Medical Tourism Vol 3 Issue 2 (English)

Vol.3 | Issue No.2 | Oct - Dec 2018

LUNG CANCER

WHAT YOU SHOULD KNOW?

IMMUNOTHERAPY

ZERO CALORIE FOODS

21 FRUITS & VEGETABLES TO LOSE WEIGHT PREVENTION AND TREATMENT OF

LIVER CIRRHOSIS

IN CANCER TREATMENT

TACKLE STRESSFUL ENVIRONMENTS AT WORK PLACE 1

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Medical Tourism Oct. - Dec. 2018

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LIFE-STYLE CHANGES CAN REDUCE MORTALITY OF CANCER

Vol. 3 | Issue No. 2 | Oct - Dec 2018

Medical

tourism RNI No. KERBIL/2016/68979

Editor & Publisher BENNY THOMAS Consulting Editor O.J. GEORGE

Most of the cancers have some relationships with diet , predominant among them are cancers of the upper aero digestive tract (mouth, throat), oesophagus (food pipe and lungs), stomach, large intestine, and breast cancer in women.

Executive Editor BYJU ARYAD

The role of diet takes special importance in countries like India which are fast moving towards industrialization and Westernization. We had a predominantly plant- based diet and with the advent of Western life- style we are moving towards a diet rich in animal proteins. This, coupled with other habits like smoking and alcohol, will lead to increase in the chronic disease burden, especially cancer and cardiovascular diseases. Prompt action has to be taken to spread the message of healthy life- style and dietary practices.

Editorial Co-ordinator NINU SUSAN ABRAHAM Layout & Design LAL JOSEPH

The biologically- active ingredients of the fruits and vegetables are from the carotenoid family and they have substantial anti-cancer properties. Intervention studies have tried to get the advantage of eating vegetables through supplementation of beta carotene, the most active ingredient.

Legal Advisor Adv. BIJU HARIHARAN Arabic Translation Dr. A. ABOOBACKER BUSINESS ASSOCIATES Overseas USA : CHICAGO: Vincent Joseph Mob: 847 299 9954 USA : HOUSTON: Shaju Joseph Mob: 847 899 2232 USA : NEW YORK Vincent Sebastian Mob: 917 992 9629 USA : CALIFORNIA: Wilson Nechikat, Ph: 408 903 8997 Canada : Jose Sebastian, Ph: 416 - 509 – 6265 UK : Dileep Mathew, Ph: 044 787 743 2378 Switzerland : Dr. George Sebastian, Ph: 527204780 Ireland : Thomas Mathew Mob: 00353 87 123 6584 Middle East : Anil Nath, Ph: 506854500 Singapore : Mahesh A, Ph: +65 906 22828 Germany : Gayatri Puranik Ph: 0049 179 127 5002 Austria : Monichan Kalapurackal Ph: 0043 6991 9249829 Korea : Dr. A. Thomas, Ph: 0082 10 5822 5820 Australia : S. Mathew, Ph: 61247026086 Oman : Legihas Ussain, 00968 95383199 BUSINESS ASSOCIATES India Mumbai : Mohan Iyer, Mob: +91 22 6450 5111 Chennai : C. Shankar, Mob: +91 984 097 8060 Coimbatore : Gurumurthy, Mob: +91 989 460 4804 Eastern India : Sanjay D. Narwani, Mob: +91 983 120 7202 Hyderabad : Ephram Joseph, Mob: +91 939 131 5072 Bangalore : C. Sivakumar, Mob: +91 974 000 4932 Puducherry : K. Ramasubramanian, +91 989 497 7161 Trivandrum : Kuriyan K. Raju, Mob: +91 944 610 6644

CORPORATE OFFICE FM Media Technologies PVT Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India.

Tel: +91 484 403 4055 Email: director@asianmeditour.com www. asianmeditour.com

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Medical Tourism Oct. - Dec. 2018

Cancer can occur in all living cells in the body and different cancer types have different natural history. Epidemiological studies have shown that 70-90% of all cancers are environmental. Life-style- related factors are the most important and preventable among the environmental exposures. Tobacco consumption, either as chewing tobacco or smoking tobacco, will account for 50% of all cancers in men. Dietary practices, reproductive and sexual practices etc will account for 20-30% of cancers. Appropriate changes in life-style can reduce the mortality and morbidity from a good proportion of cancer and heart diseases.

Cancer, cardiovascular and other chronic diseases are emerging as major public health problems in developing countries like India. The economic and social liberalisation taking place in India will lead to improvements in living standards and controls of communicable diseases. Education to promote primary prevention, early detection and appropriate referral are factors that should be underscored in any cancer control programmes.

Cancer of the oral cavity is predominantly seen among those who chew tobacco.The red and white coloured patches, non- healing ulcers of long duration, ulcers caused by sharp tooth etc have to be shown to a doctor. Lump in the breast which is increasing in size and or causing pain and changes in the overlying skin is a warning symptom of breast cancer.

Red or brown coloured discharge from the nipple or any swelling in the axilla needs to be investigated.

The cover story is aboutLung cancer, which is a leading cause of death globally. It is also a major healthcare problem in India.There is asignificant rise in the number of cases of lung cancer during the last 10 years. According to GLOBOCAN-18 data recently published, Lung cancer is the leading cause of death from all cancers in India. The mean age at lung cancer is diagnosed in India is 54.6 years.Males predominate witha M:F ratio of 4.5:1 and this ratio varies with age and smoking status.The smoker to non-smoker ratio is high, up to 20:1 in various studies.

In this issue, Immunotherapy in Cancer Treatment, relationship between physical activity and cancer, nutrition during and after cancer treatment, fruits and vegetables to reduce cancer risk are also included.

Apart from the medical news, there are news from the medical world and news from the travel and tourism sector, special feature on Oman Health Exhibition and Conference, World Travel Market, and Advantage Healthcare India 2018.

