CHEERS TO LIFE

Tackling your child’s bed-wetting

Pediatric urology problems are some of the most commonly occurring of childhood conditions. Simple problems like undecided testis and hernias are extremely prevalent occurring in 1 out of every 100 boys. Complex urologic problems in children like, posterior urethral valves, vesicoureteric reflux, bladder exstrophy, hypospadias, ureteropelvic junction obstructions and renal transplantation, need specialized surgical training in the care of children and are best done by a paediatric urologists.

Bed-wetting           

Toilet training a child takes a lot or patience, time and understanding. Most children do not become fully toilet trained until they are between 2 and 4 years of age. Some will be able to stay dry during the day. Others may not be able to stay dry during night until they are older.

Causes of Bed-wetting

Night-time bed-wetting, called enuresis, is normal and very common among preschoolers. It affects about 40% of three year olds. All of the causes of bed-wetting are not fully understood, but the following are the main reasons a child wets the bed: bladder is not yet developed enough to hold urine for a full night, or child is not yet able to recognize when his bladder is full, wake up, and use the toilet.

Most school-age children who wet their beds have primary enuresis. This means they have never developed nighttime bladder control. Children who are older when they develop nighttime bladder control often have at least one parent who had the same problem. In most cases, these children become dry at about the same age that their parent(s) did.

Dry to wet

Often, a child who has been dry will suddenly start bedwetting again. When it happens it is usually due to stress in the child’s life. Such stress could be due to change, such as a new baby at home, moving or a divorce. If your child wets the bed after having been dry in the past, your pediatrician should do an evaluation. Bed-wetting may be a sign of stress.

Symptoms

Some parents fear their child’s bedwetting is due to a disease or other physical problem. Actually, only about 1% of bed-wetting cases are related to diseases or defects such as Bladder or kidney infections, Diabetes or defects in the child’s urinary system. With any of these cases, there will often be changes in how much and how often your child urinates during the day. Your child may also have discomfort while urinating. Tell your doctor if you see any of the following signs at any age:

  • Unusual straining during urination, a very small narrow stream of urine, or dribbling that is constant or happens just after urination.
  • Cloudy or pink urine, or bloodstains on underpants or nightclothes.
  • Daytime as well as nighttime wetting.
  • Burning during urination.

 

Managing bed-wetting

Tests

If your pediatrician suspects a problem, he/she may take a urine sample from your child to check for signs of infection or other problem. Your pediatrician may also order tests, such as ultrasound of the kidneys or bladder, if there are signs that wetting is due to more than just delayed development of bladder control. On occasion when a child wets day and night then a voiding cystouretrogram is performed if it is necessary.

Managing bed-wetting

Reassure your child that the symptoms will pass. Until that happens naturally, the following steps might help. *Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime. *Use a bed-wetting alarm device. If your child reaches the age of 7 or 8 and is still not able to stay dry during the night, an alarm device might help. *Until your child can stay dry, put a rubber or plastic cover between the sheet and mattress. *Let your child help. Encourage your child to change the wet sheets and covers. This teaches responsibility. At the same time it can relieve your child of any embarrassment.

 

Tackling your child_s bed-wetting

Do Medications help?

When no other form of treatment works, your doctor may prescribe medication. The use of medications to treat bed-wetting is used once all other treatment modalities are exhausted. The type of medication that will be used varies on the child and the history of bedwetting.

Parental support

It is important that parents give support and encouragement to children. They should be sensitive to the child’s feelings about bedwetting. Make sure your child understands that bedwetting is not his fault and that it will get better in time. Reward him for “dry” nights, but do not punish him for “wet” ones. Remember, your child does not have control over the problem and would like it to stop, too!

Do not pressure your child to develop nighttime bladder control before the childs body is ready to do so. As hard as your child might try , the bed-wetting is beyond a childs control, and may only get frustrated or depressed because they cannot stop it.

Set a no-teasing rule in your family. Do not let family members, especially siblings, tease a child who wets the bed. If your child has enuresis, discussing it with your pediatric urologist can help you understand it better. Your pediatrician can also reassure you that your child is normal and that he/she will eventually outgrow bed-wetting.

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HALE ‘N’ HEARTY

LET YOUR HEART NOT SKIP A BEAT. AND TO ENSURE THIS SIMPLY START NOW. A LITTLE REGULAR EXERCISE AND A LITTLE MORE CARE IN WHAT YOU EAT WILL ENABLE YOU AVOID THAT EMERGENCY TRIP TO THE DOCTOR

 

The hectic pace of city life and the rapidly changing lifestyles are adding up to cause an alarming increase in the incidence of heart attacks among the upwardly mobile youth. How you think, feel and live your life affects your heart. Unhealthy food habits and a sedentary lifestyle can lead to obesity and a chain of problems. However, working out or adopting a disciplined exercise regimen can help in keeping weight in check.

