Doctors 'mistakenly' Preparing to Remove her Organs

Patient awoke to find doctors preparing to remove her organs by mistake

St. Joseph's Hospital Center

Not everyone looks forward to a visit to the doctor. And some people even have an irrational fear of hospitals.

But sometimes things do, in fact, go horribly wrong, as in the case of a Syracuse, New York, resident who awoke during a trip to the emergency room to find that doctors were mistakenly preparing to remove her organs.
The Post-Standard reports that in October 2009, Colleen S. Burns was taken to the emergency room at St. Joseph’s Hospital Center, suffering from a drug overdose. Although a nurse told doctors that Burns was recovering from her overdose, those same doctors pronounced her dead.
A call was placed to her family informing them that Burns had passed away, and the family subsequently agreed to have her removed from life support and gave the hospital clearance to harvest her organs.
But Burns was not dead. In fact, a number of signs clearly pointed to her being alive. When a nurse performed a mandatory reflex test on Burns, her toes curled downward. She appeared to be breathing independently of a hospital respirator, and her lips and tongue were said to have moved moments before doctors prepared to remove her organs.
Nonetheless, the nurse then followed instructions to give Burns a powerful sedative, an unnecessary move if the patient were actually dead. Which could only mean that the doctor knew that she was not deceased. Did this mean she was just sacrificed for the purpose of organ harvesting?
Thankfully, Burns awoke moments before doctors were going to cut her open to remove the organs from her presumed-dead body.
"Despite this sequence of events," said a federal report from the Centers for Medicare and Medicaid Services, "intensive objective peer review and root cause analysis of the case was not done by the hospital's quality assurance program until prompted by the Department of Health."
"They were just kind of shocked themselves," Burns’ mother, Lucille Kuss, told the paper when asked how doctors responded to the morbid mistake. "It came as a surprise to them as well."
It’s unlikely that Burns’ case was entirely isolated. A report from the American Association for Justice claims that preventable medical errors are the sixth largest cause of death in the U.S.
The hospital was sanctioned for its actions and cited for a number of mistakes that placed the patient’s health in jeopardy. But in a development that is nearly as brutally shocking as the mistakes themselves, the hospital was only fined a total of $22,000. Amazingly Burns herself declined to sue the hospital after the incident even though the hospital, whose motto is "A Higher Level of Care," never even explained to her why the mistake had occurred.
Although the fines were levied in September 2012, surprisingly they were first made public in a reported obtained by The Post-Standard on Sunday.

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Burns, who fully recovered from her injuries at the time, committed suicide in 2011 at the age of 41. But her mother says Burns was already suffering from a number of issues and that the hospital incident did not play a role in her eventual suicide.
"She was so depressed that it really didn't make any difference to her," Kuss told the paper.
For its part, St. Joseph’s has arrogantly stood by its medical staff.
"St. Joseph's goal is to provide the highest quality of care to every patient, every time," Howell said in an email to The Post-Standard. "These policies were followed in this case, which was complicated in terms of care and diagnosis," Howell said. "We've learned from this experience and have modified our policies to include the type of unusual circumstance presented in this case."
And as if all of that is not unsettling enough, one consumer advocate told The Post-Standard that there’s currently no way of accounting for how often these cases happen, because there is no centralized system for collecting information on hospital errors.
"These sorts of things do happen," Lisa McGiffert, director of Consumers Union Safe Patient Project, told the paper. "It's pretty disturbing."

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Careful When You Report Rape In Dubai

Be Careful When You Report Rape In Dubai Or You May End Up 16 months in Jail

 

 Dubai

A court in Dubai has sentenced a young Norwegian woman, Marte Deborah Dalelv, to 16 months in jail after she brought charges of rape against a colleague.
Dismissing her allegations, the court instead found her guilty of drinking alcohol and wanting the sex that she alleged was forced upon her. Meanwhile she was fired by her Qatar-born employer, the interior designer Wissam al Mana, who is otherwise known as Janet Jackson’s latest husband.

The circumstances are complicated but, could she be a victim of a grotesque miscarriage of justice? Could it also possible that she got herself drunk and consented to sex as being drunk after all will invariably lead to all sort of immoral behavior as the local judges and juries perceived it?

 

Dalelv is currently staying at the Norwegian Seamen’s Center in Dubai while appealing the verdict.


