Stemming the medical exodus-Radiology

chapter.

Dr Alfred Odhiambo.

Lecturer University of Nairobi.

The menu this afternoon

1. The warning shots of 2011.

2. The current reality.

3. Mumbai a personal experience.

4. Medicine made in India on the global

scale.

5. Where are we?

6. Where do we want to go?

7. Epilogue.

Kenyans look east for medical care.

• The number of Kenyans seeking treatment in India almost doubled in the two years to 2011 on the back of lower hospital bills and higher rate of successful medical operations.

• Data from the Indian High Commission shows that the number of Kenyans issued with medical visas to India rose from 458 in 2009 and 784 in 2010 to 810 last year.

• “The kinds of illnesses vary from heart-related, neurological, to kidney related,” said the Indian High Commission in Nairobi in an email statement to the Business Daily.

By RAWLINGS OTINIPosted Tuesday, May 1 2012.

My knee jerk response….

• This is but a passing cloud.

• It is exciting travel to see a docor but too costly to sustain.

• In my tropical mind I had malaria, typhoid and brucellosis.

• Surely the airfare alone would be greater than complete treatment in my Kenyan homeground!

Two years later the cloud was not only bigger but persistent.

• In June 2013, Research and Markets projected that the Indian

medical tourism industry would register a Compounded

Annual Growth Rate of more than 20 per cent between 2013

and 2015.

• The report, titled Booming Medical Tourism in India, stated that

India had managed “to match up with the quality of

healthcare services that are being provided in developed

countries”, and that “qualified medical staff, adoption of

advanced technology and improving healthcare infrastructure”

had made the country an attractive destination for patients all

over the world”.

Why India rocks…..

• The greatest selling point for India’s growing medical tourism industry, however, remains its drastically low costs compared to other countries that offer the same standard of care.

• For example, a heart transplant which would cost around $100,000 (about Sh8,620,000) in New York costs only $7,200 (Sh620,000) in Delhi.

Inviting figures.

• For Africa, the figures are too interesting to ignore.

• That is why a report by A&K Global Health reveals that of all the people in Africa who travel abroad seeking medical help, 95 per cent go to Asia; only four per cent go to Europe and a paltry one per cent to the Americas.

• Most of those that go to Asia ultimately end up in India.

The entrepreneurial spirit of the Kenyan.

• So big is this medical tourism that it has spawned related businesses due to the sheer numbers seeking medical care outside their countries.

• Nairobi’s Pathway Tour Company is one such firm as it exists solely to organize patient transfers outside the country.

• Chief Executive Officer Simon Karo told DN2 that, in any month, the company helps up to 100 patients go to India for treatment.

Mumbai 1999, a personal sojourn…

• A good 15 years ago.

• What a vast city.

• It had the entire population of my country.

• The peaceful nature was shocking.

• Accommodation was pricey but all else was cheaper than Mombasa where I came from.

• The city looked like one huge construction site.

• This was at the peak of the construction boom and it seemed to bother no one…

• But this was no tourist visit, t’was a study tour.

The hospitals visited.

• Hinduja.

• Jaslok.

• Lilavati.

• KEM hospital.

The 3 private hospitals only differed in location

1. All registered as research centers.

2. Operated like factories due to massive patient volumes.

3. Staff numbers mirrored the patient numbers.

4. A unique work ethic.

5. Humility universal.

6. Long working hours.

7. Modesty at all levels.

8. Most consultants seemed to operating just above the survival level.

9. They smiled a lot and enjoyed each other like family.

10. Took pride in reproducing what was released from the USA within 4 weeks at a fraction of the cost.

11. I bumped into at least 2 patients from Mombasa and felt inflated when they called me doctor in front of my hosts.

12. KEM; volumes don’t say it, had multitudes of everything.

The disparity in imaging technology was shocking.

• In Mombasa I had the 1987 Shimadzu CT vs the 1998 Siemens in

Hinduja.

• I spent the two weeks in Mumbai with my eyeballs outside their

sockets..

Disparity in work load.

• Got to Hinduja on a holiday.

• They scanned 16 patients overnight.

• In Mombasa I scanned 8 patients on a busy working

day.

• 4 ultrasound units in one hospital, all applications.

• I lost count of the CT scans done on Monday.

• But Dr Prassant Shetty showed me a fractured every

solid organ in the abdomen without a mass

accident or natural disaster.

Disparity in knowledge.

• The consultants some younger than me had been to

the most prestigious institutions in Europe and the

Americas.