We all know the risk factors that could lead to a heart attack. However, many of us choose to ignore them, conveniently forgetting their long term consequences. It’s time to take a look at your lifestyle, family history and general health.

Risk factors such as age, familial history, high blood pressure, high ‘bad’ cholesterol, blood sugar levels combined with your height, weight and waist measurement can all be assessed and you can take actions to reduce your risk of suffering from heart disease and stroke.

THERE ARE FIFTEEN MAJOR RISK FACTORS ASSOCIATED WITH HEART DISEASE AND STROKE:

  1. Increased cholesterol in the blood
  2. Increased triglycerides
  3. Decreased HDL in the blood
  4. High LDL levels
  5. High VLDL cholesterol
  6. Decreased cholesterol: HDL Ratio
  7. High blood pressure
  8. High blood sugar
  9. Lack of exercise and physical activity
  10. Smoking and tobacco consumption
  11. Obesity or overweight
  12. Lack of fiber in food
  13. Lack of antioxidants in diet
  14. Alcohol consumption
  15. Psychological stress

Stress could also be responsible for many heart problems, researchers say. Stress is basically due to five overloads: work overload (excess work), time overload (acute shortage of time), information overload (excess burden of information to the brain), requirement overload (excess desire to excess or material needs) and lastly illness overload (stress due to illness). Each working person should remember these five points every day and try to work on them.

 

Urology Surgery in India

A WORD OF CAUTION

The onset of a heart attack can be detected with a few visible warning signs like chest discomfort while walking, and/or shortness of breath etc. But, it is important to note that many heart attacks can be silent without any symptoms or without much forewarning.

PREVENTION

Although people who are genetically predisposed to heart attacks cannot actually reverse the risk, they can make amends by trying to lead a sensible lifestyle by making a few modifications in their food and exercise habits. Wockhardt Hospitals, one of Asia’s fastest growing Super Speciality Hospital groups, has made noteworthy contribution in the areas of medical super specialties like Cardiology, Cardiac Surgery, Neurology, Neuro Surgery, Orthopaedics & Joint Replacement, Urology Surgery India, Nephrology, Minimal Access Surgery, Critical Care, Medical and Surgical Oncology and Endocrinology. Associated with Harvard Medical International – the global arm of Harvard Medical School, USA – Wockhardt Hospitals is the first hospital group in South Asia to be recognised by the American Blue Cross and Blue Shield association in its worldwide network of participating hospitals. The N M Virani Wockhardt Hospital based in Rajkot boasts of being the first NABH (National Accreditation Board for Hospital & Healthcare) accredited hospital in the Saurashtra & Kutch region. This accreditation resembles the highest standards of patient care and quality medical services to one and all.

 

LET YOUR HEART NOT SKIP A BEAT

HEART CARE TECHNOLOGY

“The latest in heart care technology is the non invasive treatments called Natural Bypass and Biochemical Angioplasty. ECP or Natural Bypass (Pneumatically Assisted Natural Bypass or PANB) is the latest gadget developed in USA which gives us the ultimate non invasive treatment of heart disease. In this treatment, using a series of cuffs the muscles of the lower part of the body are squeezed to increase the blood reaching the heart arteries. This opens up millions of small arteries (called Collaterals) in the heart giving a natural bypass. This treatment has become very popular in the USA, China and is being paid by the insurance companies because of the lower cost and results. Biochemical Cleaning or Biochemical Angioplasty (BCA) is another technique which holds a lot of promise. Here a mixture of chemicals including blockage eroding EDTA is infused in the blood stream over three hours. This treatment has also become popular in USA and Govt. has now taken up a big research study to establish this treatment. It can remove the blockages from 5-50% within a span of few months. Both these treatments should be combined with lifestyle changes in order to get maximum and longtime results,” says Dr Bimal Chhajer, MD of SAAOL (The Science & Art of Living), which offers a complete solution to heart blockages at its centres through Natural Bypass and Biochemical treatments. SAAOL, which has patient education programmes called HLTP (Heart Life Style Training Program) to educate the heart patients on reversal of heart disease, claims to have treated more than 20,000 patients all over the country by their non invasive methods with 98% results – methods that focus on changing the mentality of the heart patients and enable them initiate a healthy lifestyle, whilst aiming at preventing heart disease.