Janet Jackson with new husband Wissam al Mana: he fired alleged rape victim Marte Deborah Dalelv. 


Why would the 'victim' of a terrible crime receive a jail sentence?
Understand that Asia is not America, let alone Norway. To a Westener watching the world from a vantage point in East Asia, the episode illustrates in microcosm a troubling fact: globalism is a one-word  oxymoron. It has never made sense and probably never will. Cultures are different and, in their attitude to truth and human rights, the many brands of Asian culture are particularly remote from Western expectations.

Certainly, all American wishful thinking to the contrary, the world is NOT converging to American values. Yes, of course, more and more consumers around the world are drinking Coca-Cola  and eating Big Macs. But this is a superficial observation that says nothing about any values worth the name.

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Of course, Dubai, which is the most populous constituent of the United Arab Emirates, seems on a superficial view to be highly Westernized. A more accurate description is that Dubai is highly economically advanced. It is home, for instance, to major regional operations of such U.S. corporations as Hewlett-Packard  EMC, Oracle, Microsoft  and IBM. It also boasts the world’s tallest building, the 163-floor Burj Khalifa. Meanwhile the Emirates airline, which is based in Dubai, counts, on some measures, not only as the world’s largest international carrier but the world’s best (it was so designated a few months ago by the British consultancy, Skytrax).

But Dubai’s official religion is Islam — and Islam forbid the exposure of a woman's skin other than her face and hands. Alcohol is 'haram' - forbidden, so is being alone with the opposite sex. This means that Westerners are tolerated only under sufferance. Western women in particular are not always welcome especially when many blatantly ran around in skimpy bikinis on the beaches. This despite the fact that Dubai features one of the most disturbingly imbalanced male-female ratios in world history: in the overall population, males outnumber females more than three to one. The ratio for adults is probably even more imbalanced.
Foreign prostitutes, particularly Russian and Indian ones, seem to be welcome.  The status of ordinary decent local women in Dubai is powerfully symbolized by the fact that wives when found guilty of deceiving her husband can be beaten initially with a symbolic soft cloth and much later with 'impunity' if she persists with her deceit so long as no marks are left.



Justice in an American sense does not apply in Dubai.  Marte Deborah Dalelv’s fate is that she has been indicted on a crime – drinking alcohol and having sex with a man other than her husband – that is widely tolerated though abhorred among other foreign residents of Dubai.

The larger point here is that Eastern and Western cultures are in many ways incompatible. Rudyard Kipling made the point more than a century ago: “Oh, East is East, and West is West, and never the twain shall meet.”

Probabaly, on appeal, Marte Deborah Dalelv will be shown some leniency.
Asian legal systems for the most operate quite differently from anything Americans are used to and that can lead to unpleasant surprises.

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Netherlands: Foot orgasm syndrome

Foot Orgasm Syndrome

A 55-year-old woman in the Netherlands visited the doctor with an
unusual complaint: She experienced unwanted orgasms that started in
her foot, according to a new report of her case.

The orgasmic sensations — which occurred in her left foot — were
sudden, not brought on by sexual desire or thoughts, and occurred
about five to six times a day, the report said. The sensation traveled
up her left leg to her vagina, and she said the experience felt
exactly like an orgasm achieved during sex.

These orgasms were very embarrassing and worrying to the woman, said
study author Dr. Marcel D. Waldinger, who treated the woman and is a
neuropsychiatrist and professor in sexual psychopharmacology at
Utrecht University in the Netherlands.

University Medical Center Utrecht

"She felt terrible about it," Waldinger said.



Magnetic resonance images (MRI scans) of the woman's brain and her
foot showed no abnormalities, although another test revealed some
differences between the nerves of her left and right feet, Waldinger
told LiveScience. Stimulating her left foot with an electric current
induced a spontaneous orgasm in that foot, he said.

The woman was treated with an injection of anesthetic into one of her
spinal nerves — the nerve that receives sensory information from the
foot — and the orgasms stopped completely. The woman has not had any
foot orgasms for eight months now, although she might need to return
for another anesthetic injection if her symptoms return, Waldinger
said.

The researchers believe the phenomenon was the result of a sort of
mix-up in the brain.