Medical Tourism Magazine was the media partner for Oman Health Exhibition and Conference. The magazine is also the media partner for Advantage Healthcare India 2018 and the magazine will be available at the venue.

We wish you a happy reading.

Editor

Printed, published and owned by Benny Thomas FM Media Technologies Pvt. Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India.

Editor: Benny Thomas

Printed at Sterling Print House Pvt Ltd, Door No. 49/1849, PonekkaraCheranellur Road,Aims, Ponekkara P.O, Cochin-682041, Ph: 0484 2800406.

Disclaimer: The statements in this magazine have not been evaluated by the Food and Drug Administratin of USA or any other country. Information provided in this magazine are not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, consult your physician. All information is provided for research and education purpose only.

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Contents 1) Hospitals 8 2) Wellness Centers 12 3) Medical Events 14 4) Equipment 16 5) News 18 6) Cover story-Lung Cancer:

What You Should Know?

22 7) Precision medicine has changed the landscape of

healthcare and what can it do for Oncology 26 8) Immunotherapy in Cancer Treatment 28 9) Reflections: Increasing prevalence of cancer

calls for protracted measures of treatment 30 10) RCC Thiruvananthapuram,

a tertiary care centre for all types of cancer 34 11) Role of Ayurveda in integrative medicine 38 12) Adding Fruits and Vegetables to Your Diet

Reduces Cancer Risk 40 13) Nutrition During and After Cancer Treatment 42 14) Relationship between Physical Activity & Cancer 44 15) Tata Memorial Centre delivering

well-established cancer treatment 46 16) New blood test developed for early diagnosis of

ovarian cancer 48 17) Purdue University researchers develop

technology to find tumour 49 18) Narayana Health City Successfully

Completes 1000 BMT 50 19) New technique developed by Indian doctors to

improve treatment of Ptosis 52 20) Prevention and treatment of Liver Cirrhosis 54 21) Tackle Stressful Environments at Work Place 58 22) Zero Calorie Foods:

21 Fruits & Vegetables to Lose Weight 60 22) Huge scope for Medical Tourism in India 64 23) Shaping MVT for India 68 24) Destination Kerala 70 6

Medical Tourism Oct. - Dec. 2018

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Cover story

Lung Cancer: What You Should Know?

26 PRECISION MEDICINE HAS CHANGED THE LANDSCAPE OF HEALTHCARE AND WHAT CAN IT DO FOR ONCOLOGY

44

28 IMMUNOTHERAPY IN CANCER TREATMENT

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REFLECTIONS: INCREASING PREVALENCE OF CANCER CALLS FOR PROTRACTED MEASURES OF TREATMENT

RELATIONSHIP BETWEEN PHYSICAL ACTIVITY & CANCER

46 TATA MEMORIAL CENTRE DELIVERING WELL-ESTABLISHED CANCER TREATMENT

34 PREVENTION AND TREATMENT OF LIVER CIRRHOSIS

RCC THIRUVANANTHAPURAM, A TERTIARY CARE CENTRE FOR ALL TYPES OF CANCER

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54 68

SHAPING MVT FOR INDIA

ADDING FRUITS & VEGETABLES TO YOUR DIET REDUCES CANCER RISK

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MEDICAL TOURISM HOSPITALS

ARTEMIS HOSPITAL

BLK HOSPITAL New Delhi Ph: +91- 124 4511 111

New Delhi Phone: +91-11-30403040 Email: info@blkhospital.com

E-mail: info@artemishospitals.com

www.artemishospitals.com

www.blkhospital.com

NANAVATI HOSPITAL

NAYATI HEALTHCARE Mumbai Ph: +91 22 2626 7500

New Delhi Ph: +91- 124 4511 111

Email: marketing@nanavatihospital.org

E-mail: info@artemishospitals.com

www.nanavatihospital.org

nayatihealthcare.com

JAYPEE HOSPITAL

ASTER MEDICITY Noida, Delhi NCR Ph: +91-120-4122222 Email:

Kochi Ph: +91 484 66-99-999 Email:

askus@jaypeehealthcare.com

astermedcity@asterhospital.com

www.jaypeehealthcare.com

www.astermedcity.com

NOVA IVI CENTRES

NARAYANA HEALTHCARE Mumbai , Maharashtra Ph: 1800 103 2229 Email: info@novaivifertility.com

www.novaivifertility.com

www.nhinternational.org

SRI RAMAKRISHNA HOSPITAL

VENKATESHWAR HOSPITAL

Coimbatore , Tamilnadu Ph: +91-422-4500 000 Email: sriramakrishnahospital@snrsonstrust.org

www.sriramakrishnahospital.com 8

Bangalore , Karnataka Ph: +91 99860 13353 Email: international@ narayanahealth.org

Medical Tourism Oct. - Dec. 2018

New Delhi Ph: +91-11-48-555-555 Email: mail info@venkateshwarhospitals.com

www.venkateshwarhospitals.com

MEDICAL TOURISM HOSPITALS

KOVAI MEDICAL CENTRE AND HOSPITAL

ASIAN HOSPITAL

Coimbatore , Tamilnadu Ph: +91-422-4324433 Email: getwell@kmchhospitals.com

Faridabad , Delhi NCR Ph: +91 129 4253000 Email: crm.fbd@aimsindia.com

www.kmchhospitals.com

www.aimsindia.com

GEETANJALI HOSPITAL

MANIPAL HOSPITALS

Udaipur Ph: +91-294-2500000-06 Email: info@geetanjaliuniversity. com

Bangalore Ph: +91 80 2222 1111 Email: info@manipalhospitals.com

www.geetanjalihospital.co.in

www.manipalhospitals.com

WADIA HOSPITAL

SIR H.N. RELIANCE FOUNDATION HOSPITAL AND RESEARCH CENTRE Mumbai , Maharashtra Ph: +91 - 22 - 24146965 Email: info@wadiahospitals.org