TIPS TO LIVE A HEALTHY LIFE

  • Zero oil cooking: Oil (the other name of Triglycerides) is the main culprit to block the heart tubes
  • Check your Lipid profile and control if they are high: Every adult must check his lipid profile once in a year. Heart patients should do it once in three months. If the figures are high – diet should change and if not controlled statins (medicines to reduce Cholesterol) and Fenofibrates (medicines to reduce Triglycerides) must start.
  • Practice yoga and stress management
  • Thirty five minutes of walk: It is very important to walk at least 35 minutes every day if you want to prevent heart attacks. The speed will vary from patient to patient. Walk should be at a speed below the angina threshold.
  • Include plenty of fruits and vegetables: Fruits and vegetables will provide fiber and antioxidants which will protect the heart from Cholesterol blockages.
  • Control blood pressure and sugar: Consult your physician if you cannot control these two by lifestyle alone.

HALE ‘N’ HEARTY

 

LET YOUR HEART NOT SKIP A BEAT. AND TO ENSURE THIS SIMPLY START NOW. A LITTLE REGULAR EXERCISE AND A LITTLE MORE CARE IN WHAT YOU EAT WILL ENABLE YOU AVOID THAT EMERGENCY TRIP TO THE DOCTOR

 

The hectic pace of city life and the rapidly changing lifestyles are adding up to cause an alarming increase in the incidence of heart attacks among the upwardly mobile youth. How you think, feel and live your life affects your heart. Unhealthy food habits and a sedentary lifestyle can lead to obesity and a chain of problems. However, working out or adopting a disciplined exercise regimen can help in keeping weight in check.

We all know the risk factors that could lead to a heart attack. However, many of us choose to ignore them, conveniently forgetting their long term consequences. It’s time to take a look at your lifestyle, family history and general health.

Risk factors such as age, familial history, high blood pressure, high ‘bad’ cholesterol, blood sugar levels combined with your height, weight and waist measurement can all be assessed and you can take actions to reduce your risk of suffering from heart disease and stroke.

THERE ARE FIFTEEN MAJOR RISK FACTORS ASSOCIATED WITH HEART DISEASE AND STROKE:

  1. Increased cholesterol in the blood
  2. Increased triglycerides
  3. Decreased HDL in the blood
  4. High LDL levels
  5. High VLDL cholesterol
  6. Decreased cholesterol: HDL Ratio
  7. High blood pressure
  8. High blood sugar
  9. Lack of exercise and physical activity
  10. Smoking and tobacco consumption
  11. Obesity or overweight
  12. Lack of fiber in food
  13. Lack of antioxidants in diet
  14. Alcohol consumption
  15. Psychological stress

Stress could also be responsible for many heart problems, researchers say. Stress is basically due to five overloads: work overload (excess work), time overload (acute shortage of time), information overload (excess burden of information to the brain), requirement overload (excess desire to excess or material needs) and lastly illness overload (stress due to illness). Each working person should remember these five points every day and try to work on them.

 

G-MEA_IMG_6873

A WORD OF CAUTION

The onset of a heart attack can be detected with a few visible warning signs like chest discomfort while walking, and/or shortness of breath etc. But, it is important to note that many heart attacks can be silent without any symptoms or without much forewarning.

PREVENTION

Although people who are genetically predisposed to heart attacks cannot actually reverse the risk, they can make amends by trying to lead a sensible lifestyle by making a few modifications in their food and exercise habits. Wockhardt Hospitals, one of Asia’s fastest growing Super Speciality Hospital groups, has made noteworthy contribution in the areas of medical super specialties like Cardiology, Cardiac Surgery, Neurology, Neuro Surgery, Orthopaedics & Joint Replacement, Urology, Nephrology, Minimal Access Surgery, Critical Care, Medical and Surgical Oncology and Endocrinology. Associated with Harvard Medical International – the global arm of Harvard Medical School, USA – Wockhardt Hospitals is the first hospital group in South Asia to be recognised by the American Blue Cross and Blue Shield association in its worldwide network of participating hospitals. The N M Virani Wockhardt Hospital based in Rajkot boasts of being the first NABH (National Accreditation Board for Hospital & Healthcare) accredited hospital in the Saurashtra & Kutch region. This accreditation resembles the highest standards of patient care and quality medical services to one and all.

