For a rawboned and coy 19-year old, Mahdi Rahman has surprising career goals. “I want to be a policeman who uses kung fu to fight (criminals),” Rahman pauses midsentence to catch his breath, before adding sheepishly, “and play football…. just like Cristiano Ronaldo!”
Sitting by his bedside Abdullah Rahman smiles weakly at his frail son. Mahdi, a high school student, is still bandaged across the chest from a critical surgery a week earlier to mend a hole in his heart. “Who knows what he will be,” says Abdullah pensively. “I just hope my son recovers quickly so we can go home soon.”
For the Rahmans, home is 1,000 kilometers away in Ghazni, a mostly rural province in eastern Afghanistan, and a far cry from the plush metropolis of Gurgaon neighboring India’s capital, New Delhi, where Mahdi underwent the life-saving procedure.
At first traveling to India had seemed like a daunting proposition to the 59-year old with a meager income and a large family to support. But Abdullah knew he could trust his judgment, because that’s where everyone went.
“From childhood Mahdi could never run around or play like other boys without feeling shortness of breath, and nobody could understand why. Then last year the doctor in Ghazni told me to take him to India after he became ill. That’s where the big hospitals and surgeons are,” Abdullah said.
“In Afghanistan we don’t have such facilities or huge machines,” explains the father of eight.
In the past decade India has emerged as one of the fastest growing global healthcare destinations, particularly for patients from conflict countries like Afghanistan, Iraq, Yemen, Sudan, the Democratic Republic of Congo (DRC), and Somalia where years of war have decimated public medical infrastructure. Each year the south Asian economy is attracting close to 400,000 foreign patients, half of which are from war-ravaged countries.
“We are treating 20,000 patients per year from Iraq and Afghanistan in our hospital alone, although people are traveling from as far afield as Fiji, Tuvalu, Nigeria, Ghana, Ethiopia, Libya, Uganda, Burundi, Russia, Uzbekistan, and Kazakhstan,” says Anas Wajid, sales director at Max Hospital in New Delhi.
“War and protracted violence in countries like Iraq have wrecked their healthcare system. In places like Afghanistan such infrastructure never got fully developed in the first place. The country doesn’t have a single MRI machine or PET scan. It has forced people to look beyond their borders for most affordable and quality care, and India has filled the gap perfectly,” adds Wajid.
Interestingly, in 2014, the wife of former Afghan President Hamid Karzai gave birth to a girl at Fortis Hospital in New Delhi following complications that couldn’t be treated in Kabul.
Some of the most commonly sought procedures in India include bone marrow transplants, reconstructive surgeries, heart transplants, treatment of cancers, orthopaedic and neurological treatments. “We also see a significant number of patients with shrapnel wounds, amputations, burns, and blindness as a direct consequence of war. Once we had a soldier from the DRC who had a bullet shrapnel wedged in his heart,” says Atamjot Grewal, director of medical operations at Fortis hospital.
Low cost has been a key driver in India’s rise as a medical destination of choice. For years Singapore and Thailand have been the market leaders in Asia, providing medical care to patients across the globe at a fraction of the cost of the West. However, in the last decade the emergence of Chennai, New Delhi, and Mumbai as the new international medical value hubs providing advanced tertiary care has firmly placed India in the league, on par with its Asian neighbors. According to an industry-wide study, the Indian market is likely to reap $7-8 billion in revenue by 2020, more than double its current level.
Salim Hussain, a 51-year old resident of Kazmia near Baghdad, sold his car and borrowed another $4,000 to fund his heart surgery in New Delhi.
“War has ruined my country. Most doctors have fled to Europe. The hospitals are ill equipped and the machines old. And nobody knows if the medicines and treatments they are paying for are good quality or not,” says Hussain ruefully.
The retired government official isn’t sure how he will pay back his debt but is still happy he found somewhere he could come close to affording the procedure and thus extend his lifespan. “I would have never been able to go to the U.S. or the U.K. I couldn’t have even if I had sold myself,” Hussain laughs.
Dr. Sandeep Attawar, a cardiac specialist at Fortis Hospital, however, believes cost isn’t the only reason for India’s rise as a preferred medical hub. “Cost, quality, and access are the three cornerstones of an excellent healthcare system. Currently, India is not only offering the best combination, it is also more importantly pushing the boundaries without compromising on the outcomes.”
“We are operating on beating hearts for coronary artery surgery, which is a radical new innovation. A procedure that normally costs $100,000 in America is available in India at 10 percent of the cost or a third of what you will typically pay in Thailand,” he explains. “A large number of our doctors have trained and practiced abroad. They are highly specialized in their fields, meaning patients can expect to receive the highest quality healthcare standards in the industry.”
Going a step further, large private hospital chains like Fortis, Apollo, and Max have adopted a holistic approach to providing care to the international patients. Once the patient makes contact with the hospital they are provided with accommodation, round the clock interpreter services, and their dietary and cultural needs are taken care of. The charitable arms of these hospitals have also collaborated with independent donors and international aid agencies like Afghan Red Crescent Society (ARCS) and Rotary Foundation of Nigeria to provide highly subsidized treatments to patients, especially children, from families with limited means.
“We treat a large number of children and young adults like Mahdi from Afghanistan with congenital heart diseases. Sometimes they are treated for as little as $2,500, which doesn’t even cover the basic cost of the procedure. But thanks to our partnerships with various charitable organizations no child is ever turned away, “ says Grewal of Fortis Hospital.
But despite a surge in growth and revenue, India’s international healthcare sector is not without its unique set of challenges. According to Wajid, bureaucratic hurdles often make the healthcare experience for patients more stressful than necessary. “Unlike Thailand where every patient gets [a] medical visa on arrival, India still doesn’t have a straightforward visa system in place. A medical visa costs more than a tourist visa and requires unnecessary paper work.”
But more importantly the lack of a regulatory regime for the sector makes it ripe for exploitation of the patients by middlemen and touts, he says. “Hospitals like Max and Fortis have special desks at international airports to eliminate unscrupulous elements. But it can’t be fully avoided without proper government regulations.”
“For patients, often with limited resources and language barriers, it’s a big leap of faith. It’s unfortunate that despite our best efforts many of them do get deceived,” Wajid adds.
Nishtha Chugh is an award-winning development and security journalist based in the U.K. Her work has been published in The Guardian, Al Jazeera, BBC World Service, Channel 4 News, Open Democracy, Africa News and The Independent.