Mumbai Ph: +91 22 6130 5005 Email: rfh.international@rfhospital.org

www.wadiahospitals.org

www.rfhospital.org

LOKMANYA HOSPITALS

INDIAN SPINAL INJURIES CENTRE

Pune Ph: 959 584 4844 Email: care@lokmanyahospitals.in

New Delhi Ph: 011 42255225 Email: info@isiconline.org

www.lokmanyahospitals.in

www.isiconline.org

SHARDA HOSPITAL

MVR CANCER CENTRE & RESEARCH INSTITUTE Greater Noida , Delhi NCR Ph: 0120-2333999 Email: info@shardahospital.org

www.shardahospital.org

Kozhikode Kerala Ph: +91 495 2289500 Email: info@mvrccri.co

www.mvrcancerhospital.com A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM HOSPITALS

BANGKOK HOSPITAL Huaykwang, Bangkok,Thailand Ph: +66 2 310 3000 Email: info@bangkokhospital.com

BANGKOK HOSPITAL

www.bangkokhospital.com

Pattaya, Thailand Ph: +66 38 259 999 Email: inquiry@bph.co.th

NATIONAL CANCER INSTITUTE 268/1 Rama VI Ratchathewi Bangkok ,Thailand Ph: 00 66 2 354 7025

www.bangkokpattayahospital.com

Email: admin@ncicheckup.com

CHON BURI CANCER CENTER Mueang District, Chon Buri, Thailand Ph: +66 38 784 004 E-mail : contact@ccc.in.th

www.nci.go.th

SIRIRAJ HOSPITAL Mahidol University, Bangkok Thailand Ph: +66 2 411 0248 Email: siiro@mahidol.ac.th

www.ccc.in.th

PHYATHAI 2 HOSPITAL Phyathai, Bangkok Ph: +66 2 617 2444

www2.si.mahidol.ac.th

BEACON HOSPITAL

Email: onestop@phyathai.com

Petaling Jaya, Selangor, Malaysia.

Ph: +603 7787 2992 Email: info@beaconhospital.com.my

www.phyathai2international.com

GLENEAGLES INTAN MEDICAL CENTRE www.beaconhospital.com.my

MOUNT MIRIAM CANCER HOSPITAL Tanjong Bungah, Penang, Malaysia Ph: 604 - 892 3999 Email: enquiry@mountmiriam.com

www.mountmiriam.com 10 Medical Tourism Oct. - Dec. 2018

Kuala Lumpur, Malaysia Ph: +603 4141 3000 Email: my.gkl.inquiry@ parkwaypantai.com

www.nhinternational.org

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MEDICAL TOURISM WELLNESS CENTERS

KALARI KOVILAKAM

PRAKRITI SHAKTI Kollangode, Palakkad, Kerala Ph: +91 4923 305500

Panchalimedu, Idukki, Kerala Ph: +91 90726 10130

Email: admissions@ cghearthayurveda.com

Email: admissions@prakritishakti.com

www.cghearthayurveda.com/ kalari-kovilakom/

www.prakritishakti.com

SASWARA

DHATHRI AYURVEDA HOSPITAL Om Beach, Gokarna Ph: +91 484 4261751

Kayamkulam, Kerala Ph: +91 90200 28888

Email: greswaswara@cghearth.co.in

Email: hospitals@dhathri.in

www.dhathriayurveda.com

www.cghearth.com/ swaswara

SREEDHAREEYAM AYURVEDIC EYE HOSPITAL AND RESEARCH CENTRE

PUNARNAVA AYURVEDA HOSPITAL PVT LTD Kochi, Kerala Ph: +91 484 2801415

Koothattukulam, Kerala Ph: + 91 485 2253007

Email: mail@punarnava.net

www.punarnava.net

Email: mail@sreedhareeyam.com

www.sreedhareeyam.com

AYURGREEN HOSPITALS Malappuram, Kerala Ph: +91 494 305 5555

SOMATHEERAM RESEARCH INSTITUTE AND AYURVEDA HOSPITAL Kovalam, Thiruvananthapuram Ph: +91 471 2268101

Email: info@ayurgreenhospitals.com

www.ayurgreeenhospitals. com

AYURVAIDYA

Email: mail@somatheeram.in

www.somatheeram.in

AYUR BETHANIYA Edappally North Kochi, Kerala Ph: +91 4842802383

Athani, Thrissur, Kerala Ph: +91 703 40 99 999

Email: mail@ayurvaidyahospital.com

www.ayurbethaniya.org

Email: info@ayurbethaniya.org

www.ayurvaidyahospital.com

SHINSHIVA AYURVEDIC RESORT

NIKKI’S NEST Chowara, Thiruvananthapuram, Kerala Ph: 91-471-2267822

Balaramapuram, Thiruvananthapuram Ph: +91- 471-2266331,

Email: info@nikkisnest.in

Email: ayurveda@shinshivaresort.com

www.nikkisnest.com

www.shinshivaresort.com

FRAGRANT NATURE Paravur, Kollam, Kerala Ph: +91(0) 474 251 4000 Email: enquiries@fragrantnature.com

www.fragrantnature.com

12 Medical Tourism Oct. - Dec. 2018

DR P ALIKUTTY’S KOTTAKKAL AYURVEDA AND MODERN HOSPITAL Kottakkal, Malappuram Ph: +91483 274 3703 Email: kottakkalayurveda@gmail.com

www.kottakkalayurveda.com

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MEDICAL TOURISM MEDICAL EVENTS

H.D.R. SUMMIT

(DEC 8-9, 2018), BANGALORE, INDIA

53RD INDIAN ORTHODONTIC CONFERENCE (DEC 7-9, 2018), KOCHI, KERALA

53rd Indian Orthodontic Conference (IOC) is organized by Indian Orthodontic Society (IOS) and would be held during Dec 07 - 09, 2018 at Le Meridien Kochi, Kochi, Kerala, India.

