Leave it to Howard to glean fascinating insights about India from an upper respiratory infection.
By Howard A., 19-time traveler from Ashland, MA
Early into the itinerary on a recent trip to India, I became ill. I caught a bug on our flight from the U.S. to Dubai. The woman directly behind me was coughing uncontrollably. I can’t in good faith hold her responsible, because when you get down to basics, an airline fuselage is a germ incubator. The longer you spend inside, the greater your probability of catching something. Our flight to Dubai carried 414 humans, and was 13 hours in duration. I breathed every passenger’s air! This is part of the price to be paid if my wife and I continue to venture to far off places.
I was "soldiering on" through tour after fascinating tour, not missing a single activity, but struggling to hang on. India is hot, and this trip was quickly paced and physically demanding. I often went to bed tired, and didn’t get enough sleep. I needed to do the opposite. After I was unable to pull it together for a morning adventure that I had been looking forward to, it was clear that I was out of gas. Our 7-star guide, Sudha (I Love You Brother!), encouraged me to seek medical help. I put up no argument, indicating that I was ready to leave for an office visit as soon as possible. Sudha indicated that the doctor would actually be coming to me! You have got to love this level of service.
As far as receiving adequate medical care 8,500 miles from home, I had no concerns. Earlier in our tour we had a "hands on" experience of visiting a public hospital, and learning from both doctors and patients about the workings of the Indian medical system and the rigorous training that doctors receive here. It is a system that the Indian people are proud of as care is available at no cost to everyone. No one is left without help. This is part and parcel of the socialistic structure that been part of India’s history for decades.
India, however, is rapidly shifting towards capitalism, so private medicine is available as well, on a fee basis. Along with comprehensive classroom and textbook training, each medical student in India spends thousands of hours working in public hospitals. By the time he or she is licensed, they have seen even the rarest of ailments perhaps 20 or more times. They graduate as master diagnosticians, and combine the best of eastern and western medicines in their practices. They are in demand in all developed countries of the globe.
My own MD is an Indian man who trained under their system, and is now practicing here. He has been a health beacon for me. For the past 32 years, through skillful application of his training, he has kept me well. He uses a minimum of pharmaceuticals, and places an emphasis on diet, exercise, rest, relaxation, and attitude. He will give you whatever prescription medication is appropriate, only after you have given your body a chance to do what is its biological disposition: to heal itself. He is part of the "brain drain" (not meant disingenuously) that has been robbing India of its best and brightest medical professionals for decades. You will find highly skilled Indian doctors in Dubai, Thailand, Brazil, Turkey, Costa Rica, Malaysia, and numerous other countries, as well as (clearly) here in the U.S. They have left Mother India in search of better opportunities.
But, I digress. I waited for the doctor, watching from our skybox patio overlooking the spectacular Radisson Blu Resort in Mahabalipuram, on the Bay of Bengal in Southeast India. Soon he arrived on a bicycle, steering with one hand and carrying his medical bag in the other. As a young doctor of perhaps 30 years of age, Dr. Manikandan spoke fluent English, but his youthful appearance did not inspire confidence in me. He gave me the usual examination—temperature, BP, heart, etc., but paid particular attention to listening to my lungs with his stethoscope. He seemed fully confident. We had a post-exam discussion in which he assured me he could get me well quickly. He wrote four prescriptions, two of which were antibiotics, one an immune system booster, and the fourth for a non-prescription cough suppressant. He instructed me to bring the prescriptions to the resort’s front desk, and they would do the rest. He assured me that in two days, I would be feeling better.
His exam was thorough and he very rapidly assessed that I had an upper-respiratory infection. He exuded complete confidence in his diagnosis and cure. I was becoming a believer. I thanked him and he left, leaving his medical bag behind. I thought he had forgotten it, but fifteen minutes later he returned with three individually wrapped bowls containing honey, ginger powder, and black pepper. He demonstrated how to mix these into a paste to be swallowed (surprisingly pleasant tasting) every two hours.