About a year and half before the foot orgasms started, the woman spent
three weeks in an intensive care unit — part of the time, in a coma —
because of a sepsis infection. When she came out of the coma, she had
tingling and burning sensations in her left foot, likely as a result
of damage to tiny nerve fibers in the foot, Waldingersaid.
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Interestingly, the nerve that registers sensory information from the
foot enters the spinal cord at the same level as the nerve that
registers sensory information from the vagina, Waldingersaid. Because
of nerve damage in her foot, the woman's brain did not receive sensory
information from her foot, but it did receive sensory information from
the vagina.

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After a year and a half, the nerve in the foot regenerated. When that
happened, the researchers believe "the brain could not anymore
differentiate between the foot and the vagina. So that it decided that
every stimulus coming from the foot was actually coming from the
vagina," Waldinger said. "And that means an orgasmic feeling," in the
foot, he said.

The researchers called the woman's disorder "foot orgasm syndrome,"
and it is the only known case of its kind. (A foot orgasm has
previously been reported in a man with a foot amputation).

Waldinger thinks there may be other people who have the condition, but
are too embarrassed to talk about it. Waldinger wanted to publish the
case report in part to reduce the stigma surrounding such conditions.

"It's not psychological," Waldinger said. "It’s a neurological thing —
we can explain it, we can treat it."

Waldinger is hoping to hear from more people who may have a similar
condition, and has made a website for people to contact him

The study was published online June 19/2013 in the Journal of Sexual Medicine.

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India: 19 Die After Eating School Lunch

19 children die, 27 hospitalized after Eating School Lunch in India

PATNA, India July 17, 2013

At least 20 children died and many others were sick after eating a free school lunch that was tainted by a heavy dose of insecticide, Indian officials said Wednesday.
It was not immediately clear how chemicals ended up in the food in a school in the eastern state of Bihar, though one official said the food may not have been properly washed before it was cooked.
The children, between the ages of 8 and 11, fell ill Tuesday soon after eating their school lunch in Masrakh, a village 80 kilometers (50 miles) north of the state capital of Patna. School authorities immediately stopped serving the meal of rice, lentils, soya and potatoes as the children started vomiting. The lunch, part of a popular country-wide campaign to give at least one hot meal to children from poor families, was cooked in the school kitchen.

Patna Town scene

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The children were quickly rushed to a local hospital and later to Patna for treatment, said state official Abhijit Sinha.
In addition to the 20 children who died, another 27 children as well as the school cook have been hospitalized, he said. Ten of them were in serious condition.

Authorities suspended an official in charge of the free meal scheme in the school and registered a case of criminal negligence against the school headmaster, who fled as soon as the children fell ill.
P.K. Sahi, the state education minister, said a preliminary investigation suggested the food had traces of an organophosphate used as an insecticide on rice and wheat crops. It's believed the grain was not washed before it was served at the school, he said.

Street Death in Patna
 

However, local villagers said the problem appeared to be with a side dish of soya and potatoes. Children who had not eaten that dish were fine, although they had eaten the rice and lentils, the villagers said.
India's midday meal scheme is one of the world's biggest school nutrition programs. State governments have the freedom to decide on menus and timings of the meals depending on local conditions and availability of food rations. It was first introduced in southern India, where it was seen as an incentive for poor parents to send their children to school.
Since then the program has been replicated across the country covering some 120 million school children as part of an effort to address concerns about malnutrition. According to the government, nearly half of all Indian children suffer from malnutrition.
Although there have been occasional complaints about the quality of the food served, or the lack of hygiene, the tragedy in Bihar appeared to be the worst associated with the massive food program.
Bihar's top elected official, Chief Minister Nitish Kumar, has ordered an inquiry into the deaths.

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She Chopped Her Husband's Penis

California woman gets life for chopping off husband's penis

 A judge sentenced a Southern California woman who cut off her estranged husband's penis and tossed it in the garbage disposal to life in prison with the possibility of parole.
Catherine Kieu, 50, was convicted by an Orange County jury in April of aggravated mayhem and torture following the July 2011 assault on her ex-husband.
Kieu drugged her former spouse before tying him up and severing his penis with a knife. She then threw it into the garbage disposal unit.
An attorney for Vietnam-born Kieu argued at trial that she had suffered sexual abuse as a child which left her with post-traumatic stress. She was remorseful about the attack, he said.
After the sentencing hearing, the victim - identified only as "Glen" - said he wished Orange County Superior Court Judge Richard Toohey could have given Kieu more time behind bars, City News Service reported.
"Deep down inside I was hoping for a stronger sentence, but given the restraints of the law this is what he had to do," he said.
"There may be a situation where I can be happy, but whole? Never ... I've got a long ways to go."

