unique offerings in terms of hospitality and tourism infrastructure. The State has a fine array of cultural experiences, cuisine and natural surroundings to choose from, including tropical beaches and backwaters, to misty plantations, hills and resorts. The Tourism Department has submitted a proposal to the State government to hold a national convention of MICE stakeholders in Kochi in association with Indian Convention Promotion Bureau (ICPB), a body formed under the Ministry of Tourism to promote the country as a venue for international conferences and exhibitions. A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM TOURISM
INDIA GOES UP IN
WORLD TOURISM RANKING
ndia has moved up six places to rank 34th on world travel and tourism competitiveness index, driven by rich natural and cultural resources and strong price competitiveness, a World Economic Forum (WEF) report said.
ness (51st) and natural (14th) and cultural resources (8th). Compared to global benchmarks, the country can also add price competitiveness (13th) to its roster of strengths, the report noted.
India's ranking improved from 40th to 34th, the greatest improvement over 2017 among the top 25 per cent of all countries ranked in the report.
The Indian medical tourism industry is growing at 18% a year and is expected to be worth 9 billion by 2020. Currently, it has nearly 18% of the global medical tourism market share and is expected to be 20% by 2020.
"India, which accounts for the majority of South Asia's T&T (travel and tourism) GDP, remains the sub-region's most competitive T&T economy, moving up six places to rank 34th globally," the report said. As per the report, China, Mexico, Malaysia, Thailand, Brazil and India -- which are not high-income economies but rank in the top 35 in the overall list -- stand out in the Cultural Resources and Business Travel Pillar through their combination of rich 32 Medical Tourism Jul - Sep 2019
natural and cultural resources and strong price competitiveness. "India showed the greatest percentage improvement to its overall Travel & Tourism Competitiveness Index (TTCI) score, which has helped it become the only lower-middle income country in the top 35," the report said and lauded its natural and cultural assets and price competitiveness. From a sub-regional perspective, the nation (India) has better air infrastructure (33rd) and ground and port infrastructure (28th), international open-
Medical travellers visiting India for healthcare can save up to 50% of the cost that they might spend if they travelled to a developed western country to avail the same treatment. Cost of treatment in India is approximately 40% less than that in any developed western countries without compromising on quality of care. Foreign tourist arrivals on medical visas are increasing at a CAGR of 51
per cent. Bangladesh, Afghanistan and Commonwealth of Independent States (CIS) countries are the leading source geographies accounting for more than one-third of visitors. Africa and GCC countries are expected to drive larger inbound volumes in the coming five years. The key growth drivers are alternative medicine (AYUSH), cost competiveness driving medical tourism inflow and quality healthcare and travel options at affordable price points. Indian ayurveda market is growing at approximately 16 per cent CAGR, backed by approximately 1 million traditional medicine doctor base and proactive government promotion. Medical procedures in India cost 70-80 per cent lower compared to average treatment costs in the US. A robust private healthcare sector and budget friendly travel destinations ensure lucrative India travel options for the international tourists.
FACTORS CONTRIBUTING TO THE GROWTH OF MEDICAL TOURISM IN INDIA Medical Visas: The Government of India has introduced e-Medical Visa and e-Medical Attendant Visa to support medical tourism. This facility is extended to 166 countries to hasten medical aid in India. Top hospital chains: Apollo, Fortis, Wockhardt, Max have doctors on their panel who are at par with the best doctors worldwide. Also, the standards maintained by these hospitals in terms of their digital records, the cutting-edge equipment, cleanliness, etc make them extremely competitive to offer the highest standards in healthcare services.
worked in international hospitals or have associations with internationally recognized medical bodies. No language barrier: Most of the large hospitals in India have doctors, nurses and medical staff who speak in English. English being one of the most widely spoken languages, foreign patients find it easier to communicate with the team of medical practitioners in Indian hospitals. Also with so many spoken languages in India doctors do have the advantage of speaking with the foreign patient in their preferred language. Cost of Treatment: Compared to the dollar and other currencies, medical treatment in Indian rupees looks far more affordable to a lot of people living abroad than what it would cost them in their own country. Be it Indians settled abroad who still prefer to come to India for low-cost treatment or for foreign medical tourists, Indian medical treatment is more affordable than in most developed countries. Large number of pharmaceutical companies: With India having a large number of pharmaceutical industries manufacturing indigenous drugs, it is easier to procure these drugs at fractional prices compared to their prices in developed countries. Latest equipment: Large specialty hospitals in India are outfitted with the latest medical equipment, med-
ical technology and network at par with international standards. Luxury amenities: Today hospitals in India are offering not just hospital beds but suites for the affluent medical traveler. A medical traveler seeks not only medical treatment but also luxury amenities for himself and the family while undergoing a medical procedure in India. Less waiting time: In Indian top hospitals, there is no long waiting list for medical aid for life saving treatments. Especially in the cases of organ donations or cardiovascular ailments, treatment can be availed of almost immediately. Patients donâ€™t need to wait for months to get the best medical treatment and post-operative care. Available alternative treatments: Today medical tourists are also seeking overall well being. Many a tourists are drawn to India for treatments in Ayurveda and Naturopathy.. With our Prime Minister Narendra Modi, also instrumental in recommending to the UN General Assembly, to consider Yoga as the root and an integral part of Indian culture, on December 11, 2014, the UN declared June 21 as International Yoga Day. Putting yoga on the world map, has further contributed to attracting tourists seeking yoga practice as an alternative cure to their medical ailments.
Competent doctors: Indian doctors have made a name for themselves as being highly intelligent and skilled in their profession. They keep themselves abreast of latest innovations in the medical field at par with the best doctors worldwide. Many doctors have also studied abroad, A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM MEDICAL HUB
A PREFERRED CITY FOR MEDICAL VALUE TRAVEL One of the biggest advantages that Chennai enjoys is its access from any part of the world. Major Airlines operate regularly to this city which has the Anna International Terminal and Kamarajar Domestic Terminal. The major railway stations are Chennai Central, Egmore and Tambaram. The State run Transport Corporation connects Chennai to all the major cities in the South and a few in the West and north, making it accessible from all over.
ndia is one of the fastest growing countries as a hot spot for Medical Value Travel in Asia. Healthcare and wellness have become the largest sectors in terms of revenue and employment. The services vary from clinical trials, outsourcing, telemedicine, wellness, health insurance and medical tourism. According to the Ministry of Home Affairs, 4.95 lakh foreign tourists visited India for medical purposes in 2017. It was only 2.33 lakhs in 2015 and 4.27 in 2016. Medical tourism in India is projected to be a US$9 billion opportunity by 2020. Tourists visit a destination for varied purposes and hence packages have to be custom made. Health tourism today is a niche sector developed by tourism promoting governments to attract people whose prime objective is to get good healthcare combined with good tourism facilities in general. Chennai continues to be one of the most chosen destinations in India. Some of the reasons for this are the 34 Medical Tourism Jul - Sep 2019
good communication skills of doctors in the city, advanced technology used, excellent hospitality, timely rendering of services without unwanted delay, cost-efficiency, highly qualified doctors and good translators. For the same reasons many NRIs too prefer medical treatment in their own native country instead of their overseas location. Patients across all demographic profiles visit Chennai for treatment. Proximity to South East Asia and cultural affinity is also a factor for people coming from South east Asian countries. Most hospitals catering to Medical Tourists have separate wings for international patients. Some hospitals also provide rental accommodation for people who accompany the patients. According to surveys, treatment costs in India are around one-eighth of the price of similar treatments in USA or UK. Singapore, Thailand, Malaysia, Taiwan, Mexico, and Costa Rica would be a few overseas destinations competing with Chennai.
Chennai has been attracting an average of over 35% of the Medical Tourists to India, for quite some time now. Chennai offers a host of treatments and surgical procedures across its many multi speciality hospitals. Treatments are affordable, technology is advanced and international standards are followed in these major hospitals. Chennai also boasts of some of the the finest and internationally trained doctors and surgeons in their respective fields. Chennai has some of the best multiand super-speciality hospitals that offer quality treatments popular among international patients, like cardiology, orthopaedics, fertility, neurology, organ transplantation, dentistry, ophthalmology, surgical gastroenterology, plastic surgery, Kidney transplant, laparoscopic surgery, oncology and dentistry. The city has over 15,000 hospital beds, of which only half is used by the city's population with the rest being shared by patients from other states of the country and foreigners. Hospitals like Apollo, Sri Ramachandra, Fortis, Rela, Parvathy, Kauvery, Chennai Fertility Center, Frontier Lifeline, TOSH etc are promoting Medical Tourism in a big way and attract patients from all over the world.