For details contact: Phone: 99460 18496 Email: 53rdiockochi2018@gmail.com Website: http://53rdiockochi.com/

13TH BIOSIMILARS CONGREGATION 2018 (DEC 11, 2018), MUMBAI, INDIA The 13th Biosimilars Congregation 2018 conference, being organised by Virtue Insights to be held on 11th December 2018 at Kohinoor Continental Hotel, Mumbai, India. 13th Biosimilars Congregation 2018 brings together scientists, researchers and CROs from around the world. The conference meets the target audiences from around the world focused on learning about biologics and biosimilars. This conference would be your single best opportunity to reach the largest assemblage of participants from the biologics and biosimilars community.

For details contact: Phone: 91 44 42108101 Email: info@virtueinsight.com Website: http://www.virtueinsight.com/pharma/13th-Biosimilars-Congregation-2018/

INDIAN DENTAL CONFERENCE

(JAN 18-20, 2019) INDORE, MADHYA PRADESH

2nd H.D.R. SUMMIT ( Hypertension, Diabetes & Renal Disease Summit ) at Hotel Lalit Ashok, Kumara Krupa Road,Bangalore on 8th and 9th of December 2018.

The SUMMIT will be a great opportunity for Practicing Physicians, General Practitioners, Resident Doctors and Post Graduates to update their knowledge in Diabetes and its Complications. This year we will be covering topics from Diabetes, Hypertension, Renal Diseases, Thyroid, Emergency Medicine, Critical Care and Infectious Diseases.

For details contact: Phone: 98804 45567 Email: hdrsummit2@gmail.com Website: https://hdrsummit2.com/

62ND ALL INDIA CONGRESS OF OBSTETRICS AND GYNAECOLOGY (JAN 8-12, 2019), BENGALURU, INDIA The 2nd All India Congress of Obstetrics & Gynaecology being organised by The Federation of Obstertric and Gynaecological Societies of India will be held at Gate No.4, Gayatri Vihar, Palace Ground, Bengaluru from January 8 to 12, 2019. This year’s motto of the Congress is ‘Women’s Health in Nation’s Wealth” as the essence of the womens’ healthcare consists in combining all the clinical fields and recognizing the masterpieces and evolution in science, in making an impact.

For details contact: Phone: 022-24951648 Email: fogsi2007@gmail.com Website: https://www.fogsi.org/62nd-all-india-congress-of-obstetrics-gynaecology-aicog-2019/

ANNUAL CONFERENCE OF THE ISNCC

(FEB 15-17, 2019) GURUGRAM, HARYANA, INDIA

The 72nd IDC to be held at Brilliant Convention Centre, Indore, India from January 18-to 2019. The theme for this year “Refining Skills Redefining Success” aptly describes dental professionals, continually strive for excellence in whichever filed of specialty. Featured in this conference are renowned international and National speakers, who will bring in their expertise & experience through noteworthy lectures, live surgeries, hands on classes, back to basics, open forum and panel discussion that will be relevant for all dentists.

20th Annual Conference of the Indian Society of Neuroanesthesiology and Critical Care (ISNACC) will be held from Feb 15 - 17, 2019 at The Leela Ambience Gurugram Hotel & Residences, Gurugram, Haryana, India.

Deliberations from renowned speakers, workshops on neurocritical care, neurosimulation, Transcranial Doppler and other neuromonitoring modalities will be the highlight of this conference. The theme of the conference is Evolving Frontiers in Neuroanaesthesiology and Neurocritical Care.

For details contact Phone: +91 9425054707, 6260689953 Email: orgsecretary@idc.org.in Website: http://idc.org.in/

For details contact Phone: +91 8057022757 Email: isnaccsecretary@gmail.com Website: https://www.isnacc.org/

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MEDICAL TOURISM MEDICAL EVENTS

INTERNATIONAL SYMPOSIUM ON ENDOSCOPIC ULTRASONOGRAPHY (DEC 1-2, 2018), THAILAND

INTERNATIONAL CONFERENCE ON MEDICAL AND HEALTH SCIENCES (DEC 12-13, 2018) RABAT, MOROCCO

The 21st International Symposium on Endoscopic Ultrasonography (EUS 2018) will be held at Bangkok, Thailand on December 1 and 2, 2018. The symposium will help developing an in-depth and broader view of the latest in EUS procedure. It will also practice by learning the cutting-edge technologies related to your field and enable to highlight differences in practice through participation in interactive sessions.

511th International Conference on Medical and Health Sciences (ICMHS) aimed at presenting current research being carried out in that area and scheduled to be held on 12th-13th December 2018 in Rabat, Morocco. The idea of the conference is for the scientists, scholars, engineers and students from the Universities all around the world and the industry to present ongoing research activities, and hence to foster research relations between the Universities and the industry.

For details contact Phone: +66-2-748-7881 Email: wsaipow@kenes.com Website: http://go.evvnt.com/166768-0

For details contact Email: info@iserd.co Website: http://iserd.co/Conference2018/Morocco/3/ ICMHS/

INTERNATIONAL CONFERENCE ON SCIENCE, HEALTH AND MEDICINE

INTERNATIONAL CONFERENCE ON MEDICAL AND BIOSCIENCES

(DEC 21- 22, 2018) JESRUSALEM, ISREAL

ISER- 496th International Conference on Science, Health and Medicine ICSHM is a prestigious event organized with a motivation to provide an excellent international platform for the academicians, researchers, engineers, industrial participants and budding students around the world to SHARE their research findings with the global experts. ICSHM 2018 will be held in Jerusalem , Israel on 21st - 22nd December , 2018.

For details contact Email: info@iser.co Website: http://iser.co/Conference2018/Israel/2/ ICSHM/

INTERNATIONAL CONFERENCE ON RECENT ADVANCES IN MEDICAL SCIENCE (JAN 11-12, 2019), TEHRAN, IRAN 556th International Conference on Recent Advances in Medical Science ICRAMS will be held in Tehran, Iran during 11th - 12th January, 2019 as the Conference of ICRAMS 2019 is sponsored by International Institute of Engineers and Researchers IIER. It aims to be one of the leading international conferences for presenting novel and fundamental advances in the fields of Recent Advances in Medical Science.