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Falls into coma in USA, wakes up in Poland

New Jersey man falls into coma, wakes up in Poland

In March, Jacinto Rodrieguez found himself deported to Mexico after falling unconscious in an Iowa hospital. 

Here is a scary story: you sought treatment in another country far away from home and something went awry during your surgery and you went into a coma and when you woke up you are in a different country, not necessarily yours, surrounded by unfamiliar faces who might or might not be friendly. You thought it was just a nightmare until you realize it was not.
Sixty-nine-year-old Wladyslaw Haniszewski had lived in the U.S. for about 30 years. But when the New Jersey resident fell into a coma he awoke to find himself in his native country of Poland .

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The New York Daily News reports that Haniszewski fell victim to a growing phenomenon in which uninsured immigrants are deported by U.S. hospitals that do not want to get stuck paying for their treatment.
“Imagine being carted around like a sack of potatoes," said Polish Consul General Ewa Junczyk-Ziomecka, who argues that Haniszewski was placed on a chartered flight while still unconscious, never giving his consent to being shipped to a hospital in a country he had not lived in for decades.


The practice of medical repatriation has reportedly become increasingly common. One immigration advocacy group told The Associated Press in April that it has documented at least 800 cases of individuals being deported from hospitals without consent over the past six years in at least 15 states. However, the actual number is believed to be much higher because of the significant number of cases that go unreported.

"It really is a Catch-22 for us," Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System, said at the time. "This is the area that the federal government, the state, everybody says we're not paying for the undocumented."
There is an ongoing debate over the legality and morality of medical repatriation.

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Under U.S. law, hospitals are required to gain patient consent, from either the individual directly or an immediate family member, before having the individual deported. The federal government is not directly involved in the cases and does not pay for the cost of deportation. In April, "Colbert Report" host Stephen Colbert weighed in on the controversy, saying sarcastically, "It's totally unregulated, so hospitals avoid all the red tape usually involved in shipping the unconscious."Haniszewski has reportedly fallen on hard times in recent years. Friends tell the Daily News that he recently lost his apartment and job, and was forced to relocate to a shelter.

The Robert Wood Johnson University Hospital in New Brunswick is defending its actions, saying it took the necessary precautions before placing Haniszewski on an outbound flight.

“The individual was informed regarding his discharge plan and care,” said hospital spokesman Peter Haigney. “As the hospital's understanding of the facts differs from the published reports, we are conducting a thorough review of the procedures and communications surrounding this gentleman's care.”
However, Junczyk-Ziomecka contests the theory that Haniszewski consented to the move or was even informed of the decision. After all, he was still in a coma when he arrived in Poland and even now is unable to verbally communicate with hospital staff. He’s also estranged from his two daughters, who live in Poland.
"He can smile from time to time, but he is unable to communicate," Junczyk-Ziomecka told the Daily News.

“It’s an incredibly disturbing case,” Lori Nessel, director of the Center for Social Justice at Seton Hall University School of Law, told the Daily News. “This kind of action seems clearly illegal and also not ethical, but it’s hard to bring a legal action.”

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Zombies: 'Walking Corpse Syndrome'

Warm Bodies: Man Describes Life With 'Walking Corpse Syndrome'

A man's account of living with Cotard's syndrome offers a chilling look at a rare condition that has patients convinced they're zombies.

The man, identified only as Graham in an interview with New Scientist, said he awoke from a suicide attempt feeling as though his brain were dead.
"I just felt like my brain didn't exist anymore," Graham told the magazine, recalling his bizarre state of consciousness after surviving an attempt to electrocute himself in his bathtub. "I kept on telling the doctors that the tablets weren't going to do me any good, because I didn't have a brain. I'd fried it in the bath."