• I had been a radiologist for 5 years but had to

taught by radiographers.

• I didn’t understand much of what the masters students

said.

• The medical students at the undergraduate level

sang anatomy mother tongue.

Fast forwards to 2014.

• I was at the Mumbai airport in July 2014 and the ambience would challenge

any in Europe.

• Pure opulence.

But lets leave the airport and stick with Medicine…

• Lets look at the top 30 hospitals in the world…

• Rasia ospital Kisum can rank somewhere but

the vector direction must change….

19. University of Texas MD

Anderson Cancer Center – Houston,

Texas

18. Guy’s and St. Thomas’ – London, U.K.

Now the main hospital of Harvard Medical School,

Massachusetts General Hospital is located in Boston. It

was established in 1811 and today is recognized around

the world for its pioneering cancer treatment and diagnosis

services.

15. Massachusetts General Hospital –

Boston, Massachusetts

The hospital provides the most modern surgical

technology available, intra-operative MRI, leading-edge

imaging and radiology capabilities, an automated

belowground supplies and waste transportation setup, and

a high-tech equipment- and staff-locating system.

3. Johns Hopkins Hospital – Baltimore,

Maryland

2. Fortis Memorial Research Institute – Gurgaon, India

Thanks to its 3 Tesla Digital MRI scanner, Fortis Memorial

Research Institute is the first hospital in the world to offer

digital broadband MRI imaging. It’s also the first Indian

hospital to contain a stem cell lab. Plus, it has a pair of

voice-modulated integrated operating theaters, a 256-slice

Brilliance iCT scanner, and a revolutionary “Brain Suite”

featuring intra-operative CT used for the brain and the

spine.1. El Camino Hospital – Mountain View,

CaliforniaDr. Sari Levine said, “Not only did we get a robot to do a

lot of the procedures, we get the newest version because

the company’s down the street.” The hospital’s high-tech

equipment includes advanced robotic radiosurgery device

the CyberKnife. “Literally all the procedures that you can

imagine that could help patients in radiation therapy are

available here under this roof,” said medical director of the

radiation oncology department Dr. Robert Sinha.

I am a radiologist so I am safest in the dark.

Automated Medication Dispensing Units Omnicell OmniRx

Computed Tomography (CT) - 64-slice+ Toshiba Aquilion PRIME

Digital X-ray Shimadzu RADspeed

Magnetic Resonance (MR) - 1.5T Philips Ingenia 1.5T MR

Magnetic Resonance (MR) - 3.0T Philips Ingenia 3.0T MR

Mammography - DigitalHologic Selenia Dimensions 3D Breast

Tomosynthesis

Radiation Therapy Elekta Leksell Gamma Knife Perfexion

Smart Pumps - LVP Baxter Healthcare SIGMA Spectrum

Ultrasound - Cardiovascular Philips iE33

Ultrasound - General Imaging Siemens ACUSON S3000

Software Intellispace Portal (ISP) Philips Medical Systems

Balance of radiology power.

• India has all 11 top innovations and acquired within 12 months of manufacture.

• In Kenya we have 6 acquired within 36 months of manufacture.

• South Africa does not have all 11.

• So there is catch up growth.

The biggest advances in the last 36months.

• Aplio ultrasound scanners Toshiba 4 in Nairobi.

• Ingenia digital MRI Philips 2 and one on the way next week.

• Ingenuity 128 slice CT Philips 2 in Nairobi.

• Aquilion One 640 slice CT Toshiba 1 in Nairobi.

• Cone Beam dental CT Kodak 2 in Nairobi.

By TOSHIBA World’s first 640 slice 4D dynamic volume CT scanner

•Overcomes conventional CT Cardiac hurdles•Perfect for paediatrics (less dose ,less sedation)•Unique Neuro One protocol•True dynamic 4D imaging

Triple rule out for chest pain.

4D head CT.

Index lesion.

The great deficiency.• PET CT

• PET MRI.

• Price tag is prohibitive at Usd 6million.

• There will be a way one day.

• For now radiology patients should only ship out for Metabolic Imaging.

The last word.

• India is a medical super power take it from me.

• Kenya not yet on the same platform.

• But as far as imaging is concerned the gap has greatly narrowed.

• There is almost no longer any incentive for an overseas investor to place basic imaging tools in Nairobi except PET.

• For the patient less than 1% may require an overseas referral for imaging.

• But for me this battle will only shift once we handle cost.