HEART CARE TECHNOLOGY

“The latest in heart care technology is the non invasive treatments called Natural Bypass and Biochemical Angioplasty. ECP or Natural Bypass (Pneumatically Assisted Natural Bypass or PANB) is the latest gadget developed in USA which gives us the ultimate non invasive treatment of heart disease. In this treatment, using a series of cuffs the muscles of the lower part of the body are squeezed to increase the blood reaching the heart arteries. This opens up millions of small arteries (called Collaterals) in the heart giving a natural bypass. This treatment has become very popular in the USA, China and is being paid by the insurance companies because of the lower cost and results. Biochemical Cleaning or Biochemical Angioplasty (BCA) is another technique which holds a lot of promise. Here a mixture of chemicals including blockage eroding EDTA is infused in the blood stream over three hours. This treatment has also become popular in USA and Govt. has now taken up a big research study to establish this treatment. It can remove the blockages from 5-50% within a span of few months. Both these treatments should be combined with lifestyle changes in order to get maximum and longtime results,” says Dr Bimal Chhajer, MD of SAAOL (The Science & Art of Living), which offers a complete solution to heart blockages at its centres through Natural Bypass and Biochemical treatments. SAAOL, which has patient education programmes called HLTP (Heart Life Style Training Program) to educate the heart patients on reversal of heart disease, claims to have treated more than 20,000 patients all over the country by their non invasive methods with 98% results – methods that focus on changing the mentality of the heart patients and enable them initiate a healthy lifestyle, whilst aiming at preventing heart disease.

 

LET YOUR HEART NOT SKIP A BEAT

TIPS TO LIVE A HEALTHY LIFE

  • Zero oil cooking: Oil (the other name of Triglycerides) is the main culprit to block the heart tubes

  • Check your Lipid profile and control if they are high: Every adult must check his lipid profile once in a year. Heart patients should do it once in three months. If the figures are high – diet should change and if not controlled statins (medicines to reduce Cholesterol) and Fenofibrates (medicines to reduce Triglycerides) must start.

  • Practice yoga and stress management
  • Thirty five minutes of walk: It is very important to walk at least 35 minutes every day if you want to prevent heart attacks. The speed will vary from patient to patient. Walk should be at a speed below the angina threshold.

  • Include plenty of fruits and vegetables: Fruits and vegetables will provide fiber and antioxidants which will protect the heart from Cholesterol blockages.

  • Consult your physician if you cannot control these two by lifestyle alone.

A Paradigm Shift

DESPITE THE SLOWDOWN THAT THE TRAVEL AND TOURISM INDUSTRY IS FACING CURRENTLY, IT IS PROJECTED AS ONE OF THE WORLD’S BIGGEST INDUSTRIES. SHEETAL SRIVASTAVA GIVES AN OVERVIEW

 

By the year 2020, projection is that there would be six billion tourists worldwide and tourism receipts would touch USD 2 trillion creating one job every 2.5 seconds. The Indian Government’s travel and tourism policy has given the sector further impetus. One can see many more hotels, tourist resorts, beach resorts, as well as promotion of new avenues of tourism like medical tourism, adventure tourism, rural tourism, holistic tourism, sports tourism and cultural tourism.

Commenting on the notable differences in the industry from what it was a decade back, Shubhada Joshi, chairperson, Indian Travel Congress, London says, “There are lot many products and destinations to sell.” She further adds, “Today, with open sky policies and the roads and railways getting better, there are more opportunities for people to travel. Affluence is growing and hence the spending capabilities of customers are also growing. Such situations are very rare in the history of any industry and therefore it is the best time to be in the industry.”

Talking about the industry numbers, Sanjay Narula, co-chairman, Indian Travel Congress, London notes, “Travel and Tourism, directly and indirectly accounts for 11 per cent of world’s GDP, 9 per cent of global employment and 12 per cent of global investments.”

Today, India is an emerging world power. If the world really wants to know what India has achieved in the last few years, the travel and tourism industry is the answer to that. “India being multi-cultural, there is a never ending scope in the industry. Domestic travel has been growing at 15-20 per cent p.a. Innovative sales pitches, marketing strategies and adoption of newer technologies are leading to increased sales within travel retail services especially for packaged holidays, flights and accommodation , all of which is giving us a newer global market perspective,” says Rajinder Rai, vice president, TAAI.

Challenges Faced

CV Prasad, President, TAAI says, “Very little has been done to grow domestic tourism. Lack of infrastructure is the gravest issue posing a challenge to Indian tourism and acts as a deterrent.” Domestic short haul problem is very popular. Lack of quality manpower is another serious challenge which the industry is currently facing. “There is not enough skilled manpower. The need for training institutes is a must,” Prasad stresses. Other areas where improvement is a must in order to give a boost to tourism is the need for improved roads between some tourist destinations. “There is no proper road transport quality. People above 60 travel a lot. Unfortunately, India is not equipped for them. There are no proper sidewalks,” adds Prasad. India is not positioned in many ways as far as tourism is concerned.”

 

 

 

Here comes the travel agent

There is no doubt that a travel agent has become an essential factor in the travel and tourism industry today. We all know that a travel agent helps travelers sort through vast amounts of information to help them make the best possible travel arrangements. They offer advice on destinations and make arrangements for transportation, hotel accommodations, car rentals, and tours for their clients. They are also the primary source of bookings for most of the major cruise lines. In addition, resorts and specialty travel groups use travel agents to promote travel packages to their clients.