Graham was diagnosed with Cotard's syndrome, a mysterious psychiatric condition marked by "the fixed and unshakable belief that one has lost organs, blood or body parts" or has no soul, according to a definition in the journal Neurology.
"I lost my sense of smell and taste. I didn't need to eat, or speak or do anything," Graham told New Scientist. "I ended up spending time in the graveyard because that was the closest I could get to death."
What little is known about Cotard's syndrome has come from rare case reports dating back to 1882. But Graham's recent diagnosis gave doctors an opportunity to look inside the brain of a Cotard's patient.
What they found was extraordinary.
"I've been analyzing PET scans for 15 years, and I've never seen anyone who was on his feet, who was interacting with people, with such an abnormal scan result," Dr. Steven Laureys of the University of Liège in Belgium, who consulted on Graham's case, told New Scientist. "Graham's brain function resembles that of someone during anesthesia or sleep. Seeing this pattern in someone who is awake is quite unique to my knowledge."
So while Graham's brain was intact, his brain activity looked like that of someone in a coma.
"It seems plausible that the reduced metabolism was giving him this altered experience of the world, and affecting his ability to reason about it," Laureys said.
Graham said he struggled to find pleasure in life, calling the fact that he didn't actually die "a nightmare."
"I just felt really damn low," he said, recalling his desire to lurk in graveyards. "I just felt I might as well stay there. It was the closest I could get to death. The police would come and get me, though, and take me back home."
But over time, with the help of therapy and medication, Graham said he managed to shake his zombie-like state.
"I don't feel that brain-dead anymore," he told New Scientist. "Things just feel a bit bizarre sometimes."
"I'm not afraid of death," Graham added."But that's not to do with what happened - we're all going to die sometime. I'm just lucky to be alive now."

China’s health service and medical tourism to China

There may be many things wrong with China’s health service and yet it attracts an increasing number of medical tourists mostly from Chinese population of Malaysia, Indonesia, Thailand, Philippine and, yes, Singapore. Although at the same time many more Chinese look overseas for treatment.

But in five or ten years time China could be competing as a top medical tourists destination. 

A 1995 city government survey of expatriates and investors found that 70 % wanted medical care to be available within 20 minutes and wanted health services to be of high quality. During those period, most expats went home or to Hong Kong for treatment. Now, most choose to stay in Shanghai.

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Expatriates and medical tourists have similar fears. Will they get the quality of care they are used to back home? Will they be able to communicate with doctors treating them? In Shanghai, home to about 300,000 expatriates, such anxieties are eased by the burgeoning number of internationally operated clinics and hospitals, and by the creation of VIP wards in public hospitals. 30 hospitals have set up special wards catering to foreigners. There are also 20 international hospitals and clinics financed by overseas investment and employing some foreign medical personnel.

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Mr Liu Zhongmin of Shanghai East Hospital told a medical forum in Shanghai, "Language, international insurance and quality service are the biggest concerns of international patients. But they are gaining increasing confidence in the skills of Chinese doctors." Apparently language is not such a big concern as there are a sizable citizen of Chinese descent in the aforementioned countries.

Public hospitals can be crowded and noisy, with doctors too busy to give any individual patient much attention. Compared with Western hospitals, the process of seeing a doctor and finding services focused on patients lags far behind in China. Patients have to go to different floors for different tests and to pay bills. Doctors who have too many patients have no time to explain diagnoses and treatments carefully.

Western-style services are not cheap. Charges in an international hospital may be ten times the price of those in a local one, depending on the facilities and the treatment given. For the extra money, patients get medical staff that are less harried. Bilingual help is usually available. The wards are quieter. The interior decor is soothing.

Public hospitals have been trying to emulate the Western health-care system by setting up VIP wards. Local hospitals are learning from the Western service concept, but it will take a long time. It is one thing to set up a special area with better decor, but quite another to adopt patient-focused services and assemble highly qualified professional staff.

Among local hospitals in the city, Shanghai East Hospital sees the largest number of expatriates, treating 20,000 a year. Shanghai East, located in the Lujiazui financial district of Pudong New Area, was the first publicly owned medical facility in the city to open a joint venture international hospital, financed with US investment.

The same picture can be seen in 20 cities across China, and while for now they may be happy to concentrate on providing care for increasingly well-off locals and the expatriates working there; sooner or later China is going to look seriously at attracting medical tourists. When it does, Asian countries charging too high a price for their services, will be under threat.

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Indian medical tourists: Where do they all come from?

