Medical Tourism Industry in India -- A Systems Problem

Alamgir Pasha looks on as his fourteen children play cricket in the sprawling lawns of his mansion which more or less resembles a medieval fort. Alamgir is happy with his two wives, fourteen children and one daughter-in-law. He lives in Mirpur near Dhaka, Bangladesh. Alamgir owns a rice mill and exports rice to different countries. He is 53 years old.

Alamgir wanted to celebrate Edd with all his family members. This year he had been successful in bringing all his sons together. Some of them had been studying in England for higher studies. Tears rolled down. It was tears of joy. As every member came to Alamgir for their “Eddi”, he was filled with pride. As he was doling out gifts and presents he felt a sharp pain on the back of his shoulder. Next Alamgir was in ICU at a local hospital. It was diagnosed as a cardiac arrest. He was unable to move his feet and arms. He was paralyzed. The local doctors suggested an operation. Alamgir’s family did not want to take the risk. They applied for a medical visa to India. As medical visas is open to residents of countries including Bangladesh, Sri Lanka, Pakistan and China with a validity of one year they had no problems. Why the Alamgir family opted to treat him in India? India offers medical treatment at between half and one third of the cost of similar treatments in neighboring medical tourism countries such as Singapore, Thailand and Malaysia.

Alamgir family calculated only the cost and the language factor. Why? Singapore is two to three times more expensive than India. Thailand is eighty percent more expensive while Malaysia has just started from the running blocks. They had felt comfortable in India in their last trip as they spoke their own language and not English or Mandarin to express them but what lay for them is another story. The Alamgirs did not have the considerable amount of time researching the destination and its facilities on their own and had not shown a degree of initiative. They were left totally at the mercy of the hospitals and their touts. In countries like Thailand and Singapore the governments goes out of their way to attract medical travelers as it has now become a lucrative revenue earner.

India never thought medical tourism as an industry which can give you high revenue and a number of employment opportunities for a host of people connected peripherally with this business. Putting advertisements like “incredible India” and touts and law enforcers running after one’s wallet, with no proper place to relieve yourself, getting beaten up by a taxi driver in the mid way of your journey, rouges throwing you out from your legitimized train berths and on checking up with the flight schedules in the internet you end up sitting like a frog in the airport as your flight was long away reschedule --- the tourist in you pops out “incredibly”. So India was never serious in her attempts to recognize any unorganized sector as “industry”. Medical tourism is also suffering from the same official apathy, and continues to do so.

Medical tourism is related to three ministries--- Tourism Ministry; Foreign Ministry and the Health Ministry. The Tourism Ministry has no plans for its “Incredible India” market leave alone formulating any plans for this niche market. The Foreign Ministry after issuing visas to medical travelers is oblivious to other sectors. Though they are very particular that medical travelers cannot re-enter the country sixty days after one exit post operative or cure. This hinders any post operative care. But they sometimes issue visas to black listed dreaded international criminals. They have no time to think about themselves what to think about a person on a wheel chair. The Health Ministry has enough complexities to sort out like curbing the polio, H1N1 virus, distributing condoms, ORS packets, iodized salt packets, AIDS control, sterilization and also other medieval aged diseases like malaria, diphtheria, small pox which comes to India at regular intervals. Getting into the intricacies of attracting medical tourists doesn’t suit them.  The credit for getting six lakhs patients to India and spending more than Rs.4,500/- cores in getting treated in India is purely because of private enterprise with a few corporate hospitals, pharmaceuticals companies, freelance agents all working in tandem to build a thriving ecosystem that educates, facilitates and ferries medical tourists from Africa, Europe and neighboring countries.

Alamgir Pasha got treated from Christian Medical College, Vellore (Tamil Nadu) and is now able to move around and carry on his business. Before leaving India he went to Ajmer Sharif (Rajasthan) to pray for his wellbeing and his family at the “Dargarh” of Kwaja Moinuddin Chisti.

 

Sitendu De is the author of this post.

Culture Based Design -- For Sustainable Economy

The continuing Global Economic meltdown and Japan's nuclear mishap are clearly man made disasters that caused lot of pain and agony to humanity as a whole.

How are we to come out of this crisis? Do we find a new way to survive? How do we stop environmental degradation? How do we build sustainable societies?

These important questions are not new. Even Neil Bohr expressed concerns on such issues back in 1950. Of course people did not care to listen then. They could afford not to listen. However, such questions were vigorously followed up by many activists and serious champions for the past 30 years or so.

Most predicted doom for the earth and humanity. Some thought that nothing might possibly be done unless individual consciousness or the way we think and act change for the better.