It also serves to foster communication among researchers and practitioners working in a wide variety of scientific areas with a common interest in improving Recent Advances in Medical Science related techniques.

For details contact Email: info@theiier.org Website: http://theiier.org/Conference2019/Iran/1/ ICRAMS/

(JAN 6-7, 2019), PATTAYA, THAILAND 519th International Conference on Medical and Biosciences ICMBS is a prestigious event organized with a motivation to provide an excellent international platform for the academicians, researchers, engineers, industrial participants and budding students around the world to SHARE their research findings with the global experts. 519th ICMBS 2019 will be held in Pattaya , Thailand during 6th-7th January, 2019.

For details contact Email: info@researchworld.org Website: http://researchworld.org/Conference2019/ Thailand/1/ICMBS/

CONFERENCE ON “MEDICAL, MEDICINE AND HEALTH SCIENCES

(JAN 12-13, 2019), LONDON

The 4th International Conference on “Medical, Medicine and Health Sciences” (MMHS-2019 London) will be held at Mercure London Hyde Park Hotel, London, on January 1213, 2019. The conference will cover vital issues in medical, medicine and health sciences under multiple sub-themes.

The aim of our conference is to support, encourage and provide a platform for networking, sharing, publishing and nurturing the potential growth of individual scholars across the globe.

For details contact: Email: lon219@academicfora.com Website: http://academicfora.com/mmhs-january-1213-2019-london/

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MEDICAL TOURISM EQUIPMENT

MEDCOMP PICC CATHETERS

Pulse Oximeter

Wireless Fetal Monitor (CTG)

A wide range of high quality products, guaranteed by Medcomp, for all venous access needs.

PRO-PICC: a new range of power injectable catheters available with or without integrated valve VASCU-PICC: polyurethane PICC catheters with open tip designed to ensure intravenous access for administration of antibiotic therapy, pain therapy, and for parenteral nutrition.

Being one of our best selling products this product has several distinctive features including: Manufacturing: Solaris- New tech, Inc.(USA); For veterinary use.Bright, easy-to-read large LED display; Durable, compact and lightweight.; Accurate, reliable readings during low perfusion and motion; Audible/Visual alarms with adjustable alarm limits, etc.

CTG - wireless fetal monitor, created by our research team at Borze India, includes a remote fetal monitoring device using advanced technology. The data that would be captured then be securely stored, sent, and accessed by relevant clinicians via Internet. This technology enables you fetal monitoring to become decentralized, ultimately leading to enhanced access for high-risk deliveries that could result in preferable health outcomes and lower health care costs. B'orze wireless fetal monitor can be done by listening to your unborn baby's heartbeat with a special device known as fetal monitor or baby monitor, except listening baby's heartbeat fetal monitor can also analyze the activity of unborn baby. More often, wireless fetal monitor is used with flat devices held in place with comfortable belts on your stomach. Sensors of fetal monitor uses waves of sound to analyze and track of your unborn baby's heart rate. Your unborn baby's heartbeat especially heard as a beeping sound as well.

www.seda-spa.it/en/

Soprano Remove

www.technocarem.com/pulse-oximeter.html

Patient Monitor

www.borzeindia.com/wl15000.html

Vessel Sealing System

Using an 810 nm “gold standard” diode laser, REMOVE is the world’s best-selling laser hair removal technology, found in over 3,500 clinics worldwide.

Laser hair removal is a high-end, professional-grade hair removal method and is among the most effective treatments in the industry for achieving smooth and beautiful hair-free skin.

The combination of Alma’s 810 nm diode laser with patented SHR technology makes REMOVE the safest, most reliable and most effective laser hair removal solution available today.

www.almalasers.co.in/2016/ alma-product-soprano-remove.html

Neuro Attachment

The CMS 8000 Patient Monitor has abundant functions that can be used for clinical monitoring with adult, pediatric and negate.

Users may select different parameter configuration according to color TFT LCD displaying real-time date and waveform. It can synchronously display eight-channel waveform and full monitoring parameters equipped with an optional 48mm thermal recorder.

The monitor can be connected to the central monitoring system via wire or wireless network to form a network monitoring system. Its replaceable internal battery brings a lot of convenient for patient moving.

www.ishealthcare.in/ patient-monitor.html#patient-monitor

Refurbished Dialysis Machine

Enabled with sophisticated and advanced technology, our Vessel Sealing System presents a new and improved solution for vessel sealing in minimal access and open surgeries. We offer two different models of sealing system with different operating modes. All these medical equipments are specially developed and intended for fast and safe patient’s recovery. The major advantage with this system is that it uses body’s own callogens and not any foreign material for sealing vessels. This prevents any complications in the body. We have integrated inbuilt safety features in the equipments for protection against current leak.

www.easesystems.net/ vessel-sealing-system.html

Medical Microscope

The Neuro Attachment is basically designed for hypo-physectomy and is used for all prone position procedures.

The company offers a supreme range of Three Pin Head Mayfield Fixtrator, which is suitable for brain surgery. This Neuro attachment has been developed & manufactured with innovative quality to meet the demanding needs of Neurosurgeons.

The skull clamp has the additional feature of a swiveling C-Arm. This swiveling capacity greatly facilitates positioning the pins on the head around nerves, vessels, and thin bone in the temporal region. For better result, the arm is locked by control knob and the width is adjusted by a ratchet mechanism. The three cone-shaped pins available in adult and child sizes are interchangeable and may be removed for sterilization.

www.meditech-india.com/ neuro-attachment.html

16 Medical Tourism Oct. - Dec. 2018

These machines are widely used in the transfer of blood from one being to another owing to their high efficiency and reliable uses.