Ms Asin: a pretty Indian actress

Countires aspiring to be the global hub of medical tourism always trumpets on how people from developed countries (translate: USA/EU) are lining up at their health care facilities. India is a case in point.
The International Welllness and Healthcare Travel Association (IWHTA) however beg to differ. They recently analysed where Indian medical tourists come from.
Their analysis confirms that although Europe and the USA are often mentioned as a source of medical tourists, together they only account for one in ten travelers. The analysis provides the following breakdown:
• Bangladesh/Nepal/Sri Lanka 19%
• Iraq 18 %
• Middle East 16 %
• Africa 9%
• Afghanistan 9%
• Europe 6%
• USA 4%
• * Non resident Indians from all countries 22%
Naresh Jadeja of IWHTA also analyses the current position of India:
• The last five years has changed Indian hospitals and services by adding thousands of hospital beds and a number of world-class hospitals with state of the art health care and technology.
• Many Indian hospitals are not attracting international patients not because they are not up to the mark but because they are running at their capacity as both health insurance and the healthcare demands of India’s middle class rocket.
• Although the Indian health care industry is advertising less it is enjoying a substantial share of international patients from around the world. More than 580 multi specialty hospitals and over 400 single specialty clinics in India are treating international patients.
• A key market is non-resident Indians who visit their home town every year or every other year and opt for diagnostic and wellness tourism activities as it is time consuming and costly in their countries. Hospitals promoting executive checkups are trying to build trust through feel good visits to show people their quality commitment and technology.
• IVF and infertility procedures are offered by hundreds of clinics in India.
• Alternative medicine such as yoga and ayurveda is very popular and wellness treatments are attracting many visitors. Hotels with these options and medical spas are in big demand.
• Dental tourism is a growth area.
• There are two totally different types of patients going to Indian hospitals. Those from less developed countries do not expect any added services or soft skills from medical staff, but those from developed countries do expect this and more.

New Influenza Vaccine Guidelines for 2010-2011

From the CDC:

There are some significant changes in this flu season's recommendations that healthcare providers and clinicians should be aware of before beginning flu vaccination efforts.

On July 29, 2010, the CDC's ACIP issued recommendations for everyone 6 months of age and older who do not have any contraindications to vaccination, to receive a flu vaccine each year, beginning this flu season. ACIP recommends that children 6 months through 8 years of age receive 2 doses of the 2010-2011 flu vaccine with a minimal interval of 4 weeks unless they have received:

• At least 1 dose of 2009 H1N1 flu vaccine last season; and
• At least 1 dose of seasonal flu vaccine prior to the 2009-2010 flu season or 2 doses of 2009-2010 seasonal flu vaccine.

If a child has fulfilled both of these requirements, they only need 1 flu vaccine.
Also important to note within the new recommendations is information about a newly approved vaccine, Fluzone High-Dose, for those 65 years of age and older, which simply adds another vaccine option for this group. Those 65 years and older can choose a standard-dose trivalent flu vaccine (15 mcg per strain) or the Fluzone High-Dose vaccine (60 mcg hemagglutinin antigen per strain).
Other additions to the recommendations include information about newly approved flu vaccines, as well as previously approved vaccines with expanded age indications.

A new inactivated flu vaccine, Agriflu, has been approved for people 18 years of age and older. Fluarix is now approved for use in those 3 years of age and older, while Afluria is available for use in those 9 years of age and older. High-risk children 5 through 8 years of age are recommended to receive Afluria ONLY if all other age-appropriate alternatives are unavailable.

The 2010-2011 flu vaccine is made in the same way as past flu vaccines. Over the years, hundreds of millions of people in the US have safely received seasonal flu vaccines. This year's vaccine will protect against the 3 main viruses that research indicates will cause the most illness. This season's flu vaccine will protect against 2009 H1N1, an A- H3N2 virus, and a B virus.
Since the seasonal vaccine will protect against the 2009 H1N1 virus, 2 different flu vaccines will not be necessary this season.

While everyone should get a flu vaccine each flu season, it's especially important that certain groups get vaccinated either because they are at high risk of developing serious flu-related complications or because they live with or care for people at high risk of developing flu-related complications. They are:

• Pregnant women;
• Children younger than 5, and especially children younger than 2 years;
• People 50 years of age and older;
• People of any age with certain chronic medical conditions such as asthma and diabetes;
• People with immunosuppression, whether due to illness or medications;
• People who live in nursing homes and other long-term care facilities; and
• People who live with or care for those at high risk for complications from flu, including:
  
  
  1. Healthcare workers
  2. Household contacts of people at high risk for complications from the flu
  3. Household contacts and out of home caregivers of children less than 6 months of age (no vaccine is approved for children younger than 6 months, as these children are too young to be vaccinated)

Indonesian “international” hospitals are banned

The Health Ministry of Indonesia has banned local hospitals from branding themselves as international hospitals. The ministry's Farid W. Husein says, "By August this year, hospitals must have removed the word international from their brand unless they are internationally accredited." The Health Ministry added that ten local hospitals have planned to apply for international accreditation this year with The Joint Commission International. The ministry will pursue any hospital using global or international labels to which they are not entitled.