Nothing happened. Perhaps there was no need to. Critics were harsh when they sneered by saying that more than 95% of humanity suffers the 'boiled frog' syndrome. Others were frustrated and almost gave up. Still some wanted to find the culprits and punish them. 

But there are new signs of change. Harsh economic reality has rudely shaken us up from our deep slumber. It is like pouring ice cold water on our face on a winter morning.

What are these signs? More visible of these that catch our attention is the dramatic and swift wave of revolt sweeping over Middle East. People can't go hungry for sure.

However, there is another vital sign that is virtually going unnoticed -- sort of happening very quietly away from the glare of the media. And that is Culture Based Design (CBD) as I would like to call it.

In essence it is simple indeed. Look around what is unique in the culture of the land. Build up the economy through products and services based on the uniqueness of such culture. This is indeed a far cry from the standardized offerings being pushed around the globe by fairly large corporations who have no other business but to grow and keep growing richer at the expense of everything (champions of the old Industrial age thinking) only to flatten the earth.

Now this small but vital sign of Culture Based Design (CBD) might be a clue to greater unfolding possibilities to answer those serious unresolved questions humanity has been asking for the past 60 years.

Some examples might be in order:

1. Chinese are deeply studying the culture of India to design products that match the cultural traditions of India and her sensitivity. Recently during Holi (a spring festival in India) they did care to provide the accessories needed for the event -- designed and manufactured in China and sold in India at affordable prices. A win win situation for both countries.

2. Iceland whose economy was virtually wiped off by the Great Recession in a matter of days is hobbling back on its feet through intense design activity. They have tapped into the country's Nordic/Viking cultural heritage for their economic revival. As of now Iceland occupies the number 1 slot as the innovation champion displacing the mighty USA (as per ISEAD)

3. India is yet to leverage this idea as Chinese and Icelanders have done. But a new generation of entrepreneurs, mostly trained in the West, is successfully exploiting traditional culture and techniques coupled with narrative marketing (good old storytelling) in areas like jewelry and ornaments. 

What possibilities might unfold from this new phenomenon?

1. A paradigm shift from globally imported cultural criteria to more local home grown products and services based on traditional culture.

2. A sustainable economy that would look more distributed than unified and based on local needs and aspirations.

3. More job creation. People would have a choice to either work as laborers in dark and damp factories or in more exciting fields touched by the glow of human creativity. Education and knowledge gained through the traditional environment would be enough to create most jobs -- a far cry from Obama's urgent plea of 'go to college again or starve'. 

4. Solve the nagging problems of environmental crisis since such efforts are not energy intensive and have been around for centuries when issues of global warming were nonexistent. 

5. Cultural preservation is also ensured.

Hence Culture Based Design would need more serious attention and development if it were to become a part of the integral solution to sustainable livelihood and economy. New internet based social learning technologies would surely come to great help in this endeavor.This would be closely coupled to the Observation Based Learning (OBL) as proposed in my earlier posts. My guess is that CBD along with OBL would be evident in every sphere of a local economy even worming its way into traditional brick and motar companies barring major infrastructural activities.

A seriously inward looking world is unfolding its still rough and jagged edges poised to draw in lots of creative energy to throw up possibilities that would impact the way we live and think.

We shall live by design -- by the people, of the people and for the people!

I may be totally wrong or am I missing something?

 

Ref:

1. http://davidreport.com/the-report/design-culture-time-cultural-fundamentalism/

The Sun Still Shines

While returning from the Sunday church services, Karan Hasda Francis passionately sees his plot of red soil land by the side of the national highway. Francis patiently waits for the monsoon to arrive. He has followed the newspaper. It has already arrived in Kerala and within a month it will reach here.

 Karan Hasda Francis’s forefathers came from a place near Ranchi, Jharkhand. Now they have 17 acres of land at Raghunathpur in Purulia district of West Bengal. For irrigation they have to depend upon the monsoons and the ground water which is depleting every year.

 They are converted Christians. Though the education of his four sons and one daughter had been taken care of by the church, his second son has mostly run away from schools. Eldest son is a local school teacher; second one does odd jobs; the third one has passed ITI examinations (skilled labour) and is looking for a job; the youngest one is still studying in seventh standard; his daughter has eloped with her love to Delhi.

Its very hard times for Karan Hasda Francis wife to make both ends meet. She had been struggling to feed her family. Whatever crops they have from their land is equally divided between them and the tillers. Added to this are the numerous crops failure, wild elephants coming out from the forests and smashing the crops, erratic rainfall and low quality of seeds.