Nigeria, Kenya, Burundi, Congo, Bangladesh, Oman and Iraq are some of the countries from which patients fly down to Chennai for medical treatment. Besides treatment, patients on the road to recovery and caretakers also get to go on sightseeing tours, sometimes arranged by the tour operators / facilitators themselves. The hospitals also assist them if there is a need to travel on leisure. The real boon for many is that many of these tourist destinations like Mahabalipuram, Covelong, Tirupati, Kanchipuram, Chidambaram, Vandalur Zoo, Madurai, Thanjavur and Pondicherry are easily accessible from Chennai. Chennai has hotels suited to all budgets and hence the relatives or bystanders of patients do not face any major difficulty in finding places to stay. Hotels serving both Vegetarian and Non-vegetarian food are available in every nook and corner of the city making it easy for the visitors to have the food of their choice. Service apartments are also available in Chennai near major hospitals.
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MEDICAL TOURISM WELLNESS
MIRROR, MIRROR ON THE WALL…
DEVELOP A HAPPY MIND FOR A SHAPELY BODY Ninu Susan Abraham
irror, mirror, on the wall, who's the fairest of them all?" This famous question posed by the evil queen in the 1937 Disney classic, Snow White and the Seven Dwarfs flash across our minds when we look at the mirror. Doesn't it? The magic mirror’s answer that the queen’s “seven-year-old step-daughter, Snow White is the most beautiful turns the queen green with envy and orders a huntsman to take the child to the woods and kill her. It is not surprising that the queen got so angry as she was truly a very beautiful woman. The mirror is one of a kind that never lies. This might let us wonder why the mirror said that about the queen. The answer is simple, the mirror was able to understand both the mind and face of an individual. The queen was always full of hatred towards Snow White and the mirror reflected the ugly mind of the queen. An ugly mind makes a person brooding and the face ugly. It proves beauty is not just skin-deep. And as the saying goes, an ugly mind reflects the same on the face. A joyful mind makes another person happy and the surroundings enlightened. It shows how the mind, body and spirit work together to shape up the well-being of a person.
36 Medical Tourism Jul - Sep 2019
A happy mind keeps the body and the spirit healthy and beautiful. Thus, according to the age-old science of Ayurveda, it is our lifestyle that defines our wellbeing. A healthy lifestyle keeps the body rejuvenated . An alcoholic or a drug addict cannot have a positive mind. He lives a life drifted away from reality causing trouble and worry to others around. Certain foods make our body unhealthy and prone to illnesses. Illness always makes a person irritated and disappointed. No good thoughts will come into that mind. Ayurveda suggests a certain lifestyle and diet for a healthy living. It is based on the right balance of good thoughts, good foods and physical activities, because all the three are interlinked and inseparable. Any changes in the order make the body sick. We need to understand that the queen in the story, Snow White and Seven Dwarfs were not ugly. But, the reason for the mirror to mention Snow White’s name each time the queen asked the mirror the above question was Snow White was beautiful both inside and outside while the evil queen’s mind was full of vengeance, envy and hatred towards her step
daughter, who looked beautiful, calm and serene, even when she was going through the most dire situations in her life. Thus, we need to understand the importance of wellness of the body as well as that of the mind. Also, we need to understand that physical beauty is temporary and it perishes as age catches up. If one achieves inner or spiritual strength, it will stay with them until their last day on earth. To attain this inner strength, which will lead to a bright outer beauty, it is essential that we follow a certain lifestyle sans hatred and envy. It also requires right diet practices. For this, resorting to Ayurveda is necessary since this ancient medical system suggests a lifestyle and diet pattern based on the nature and the individual body constitution of a person for attaining perfect wellness. If this is diligently followed, it gives happiness and that reflects in every action of the person. Once the mind is calm and the body is disease-free, one can find positiveness in everything around and naturally that is shown on the face and body. No other medical system works for the inner beauty like the way Ayurveda does. And this branch of wellness in Ayurveda is termed ‘Sukhachikitsa’.
Sukachikitsa is based on the prakriti or body constiution of a person. This prakriti of a person is known to vary from individual to individual. Hence the treatment methodology to attain wellness in Ayurveda is different for each person. In Ayurveda, treatment is done by understanding the root of the disease and thus nipping it at the bud so that this disease never occurs again. Yoga and meditation are too important tools in achieving wellness. While regular practice of Yoga ensures the body is fit and healthy, a 30-mimute meditation in a calm atmosphere can work wonders, making the mind tension-free and rejuvenating the body. But yoga should be practised under a
learnt guru. Even the United Nations has accepted Yoga as the perfect method for fitness. Wellness treatment requires a lot of dedication and patience from the part of the patient as well as the vaidya who agrees to do the treatment. It is not possible to attain this from a single sitting with the vaidya. Ayurvedic wellness requires several sittings and the patient might be asked to follow a set pattern of lifestyle and diet that may be often cumbersome. Thus, a patient can be assured of complete wellness of mind and body by diligently following a diet and lifestyle pattern as prescribed by the learned vaidya.
According to Ayurveda, a person can achieve perfect wellness only if the people associated with him also undergo the same regimen, such as pure thoughts and harm-free activities. The perfect wellness of mind and body for a person can be equated with playing Rubickâ€™s Cube to attain the perfect colour pattern. Once this wellness cycle is practised and the required results achieved, life on earth will be a heaven. So be beautiful inside and outside of your mind to live like Snow White and her prince who â€œlived happily foreverâ€? at the end of the story.
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MEDICAL TOURISM STRESS
STRESS AND ANXIETY
MAY NOT BE AS HARMFUL AS YOU THOUGHT 38 Medical Tourism Jul - Sep 2019
eople generally think of stress and anxiety as negative concepts, but now a new study shows that they often play a helpful, not harmful, role in our daily lives. “Many Americans now feel stressed about being stressed and anxious about being anxious. Unfortunately, by the time someone reaches out to a professional for help, stress and anxiety have already built to unhealthy levels,” says the study researcher Lisa Damour, private-practice psychologist from the US. Stress usually occurs when people operate at the edge of their abilities — when they push themselves or are forced by circumstances to stretch beyond their familiar zones. It’s also important to understand that stress can result from both bad and good events. For instance, being fired from your job is stressful, but so is bringing a baby home for the first time. Anxiety, too gets an unnecessarily bad rap, said the study. “As all psychologists know, anxiety is an internal alarm system, likely handed down by evolution, that alerts us to threats both external — such as a driver swerving in a nearby lane — and internal — such as when we have procrastinated too long and it’s time to get started on our work,” Damour says. “Similarly, if a client says that she’s worried about an upcoming test for which she has yet to study, I am quick to reassure her that she is having the right reaction and that she will feel better as soon as she hits the books,” she adds. According to the researchers, stress causes harm when it exceeds the level that a person can reasonably absorb or use to build psychological strength. Likewise, anxiety becomes unhealthy when its alarm makes no sense. “Untreated stress and anxiety can cause persistent misery, but can also contribute to a host of additional psychological and medical symptoms, such as depression or an increased risk
of cardiovascular disease”, Damour says. Viewing anxiety as sometimes helpful and protective allows people to make good use of it. The study tells teenagers to pay attention if they begin to feel anxious at a party because their nerves may be alerting them to a problem. That doesn’t mean that stress and anxiety can’t be harmful. Stress can become unhealthy if it is chronic (allowing for no possibility of recovery) or if it is traumatic (psychologically catastrophic). Just as stress is what makes our bodies stronger, the same is true for work–it’s just a different type of stress and a different skillset that make us stronger. Whereas exercise stress strengthens our muscles and capacity to lift weights or run, work stress strengthens our brain and capacity to get things done. But just like exercise, overdoing it with work stress can have just as many bad side effects. Too much stress, or chronic stress, can result in memory problems, lead to depression, or even cause chest pain–certainly not positives. Stress isn’t a bad thing. In fact, it’s absolutely necessary to become more efficient, productive, and effective. The key is managing stress in such a way that it helps you grow and improve, but doesn’t impact your work, life, or health negatively. To do this, like with exercise, you want to systematically increase your capacity to deal with stress. Our body and mind grow through increased stress, not continual stress–that means to push ourselves further, but to still take breaks, to re-charge, and to provide the proper fuel. So if we hope to improve our productivity and ability to work over time, stress is a must to push us past our current ability–and that’s why stress isn’t a bad thing.
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MEDICAL TOURISM FOOD
EAT MORE PLANT- BASED FOOD, IMPROVE HEART HEALTH
ating more plant-based food and fewer animal-based food may be linked to better heart health and a lower risk of dying from cardiovascular diseases.