My wife delivered the prescription to the front desk and 20 minutes later, a hotel employee was at our door. All four of my needs were handed to me in a small bag. He provided me an invoice for 178 rupees. That’s $2.63 in U.S. dollars. Hard to believe. I tipped him with a 100 rupee note ($1.48), and he was over the moon. I began taking my meds and downing the paste. I relaxed for the rest of the day, and slept.
That evening, Dr. Manikandan dropped by unsolicited, inquired as to how I was doing, and indicated the importance of taking the medications and paste exactly as directed. I heeded his instructions but felt no change in condition upon awakening, and rested that day. That evening Dr. Manikandan again arrived unsolicited at our room. Once again, he thoroughly physically examined me, checking for fever mainly, but again listening to my lungs carefully. He indicated that positive changes were underway. I thanked him and he left, only to return 20 minutes later (still on his bicycle) with a thermos of boiling hot tea with ginger. I was instructed to drink it every two hours until bedtime. I did as directed.
By the next morning, I was much improved. I participated in all activities that day, dragging only a bit near the end. After dinner, guess who dropped by? Another physical ensued in which he indicated that I was progressing nicely, and to stay on the medications and paste. By the following morning, I was almost 100%.
I participated in the AM activity and returned to the hotel for lunch and a 1:00 pm "bags out." We were saddling up for an overland. While putting our bags out, (you guessed it) Dr. Manikandan arrived. He wanted to see how I was progressing, and gave me some last-minute advice about not overexerting myself and continuing the meds and paste as advised. He handed me an invoice for his services. Total cost for his six house calls, three complete physical exams, three bowls of organics, and the magic tea, was 300 rupees—a whopping $ 4.45.
I’ll give you the financial details:
- Doctor’s Fee—Six house calls, including three physical exams, three bowls of herbs, and magic tea: $4.44
- Medication—Three prescriptions and a bottle of over-the-counter cough suppressant: $2.63
- Voluntary over-tipping of runner—$1.48
- Total for all: $8.55.
You get a lot of medical care for $10 bucks in India, friend, including a 100 rupee note and some coins back!
A handwritten bill from Dr. Manikandan.
This fact has not been overlooked by the entrepreneurs of India itself. As the shift from socialism to capitalism is transpiring, and India currently undergoing strong economic growth (7.5% and expected to reach 9.5% by 2020), the country is making big inroads into the rapidly expanding worldwide medical tourism industry. Currently, most patients come from wealthy nations in Africa and the Middle East where private insurance is not the norm. More and more people, however, are starting to come from other parts of the globe. Cardiac, organ transplantation, orthopedic, fertility, and oncology procedures are where the country truly excels. Private hospitals and clinics are turning up in every major city. With first rate hospitals and doctors, and a cost of approximately 10% of what would be charged in the U.S., India is in a unique position to compete on today’s flat earth in this 80 billion dollar industry, which is expected to double in size in the next five years.
I am told by a reliable source that U.S. insurance carriers are in discussion with medical facilities in India to procure contract medical services for subscribers. It is financially feasible to offer a U.S. patient and his or her caregiver round trip flights to India, lodging before, during, and after the procedure(s), full medical services, all medications, rehabilitation, and a few weeks to travel around the country, all inclusive, for about 1/4th of what this would cost in the U.S. This would be voluntary of course. U.S. care will still be offered at least for now, but with U.S. medical costs straining the system, outsourcing of this type may be a viable means of cost containment in the future. It is possible that we will all become "patients without borders." This surge in fee-based service is spawning a new wave of private enterprise, and providing Indian doctors with an income that is satisfying enough to keep them from Brain Draining-out, and, in fact, drawing medical expats back home to Mother India.
That’s my personal experience with health care in India, reader, as well as a short tutorial on how it is done, and perhaps some insight into the future.
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