Much ado about ‘Medical Tourism’ (II)

THURSDAY Column WITH Mohammed Adamu

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Domestic Medical tourism –as in seeking medical care across states- has never been the problem. Nigerians have never had issues with people traveling anywhere within the country to seek medical help. And so interstate medical tourists may do so anywhere within the country whether in search of orthodox or un-orthodox medicine. In fact those in search of un-orthodox medicine, whether they travel within or outside the country, hardly count for those we censure for medical tourism abroad. And so for all we care, the fetish ones among us may travel to see some babalawo in nearby Togo or some marabou in faraway Senegal, but they dare not go to Europe, America, Asia or the Middle East for orthodox medical help or else they share in the national guilt if not of warranting then of condoning the sorry state of our medical system. The same way that we see parents (whether those culpably rich or those vicariously struggling) who send their children abroad to study, as guilty of promoting ‘educational tourism’ and thus sharing in the national guilt of warranting or condoning the sorry state of our educational system. We seem to suggest, ridiculously, that parents are free of liability from the collective national guilt only if they keep their children at home to suffer the consequences of the educational system that we have warranted or condoned. The same way we see medical doctors who flee for greener pasture abroad as responsible for our ‘Brain Drain’ situation; because we believe that they should remain at home so that we can salvage the situation together. Just as we blame teachers, who hawk their intellectual wares abroad.
And so it is medical tourism ‘abroad’ –for orthodox medicine- that is the chief culprit whenever we bemoan the sorry state of our medical system. Without a legislation outlawing it, we have still managed to make it repugnant to good conscience. We insist that even people who are critically ill must be patriotic enough to stay at home and make do with the ‘available’ –even if not qualitative- medical care. We seem always to pore on the idyllic, but we do not appear to have the courage to reflect on the realistic. We want our abducted school girls rescued but we have made negotiating with Boko Haram repugnant to our ‘patriotic’ sense. We collectively –even if hypocritically- condemn bargaining privately with kidnappers, but now almost every victim-family of kidnap, secretly bargains with and pays kidnappers to recover their loved ones. Because we do not trust our law enforcement agencies; just as we shy away from litigation, because we do not trust the justice system; just as parents seek quality education abroad for their children because they do not trust the system at home; just as teachers and doctors seek better paying jobs abroad because they cannot rely on the system at home to pay a living wage; and just as patients (both the rich and the struggling) are forced to seek quality or available medical care abroad, because they do not trust the systems at home to provide either.
My good friend Mike Ejiofor, the retired DSS Director now-turned public analyst on security matters, is more than an existential ‘witness’ in the reality check that practical experience affords over idyllic opinionation. He is in fact an ‘exhibit’. For long Ejiofor had been an advocate of ‘no negotiation with kidnappers’. But not after he was kidnapped to a forest somewhere between Ekiti and Kogi states. Thereafter he recanted, and now publicly preach a new, realistic evangel: ‘obey thy captors, negotiate’! When the odds are stacked against, even the ‘almighty’ America negotiates. But on an ironic side note, I did not have the luxury to negotiate my freedom while in Abacha’s gulag and under the care of Mike Ejiofor, then the Service’s Director of Operations. But concerning the prison that my beloved wife’s critical medical condition had put me recently, at least I had the luxury to decide I would rather be not ‘patriotic’ than submit her life to the uncertain vagaries of our dilapidated medical system. I took her to the Iranian Hospital in Dubai –one of many such partnership between Dubai and other countries with advanced medical knowhow. And as the Hausas would say ‘wanka yaa biya kudin sabulu’ –the result was worth the trouble.
There I learned that Gallbladder stones or ‘gallstones’ -unlike their pathogenic cousins (kidney stones) which are formed mostly from overconcentration of calcium and uric acid- are formed from bile deposits containing undissolved cholesterol or excess bilirubin –an intermediate product of the breakdown of hemoglobin in the liver. My wife’s resulted from the former. Gallstones range in size from as small as a grain of sand to as large as a golf ball. My wife’s eleven removed stones were each the size of a pebble. Gallstones are common in most people but may become complicated only in those disposed to risk factors like being: female, over forty, overweight, sedentary, diabetic or high-cholesterol-eating. My wife insists she was a victim only of gender. And although they may stray from time to time, into the bile duct to the bowel to be passed as stool, gallstones may also get stuck in the duct and cause inflammation of the gallbladder, blockade of the bile duct or of the pancreatic duct or may even cause gallbladder cancer. My wife’s had done all these except become cancerous because thanks to the operation that possibility has been permanently eliminated. Tests to diagnose gallstones and to generate images of their locations and sizes preparatory to their removal, include but may not be limited to: abdominal ultrasound, Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI). Gallstones can be removed either by the traditional ‘open surgery’ system which opens an 8 to 10 inch incision on the abdomen for surgeons in the theater to grapple with the elements as would a butcher at the abattoir, or they may be removed by the now avant-garde method of laproscopy, a ‘minimally invasive’ method (termed ‘keyhole surgery’) with three tiny, half-inched holes on the abdomen by which surgical tools including a camera are inserted and manipulated on a screen to conduct the operation. This surgery, as even I can testify, has shorter recovery time and ‘better quality-of-life-outcome’ than the ‘open surgery’ method and patients are almost immediately discharged and in no time may resume their normal life. And unlike ‘open surgery’, laproscopy has 99% success rate when conducted by the appropriate medical personnel and under the right condition.

Research has shown that many medical tourists who go to the United States ‘seek advanced and sophisticated procedures that are either unavailable or rationed in their countries’. And yes, there may be filthy rich persons who regale in the luxury or glamour of medical tourism abroad, but for majority of health seekers globally, it is not because they swim in superfluous riches; rather a great number of them are forced by circumstances -the search either for ‘available’ or sometimes even ‘affordable’ Medicare. Yet many go looking for particular medical remedies which may be scarce because they are expensive (so that even the superbly rich must go looking for them), or they may go in search of ‘affordable’ remedies where the ‘available’ ones are prohibitive. Which is not to suggest that ‘availability’ and ‘affordability’ alone are endnotes to the fundamental raison d’être for medical tourism outside of one’s country. Because where a particular medical remedy is both available and affordable, it may still not be qualitative. Or it may even be more expensive at the domestic level than abroad. Again where there is just one quality remedy available, those who can afford it may still search for options from among many competing quality remedies.
But truth is: the right to seek medical remedy abroad belongs to all who can afford it; except those who had a chance but woefully failed to make it available to all of us. This I learnt from many of my FaceBook friends particularly Tunde Asaju, who vehemently disagreed that I am one of those who should share in the collective guilt of the current state of our medical system.

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