“Eating a larger proportion of plant-based foods and a smaller proportion of animal-based foods may help reduce your risk of having a heart attack, stroke or other type of cardiovascular disease,” says study lead researcher Casey M. Rebholz, Assistant Professor at Johns Hopkins Bloomberg School of Public Health in the U.S. Researchers reviewed a database of food intake information from more than 10,000 middle-aged US adults who were monitored from 1987 through 2016 and did not have cardiovascular disease at the start of the study. Those who ate the most plant-based food overall had a 16 per cent lower risk of having a cardiovascular disease such as heart attacks, stroke, heart failure and other conditions; 32 per cent lower risk of dying from a cardiovascular disease and 25 per cent lower risk of dying from any cause compared to those who ate the least amount of plant-based food. “Our findings underscore the importance of focusing on your diet. There might be some variability in terms of individual food but to reduce cardiovascular disease risk peo40 Medical Tourism Jul - Sep 2019
ple should eat more vegetables, nuts, whole grains, fruits, legumes and fewer animal-based foods,” Rebholz said. Eating healthy food will help you recover and reduce risk of more heart problems. We usually find all the food at the local supermarket. We should know what food to buy to make healthier meals. Eating a diet low in salt and saturated fat is important if you've had a heart attack. If you have coronary heart disease, you need to be careful about the food you eat. It’s important to change the types of fat you eat. Eating too much unhealthy saturated and trans fats can increase high cholesterol. Choosing food with healthier fats can help you lower your cholesterol and avoid more heart problems. As new evidence emerges, the link between diet and heart disease grows stronger. What you put on your plate can influence just about every aspect of heart health, from blood pressure and inflammation to cholesterol levels and triglycerides. Including heart-healthy food as part of a nutritious, well-balanced diet can help keep your heart in good shape and minimize your risk of heart disease.
HEART-HEALTHY FOOD Leafy green vegetables Leafy green vegetables like spinach, kale and collard
ing to some animal studies, resistant starch can improve heart health by decreasing blood levels of triglycerides and cholesterol. Dark Chocolate Dark chocolate is rich in antioxidants like flavonoids, which can help boost heart health. Interestingly, several studies have associated eating chocolate with a lower risk of heart disease. Tomatoes Tomatoes are loaded with lycopene, a natural plant pigment with powerful antioxidant properties. Antioxidants help neutralize harmful free radicals, preventing oxidative damage and inflammation, both of which can contribute to heart disease. Almonds Almonds are incredibly nutrient-dense, boasting a long list of vitamins and minerals that are crucial to heart health. Theyâ€™re also a good source of heart-healthy monounsaturated fats and fibre, two important nutrients that can help protect against heart disease. Seeds
greens are well-known for their wealth of vitamins, minerals and antioxidants. In particular, theyâ€™re a great source of Vitamin K, which helps protect your arteries and promote proper blood clotting.
Chia seeds, flaxseeds and hemp seeds are all great sources of heart-healthy nutrients, including fibre and omega-3 fatty acids. Numerous studies have found that adding these types of seeds to your diet can improve many heart disease risk factors, including inflammation, blood pressure, cholesterol and triglycerides.
Whole grains include all three nutrient-rich parts of the grain: germ, endosperm and bran. Common types of whole grains include whole wheat, brown rice, oats, rye, barley, buckwheat and quinoa.
For centuries, garlic has been used as a natural remedy to treat a variety of ailments. In recent years, research has confirmed its potent medicinal properties and found that garlic can even help improve heart health.
Berries Strawberries, blueberries, blackberries and raspberries are jam-packed with important nutrients that play a central role in heart health. Berries are also rich in antioxidants like anthocyanins, which protect against the oxidative stress and inflammation that contribute to the development of heart disease. Avocados Avocados are an excellent source of heart-healthy monounsaturated fats, which have been linked to reduced levels of cholesterol and a lower risk of heart disease.
Olive Oil A staple in the Mediterranean diet, the heart-healthy benefits of olive oil are well documented. Olive oil is packed with antioxidants, which can relieve inflammation and decrease the risk of chronic Edamame Edamame is an immature soybean frequently found in Asian cuisine. Like other soy products, edamame is rich in soy isoflavones, a type of flavonoid that may help lower cholesterol levels and improve heart health.
Walnuts are a great source of fibre and micronutrients like magnesium, copper and manganese. Research shows that incorporating a few servings of walnuts in your diet can help protect you against heart disease.
Green tea has been associated with a number of health benefits, from increased fat burning to improved insulin sensitivity. It is also brimming with polyphenols and catechins, which can act as antioxidants to prevent cell damage, reduce inflammation and protect the health of your heart.
Beans Beans contain resistant starch, which resists digestion and is fermented by the beneficial bacteria in your gut. Accord-
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MEDICAL TOURISM NEWS
ADVANTAGE HEALTH CARE INDIA 2019
FIFTH INTERNATIONAL SUMMIT ON MEDICAL VALUE TRAVEL
dvantage Health Care-India 2019, the 5th International Summit on Medical Value Travel, will be held at India Expo Centre and Mart, Greater Noida, India from November 13 to 15, 2019.
The Summit is being organised by the Ministry of Commerce and Industry, Federation of Indian Chambers of Commerce and Industry (FICCI) and Service Export Promotion Council (SPEC). This is the first ever international summit on medical value travel being organized in India for promoting services exports from India. This exhibition will focus on hospitals, healthcare centres, AYUSH hospitals, educational institutions (medical colleges, nursing colleges & AYUSH colleges), medical devices, electronics and associated infrastructure, medical tourism facilitators, hotels, airlines, tour and travel companies and TPAs. There will be a knowledge sharing programme, where internationally renowned Indian doctors and AYUSH experts will deliver lectures on different topics. Reverse Buyer Seller Meeting and planned B-2-B sessions
with hosted delegates from more than 60 identified countries of Africa, Middle East, CIS and Asia (including SAARC) are also being organised. Health Ministersâ€™ Round Table Session with Health Ministers invited from the selected 60 countries will discuss issues related to medical value travel and formulate plans for the way forward. The Summit would bring Indian healthcare providers and global healthcare stakeholders on a single platform and facilitate B-2-B meetings and tie-ups with hospitals and healthcare centres. The conference will also focus on the opportunities for encouraging foreign companies to start manufacturing medical devices in India with local partners. The medical value travel industry has emerged as one of the fastest growing segments of tourism industry despite the global economic downturn. According to a FICCI-IMS report, India is one of the key MVT destinations in Asia with over 500,000 foreign patients seeking treatment in the country. MVT can be a 9 billion USD opportunity by 2020 with adequate focus and effective execution.
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MEDICAL TOURISM NEWS
KTM MANAGING COMMITTEE FOR 2019-21
erala Travel Mart (KTM) Society revamped its managing committee for 2019-21, retaining top functionaries including Baby Mathew Somatheeram as the president, Swaminathan S as vice-president and Jose Pradeep as honorary secretary of the organisation that works for the promotion of the state’s tourism with the help of publicprivate partnership. The 2000-founded institution, which conducts the biennial KTM that hosts the country’s largest buyer-seller meet in the tourism segment, will have Hari Kumar C as the honorary joint secretary and Scaria Jose as the honorary treasurer. The appointments were made based on an election held in Kochi.
India’s largest gathering in tourism industry, facilitating meetings involving buyers, sellers, media and government agencies among others.
The other members of the 17-strong committee are Bony Paul, Janeesh J, Jobin Joseph, Jose Mathew, Lalith Viswakumar, Mallika Dinesh Kumar, Muhammed Ansari K A, P M Ross Masood, Rakesh O M, Riyaz U C, Shilendran M, Tejus Jose. KTM is
KTM is a trade fair for the promotion of tourism in Kerala and held in Kochi. Exhibitors are owners and operators of hotels, resorts, houseboats, Ayurveda centers, specialty hospitals, as well as host families and tour operators.
Visitors come from Kerala, India and around the world. This exhibition is communication and information platform in the industry and offers the exhibiting companies the opportunity to present themselves to a professional audience. The visitor can learn in depth and comprehensive about the latest developments, trends, services and products from different areas.
Quality and Accreditation Institute (QAI) was set up to create an ecosystem of education, training, quality improvement and accreditation. We believe that it would provide a platform to stakeholders including professionals and organisations, associated with quality in any Change Adapt Improve
way, share their wisdom and knowledge in order to make its Vision realized.