Going to a full-service travel agency that sells standard travel agency goods and services, including airfare and travel packages is like a one-stop shop to the travel needs. Most travel agents provide additional services which include passport assistance, providing access to top-of-the-line equipment and supplies and a superior offering that includes access to better than average terrain and activities, accommodations, and entertainment. “The value added offerings by a travel agent is his knowledge and expertise, competitive rates, and specialty focus on various segments of travel, which translate into increased satisfaction for the customer,” adds Prasad. “Destination knowledge is a very critical aspect. The most important role that travel agents play is planning the trip. Very few people today have mastery over destinations. So a travel today has become a destination expert,” notes Shubhada. Leisure travelers can be broadly classified according to the type of trips they take, income or age. Heritage and Culture tourism, Adventure tourism, Special-Interest, Honeymoon & sight-seeing trips High-Income Travellers Budget-Conscious Travellers Families, Students & Seniors Pilgrimage Tourism, Medical and Wellness Tourism

Need for trained personnel

Like every other industry, there is a need of skilled personnel in this industry too. Besides the IATA certificate which is only academic, the personnel need a lot of soft skill training. Clients today need a host of services and not just an air ticket. It may be product knowledge, visa, insurance or foreign exchange or about a self driven car or only the weather.

 

Travel and Tourism - India being multi-cultural- there is a never ending scope in the industry

“Our job is not complete unless and until we don’t give all the information to the clients. A client can get to buy an air ticket on the net. But it is still cumbersome for him/her to get all the related information. Hence, we need to be travel consultants and not just ticketing agents,” asserts Mamta Nichani, chairman, managing committee member, TAAI.

It has become imperative today to change the mindset in order to forge successful careers in the travel and tourism industry. Hitherto, the travel distribution role was performed by traditional travel agents and tour operators. They were supported by global distribution systems or tour operators’ videotext systems (or leisure travel networks). The coming of the Internet created the conditions for the emergence of interactive digital televisions and mobile devices selling directly on the Internet by allowing users to access the airline reservation systems, web-based travel agents and travel portals. This has gradually intensified competition. Consequently, traditional travel agents must re-engineer their business processes in order to survive and remain competitive. Research findings point out to the evolving nature of business in a globalised environment and the necessary strategic adjustments in human resources management.

Future of the industry

Expressing his views on the future of the travel and tourism industry and of the travel agents Prasad says, “The future is very bright. A 15-20 per cent growth can be seen in the next 5-6 years. Tourism revolution has yet to begin in India. Interest in India is beginning to catch up and it certainly has a long way to go.”

He further adds, “The internet can never replace personal contact. Travel agents are here to stay provided they adapt to the changing environment, adopt emerging technology and understand customers as well as cater to their needs.”

Says Ashwani Kakkar, CEO, Mercury Travels, “Globally, the travel and tourism industry is the single largest industry in the world. It is the best wealth distributor as an industry.”

The list is endless, for you can find many a reason and more to travel. All of these have a specific need and require knowledge of the local customs and people besides information on the destination which can be attained in a limited way from the internet. The Travel agents fulfil this very need and create not just a holiday or a trip but an experience to remember.

 

How To Bounce Back

The tourism industry could convert crisis into opportunity

 

The economic downturn and the terror attacks in Mumbai have adversely impacted tourism. But in many ways tourism is an antidote to terrorism; tourism is a catalyst for employment creation, income redistribution and poverty alleviation. One of the best ways to fight the terrorists is to support India’s beleaguered tourism industry.

The Indian tourism industry will be resilient and bounce back as it did post-September 2001. The present crisis presents an opportunity. There was an even bigger crisis in Indian tourism in 2001-02. The attacks on the World Trade Center in New York, war in Afghanistan, withdrawal of flights, attack on Parliament House in New Delhi and troop mobilisation on the India-Pakistan border meant that Indian hotels had just 20-25 per cent occupancy. International tour operators had removed India from their sale brochures and inbound Indian tour operators had switched to outbound operations.

Then tourism was positioned as a major driver of India’s economic growth and its direct and multiplier effects were harnessed for employment generation, economic development and providing impetus to infrastructure development. At a time, when the national tourism boards of Thailand, Singapore and Malaysia had stopped their advertising, promotion and marketing budgets, the ‘Incredible India’ campaign was launched to bring back consumer demand, generate momentum and enhance growth in the tourism industry. This was also a period when the tourist infrastructure around Ajanta Ellora, Mahabalipuram, Kumbalgarh, Chittorgarh, the Buddhist circuit and at Humayun’s Tomb was improved.