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A number of the country’s private hospitals are now known by a new name following the government ruling barring hospitals from using the often misleading attributes: international, global or anything else referring to worldwide networks or high quality of health care. The Bintaro International Hospital (RSIB) has adopted its new name, Bintaro Premier Hospital. The hospital argues that the stripping of the international attribute does not necessarily mean a lower quality service, “The change of the name has been carried out because we have to meet the prevailing regulations.” The hospital formerly known as Omni International Hospital in Serpong, Tangerang, Banten, dropped its middle name, now renamed Omni Hospital.
Dr. Supriyantoro at the Health Ministry comments, “The existence of such international attributions did not guarantee the quality of a hospital’s service to the public.” The use of those attributes has been widely criticized by the public amid reported cases of malpractice involving doctors from several so-called international hospitals. In one recent case Prita Mulyasari was imprisoned and fined by a civil court for allegedly defaming an international hospital following complaints made by her via email over receiving poor medical services. The case sparked widespread protest and led to an unprecedented campaign over social networking sites such as Facebook and Twitter to raise money to help Prita pay off the fine. Public pressure eventually saw the court acquit the case, while the hospital has not yet retracted its lawsuit against Prita.

Dadang M. Epid of South Tangerang Health Agency has called on the hospitals that have stripped their international names to inform the public of the change, “With the announcement, hopefully, there will be no more misunderstanding among the public. People will no longer regard those hospitals as hospitals operating under international standards.”

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Thailand’s medical tourism: Fighting Sisters

Wat Rong Khun - White Temple

Thailand’s medical tourism had been badly battered by troubles earlier this year, particularly in and around Bangkok. Phuket by the way suffered very little and is keen to promote itself as a safe and affordable destination, even at the cost to local rival Bangkok.

“With droves of expatriate foreigners having moved out of Thailand, hospitals like Bumrungrad Hospital and Bangkok Hospital Medical Center are working on solidifying their home base and focusing efforts on bringing back local Thai residents, who often view these high end private hospitals as too expensive. Both hospitals continue to draw medical travellers from surrounding countries like Burma, Bangladesh and Indonesia, and from the Middle East. Thailand as a medical destination was not put on the medical travel map by government policies, it was the top hospitals, and they will continue to do this, with or without official government support.”

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Medical and healthcare providers on the island of Phuket can expect to get a large slice of the 402.9 billion baht that the Thai Ministry of Health expects Thailand’s medical tourism industry to take over the next five years, says Dr Wiwat Seetamanotch of Phuket Public Health, “Over the past five years, Phuket has enjoyed great success in health services provided to tourists and earned a huge amount of money. In addition, health services here are cheaper than in neighboring countries.”
The MoH, according to its current five-year plan for 2010 to 2014, expects medical tourism to generate 400-billion-baht .The previous plan, for 2004-2008, concentrated on providing medical services to patients from abroad. Under that plan, the MoH aimed to make Thailand the centre of excellent healthcare in Asia through treatment businesses, health supplement businesses, health products and Thai herbs. The current plan targets developing the same businesses and products, but adds more services in the realms of Thai traditional medicine and alternative medicine. The move follows Thailand’s enjoyment of huge growth in its medical tourism over the past decade.
 According to MoH statistics, although these are only estimates based on information from hospitals and include holidaymakers, business travelers and expatriates, 550,161 foreign patients received treatment or healthcare in Thailand in 2001, while in 2007 that number had swelled to 1,373,807. Most were Japanese, followed by Americans and Europeans. Although key markets claimed are Japan, Australia, New Zealand, USA, Myanmar and Indonesia, in reality, 80% come from South-East Asia including Japan and Indonesia. An estimated 70% of the foreign patients during that period were medical tourists, with 25% being expatriates and less than 5% being tourists. The most popular health services during that year were health checks, heart operations, knee replacements, cardiovascular surgery, cosmetic surgery, gender reassignment surgery, dental care and Lasik corrective eye surgery.
Dr Wiwat expects the number of medical tourists to Phuket to increase dramatically in the coming years, “In addition to three government hospitals in Phuket, there are also three private ones that are recognized as international standard.”