QAI is an institutional member of the International Society for Quality in Health Care Change Adapt Improve (ISQua) . Services Offered: Accreditations/Certifications & Trainings (including Internal Auditor Course or Practicum, Assessor Training Course) QAI Programs: Following are the Accreditation/Certification Programs Centre for Accreditation of Health and Social Care: • ART Centres • Dialysis Centres • Home Care • WHO Patient Safety Friendly Hospital Standards • Green Hospital • Healthcare Facilities Centre for Laboratory Accreditation: • Medical Laboratories ISO 15189 • Testing Laboratories ISO/1EC 17025 • QAI Certification for Basic Composite Medical Laboratory Upcoming Program: • Ambulatory Care
WHY QAI? We are a progressive organization and our clients are our priority. We listen, respond, support and encourage. We help you in building confidence and trust in your clients. We promise to be innovative, transparent, good listener and competitive. Accreditation mark
Contact Details: Dr. B.K. Rana (CEO) Email: email@example.com Website : www.qai.org.in Quality and Accreditation Institute Pvt.Ltd. 416, Krishna Apra Plaza, Sector-18, Noida-201301, U.P., India Tel: +91-120-4113234
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MEDICAL TOURISM NEWS
THUMBS UP FOR KERALA
KERALA HEALTH TOURISM CONFERENCE AT KOCHI UPBEAT ABOUT KERALA'S MEDICAL VALUE TRAVEL POTENTIAL sector has been a major bonding element in the relationship between India and Maldives for almost a century now. She recalled her childhood experiences when the ingredients for traditional medicines in Maldives were procured from Kochi. “Maldivians come to Kerala for healthcare not because of the State’s proximity, but because of the good quality healthcare that is on offer here. We have always felt welcome here,” she said, adding that Kerala continues to be a preferred healthcare destination for Maldivians. Abdulmalk Abdullah Al Eryani, Ambassador, Republic of Yemen, in his keynote address, said that India has been a major centre for treatment for Yemenis for the past 40 years. “In Kerala, we have found a very safe environment for our patients,” he added. Paul Thomas, Chairman, CII Kerala & Founder-Managing Director & CEO, Esaf Microfinance & Investments Pvt Ltd, pointed out that the medical tourism sector in the country was expected to grow in size to $7-8 billion by 2020. Foreign nationals are looking at Kerala for advanced medical treatment, he pointed out.
he seventh edition of Kerala Health Tourism (KHT), the international conference and exhibition on health tourism, organised by the Confederation of Indian industry (CII), in association with the Services Export Promotion Council (SEPC), was held at Kochi, inJuly. The Summit deliberated on the theme ‘Kerala-An Emerging Global Hotspot for MVT’. International delegates from 9 countries (Bangladesh, Oman, Africa, Saudi Arabia, Cambodia, Iraq, Maldives, Yemen and Uzbezkistan) participated in the two-day summit. Aishath Mohamed Didi, Ambassador, Republic of Maldives, in her keynote address, said that the healthcare 44 Medical Tourism Jul - Sep 2019
Dr Harish Pillai, Chief Executive Officer, Aster Hospitals & Clinics, India, introduced the theme for the Summit. In his address, Dr Pillai said that Kerala has invested significantly in social sectors and has already achieved the millennium development goals. The state is on par with OECD countries in many healthcare indicators and currently, it is capable of offering the best in medical care to a wide swathe of population drawn from different countries. Gokulam Gopalan, Chairman, Gokulam Group, E M Najeeb, Executive Director, KIMS Healthcare Management Limited, Fr Johnson Vazhappilly, Executive Director & CEO, Rajagiri Hospital, Jyoti Kaur, Deputy Director General, Services Export Promotion Council (SEPC), Thomas John Muthoot, Vice Chairman, CII Kerala and Chairman & Managing Director, Muthoot Fincorp Ltd, and John Kuruvilla, Director, CII Kerala, also graced the occasion.
MEDICAL TOURISM NEWS
GCC TRAVEL AGENTS VISITED KERALA At the event, the tourism promoters of Kerala got an opportunity to discuss with the delegates about the facilities on offer for tourists visiting Kerala. The nine days program covered Kerala's main tourist destinations like Kumarakom, Allappuzha, Thekkady, Munnar and Kochi. Around 40 travel agents from GCC and social media influence people participated in the event.
Kerala Tourism Minister Kadakampally Surendran inaugurating the GCC travel agents networking in Kerala organised by Grace Travel Mart (GTM) at Kochi.
s part of promoting tourism in Kerala, the Grace Travel Mart (GTM) organised the biggest GCC travel agents networking event in Kerala. The event took place at the Grand Hyatt, Kochi. The highlights of the program were a FAM trip, networking event, seminar & interactive session. An album on Kerala was launched at the validctory functon followed by cultural programmes.
The event took place with the support of Kerala Travel Mart, Munnar Travel Mart, Ayurveda promotion Society, Ayurveda & Health Tourism magazine, Showcase Munnar, Wayanad Tourism Organization, ATTOI and Thekkady Destination Promotion Council and Destination Kerala. Kerala Tourism Minister Kadakampally Surendran officially inaugurated the programme. Other officials of Kerala Tourism were also present at the occasion. After the meet at Kochi, GTM will organise a programme for the tour operators of Kerala to visit all the countries in the Gulf region.
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MEDICAL TOURISM NEWS
BOOST FOR B2B IN HEALTHCARE AT MEDICALL EXPO, CHENNAI
edexpert Business Consultants Pvt Ltd, in association with Kauvery Hospital Joint Managing Director Dr Manivannan S, organised the 23rd edition of the medical equipment trade fair, ‘Medicall’, at the Chennai Trade Centre. The expo was inaugurated by German Consul General Karin Stoll. Medicall is an international show with exclusive hall for international companies from Germany, Japan, China, Taiwan, Malaysia, South Korea, Portugal, Italy, UK, and USA. On display at the exhibition were more than 6,000 products from 20-plus countries. The trade fair focused on all the needs of a hospital from surgical cotton to the latest imaging equipment and surgical tools. Around 18,000 medical professionals visited the expo. Dr Manivannan said, “Small- and medium-size hospital owners from Tier-II and III cities cannot afford to have qualified purchase managers. Equipment companies
46 Medical Tourism Jul - Sep 2019
also do not have adequate sales force to meet all these hospital owners. Since I have undergone the difficulty for my hospital, I thought Medicall will bring in all equipment manufacturers under one roof.” Medicall is India’s largest B2B trade fair for medical devices and hospital supplies. Approximately 750 exhibitors and 15,000 trade visitors from over 20 countries, among them physicians, biomedical engineers, sales people, decision makers, consultants and hospital owners, were represented at this important industry event. In addition to the presentation of the best and the latest medical and medical-technical equipment, software, supplies and other devices the market has to offer, the fair mainly served as a platform for exchange of knowledge and experiences among renowned industry experts. Various conferences and innovation awards in different categories complemented the event.
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MEDICAL TOURISM NEWS
LATEST TRENDS IN EMBRYOLOGY IN FOCUS
FIRST INTERNATIONAL CONFERENCE ON INFERTILITY, CLINICAL EMBRYOLOGY AND ENDOSCOPY DISCUSSES SPECIALIST AREAS IN IVF, EMBRYOLOGY AND REPRODUCTIVE BIOLOGY
ertility is a widely discussed topic in these times of stress and mental unrest. Today’s stressful work culture and life has left many couples, who are yearning for children from their own blood, childless. This is one of the many reasons why the Infertility Society of India decided to conduct the first International Conference on Infertility, Clinical Embryology & Endoscopy (ICE 2019) at Chennai. The theme of the conference was “Exploring the Novel Research & Techniques in Reproductive medicine”, and the event was intended to bring forth the most recent technologies to tackle the various challenges encountered in the field of Assisted Reproductive Techniques (ART). ICE 2019 saw participants from across the globe who spoke and discussed the current challenges, controversies, advances and the future perspectives in the field of reproductive medicine.
in a wide range of synchronized sessions focused on specialist areas in IVF, embryology and reproductive biology. The conference had sessions on ‘The next generation of embryo aneuploidy testing: to biopsy or not to biopsy’, ‘Carrier screening programs and its impact on PGT-A’, ‘Genetic screening for PGD’, ‘Cleavage stage biopsy and Tubing, Blastocyst embryo biopsy and Tubing, ‘Infertility is on the rise, isn’t it?’, ‘Optimization of IUI Outcomes’, ‘Ovulation Induction’; ‘Ovarian stimulation; optimization of ART outcomes’, ‘Woman with ovarian insufficiency’, ‘Optimizing PCOS prior to Ovulation induction’, ‘Predictors of ovarian response – individualization matters’, ‘Prevention of premature leutinization in IVF stimulation protocols’, ‘GnRH analogues in ART-Current updates and newer IVF stimulation protocols’, and ‘HMG / Recombinant FSH/ HMG HP/Recombinant LH – Drug and dose decisions’.