 

Indian medical tourism industry

The Indian tourism sector had been crippled by the limited air services, seat capacity and high ticket prices. Changes were ushered in this sector. It started with the permission to ASEAN carriers to operate to seven Indian metros, permitting low-cost carriers to launch operations, liberalisation of charter policy, the opening up of the UK bilaterals, granting approvals to new airlines and permitting private airlines to operate on international routes. One of the most closed sectors of the Indian economy was suddenly opened up and it unleashed huge growth in both India’s GDP and higher tourism flows.

This was also the time when young entrepreneurs launched travel portals. These changed the way Indians booked their travel. It is now projected that online channels would continue to outpace the total travel market and online penetration would be nearly one-fourth of the travel market by 2010. New products like medical tourism, value, cruise and rural tourism were conceptualised and implemented in partnership with the private sector and the community.

The 2008 economic slowdown and terror attacks require another such response. The terror attacks were restricted to Mumbai. Other regions and states such as Kerala, Rajasthan, Karnataka, Tamil Nadu, Madhya Pradesh, Himachal and UP remain safe, calm and normal.

 

Indian tourism industry

Long haul markets still make for 95 per cent of India’s international traffic. There is a need to focus on China and Japan, which will emerge as the biggest source of tourists in the coming years. Kerala as a tourism destination was unheard of almost a decade back. Its emergence was largely on account of travel diversion from terror-prone Jammu & Kashmir. Kerala, of course, had developed new products like backwaters and Ayurveda, its entrepreneurs had created experiential boutique resorts and infrastructure had been spruced up. There is a need for new states to emerge as tourism destinations by enhancing the quality of experience and improving infrastructure. In fact, the next year should see focused attention on infrastructure deficiencies which have threatened to derail India’s aim to become a world-class global destination.

The imbalance in demand and supply of hotel rooms and a near-total absence of the two- to four-star category of hotels have led to escalating prices thereby reducing India’s price competitiveness. India needs to create an additional 1,50,000 rooms in the next three years to penetrate large volume markets like China. Domestic tourism can help balance both the present adversity and the seasonality of inbound tourism. The strategy necessitates creating awareness among the rising Indian middle classes about new experiences (chasing the monsoons), new attractions (plantation holidays) as well as pilgrim circuits, heritage and monuments.

To drive growth, we need to push five critical C’s: civic governance (improving the quality of tourism infrastructure),capacity building of service providers (taxi drivers, guides and immigration staff), communication strategy (constant innovation of the ‘Incredible India’ campaign and penetration in new markets), convergence of tourism with other sectors of the Indian economy, and civil aviation (continued opening of the skies, improved airport infrastructure and rationalisation of taxes).

In the context of India, the vast potential of tourism as an employment creator and wealth distributor still remains untapped. The size of the tourism industry worldwide is $4.6 trillion whereas the software industry globally is a mere $500 billion. The tourism industry globally generates over 250 million jobs whereas the software industry generates only 20 million jobs. In India, in 2007, revenue from foreign tourists was $10.7 billion and 53 million people were employed in the tourism sector.As India grows and expands its base in travel and tourism, it will generate many more jobs and the sector will become a major catalyst for India’s growth with employment creation.

World flies to India for cheap cure

Travelling far and wide for health care that is often better and certainly cheaper than at home, appeals to patients with complaints ranging from heart ailments to knee pain. Why is India leading in the globalisation of medical services? Q&A with Harvard Business School’s Tarun Khanna

What used to be rare is now commonplace: travelling abroad to receive medical treatment, and to a developing country at that. So-called medical tourism is on the rise for everything from cardiac care to plastic surgery to hip and knee replacements. As a recent Harvard Business School case study describes, the globalization of health care also provides a fascinating angle on globalization generally and is of great interest to corporate strategists.

“Apollo Hospitals-First-World Health Care at Emerging-Market Prices” explores how Prathap C Reddy, a cardiologist, opened India’s first forprofit hospital in Chennai in 1983. Today the Apollo Hospitals Group manages more than 30 hospitals and treats patients from many different countries, according to the case. Tarun Khanna, a Harvard Business School professor specializing in global strategy, co-authored the case with professor Felix Oberholzer-Gee and Carin-Isabel Knoop, executive director of the HBS Global Research Group. The medical services industry hasn’t been global historically but is becoming so now, says Khanna. There are several reasons that globalization can manifest itself in this industry:

Patients with resources can easily go where care is provided.

High quality care, state-ofthe-art facilities, and skilled doctors are available in many parts of the world, including in developing countries.

Auxiliary health-care providers such as nurses go where care is needed. Filipino nurses provide an example.

“From a strategic point of view you can move the output or the input,” explains Khanna. “Applying this idea to human health care sounds a bit crude, but the output is the patient, the input is the doctor. We used to move the input around, and make doctors go to new locations outside their country of origin. But in many instances it might be more efficient to move the patients to where the doctors are as long as we are not compromising the health care of the patients.”