Designed and fabricated by diligent experts with the use of skilled expertise, we make sure to fabricate them as per latest health regulations. Furthermore, we intend to make the supply of these products to customers at nominal price tags.

http://www.srihealthcare.net/ dialysis-machine.html#diamax-dialysismachine

Medical Microscopes is a straight tube monocular research microscope. The body is inclined upto 90° with separate coarse and graduated fine adjustments reading to .002 mm. Triple revolving nose-piece, double lens condenser Numerical Aperture of 1.2 with iris-diaphragm and rack-n-pinion adjustment. Fixed stage with detachable mechanical stage, sub-stage plano-concave reflecting mirror inter-changeable with sub-stage microscope lamp.

www.eselinternational.com/microscope.html

Palace Road, Kovalam Beach, Trivandrum, Kerala, India Mobile: +91-99619-75000, +91-99951-25000, Phone: +91-471-2488250 Email: chakraresort@gmail.com, Web: www.chakraayurvedicresort.com A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM NEWS

OMAN HEALTH EXHIBITION AND CONFERENCE A GREAT SUCCESS the healthcare sector in the country. New hospitals and medical facilities offering quality service can help create a positive image about the country’s healthcare sector.

“With all the efforts exerted to provide better healthcare, Oman has the potential to become a medical tourism destination in the future.”

T

he international annual event, Oman Health Exhibition and Conference, held at Oman Convention and Exhibition Centre, from September 23 to 25, 2018, was a great success with around 150 companies from various parts of the globe participating in the event.

The Exhibition and Conference targeted all aspects of the health and wellness industry, opening doors for health products, services and facilities, and opportunities for new developments and trends, and trade and investment. The Oman Health Conference was aimed at addressing the present and future of the Sultanate's healthcare sector.

It served as a platform for industry experts and stakeholders to share and discuss tangible solutions to the variety of healthcare issues and encourage collaborative efforts for the development, improvement and growth of the Sultanate's healthcare industry. The event also gave the participants an excellent opportunity to network with government, regulatory authorities, colleagues, and learn up-to-date information, emerging trends, strategies, innovative approaches, management techniques and technologies that would help them enhance the quality of healthcare services in the country.

H E Dr Ahmed bin Mohammed al Sa’eedi, Minister of Health, inaugurated the Exhibition & Conference. Around 150 companies from 12 countries participated.

Inaugurating the event, H E Dr Sa’eedi said, “We are delighted to host this event alongside Oman Medical Association. It will definitely continue to bring added value to 18 Medical Tourism Oct. - Dec. 2018

Participating firms showcased the latest medical products and equipment, personal care products, diagnostic and laboratory equipment, pharmaceutical products, physiotherapy and orthopaedic technology and offer infertility treatment consultancy.

Visitors also had the advantage of free medical consultations with specialists from the biggest hospitals and healthcare centres around the world.

This year’s edition has pavilions from India, Iran and Taiwan. Iran has brought a consortium of top manufacturers of medical devices and exporters. The Taiwanese pavilion is being represented by the Taiwan External Trade Development Council which is exhibiting innovative medical and surgical products and technologies that include non-invasive detection methods and minimally invasive surgical applications. The Indian pavilion is being represented by the Federation of Indian Chambers of Commerce and Industry.

On the sidelines of the exhibition, a three-day scientific conference - organised in conjunction with the Oman Medical Association was also held.

Accredited by the Oman Medical Specialty Board, the conference presented sessions and workshops covering general surgery, paediatrics, medicine, quality management, medical ethics, patient safety, risk management, medical error and such other topics that reflect the current issues in Oman’s health and medical sector and in line with the government’s strategies outlined in its Health Vision 2050.

Business-to-business meetings was also held alongside the exhibition and conference.

Medical Tourism Magazine was the media partner for the event.

MEDICAL TOURISM NEWS

WORLD TRAVEL MARKET (WTM 2018) A TECHNOLOGY FOCUSED EVENT

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he World Travel Market (WTM 2018), London, held from November 5 to 7, 2018 attracted more than 120 exhibitors from around the globe which was a technology-focused event.

Singapore-based Zumata uses artificial intelligence, natural language processing and image recognition to power a hotel booking API and chatbots. One of the many new exhibitors at Travel Forward is Criton, an Edinburgh-based tech firm which provides the technology template for individual properties and small chains to build their own app.

The Responsible Tourism programme of talks, presentations, discussions and interviews held across all four WTM shows reflects the broad agenda of Responsible Tourism.

At WTM London there were sessions on plastics and child protection, the sharing economy and overtourism and partnerships.

WTM helped to find and meet new suppliers exhibiting at the show, build and strength current network, learn from industry experts through the events programme, discover tourism trends and innovations and socialise at informal networking events.

Every year, World Travel Market London brings together the global travel trade under one roof to discuss business, innovations and trends in the travel industry. One of the key reasons why so many travel professionals attend the show year after year is because of the valuable networking opportunities and connections they make.

World Travel Market London is the leading global event for the travel industry to meet industry professionals and conduct business deals. Through its industry networks, unrivalled global reach, WTM London creates personal and business opportunities, providing customers with quality contacts, content and communities.

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM NEWS

KERALA TOURISM WINS GOLD AT LONDON FOR RESPONSIBLE TOURISM INITIATIVE

K

erala Tourism has won gold at the maiden International Travel and Tourism awards, presented at the World Travel Market (WTM) in London, for its Responsible Tourism initiative.

Kerala Tourism was chosen for the coveted award in “The Best in Responsible Tourism in the World “category, in recognition of its endeavours in promoting eco-friendly and heritage preserving activities with the involvement of local communities.

Kerala has 10,938 units working under Responsible Tourism Mission. Over 50,000 families enjoy the fruits of responsible tourism in the state. Billed as the biggest annual global event for the travel industry, WTM-2018 was held in London from November 5 to 7, generating more than £2.8 billion of business contracts between attendees.

The awards, decided by an eminent jury from among international competitors, were instituted in 14 categories.

With Kerala Tourism winning the gold in the Responsible tourism category, the first silver medal went to Cinnamon Elephant Project of Cinnamon Hotels (Sri Lanka) and the second silver to Coral Reef Revival project from Indonesia.