It was an opportunity to modernise the relevant research information, their clinical applications and interactive moments which clarified the indecisions. This meeting had a thrilling, cutting-edge dimension to it with a clutch of high profile international and national speakers participating
Fertility Society of India (FSI) is a non-governmental organisation established to connect professionals, embryologists and all other people involved in fertility treatment and reproductive medicine. FSI focuses on knowledge sharing and sharpening of skills by organising conferences, seminars, CME programs, training programs and workshops.
a slow scale given the low participation of exhibitors, but eventually gathered momentum and recognition.
THE MAN OF EXHIBITIONS AND CONFERENCES IN OMAN
Oman, the most important hub for Exhibitions, Conferences and Expo shows. One of the pioneers in bringing this large scale Indian exhibitions to Oman is Lijihas Ussain. A young, dynamic entrepreneur who set his goals high and left no stone unturned. Lijihas Ussain, starting his career as a visualizer in a small advertising agency and gradually developed his skill set and business acumen taking a bold leap into a competitive scenario, opening an advertising agency Sixth Element. He realized that there was a huge untapped potential for Indian exhibitions in the field of Indian real estate and education. He used to visit every exhibition and honed in his skill set and initially he organized two exhibitions independently. Now he plays the role of an Exhibition Manager. A holiday stop in Thailand opened his eyes to the scope for starting Medical Tourism in Oman as many Omani’s were travelling there for medical treatment. A good concept, started on 48 Medical Tourism Jul - Sep 2019
He had seen the potential of this Medical Value Travel business, hence, connected with all Hospitals & Ayurveda centers. The exhibition is on a growth curve as Omani patients do consider and willing to travel to India as their main destination. Indian emigration is issuing more than 7500 plus medical visa’s in a month. Undoubtedly, it’s a big growth and India is getting the Forex.
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MEDICAL TOURISM NEWS
Focus to be on
HEALTH VISION 2050
at OMAN HEALTH EXHIBITION AND CONFERENCE
man Health Exhibition & Conference, the annual international trade event that highlights the rapid and continuous advancements of the health and medical sector in Oman, will be held from September 23 to 25, 2019 at the Oman Convention and Exhibition Centre. It is a common platform that brings together different segments of the health and medical industry to explore new opportunities, showcase the latest technologies, services and facilities, and leverage potential for trade and investment. The Conference is aligned with the government’s Health Vision 2050 and aimed at addressing the challenges as well as discussing initiatives to improve the sector. Further building upon the foundation of Oman's Health Vision 2050 which prioritizes the elevation of quality in the sector, the Exhibition and Conference has a strong focus on improving healthcare facilities and capabilities of medical professionals in the country, meeting the rising demands of the sector through establishment of health centers and strengthening tertiary care amenities around the Sultanate. It was launched in October 2009 as MedHealth & Wellness as a major healthcare exhibition in Oman and served as the pioneer event focusing on health, medicine and fitness and as a launchpad for various conferences and fora in the Sultanate. The event was granted “UFI-Approved Event status” by UFI-The Global Association of the Exhibition Industry in 2012. The event will also provide participants with an excellent opportunity to network with government, regulatory authorities, colleagues, and learn up-to-date information, emerging trends, strategies, innovative approaches, management techniques and technologies that would
help them enhance the quality of healthcare services in the country. Ahmed Sayed, exhibition director, Oman Health Exhibition and Conference, says “We are glad to see the positive response to this event from the relevant representatives from the industry as with the continued support of the Ministry of Health. We are committed to organizing industry meetings such as this to ensure that this event serves a real purpose for Oman and its fast-growing healthcare industry. Only through close collaboration and year-round interaction with stakeholders could we ensure that we are on the right track.” The ninth edition of the landmark event expects to welcome more than 100 exhibition companies from more than 10 countries, showcasing the best of the industry products, services, equipment and technologies representing hospital and medical infrastructure, medical supplies and healthcare services. Concurrent to the exhibition is a three-day conference and a two-day workshop accredited by the Oman Specialty Board (OMSB), which will be presented by a qualified lineup of highly esteemed health and medical experts. Providing added value are the business-to-business meetings, guaranteeing significant return on investment (ROI) for exhibitors. The organizers have also ensured a more worthwhile visitor experience by offering free medical consultations with specialists from some of the biggest clinics, hospitals and healthcare providers in Germany, Iran, India, UAE, Thailand, Malaysia and Turkey. Oman Health Exhibition and Conference is recognized as Oman’s biggest healthcare event and has been supported by the Ministry of Health since its launch in 2009. Medical Tourism Magazine is the official magazine for the event
50 Medical Tourism Jul - Sep 2019
MEDICAL TOURISM MEDICAL EVENTS
INTERNATIONAL CONFERENCE ON MEDICAL AND HEALTH SCIENCES (ICMHS) (September 25 and 26, 2019) Macau, China
The International Conference on Medical and Health Sciences (ICMHS), aimed at presenting current research being carried out in the area of healthcare, is scheduled to be held on 25th and 26th September 2019 in Macau, China. The conference would provide a forum for scientists, scholars, engineers and students from universities around the world and the industry to make presentations on their ongoing research activities, thus fostering research relations between the universities and the industry. This conference would provide big opportunities for delegates to exchange new ideas and share their experiences, to establish business or research relations and to find global partners for future collaboration.
INTERNATIONAL CONFERENCE ON RECENT ADVANCES IN MEDICAL, MEDICINE AND HEALTH SCIENCES (ICRAMMHS) (September 25, 2019) Chennai, Tamil Nadu, India
An International Conference on Recent Advances in Medical, Medicine and Health Sciences (ICRAMMHS) will be held on 25 September 2019 at Chennai, India. ICRAMMHS will bring together innovative academics and industrial experts in the field of medical, medicine and health sciences on a common forum. All the registered papers will be published by the World Research Library and will be submitted for review for indexing by Google Scholar.
INTERNATIONAL CONFERENCE ON MEDICAL, PHARMACEUTICAL AND HEALTH SCIENCES (ICMPH) (October 3 and 4, 2019) Berlin , Germany
INTERNATIONAL CONFERENCE ON MEDICAL ETHICS AND PROFESSIONALISM (ICMEP) (October 2, 2019) Dubai, United Arab Emirates
An International Conference on Medical Ethics and Professionalism (ICMEP) that focuses on academic research and development across the globe would be held on 2 October 2019 in Dubai. The event is intended to meet the challenges before the global academic and research community in the current times. The event will provide a unique opportunity for researchers from different domains to make presentations. The event would strive to encourage researchers to work their way towards achieving excellence through cutting edge research from all the disciplines of technology.
INTERNATIONAL CONFERENCE ON HEALTHCARE AND CLINICAL GERONTOLOGY (ICHCG) (October 10, 2019) Fukuoka, Japan
This is a premier global platform for the International Conference on Healthcare and Clinical Gerontology (ICHCG) that uniquely describes the academic research and development across the globe. It will be held on 10 October 2019 at Fukuoka, Japan. The event will provide unique and rational opportunities to all the attendees and researchers from different domains.
WORLD CONGRESS ON MEDICAL AND HEALTH INFORMATICS (November 2 and 3, 2019) PetalingJaya , Malaysia
This conference provides a platform for professionals involved in Medical and Health Informatics to exchange knowledge and gain insights into the state-of-the-art technology, techniques and solutions in medical and health Informatics as they have been developed and applied in different countries. Participants would include a wide variety of stakeholders from research and academia, industries as well as government organizations.
The 143rd International Conference on Medical, Pharmaceutical and Health Sciences (ICMPH) will be held on 3 and 4 October 2019 at Berlin, Germany. ICSET-2019 is being organized by the Global Society for Research and Development (GSRD). The aim of the conference is to provide a platform for students, engineers, researchers and scientists to share knowledge and ideas about the recent trends in the field of medical, pharmaceutical and health sciences.
INTERNATIONAL CONFERENCE ON SPORTS NUTRITION AND SUPPLEMENTS (ICSNS) (October 29 and 30, 2019) Beijing , China
An International Conference on Sports Nutrition and Supplements(ICSNS) will be held on 29 and 30 October 2019 at Beijing, China. The ICSNS is part of an effort to bring together innovative academics and industrial experts in the field of science, technology and management on a common platform.