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Bangkok can regain its top place in Thailand, but it will require more work than the authorities are currently putting in: “Whether Bangkok can restore its prominence as a medical destination hinges on how the Thai government, specifically Tourism Authority of Thailand (TAT), acts to promote Thailand for medical tourists in the coming year. Sustained and cohesive promotion efforts are not likely to happen soon. While TAT has been working on a medical tourism marketing plan for almost a year, it has faced leadership changes and budget cuts. It has had to put other priorities, namely bringing back tourists - any tourists - ahead of promotion of medical travel and health tourism. TAT has, however, announced that it will continue promotion of Thailand's spa, wellness and medical services in the Middle East, but not medical tourism. The private hospitals have their own problems.”

Without coordinated promotion of medical tourism by government and trade groups, will hospitals like Bumrungrad International or Bangkok Hospital Medical Center be able to maintain their position within the global or even regional medical tourism industry? Will Bangkok lose out to the northern city of Chiang Mai or the tropical island of Phuket?
“What remains of Thai medical tourism will continue to favor Bangkok. Phuket has daily international flights by regular and discount airlines to dozens of regional cities, and it has lovely resorts - now mostly empty. But its two private hospitals, Phuket International and Bangkok Phuket, are considered by most local expat residents a clear second choice, and prefer flying into Bangkok for care. The two private hospitals are considered expensive, with high hospital costs and doctor fees.”

Phuket is to be the home of the country’s first purpose built “Health Promotion Hospital”, co-funded by the Chinese government. The Kamala Public Health Center will incorporate traditional Chinese medicines into its array of medical services. To be completed next year, it will initially offer health checkups and traditional Thai massages to both Thais and foreigners.

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Why do medical tourism businesses fail?

 The internet and the media in general often report stories of (purported) medical tourism business success, but remain silent when it comes to the reporting of failures. People who have developed a medical tourism business; for the most part means that they became “medical tourism facilitators”. Stories of people and businesses who decided to enter the “billion dollar medical tourism market” by addressing and targeting the patient from abroad. These are typically medical services providers who have an existing and well established domestic healthcare business or typically medical tourism facilitators who may be new to the healthcare sector.

Inspired to enter the medical tourism and medical travel sector by what they read on the internet, what they heard at conferences or based on the advice of various industry experts and consultants.

Their experience of entry into the market range from disappointment to stories of sorrow and woe. The answers are clear and simple:

• In determining the opportunity, these failed market entrants may have overestimated the size of the market (both current and potential). Some may have got this badly wrong.

• These failed market entrants to medical travel tended to be ill equipped aspirants who knew about but did not fully understand the market sector. And to their detriment, placed too much faith and trust in the knowledge and understanding of others.

• Some failed market entrants got their assessment of current and potential market size right, but they failed to consider the number of pre-existing, well qualified and established industry players.

• And of course, some perhaps did not factor in the risks of entering international markets and the effect that national and international events can have on a business which is dependent on international travel. Recent examples include drug related violence in Mexico, civil unrest in Thailand, and the NDM- 1 “superbug” story emanating from India.

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The decision to enter the international medical travel either as a facilitator or a medical services provider should take into consideration not only the size of the market, but also the number of industry players, especially those who are well equipped, in terms of capital, financing and knowledge and understanding.

In a market with many players, a good idea may become a bad idea.

The competition is becoming more aggressive and sophisticated, and often has deep pockets. And which is also the reason emphasizing the need for formal “sector-specific” executive education for those contemplating going into the health tourism business (from empiricism to professionalism).

It’s been argued that contrary to simplistic thinking, the growth of medical tourism, in isolation, (as opposed to health tourism, which includes medical tourism) will not experience the “explosive growth” predicted by some consultants and experts who fail to appreciate how healthcare delivery and consumption actually works.

Medical travel destinations which set out to become the “leading destination for medical tourism” on the basis that they were cheaper and better than domestic facilities and providers are now experiencing the effect of the “West’s Revenge”. This has been compounded by the effects of the worldwide recession. Again, contrary to the simplistic thinking of some commentators who argued that recession would drive more and more patients abroad for cheaper treatment, this has clearly not been the case; medical tourism and healthcare businesses in general are being hit by recessionary factors the same as other international markets and businesses.