Khanna recently sat down with HBS Working Knowledge to discuss the globalization of health care in the context of India and Apollo Hospitals.

 

Apollo Hospitals-First-World Health Care at Emerging-Market Prices

Q: What led you to research and write this case?

A: I came across the company during some of my travels in South India. It was so unusual to find “first-world health care at emerging-market prices” as the case says. Often better care—by which I mean technologically first-rate care with far greater “customer service” and accessibility—is available in parts of India than in my neighborhood in Boston.

Felix Oberholzer-Gee, Carin-Isabel Knoop, and I decided to write the case just because health care is such a primal thing—it arouses a lot of emotions and insecurities. After all, it’s one’s life and health that one is dealing with. And the prospect of entrusting health care to a developing country had a pedagogical “shock value,” too.

The fact that the cost of living is so much lower in India means that the same service is possible at a fraction of the price elsewhere.

Q: The term “medical tourism” is fairly new, but how new is the phenomenon of going overseas for medical treatment?

A: When I was a college student in the United States I discovered that dental care was very expensive. Even back then, many of my international classmates essentially engaged in medical tourism—they would simply bundle up the care they needed, make a trip to their country of origin, and take care of it. India was certainly one of those countries I was aware of due to my own personal background.

We didn’t have a term for medical tourism, but in a sense it was all around us. It took a set of entrepreneurs to begin to make it happen. By the late 1990s, when I was teaching courses in global strategy, some of my Thai, Malaysian, and Singaporean students were perfectly aware of the term, because these countries of Southeast Asia already had very good tertiary-care hospitals.

Medical tourism usually refers to the idea of middleclass or wealthy individuals going abroad in search of effective, low-cost treatment. But there is another dimension of medical tourism that is not called medical tourism. Narayana Hrudayalaya, a heart hospital in India, treats indigent people from neighbouring countries — Pakistan, Bangladesh, Burma—who suffer from heart disease and can’t afford surgery. Treatment for them is free. The hospital is able to provide it because surgical methods are efficient enough that pro bono care doesn’t hurt the bottom line.

Q: Why is India gaining prominence for medical tourism?

A: India is encouragingly less “scary” now. I think a lot of entrusting medical care to different locations is about a psychological fear of the unknown. An important strategic challenge for developing-country hospitals is to reduce the psychological fear.

In India, the same depth of pool of engineering and mathematical talent for software, offshoring, and outsourcing is there for medicine, too. In the 1950s and ‘60s, the Indian government invested a lot in tertiary education. By now there is at least a small handful of medical institutes that are really first-rate, and the doctors they produce are extremely well trained.

 

overseas medical treatment india

Q: What are the recruiting challenges for staffing these hospitals with doctors?

A: In the case, Prathap C Reddy, the founder and chairman of Apollo Hospitals, says he spent a lot of time studying specialists almost like an executive search firm would, to identify their pleasure points and pain points in terms of building a successful practice in the West and potentially in India. He wanted to understand not just medical training and specialties but also family circumstances, since it is always a family decision to relocate.

In the past, Indian doctors left India so they could multiply their incomes. But now we’re seeing the reversal of that. India is booming so why leave, and by the way, patients can go there.

Q: How does growth in private hospitals affect public health care in India?

A: There is an assumption in the view often expressed in the media in India and Europe, for instance, that when private hospitals in India provide care to heart patients from England, the hospitals are somehow taking care away from poor people in India. The assumption seems to be that if medical tourism was banned, the doctors in question who were catering to wealthy patients would suddenly, as a practical matter, move to a village. It takes a different set of individuals, a different set of infrastructure circumstances to create that scenario.

My guess is that the bulk of India’s problem is primary health, and has nothing to do with tertiary care. And the primary health problem is not going to be addressed by a private hospital for the most part anyway.

 

India is becoming a medical tourism hotspot

In a globalised world it’s inevitable that people will travel abroad for medical treatment. India is well-placed to capitalise on this trend. It has world-class medical facilities and expertise in many areas, and treatment costs can start at about a tenth of comparable treatment in America or Britain. Even if one throws in airfare, it amounts to a good bargain. According to a McKinsey-CII study, medical tourism could generate as much as Rs 100 billion of revenue for India by 2012.

The notion that catering to foreigners and rich Indians at expensive medical facilities is going to take away from health care for the poor is entirely mistaken. These are private facilities whose clients pay for their services, which doesn’t prevent the government from setting up a first-rate public health system that takes care of everybody.

It’s wrong to look at medical care as a zero-sum game. If India makes a success of medical tourism that will build bigger capacities and draw more investment for the health sector. Indian doctors who routinely travel abroad to look for work will be tempted to stay back in India. Once the market signal goes out that there are more opportunities for doctors, nurses and trained medical personnel, more young people will opt for a career in these areas.