RESEARCH AND INNOVATIONS MEDICAL CONFERENCE 2019 (November 22 to25, 2019) Plovdiv, Bulgaria
The topics to be covered during this conference that will take place in Bulgaria, include advances in medical education and research approaches, stem cell techniques, surgery, evidence-based medicine, quality of patient care, general internal medicine, medical emergencies, primary care issues, epidemiology and public health matters, paediatrics and child health issues, cardiovascular diseases, diabetic care advances, progress in respiratory diseases, medical ethics and legal issues in healthcare, medical education, medical informatics, emerging foodborne disease, infectious diseases and global diseases epidemics, tropical diseases, obstetrics and gynaecology, mental health issues, co-morbidities, managing chronic diseases in the community, medical ethics, manmade diseases and many more. The conference will take place from November 22 to 25; 2019. A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM RARE SURGERIES
SUDANESE MAN WITH MALIGNANT BRAIN TUMOUR TREATED AT DELHI HOSPITAL
57-year-old man, Babiker Hassabelgawi Ahmed from Sudan, who underwent a tumour removal surgery 15 years back, did not have any problems till 2018. He was diagnosed with his first tumour on the left side of his head at the age of 42 and got it surgically removed in Sudan. Two years back, following few episodes of seizure a small nodule over his forehead came to the notice of medical experts. This exponentially increased in size within seven-eight months. By that time, the skin around the tumour mass eroded, his health deteriorated and he once again started having frequent seizures. Medication did not help to improve his health. Doctors advised him to have an MRI scan in Sudan which he flatly refused. Within a short span of time the tumour grew from his forehead and bulged in the shape of a horse-shoe. 52 Medical Tourism Jul - Sep 2019
On July 17, 2019, he reached the Aakash Healthcare Super Speciality Hospital in Dwarka, India from Sudan in a bad state. The size of his forehead tumour was of 6 cm x 8 cm long outside and 18 cm x12 cm deep inside, the brain. It had turned malignant due to sheer negligence. “After understanding Ahmed’s case, we planned to do surgical removal through bicoronal flap mobilisation, strip craniotomy and excision of the complete bone tumour, exteriorisation of frontal sinus and duroplasty by artificial dura and cranioplasty by titanium mesh and flap tailoring to close the galea,” said Amit Srivastava, Director and Senior Consultant Neuro Surgery at Aakash Healthcare. The condition that he was suffering from was called invasive anaplastic meningioma WHO Grade III arising from frontal convexity dura and falx. “We created a flab on the forehead skin, since skin was involved, we had to remove the upper lining and bones
in the brain along with the tumour, as it vastly spread across the forehead skull and skin,” Srivastava said. “The area above the nose and the middle of the forehead which was affected due to the tumour was removed and thigh fascia and fat was used to re-graft that area,” he added. The surgery was completed successfully after almost 11-12 hours with a team of three doctors. These kind of tumours are usually due to some genetic disorders. “This hospital extended all possible support to us and the entire team of doctors were very comforting and helpful. Our case was treated on priority and I was given a second chance to life,” Ahmed said. The patient was discharged on the seventh day after surgery and is fine now. His urinary incontinence and blurry vision have been managed but he will be on medication for a few months.
MEDICAL TOURISM RARE SURGERIES
50-YEAR-OLD WOMAN WALKS AFTER 15 YEARS
ifty-year-old Sandhyawati could not walk straight for the last 15 years. She could only crawl because her knees were affected by a rare rheumatoid arthritis that left her knees permanently bent. Last month, she underwent a complex knee replacement surgery and today her happiness has no limits. Sandhyawati, who now stands on her feet with support as she is recovering, said: “For the last 15 years, I have only been crawling. The fact that now I can walk on my own work gives me immense happiness.” As per doctors at the Paras Hospitals where she underwent surgery, the patient was suffering from rheumatoid arthritis that affected her knees and caused severe acute flexion deformity, a condition in which the
knees were permanently bent by more than ninety degrees. Rheumatoid arthritis is an autoimmune inflammatory arthritis which affects small as well as large joints of the body and rapidly destroys the joint cartilage. This can be treated only with an early specific therapy.
preservation and special soft tissue release techniques which are safer to allow correction of deformity easily in a few days of surgery. Sandhyawati who hails from Khosli village in Rewari, Haryana said that she came to the hospital last month after which she was admitted.
“Such cases are extremely rare and we have treated about a dozen such crawling patients in the last 17-18 years of exclusive joint replacement practice. The complexity of the procedure is enormous and risks of nerve and blood-vessel damage are very high,” said Vivek Logani, Chief, Paras Joint Replacement and Sports Injury Centre, Paras Hospitals, Gurugram.
Her family members told the medical experts that she can move around on her own and do chores like taking the food and roaming around in the house.
The surgery was performed with the help of computer navigation technology, to ensure accuracy and bone
Despite surgeries at innumerable hospitals in the past, no conclusive solution had come to her rescue until she was referred to Paras Hospitals.
“Two or three women in our village faced the same problem and they told us about the success of this surgery,” said a family member.
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MEDICAL TOURISM RARE SURGERIES
RARE SURGERY ON CONJOINED MAURITIAN TWINS ENSURES ONE SURVIVES
n a rare surgery, specialists at a Bengaluru hospital operated on two conjoined two-monthsold Mauritian twins, who were sharing one heart with seven chambers. They managed to save the life of one of the twins, while performing South India’s first thoracopagus separation surgery. The procedure, stenting of the patent ductusarteriosus (PDA) – an opening between two blood vessels leading from the heart – was carried out at the Narayana Health City. The surviving twin, a baby girl, is named Cleanne Papillon. Usually, conjoined twins have their bodies joined from the neck to the upper abdomen. In this case, however, their hearts were also joined. Instead of four chambers for each heart, they had seven chambers, an extremely rare case which had doctors in Mauritius shocked. The twins’ parents were asked to consult other hospitals and they eventually decided to bring the children to Bengaluru after visiting other hospitals in Europe and Asia. A multidisciplinary team headed by a paediatric surgeon, and comprising of a pediactric cardiologist, critical care service consultant, anaesthesia consultant, and neonatology consultant, examined the babies. The doctors put them in intensive care, and once stabilized, PDA stenting was performed to improve the condition of the heart. It was then found that one of the child was weak with poorly developed lungs and abnormal blood vessels and they could only save the healthy child. “The survival rate in conjoined twins is minimal. In fact, the survival ratio of Siamese twins with a fused heart is even lower. The child is the ‘3rd Miracle Baby’ in the world who has survived a Thoracopagus separation surgery,” said D’ Cruz. Cleanne’s father Ian Papillon said, “We thought we will lose both of them. Today, we have at least one of our babies with us.”
54 Medical Tourism Jul - Sep 2019
MEDICAL TOURISM RARE SURGERIES
DOCS REMOVE TOOTHBRUSH FROM MAN’S BELLY IN CHINA
octors from a southern Chinese hospital removed something unusual from a man’s intestines: a 14-centimetre-long toothbrush he swallowed 20 years ago. The No.3 People’s Hospital of Shenzhen in Guangdong province said it was among the most bizarre items doctors have found in a patient’s entrails, along with nails, coins and lighters. The patient, a 51-year-old man surnamed Li, was admitted to the hospital for abdominal pain in late June, and a CT scan revealed a mysterious item in his duodenum, Xinhua news agency reported. Li then told doctors it could be a toothbrush he swallowed in a suicidal attempt made 20 years ago when he was diagnosed with HIV contracted from using drugs. Feeling no discomfort after the failed suicide, he went on with his life and put aside the embarrassing experience. The toothbrush stayed peacefully in his belly until 2014, when Li began to suffer from abdominal pain and gallbladder inflammation. “The toothbrush might have stayed in the stomach and duodenum for many years before sticking into the bile duct, causing the inflammation and pain. If left untreated, it could touch the liver and result in a fatal infection,” said Liu Jialin, Li’s surgeon. Liu said they resorted to an endoscope to retrieve the toothbrush, which had a “bare” look with all its bristles dissolved. Li said that after the suicide attempt, he renounced drugs and began HIV treatment. He later got married and his wife gave birth to two healthy children. “I have long forgotten the toothbrush, assuming that it had expelled on its own,” he said.
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MEDICAL TOURISM RARE SURGERIES
CHENNAI DOCTORS EXTRACT 526 TEETH FROM 7-YEAR-OLD’S MOUTH tering general anaesthesia and saw a bag/sack inside it. The sack, weighing about 200 grams, was carefully removed and was later found to contain 526 teeth — small, medium and big sized,” Senthilnathan said.
