Ian Youngman, author of “MedicalTourism: Facts and Figures 2014” questions the effect that Ebola might have on medical tourism and how the subject should be up for discussion due to it’s potential affects on the industry.
When Ebola was just a disease that affected Africa, the Western world took little notice. It was just one of many global issues, overshadowed in the Western media by conflict in the Middle East and fears of the spread of terrorism.
But when Ebola reached Europe and the USA, it began to dominate the media. Media stories on Ebola, some well researched and written, but others with dangerously misleading information (‘no more dangerous than flu’) populated the front pages. As I write, there are certified cases in Spain and the USA, and possible ones in four other non-African countries.
Western politicians and medical professionals were initially confident that they could deal with the disease, until patients travelling to the USA and Europe started dying, and the disease spread to health professionals treating them. The ‘virus ready national schemes”, even in major EU countries, either turned out to be non-existent, or consisted of a couple of beds in an isolation ward in one hospital.
Why this matters to medical tourism
In six months of reading about Ebola, I cannot recall any discussion of the Ebola threat to the medical tourism sector. A business dependent on sending sick people from one country or continent to another should be concerned about a disease that could have serious consequences for parts of the industry.
If nothing else, it should be up for discussion at medical tourism conferences in the coming months. And every hospital, agent or clinic should be able to answer the question from any potential medical tourist of “what about the risks from Ebola? “
A disaster scenario
My background is in insurance and risk management; it is an area that medical tourism pays too little attention to. Every business should embrace disaster planning. In medical tourism, businesses should have disaster plans to cope with getting patients out of a country that suffers a sudden political or weather catastrophe; or dealing with a scenario where you can no longer send customers to certain countries.
The insurance term “estimated maximum loss” (EML) roughly translated means ‘think of the worst possible thing that can happen and the maximum financial loss to your business”. In medical tourism, the EML is that you cannot send a single patient overseas.
Worst possible outcome
Politicians tend to panic, so there is the faint possibility that there might be a global ban on all medical travel. Much more likely is that there will be local bans, and warnings not to travel to or from listed countries.
Morocco has just suggested that the 2015 Africa Cup of Nations should be postponed because of the epidemic. Tourism companies in East and South Africa are reporting drastic falls in bookings.
Medical screening
There are two scenarios on medical screening for Ebola. One is that it will be extended for outbound flights from a few African countries, to all African countries. The second is that the US and Europe will extend medical screening of inbound passengers firstly to all African countries, and then perhaps to all countries.
The effect of medical screening
Increases in medical screening could impose major delays on travel and airport time. For healthy passengers this is an inconvenience and may, at least for a few months, discourage people from travelling.
For medical tourists with a bad tooth or dodgy hip, the inconvenience could be painful and off-putting. For medical tourists needing surgery, any delay may mean that it becomes impractical to travel by air from A to B.
If you “ look like a terrorist” you will be used to being stopped at airports. So what happens when a medical tourist “ who looks and sounds ill” and has given a big clue in “ reason for travel – medical treatment” is stopped in an airport, particularly if there has been an Ebola story on the news that day?
How many medical tourists will be stopped? How many will be turned back from the departure terminal? How many will be stopped when arriving at an airport and told to go back home? How many could be whisked away to a hospital, as “they might be an Ebola risk”?
A handful of medical tourists being stopped and some turned back, could have a major impact on the future of medical tourism.
Am I painting too dark a picture? As I write this, the UK has announced that not only are people travelling from Liberia, Sierra Leone and Guinea, to face a questionnaire from medical staff on their travel history and forward plans when they land in the UK, but people from all countries travelling on the Eurostar to London from Paris and Brussels will be screened, with medical staff to check body temperature for early symptoms such as fever. Five major US airports have begun screening passengers from Guinea, Liberia and Sierra Leone as a precaution, starting with New York JFK from this weekend, followed by Washington. And both the EU and the US will probably have announced a raft of new measures by the time you read this.
Africa
The main African countries where Ebola is now a serious problem are Guinea, Liberia and Sierra Leone. The US Department of State has warned against all travel to these three countries, and added a travel warning for Nigeria. Countries most at risk of spread are their neighbours; Senegal, Ivory Coast and Ghana.
The first three countries have little or no inbound medical tourism, and although there are no known figures on outbound medical tourism, people from all three will mostly go to India or South Africa. The same is true of most neighbouring countries.
Nigeria is a major exporter of medical tourists. Most go to India, some to South Africa and the UK. A few people go from Ghana to Nigeria. Nigeria’s containment of Ebola is awaiting World Health Organisation certification as an Ebola-free nation, led to the USA and Canada dropping Nigeria from countries whose nationals will be carefully screened at their major airports while entering the country.
What are hospitals doing?
So what are hospitals in India, South Africa and the UK doing to screen medical tourists from potentially affected countries for Ebola? The UK is taking many measures. South Africa and Nigeria have some national preparations, but it has not filtered down to individual hospitals.
Dr. Soumini Ramesh of Sri Krishna hospital is worried that Indian health professionals could bring the disease back to India, and with India’s health system being less advanced than Europe, could even cause a pandemic, “Our best course of action is prevention. Prevent all persons originating from the three hardest-hit nations — Guinea, Sierra Leone and Liberia — from coming into India, no matter what their status (health or otherwise). Pre-boarding scrutiny of passports will accomplish this.”
South Africa is the reported destination of hundreds of people from the three West African countries.
Panic does stop people travelling
Many in the travel business will recall the impact of the SARS virus of 2003 and early 2004 when air traffic, notably in Asia and Canada, collapsed and travel retail spending in the most-affected regions was devastated. It took years to recover. This was before medical travel really took off, so the effect on the medical tourism industry of similar panic now could be catastrophic.
What next?
A study by the US Centers for Disease Control and Prevention (CDC) predicts there could be up to 1.4 million cases of Ebola in West Africa by the middle of January. The World Bank has warned of catastrophic consequences on the economy across the African continent estimated at £20.3bn by the end of 2015, because of the failure to adequately and urgently contain the virus.
All I can do is raise the issue and suggest you all watch and read the news carefully; and as an industry, discuss what you can do to avoid public panic, and to plan for disaster scenarios. Bland tourism board or hospital statements of Do not worry, we have it all in hand, there is no risk” will not cut it on Ebola.
A global health problem where one in two of those who get it die, is something that a mature medical tourism industry should discuss, sooner rather than later.
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