A booming health-care sector would also spawn research and development in medical technologies, therapies and drugs in India. The advantage of having a large medical R&D establishment is not only that it would boost India’s competitive pharmaceutical industry, but also that it would spur research into diseases — such as tuberculosis and malaria — that afflicted Indians more. If India’s economy grows by an additional Rs 100 billion that generates a bigger tax base, giving the government enough leeway to raise more revenue and invest it in public health. The government shouldn’t look this gift horse in the mouth.

 

India is becoming a medical tourism hotspot

Move from medical tourism to medicine

It is absurd that a country that cannot provide basic health to most of its citizens should try to be a hub for medical tourism. Multi-speciality hospitals will cut into public health, unless the government lays deliberate emphasis on the latter. Doctors will be weaned away from specialising in ailments that concern the masses at large, such as HIV/AIDS, tuberculosis, malaria and gynaecological disorders, to concerns that affect a section of people, such as obesity, plastic surgery and so on.

India’s growth story will mean very little, if it does not translate into improvement in life expectancy and control of killer diseases. For every 1,000 persons there is one hospital bed. Similarly, there is one doctor for nearly 1,700. This is all the more distressing, given the India’s health and morbidity indicators. TB claims 4,00,000 lives every year. Infant mortality and maternal mortality rates, at 54 per 1,000 live births and 301 for 1,00,000 live births, respectively, are higher than even developing country levels, while life expectancy remains a laggard at 63. With such a gross mismatch between demand and supply of health services, mass health care must be awarded top priority.

 

private hospitals should provide a certain minimum number of free beds. As a case before the Delhi high court on this issue argued, private hospitals are given land at below market rates, if not free of charge, and are therefore bound by social obligations. It is in large measure due to the shortage of government hospitals that health spending has become a major cause of indebtedness. Medical tourism will accentuate the shortage. Per capita state spending on health happens to be lowest in less developed states, where, in fact, the demand for health services is acute. Annual health spending of the Centre and states, at 1.39 per cent of gross domestic product, is abysmal. The Centre and states should raise health expenditure at least by three times to about Rs 1,70,000 crore per annum before they focus on medical tourism.

 

medical-tourism-in-India

Medical tourism or ‘Medical value tourism’?

Top-class Indian doctors, a good mix of nursing, customer care services and treatment cost estimated to be one-sixth in developing countries as compared to developed countries, the Indian corporate hospitals are witnessing an emerging trend!

If a by-pass surgery costs $40,000 – 50,000 in the U.S., few Indian hospitals such as the Krishna Heart and Super Specialty Institute in Ahmedabad have the wherewithal to do it in around 5,000 dollars. Similarly if a joint replacement surgery costs $30,000 in U.S., the same would be done by corporate hospitals in Ahmedabad at a roughly 6,500 dollars.

India, especially Ahmedabad is the most touted healthcare destination for countries like South-East Asia, Middle East, U.K., U.S., Africa and Tanzania. And the most sought-after specialties are cardiology, joint replacement, gastroenterology, plastic, cosmetic and laparoscopic surgeries.

“There are around 3.5 lakh people waiting for treatment under the National Health scheme of U.K. The lower level workers abroad are often not covered by insurance. Countries like Tanzania do not have good medical expertise and nursing care. All of this has led to Ahmedabad contributing

 

the Indian corporate hospitals are witnessing an emerging trend

greatly to the medical tourism pie in the country,” says Dr.Animish Choksi, Joint MD, at Krishna Heart Institute, Ahmedabad. Expanding into Cardiology, Orthopedic Surgery, Laparoscopic and Gastroenterology, Plastic Surgery, Cancer Surgery, Neuro Surgery, Urology Treatment the institute comprises of 15% – 20% of NRI occupancy every month.

Low costs and prompt email communication convinced Gary Konkol to travel from Wisconsin to Ahmedabad for hip replacement therapy at Krishna. “A hip replacement surgery requires a lot of assurance for me to come to India and the treatment would have costed me six times more in U.S.,” says Konkol. More than costs, Konkol feels the efficient nursing standards of Indian hospitals are better than most of the U.S. hospitals. Hansaben Patani, who underwent a knee replacement surgery at Krishna from Tanzania, feels it was lack of good medical expertise that pushed her to come to India.

Which explains, what more can be done for importance of accreditation in medical tourism? “Right from airport pick-up, to providing wheelchair to relieving the patient from anxiety regarding cleanliness, nursing care and transparency in business transactions, it is all about adding value to customer satisfaction. So it is more about ‘medical value tourism’ than medical tourism only,” Dr. Choksi concludes.