Chennai doctors extracted an astounding 526 teeth from the mouth of a seven-year-old boy in a rare surgery performed at the city’s Saveetha Dental College and Hospital, doctors said. Suffering from a rare case of “compound composite ondontome”, the boy was brought to the hospital with a swelling in his lower right jaw. “The parents first noticed the swelling when the boy was three years old. But they didn’t bother much as the swelling wasn’t much then and
the boy did not cooperate with the investigative procedures either. “Later as the swelling increased, the parents brought the boy to our hospital,” said P. Senthilnathan, Professor -Department of Oral and Maxillofacial Surgery at the hospital. He said, an X-ray and CT-scan of the boy’s lower right jaw showed a lot of rudimentary teeth following which the doctors decided on the surgery. “We opened up the jaw after adminis-
Though some were very tiny particles, the doctors said, they had the properties of teeth. It took five long hours for the doctors to remove all the minute teeth from the sack. “It was reminiscent of pearls in an oyster,” the doctors said. “The boy was normal three days after the surgery,” said Pratibha Ramani, Professor and Head of the Department, Oral and Maxillofacial Pathology. According to the doctors, this is the first ever case documented in the world in which in an individual has been found to have so many minute teeth.
MAN’S HEART RESUMES FUNCTIONING 18 MONTHS AFTER ARTIFICIAL IMPLANT SURGERY
n a miraculous turn of events, a 52-year-old man got a new lease of life when his heart resumed functioning almost 18 months after he underwent an artificial heart implant procedure following a cardiac failure. Detecting the recovery, doctors switched off the artificial heart and the man is alive on his original heart now. Iraqi businessman Hani Jawad Mohammed was implanted with an artificial heart after he suffered a heart failure, a condition in which heart muscle doesn’t pump blood as well as it should, Chairman and Head of CTVS, BLK Heart Centre, New Delhi, Dr Ajay Kaul said. “The patient had visited us in a critically ill state a year-and-half ago with a failing heart and rapidly deteriorating health. He was given an option of a heart transplant or artificial heart implant. “Due to the acute shortage of donor and his serious condition, artificial heart implant was the only alternative we had,” Dr Kaul said.
56 Medical Tourism Jul - Sep 2019
“After surgery, he was under constant check up and we were monitoring his implant and his organic heart which was put on medication and rest,” consultant cardiologist at the hospital Dr Dheeraj Gandotra said. This time, when he came for a follow up, almost after a gap of three months, it was noticed that his original heart had recovered and was functioning properly, Dr Kaul said. A team of doctors monitored his original heart’s functioning by slowing down the artificial implant. They repeated the process three to four times in over two months and realised that his original heart has recovered. “Generally the original heart may show recovery of 10-15 per cent but his heart functioning was way better. It is a medical miracle. “After confirmation, we weaned off the artificial heart with a new technology without performing surgery on him again,” said Dr Kaul, who has invented the most advanced technique of weaning off artificial heart support.
His heart is beating again normally without any support, the doctor said. Mohammed said, “It’s a rebirth for me — from a failed heart to an artificial heart to a natural one again.” “I had several attempts on my life. The first was one being in the captivity of terrorists, from where I managed to escape. Even after having received multiple gun-shot injuries, I survived many surgeries and finally underwent an artificial heart transplant here,” he said.
Avoid Bypass Surgery Avoid Stents Established in 2003 Leading EECP centre in India Treated hundreds of patients from middle east
What is ECP It is an American machine (USFDA approved) to treat blocked arteries of the heart without Bypass Surgery and without Stents Are you suffering from any of the following? BLOCKED ARTERIES OF THE HEART CHEST PAIN HEART ATTACK BREATHLESSNESS ON WALKING You can now avoid Bypass Surgery and Stents with this new technique from America called EECP+AMT. It is totally painless. Has no side effects. It is as effective as Bypass surgery and Stents. It is USFDA approved. It is very economical
Who can benefit from EECP+AMT? 1.
Those who are unfit for bypass surgery.
Those who have had a failed bypass surgery.
Those whose stents have got blocked
Those who are very sick, very weak or very old.
Those who are afraid of operation.
Patients who’s EF (ejection fraction) is very low and have breathing difficulty during exertion.
12, The Mall, Amritsar – 143001 – Punjab – India Ph: +91 183 222 6660 | +91 981 405 2303 Email: firstname.lastname@example.org www.randhawahospital.com A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM EQUIPMENT WORLD
I CORE 10 INFANT RADIANT WARMER I Core 10 series of Infant radiant warmer or baby warmer provide highly effective solutions to providing regulated heat to newborn babies. An advance servo micro processor mode provides up to date, well monitored warmth to the babies. Temperatures can be set and then the machine takes over and constantly provides the required heat output efficiently. The control panel is laid out in an easy to view and easy to operate manner. All essential information including the temperature setting/set temperature, current baby skin temperature and heater output is provided in bright clear LED panels.
DIGITAL RADIOGRAPHY (CEILING SUSPENDED) Allengers Digix FDX system, a US FDA approved diagnostic Digital Radiography system, is intended for general purpose Radiography. It is a fully motorized 3D ceiling suspended stand with auto tracking facility of tube for table & vertical bucky. Preview image is available in less than 5 seconds. The features include digital touch display on tube stand for various parameters selection, oblique tracking of tube head synchronized with FPD in VBS, superb image quality due to fine pixels and high contrast range, efficient and user-friendly workflow due to DICOM based system, easy to connect with existing HIS / HMS / RIS / PACS in a hospital environment, tracks detector positioning (vertical stand or 6-way table) for accurate source to detector positioning, unlimited positioning freedom, and high-resolution 3K x 3K detector.
Orthopedic Bone Plates are used for healing the fractured bones. These Orthopedic plates hold the broken bones together. A wide range of Orthopedic Surgical Plates is produced by GPC. These include Cloverleaf Plates, Cobra Plates, Condylar Buttress Plates, DHS Barrel Plates, Reconstruction Plates, 'T' Plates, etc. etc. The Orthopedic Plates, including the Titanium Bone Plates, are produced from high quality raw material. The GPC Orthopedic Surgical Plates are available in various sizes, thickness, width and hole spacing, as per individual requirements of our valued patrons.
CURA has redefined the Ultrasound Imaging with its advanced, first of its kind, Sonoscape Ultrasound systems. The new VISTA platform offers great imaging experience. Sonoscape brings its proprietary technology transducers. World’s first 15 inch touch screen, 200 degree transvaginal imaging, high density transducers and scores of other features makes Sonoscape preferred ultrasound. Sonoscape’s ultrasound clan, brings advanced single crystal transducer, 4D functions and intelligent workflow. The advanced software and hardware features offers clarity like never before.
BSMT 2014 Motorized Operation Table BS MT 2014 is an electric operation table with double eccentric base which is designed and developed in accordance with customer’s need and desires. It is controlled by complete electric driven actuators. The top of the table is radiolucent and the frame work in complete 304 grade stainless steel which makes it easy to clean . The table top is in 5 parts. The free adjustments for dynamic angles can be satisfactory for various surgical requirements. The control panel has keys for confirmation avoid any confusions during usage. www.bharatsurgical.com/medical-hospital-surgical-products/ot-table-solutions/motorized/bsmt-2014
58 Medical Tourism Jul - Sep 2019
CLOSED WOUND SUCTION UNIT Closed Wound Suction Unit by Asco Medical is an effective device for closed wound drainage under negative pressure post operatively. The Radio opaque drainage catheters are having muti perforation for efficient drainage. It is suitable to offer surgeons/doctors to use one or two catheters simultaneously. The features include flexible bottle chamber is easy to operate by one person to activate the suction and available in different sizes with matching needle .
MEDICAL TOURISM EQUIPMENT WORLD
DENTAL AIROTOR AIR COMPRESSOR Cleanair-200 Monobloc Oil-free Medical Grade Airotor Air Compressor by Confident with 1 Minimum noise is fitted on MS tank. It comes with radiator cooler, Condensor, Silicon column filter for moisture, dust filter microbial filter fitted on M.S.Tank. The Oil-free compressor (without oil lubrication) is a complete compressor with drying system. It is capable of supplying dry compressed air of extremely high quality and purity, required for surgical procedures. This is not just a compressor. It is a Total air Technology system. The air used in the clinic requires total filtering, where utmost care is absolutely essential. It has been designed for specially for medical applications.