Also, Kerala emerged as the finalist in Best Regional/ City Campaign for its campaign ‘Live Inspired.’ Other finalist 20 Medical Tourism Oct. - Dec. 2018

destinations included Canary island, Manchester, for visit Flanders, which won the gold.

The Kerala delegation to the 38th edition of the WTM, which attracts global audience that shapes the travel industry, was led by State Tourism Minister Kadakampally Surendran. The awards were received at London by Surendran and Rani George, Secretary, Tourism.

Surendran said the credit for this international honor primarily went to the Responsible Tourism Mission for its persistent and systematic efforts in popularising the best practices. “They have also helped local communities in tourism destinations in the state,” he added.

George, noting that the laurels were a matter of great pride for the entire state, said Kerala’s initiatives in Responsible Tourism have earned international attention and have duly been awarded.

Kerala Tourism Director P Bala Kiran said the award will encourage the state to take forward the Responsible Tourism activities in a more effective manner. Rupesh Kumar, state coordinator of the Responsible Tourism Mission founded on October 20, 2017, said this award will impart further strength to community-friendly tourism in Kerala.

MEDICAL TOURISM NEWS

8th WAC & AROGYA 2018: RE-ALIGNING THE FOCUS ON HEALTH FROM DEC 14 TO 17

T

he 8th World Ayurveda Congress (WAC), scheduled to be held at the prestigious city of Ahmedabad from December 14 - 17, 2018, aims to redefine “healthcare” as the basis for health of individuals and populations.

put Ayurveda at the top of the map, as the choice, in all health- seeking societies.

This is tangentially different from the current status it enjoys “as the tool for disease management”. The 8th WAC thus places Ayurveda at the forefront of healthcare from this perspective, making use of its core values and principles of health preservation and promotion.

The World Ayurveda Congress (WAC) is a platform established by World Ayurveda Foundation to propagate Ayurveda globally in its true sense. The first World Ayurveda Congress (WAC) was held in 2002 at Kochi as an outreach programme, to create greater awareness and opportunities in the practice, science, and trade of Ayurveda.

The event is supported by the Ministry of AYUSH, Govt of India, and organised by the World Ayurveda Foundation.

The focal theme of the congress will be – Re-aligning the focus on health.

Mapping out the current resources and drawing out the possible paths of enquiry to achieve the dream of a healthy nation, is the goal of this Congress. Thus, the 8th WAC shall initiate a new quest in the realm of healthcare, which will support the bold steps taken by the Government of India and also the Universal Health Coverage program of the World Health Organisation, thus assuring sectorial equity and responsibility in healthcare for Ayurveda.This could

The subsequent Congresses organised at Pune, Jaipur, Bangalore, Bhopal, Delhi &; Kolkata not only helped in promoting Ayurveda within the country but also had a huge impact in propagating Ayurveda globally.

Previous themes at the Congress have included “Ayurveda and World Health”, “Globalisation of Ayurveda”, “Mainstreaming Ayurveda”, “Ayurveda for All”, “Enriching Public Health Through Ayurveda”, “Health Challenges and Ayurveda” and “Strengthening the Ayurveda Ecosystem.

ADVANTAGE HEALTHCARE INDIA 2018

FROM DECEMBER 4-6, 2018

T

he 4th edition of International Summit on Medical Value Travel, Advantage Healthcare India 2018 (AHCI 2018), jointly organized by the Ministry of Commerce & Industry, Government of India, Federation of Indian Chamber of Commerce & Industry (FICCI) and Services Export Promotion Council (SEPC), will be held at India Expo Center and Mart, Greater Noida (National Capital Region), from December 4 to 6, 2018.

The summit is organised aim at promoting services, exports from India. The event is being supported by the Ministry of Health & Family Welfare, Ministry of AYUSH, Ministry of External Affairs and National Accreditation Board for Hospitals & Healthcare Providers (NABH).

AHCI 2018 will comprise of Exhibition, Conference, Regional Forums and B2B Meetings and will engage participation by all leading Indian Hospitals, Health care and Wellness Organizations and renowned medical experts. A Reverse Buyer Seller Meet (RBSM) with delegations of health care

decision makers will be organized during AHCI 2018 with the objective of developing strategic partnerships in the medical and holistic health care sector between India and focus countries and to promote quality health care services from India at highly competitive prices across a wide range of medical streams, therapy and surgery.

AHCI 2018 will help to bring together Indian health care providers and the International audience to enable interactions and discussions to enhance existing synergies in the health care and wellness sector. The medical value travel industry has emerged as one of the fastest growing segment of tourism industry despite the global economic downturn.

According to the FICCI – IMS Report, India is one of the key MVT destinations in Asia with over 500,000 foreign patients seeking treatment. MVT can be a 9 billion USD opportunity by 2020 through adequate focus and effective execution.

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM COVER STORY

LUNG CANCER WHAT YOU SHOULD KNOW?

22 Medical Tourism Oct. - Dec. 2018

L

ung cancer is a leading cause of death globally. It is also a major healthcare problem in India.

There is a significant rise in the number of cases of lung cancer during the last 10 years.

According to GLOBOCAN-18 data recently published,Lung cancer is the leading cause of death from all cancers in India.The mean age at lung cancer is diagnosed in India is 54.6 years.Males predominate with a M:F ration of 4.5:1 and this ratio varies with age and smoking status.The smoker to non-smoker ratio is high up to 20:1 in various studies.

Smoking tobacco, both cigarettes and beedis, is the principal risk factor for causation of lung cancer in Indian men; however, among Indian women, the association with smoking is not strong, suggesting that there could be other risk factors besides smoking.

Passive smoking has been found in 3% of patients. Beedi has been found to be more carcinogenic than cigarette smoke and the relative risk of developing lung cancer is more (2.64) for beedi smokers compared to that of cigarette smokers (2.23).

Hookah smoking has also been associated with lung cancer.