Karan Hasda Francis was toiling in the July sun trying to grow some vegetables in his backyard.  A cavalcade stops near his house. People in designer suits come out from the cars. Maps were spread across the bonnet. Karan was curious. What was the motive of these people?

He runs to the church. He looks out for the father. He is the only person in the whole village who has some knowledge. A fear gripped him as he came to realize the real motive of the people who came from the big city. Is he going to loose his land again. Once his forefathers were driven out from the village by the upper caste community as they failed to pay their debts. Lands were taken away forcibly and houses were torched. The Hasda family was shattered. They crossed over to Bengal. They were given shelter by the church. They got back the will to live in this world.

A car manufacturing unit is going to come up at his village. Karan Hasda Francis heaved a sigh of relief as his land is not among the 400 acres of land as requisitioned by the car manufacturers. Though other land owners got huge compensation, Francis was thinking of other ideas. Political parties held rallies. They demanded more jobs for the locals. Seven Hundred jobs in a car making factory is just too few for them.

One and half years went by. The factory took its shape. It looked monstrous yet beautiful. Electricity came to Raghunathpur. The roads were widened. Potable drinking water was available. Satellite T.V made its entry. The Banks were desperate to open its branches at Raghunathpur. More ancillary industries came up in its surroundings. Prices of land shot up. People came from outside to work here.  The population of Raghunathpur rose by thirty percent.

Money was flowing. Raghunathpur, once a dead village came back to life. Karan Hasda Francis wife was busy making food for the workers in the factory canteen. His eldest son is busy giving private tuitions. Second son of Francis now days drive a three wheeler through out the day ferrying people from railway station and bus stand to the factory. His third son has got a job in the factory. Francis has opened up a motel by converting a part of his house. All the rooms remains booked throughout the year.   

The Francis family now days go to the church every Sunday morning in their new car.

 

Sitendu De is the author of this post.

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RESISTANCE TO CHANGE

The world has been changing so fast that it scarcely seems to be the same every other day. In 1997, when India was punished for going Nuclear and letting the world knows about its nuclear capability; In Europe, the euro had not been introduced as a common currency; Amitabh Bacchan was still young and Madhuri Dixit was not so plump; Hong Kong had not yet been handed back to China; Google did not exist; the dragon’s  dominance in the world economic map was still a far cry and the terrorist attacks of 9/11 were still four years away ---- Deepak was frustrated , why is his father not listening to him.

Deepak wanted to change his father’s old “Ambassador “car (a distant cousiin of 1941 model Austin) for a new Generation X car. The newspapers were full of advertisements. “Exchange your old car for a new one, and pay on easy monthly installments. Deepak was trying desperately to convince his father but he was adamant. What his son is not aware of are the many cherished memories attached to the car. When Deepak was born he was brought from the local hospital in this car. Deepak had grown up with this car.

Deepak graduated and got into a Post Graduate Business Administration course.

He wanted to change the world too soon. He has now acquired a new motorbike with a funky look. He has changed his attire and wardrobe. Everything he has changed with the passage of time but he is still not able to change his father’s outlook, attitude and business policies. His father still goes to the factory in a white sweat shirt and a cotton trouser. He still mingles with the factory workers. Tries to gauge their feelings. Hugs them when he is overjoyed and also hurls choicest abuses when angry.

Now India has opened up. Private bankers have come in. “Gone are the days when a nationalized Bank staff would talk to you rudely”. Smart young people are now manning the private banks with their plastic smile, trying every moment to access a customer in terms of business he would give. But India is different. People can differentiate between the artificial and the natural. The common man can do wonders. He can shun Ray-Ban, Reebok and prefer locally made under garments. He uses Debit Cards instead of Credit Cards. The billions of middle class Indian market use their own thinking based on their sincere feelings for their families.  

Deepak comes to the factory in a Ford but his father still comes in the old car. People love his father more than him. Deepak had tried to implement all his “imported management policies” in the factory. His father had given him the required space. Some were successful while others miserably failed.

Deepak wonders why things don’t work here. He has tried to implement most of the case studies that he has learned. He is impatient. Why India is so averse to change? Is there a physiological factor playing among the Indians? A change is required but why there is so much resistance?

What he fails to notice are the small meaningful energetic changes that keep taking place against seeming changelessness.

He forgets that small changes are much more powerful than big artificial ones. There is actually no resistance. How can one grapple and fight against something that has no resistance at all. So, no big changes can be brought about in India by copying something or somebody else. It is always a state of becoming not being. That is the ethos of the land called India.

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