KOJAK SELINGE Kojak Selinge HMD has remarkably taken the challenge of providing solution to the problem of unsafe injection practices arising due to use of reused syringes, by presenting for the first time in India Kojak SelingeNon Reusable Syringes which ensure against any possible risk of re usage, as its plunger component breaks off in case of an attempt to reuse the syringe. Its brrels are made of medical grade polypropylene that is nontoxic & compatible with any medications. The plungers are made of medical grade polypropylene which is non-toxic and compatible with any medications. Gaskets are made of natural rubber which is chemically inert and compatible with medication for short term contact drug delivery application. The Presence of ring & lock mechanism which automatically breaks the plunger, if reuse is attempted.
NICE 3010 H
Baby Incubator with electrically height adjustable manufactured by nice NeĂśtech Medical Systems Pvt Ltd is built to Embody precision, reliability and convenience. Micro-processor is controlled with simultaneous display of Skin, Air and Set Temperatures. The other features include thermistor based Temperature Sensor for accurate temperature measurement, memory Backup restores set temperature and control mode automatically, in the event of power failure. it helps to reduce the attention failure of users, centrifugal blower operation ensures intake fresh air for the infant, and minimizes the CO2 level inside the hood, always, withdrawable baby tray gives unimpeded access to the new born, Electrical Adjustment of working height ensures convenient care of the new born, unit has a built-in Humidity Chamber and integrated O2 Flow Meter and baby bed is tiltable at both sides, Head up and down, with externally operated Trendelenburg and Fowlerâ€™s position.
Sonotens an advanced solid state 1 MHz ultrasound therapy and dual channel TENS equipment manufactured by HMS Medical Systems is available in a sleek, compact and water-resistant design. It can be operated in either continuous mode or in pulsed mode. A digital display is provided to indicate all the necessary details like mode, power, timer etc. This combination therapy equipment come with an easily selectable micro-controller-based timer and plastic moulded lightweight transducer. Sonotens has six pre-programmed output modes which can be selected via a soft touch key and comes with a 15 mins built-in timer. It can be operated both via a rechargeable battery and main power supply.
RYLES TUBE Angiplast delivers Ryles Tube which is specially designed for patient undergoing long term gastro- intestinal feeding, aspiration and intestinal secretion. Features of Ryles Tube include Siliconized and smooth outer surface to reduce chances of tissue irritation, Thermo- sensitive material softening with body temperature conforming to the shape of nasal - gastric tract, Corrosion resistant stainless steel balls are sealed at the distal end of tube for X-ray identification and for assisting the movement of tube during insertion, provided with full length Radio Opaque line for checking the tube placement, provision of four lateral eyes for efficient aspiration and provided with soft tapered connector at the proximal- end to fit easily with standard accessories. /www.angiplast.com/product/gastroenterology/ryles-tube
VERSATOR DRIVE UNIT The Versator Drive Unit (VDU) by Veol Medical Technologies consists of an innovative design to drive the Versator Handpiece efficiently for any type of laparoscopic tissue morcellation. High torque motor and razor sharp blade ensures smooth cutting even through calcified myomas. Ergonomically placed controls & grip of Handpiece, an intuitive interface, and foot pedal activation goes a long way in creating a fatigue free procedure. It has simple and easy user interface and a Quick & One-touch connection with the Handpiece helps the user in quickly mastering the technique. The Drive Unit has a minimum speed and maximum speed which can be fine tuned in eight steps. This gives users better control over morcellation speed and increases efficiency. Highest quality materials are used to ensure longer life and better reliability for years.
Esteemed manufacturers of medical equipment /devices may forward details of new products for free featuring in Medical Tourism Magazine. The details can be forwarded to: email@example.com For more information call: + 91 98461 21715 A Complete Magazine on Healthcare in Asia
MEDICAL TOURISM HOSPITALS
RAK HOSPITAL Sosun Magu Male', 20040 Maldives Phone: (+960) 331 3553 Email: firstname.lastname@example.org
Al Qusaidat Ras Al Kaimah UAE Phone: +971 72074444 Email: email@example.com www.rakhospital.com
HOSPITALS IN INDIA
MVR CANCER CENTRE & RESEARCH INSTITUTE
Calicut, India Email: firstname.lastname@example.org
Ernakulam, Kerala India Phone : +91 484 4134444 Email : cimarcochin@gmail. com
BABY MEMORIAL HOSPITAL
NARAYANA HEALTHCARE Bangalore , Karnataka Ph: +91 99860 13353 Email: email@example.com
Kozhikode, Kerala Phone: +91 - 495 â€“ 2723272 Email: firstname.lastname@example.org
SRI RAMACHANDRA MEDICAL COLLEGE
ASTER MEDCITY Kochi Phone: +91 484 66-99999 Email: email@example.com www.astermedcity.com
MANIPAL HOSPITALS Bangalore Ph: +91 80 2222 1111 Email: firstname.lastname@example.org
www.manipalhospitals.com 60 Medical Tourism Jul - Sep 2019
Chennai India Ph: +91 984 096 9698 Email: email@example.com
Cochin, India Ph: +91 484 290 5037 Email: firstname.lastname@example.org
MEDICAL TOURISM HOSPITALS
ARMC IVF FERTILITY CENTRE
BELIEVERS CHURCH MEDICAL COLLEGE HOSPITAL Thiruvalla India Ph: +91 469 2703100 Email: email@example.com
BMT Annex, Puthiyara, Kozhikode Kerala, India . Phone:+91 495 272 7376 Email: firstname.lastname@example.org www.bcmch.org
CHENNAI FERTILITY CENTER
Aminjikarai, Chennai India Phone : +91- 44 â€“ 6458 2299 Email: email@example.com www.chennaifertilitycenter.com
APOLLO HOSPITALS CHENNAI
Hyderabad Ph: +91 40 67000000
SIR H.N. RELIANCE FOUNDATION HOSPITAL AND RESEARCH CENTRE
Chennai, India Ph: +91 40 4344 1066 Email: internationalcare@ apollohospitals.com
Mumbai Ph: +91 22 6130 5005 Email: firstname.lastname@example.org
ASTER MIMS Kozhikode, India Ph: +918157880111 Email: email@example.com,
Thiruvananthapuram, India Ph: +91 471 294 1888 Email: firstname.lastname@example.org
MEITRA CALICUT Delhi, India Ph: +91 11 401 28881 Email: email@example.com, firstname.lastname@example.org
Kozhikode, India Ph: +91 495 7123456 Email: email@example.com
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MEDICAL TOURISM WELLNESS CENTERS
NIMBA NATURE CURE
KAIRALI AYURVEDIC GROUP Ahmedabad Gujarat India Phone: +91 276 228 3313
New Delhi Phone: +91 11 65028307 Email: firstname.lastname@example.org
SHATHAYU AYURVEDA YOGA RETREAT
Bangalore Phone: +91 8884133300 Email: info@shathayuretreat. com
Kollangode, Palakkad, Kerala Phone: +91 4923 305500 Email: email@example.com
DHATHRI AYURVEDA HOSPITAL Om Beach, Gokarna Phone: +91 484 4261751 Email: firstname.lastname@example.org
SREEDHAREEYAM AYURVEDIC EYE HOSPITAL AND RESEARCH CENTRE
Kayamkulam, Kerala Phone: +91 90200 28888 Email: email@example.com
PUNARNAVA AYURVEDA HOSPITAL PVT LTD
Koothattukulam, Kerala Phone: + 91 485 2253007 Email: firstname.lastname@example.org
Kochi, Kerala Phone: +91 484 2801415 Email: email@example.com
SOMATHEERAM RESEARCH INSTITUTE AND AYURVEDA HOSPITAL
Malappuram, Kerala Phone: +91 494 305 5555 Email: firstname.lastname@example.org
www.ayurgreeenhospitals.com 62 Medical Tourism Jul - Sep 2019
Kovalam, Thiruvananthapuram Phone: +91 471 2268101 Email: email@example.com
MEDICAL TOURISM WELLNESS CENTERS
AYURVAIDYA Athani, Thrissur, Kerala Phone: +91 703 40 99 999 Email: firstname.lastname@example.org
SHINSHIVA AYURVEDIC RESORT
Edappally North Kochi, Kerala Phone: +91 4842802383 Email: mail@ayurvaidyahospital. com www.ayurvaidyahospital.com
Balaramapuram, Thiruvananthapuram Phone: +91- 471-2266331, Email: email@example.com www.shinshivaresort.com
Chowara, Thiruvananthapuram, Kerala Phone: 91-471-2267822 Email: firstname.lastname@example.org
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Medical Tourism is part of the FM Media Technologies Private Limited, a fast growing publishing group based in Kochi, Kerala,India, which pu...
Published on Sep 23, 2019
Medical Tourism is part of the FM Media Technologies Private Limited, a fast growing publishing group based in Kochi, Kerala,India, which pu...