In spite of a rapidly developing health care sector, which includes world-class medical centers and some of the most modern and state-of-the-art facilities in the world, the Kingdom has yet to make its mark in the booming medical tourism industry. A greater paradox lies in the fact that the nation's own citizens often look outwards when it comes to medical help for some specific problems. However, according to Dr. Sami Badawood, Director for Jeddah Health Affairs, the number of such people are less than they used to be, and more people, particularly from Gulf countries, are coming to the Kingdom to receive medical care. Speaking exclusively to Saudi Gazette, Dr. Badawood talked about the government's initiatives to boost medical tourism, which includes five-year plans to develop medical cities in Jeddah and related workshops that are in progress. “The number of people going abroad for medical treatment has decreased by around 20 to 30 percent over the last three years. This is because of two reasons. One, the global economic downturn, and two, the fact that better medical services are now available in the Kingdom itself,” he said. Admitting that there has not been enough marketing for the Kingdom's heath sector as the government “pays more attention to services to nationals,” Dr. Badawood said there are strategic plans afoot and that special attention is being given to build a brand for medical tourism in Jeddah, the country's commercial hub and gateway to the Two Holy Mosques. “The strategic five-year plans seek to develop medical cities in Jeddah that will have concentrated medical services, similar to those in other countries, and this will attract people,” he said, stressing that more private sector investment and cooperation with specialized companies is required. Jeddah's summer festivals also attract tourists from different regions, and medical tourism is at a peak time at this time of the year with a dramatic increase in the number of patients seeking appointments. Jeddah's medical tourism, if promoted alongside tourism in Jeddah, which has 40 hospitals and a whole array of mushrooming private clinics, can reap the benefits from its association with the tourism industry. “A workshop between the Ministry of Health and the Jeddah Governorate is scheduled to boost medical tourism in Jeddah. Formal conclusions from this gathering will be forwarded to the SCTA (Saudi Commission for Tourism and Antiquities),” said Dr. Badawood. Medical tourism, in view of the huge economic potential that it offers, is reportedly the fastest growing outbound tourism sector in the Middle East. Recent research conducted by author Josef Woodman suggests that the Middle East, Saudi Arabia in particular, is one of the fastest growing markets for an industry that already attracts over three million tourists a year. And it's no surprise that Saudi Arabia, like other Middle Eastern countries, such as, Jordan and the UAE, is gearing up to meet this growing demand by launching initiatives to establish itself as a top-notch cost-effective destination for the medical tourism market. Korea, Malaysia, Thailand, India and the Philippines are attractive places for patients from the Middle East to visit as medical tourists. According to Dr. Badawood, there is no need to travel abroad for medical treatment for common problems. Those who seek treatment overseas may need transplants as “donors are not easily available here,” or may be taking advantage of the availability of “natural resources in some East European and South Asian countries.” “Some countries have a reputation for certain treatments, such as rehabilitation, sports surgery, etc. Some patients also travel to seek second opinions,” he added. It can be assumed that the health industry, like most other industries, sees an increase in business during the Haj and the Umrah season, and this could well be one way to market the country's medical tourism. However, “We do not utilize the Haj and Umrah for promoting medical tourism. There is no connection between the two areas,” said Dr. Badawood. He said the most popular medical services for which people come to the Kingdom include: pediatric and obesity treatments and eye surgery. Dr. Srinivas Rao, a Jeddah-based plastic surgeon, said that around 100-150 international patients annually seek treatment at his clinic, and that the most sought after cosmetic surgeries are nose reshaping and tummy tucks. Nowadays, he said, local doctors attempt to convince patients to undergo treatment in the Kingdom. “Although cosmetic treatment in the Kingdom is relatively expensive, if an individual travels abroad for treatment it may cost him more as the overall expenditure of travel, hotel, food, etc., outweighs the costs that he would incur for the same treatment in Saudi Arabia,” he explained. “There is a general feeling that doctors here are not competent enough. In every country, about 10 to 20 percent of doctors may not be good, but this cannot be generalized,” said Dr. Rao. “Expat doctors are not allowed in government hospitals unless there is an emergency. Expat patients are not seen in government institutes and most of them postpone their treatment, surgeries, etc., till they visit their home countries,” Dr. Rao said. He said that there are appointment problems, and that one can have to wait for six months to see a doctor. “The other reason why individuals travel abroad is social stigma. Patients fear that their relatives who live here will learn that they have undergone cosmetic treatment,” he added. He said that if the treatment takes place outside the country, one cannot contact the doctor often as the physical distance between the doctor and the patient poses a communications problem. Diagnosis and overall care Zahid Eskander, a Saudi national and father of a 12-year-old girl who has juvenile rheumatism, took his daughter to the southern Indian state of Kerala for alternative treatment (massages, herbs). He says that it took six months for doctors here to even diagnose the disease. “Doctors here were unable to diagnose her condition. They even scared us by saying that our daughter had a very dangerous brain disease, while some others claimed she suffered from myopathy (a muscular disease). And during the six months that we had to go around to different doctors, her joints suffered permanent damage and now her leg is 80 percent damaged,” said Eskander. He said after researching about Kerala on the Internet, he found that the place has “good resources, and is inexpensive when compared to the cost of the same treatment in Dubai and Bahrain.” Eskander's daughter is undergoing medical treatment in Jeddah, but her parents decided on alternative treatment as “it has no side effects, and there is no harm in trying it till she turns 16 as doctors say they can operate on her only then”. “In Kerala,” he said, the whole system is very organized, the hospital has a computer room, library, and the patients are taken out for tours and made very comfortable.” This overall patient care is perhaps what the medical sector here lacks. “Given the option, most would choose to go abroad for treatment rather than stay here. While it is true that Saudi Arabia does have some great medical facilities and doctors, it lacks overall patient care. There is more to treating a disease or ailment than facilities, doctors and medicine. What seems to be missing is that a patient should be treated with proper follow-up care, educational materials, group support, and other patient treatments that are available in other parts of the world,” said Ann Tamimi, (Nzingha), an American Muslim married to a Saudi and a mother of a child with Down Syndrome. She said she is unable to find proper facilities for physical therapy, occupational therapy and speech therapy, and that there is a complete lack of understanding when it comes to home care with pediatric patients, including the elderly. “I take my son to a very good physical therapist. However, it is such a sterile environment that my child dreads going every week. Broken cheap toys, dull colors, and equipment that looks like it was designed to cage an animal rather than to treat a child,” said Nzingha, adding that it is difficult to find educational facilities with trained staff for children with disabilities. She said that medical care should be an individual choice, which would include Saudi women, “who usually can't determine what medical care they will receive (male guardians do)”. “If a person feels more comfortable being treated in another country then that should be considered, as the overall health is needed in order to fight disease or deal with disabilities. For example, it is better for a person's health to have a positive attitude in which he feels secure and has faith in his doctor than to be negative in outlook or unsure of his doctor's abilities, which is an aspect of care that I believe the Kingdom is not taking into account,” Nzingha said. Cost comparison Nzingha said that cost-wise, Saudi Arabia is much cheaper for quality treatment. “For example, my father's many medications cost him over $3,000. However, the same medications in Saudi Arabia cost us only $800. A recent hospital stay for my father who had an accident cost us about $3,000 for a week's stay at Saad Hospital. The same would have run anywhere from three to four times more in the US,” she said. According to Dr. Rao, cosmetic treatment (average cost – SR20,000 to SR40,000) is expensive in the Kingdom as compared to other countries, such as India (approximately SR8,000), and Egypt and Lebanon, “where it is half the cost of what it is in the Kingdom”. A humanitarian cause The National Guard Health Affairs (NGHA) in Riyadh is known worldwide for its efforts of separating conjoined twins. Majority of these separations have been performed by Dr. Abdullah Al-Rabeah, Minister of Health, who is an orthopedic surgeon. The complex surgeries on twins who come from all over the world are performed as humanitarian acts with no costs to the families. To date, 23 sets of conjoined twins have been successfully separated in the Kingdom under the sponsorship of King Abdullah, Custodian of the Two Holy Mosques. Last month, a multidisciplinary team headed by Dr. Al-Rabeah performed a lengthy surgery on a set of Moroccan twins who shared a liver and pancreas, and the upper part of their intestines. The separation was carried out in seven phases. The twins were brought from Morocco on the instructions of King Abdullah, who is personally involved in supporting conjoined twin operations. Other sets of twins who have been operated on in the Kingdom have come from countries, such as, Egypt, Poland, Philippines, Malaysia, Sudan, Yemen, Morocco and Iraq. Scope for improvement On ways to boost medical tourism in the Kingdom, Dr. Rao remarked that it “depends on the participation of the private sector and the reputation of the institution and individual doctors, both of which are built up over the years. Moreover, advertising by the authorities plays an important role”. Recently, the Ministry of Health announced the creation of a new Clinical Revision department to improve medical performance and reduce medical errors, as part of an overhaul of the ministry ordered by Dr. Al-Rabeah. Dr Iqbal Musani, consultant pathologist and director Al-Jedani Group of Hospitals, said: “There is no doubt that the Kingdom's health sector is fast developing and this is particularly in specialized fields, such as, stem cell research and infertility treatment, where a lot of work is in the offing”. “Development in the health sector is very fast, but there is always room for improvement,” said Dr. Badawood. But as Dr. Musani puts it: “It's something like this: Home food is more hygienic and tastier than restaurant food, but still people, out of the habit of wanting to try something new, tend to eat out.”