We have, in particular, a limited understanding of the impact of the factors that are unique to our country such as the presence of indoor air pollution, the use of domestic or biomass fuel exposure, the presence or lack of micronutrients in our diet, occupational exposure, and the possible contribution of infections such as tuberculosis.

Small cell cancer (SCLC) tends to grow more quickly than non-small cell cancer. Because it grows more quickly, SCLC is often found when it has spread outside of the lung.

Lung cancer is often found at a late stage because symptoms go undetected until the cancer has spread to other parts of the body.

WHEN SHOULD YOU CONSULT A DOCTOR? Lung cancer typically does not cause any specific signs and symptoms in its initial stages. The patients may just have general symptoms of not feeling well. In most people with lung cancer, the symptoms arise only when the disease is advanced. The common symptoms include: 1. Persistent cough that gets worse despite usual treatment.

2. Shortness of breath 3. Coughing up phlegm (sputum) with traces of blood in it 4. Coughing up frank blood

EARLY DETECTION Early detection can help people live longer and live better. Detecting cancer even before a person develops symptoms is called Screening.

Screening for lung cancer with a low dose CT (LDCT) scan is currently the only proven method for detecting lung cancer at an early and treatable stage.

WHO SHOULD BE SCREENED? Currently, lung cancer screening is recommended for a specific highrisk population. There is ongoing research to determine who else may have an elevated risk of developing lung cancer.

HIGH RISK CRITERIA:  You are between the ages of 55-80.  You have a 30 pack-year smoking history. 

(Calculated as # of packs smoked per day multiplied by # of years smoking. For example: 1 pack per day X 20 years = 20 pack years)

5. Wheezing

 You are a current smoker or quit within the past 15 years.

6. An ache or pain in the chest or shoulder

TESTS TO DIAGNOSE LUNG CANCER

7. Unexplained weight loss 8. Feeling of extreme tiredness 9. Loss of appetite

If there's reason to think that one has lung cancer, we order a number of tests to look for cancerous cells and to rule out other conditions. These tests may include:

10. Hoarsness of voice

WHAT ARE THE TYPES OF LUNG CANCER? Lung cancer includes two main types: non-small cell lung cancer and small cell lung cancer.

The type of cancer is based on how it looks under the microscope.

Non-small cell lung cancer (NSCLC) includes the following types; squamous cell carcinoma, large cell carcinoma and adenocarcinoma.

A Complete Magazine on Healthcare in Asia

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 Imaging tests. An X-ray image of lungs may reveal an abnormal mass or nodule. A CT scan can reveal small lesions in lungs that might not be detected on an X-ray.

cells.A biopsy sample may also be taken from lymph nodes or other areas where cancer has spread, such as liver.

 Sputum cytology. If one has cough and are producing sputum, looking at the sputum under the microscope can sometimes reveal the presence of lung cancer cells.

Molecular testing (also called biomarker testing) looks for biological changes in genes or proteins, like EGFR or ALK, that may be associated with Lung cancer. In most cases, this involves testing a piece of tissue from the cancer (a biopsy).

 Tissue sample (biopsy). A sample of abnormal cells may be removed in a procedure called a biopsy.A number of ways a biopsy can be performed, including bronchoscopy, in which experts examine abnormal areas of lungs using a lighted tube that's passed down the throat and into lungs; mediastinoscopy, in which an incision is made at the base of neck and surgical tools are inserted behind breastbone to take tissue samples from lymph nodes; and needle biopsy, in which doctor uses X-ray or CT images to guide a needle through chest wall and into the lung tissue to collect suspicious

BIOMARKER TESTING

STAGING OF LUNG CANCER Once Lung Cancer is diagnosed,next step is staging.Lung cancer staging means finding out where the lung cancer cells are located,the size of the lung cancer tumor,if and where the lung cancer has spread.Lung cancer staging helps determine what treatment options one can have.

Staging also gives some information about lung cancer prognosis but does not predict how long one will live. Knowing the stage of lung cancer guides the medical team on how to best treat the cancer.

TESTS TO DETERMINE THE EXTENT OF THE CANCER Once lung cancer has been diagnosed, we have to determine the extent (stage) of cancer.Stage helps us to decide what treatment is most appropriate.Staging tests may include imaging procedures that allow treating doctor to look for evidence that cancer has spread beyond your lungs. These tests include CT, MRI, positron emission tomography (PET) and bone scans. Not every test is appropriate for every person.A particular test is decided according to one’s clinical examination findings.The stages of lung cancer are indicated

by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to the lung.

By stage IV, the cancer is considered advanced and has spread to other areas of the body

WHAT ARE THE TYPES OF TREATMENTS? The treatment for lung cancer depends on lung cancer type, lung cancer stage and treatment goals. Options may include surgery, radiation, chemotherapy, targeted therapy, immunotherapy, clinical trials and/or palliative care.

Surgery may be an option if cancer is confined to the lungs.Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells.Chemotherapy uses drugs to kill cancer cells.One or more chemotherapy drugs may be given through a vein in your arm (intravenously) or taken orally. A combination of drugs usually is given in a series of treatments over a period of weeks or months, with breaks in between so that you can recover. Chemotherapy is often used after surgery to kill any cancer cells that may remain. It can be used alone or combined with radiation therapy.

Chemotherapy may also be used before surgery to shrink cancers and make them easier to remove.

TARGETED DRUG THERAPY Targeted drug treatments focus on 24 Medical Tourism Oct. - Dec. 2018

specific abnormalities present within cancer cells like EGFR,ALK,or ROS mutation. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

Many targeted therapy drugs are used to treat lung cancer, though most are reserved for people with advanced or recurrent cancer,very often given as oral drugs and with out much side effects,like Gefitinib.

Some targeted therapies only work in people whose cancer cells have certain genetic mutations. Cancer cells may be tested in a laboratory to see if these drugs might help.

IMMUNOTHERAPY This is the latest treatment recommended for Lung Cancer.Immunotherapy uses one’s immune system to fight cancer. Human body's disease-fighting immune system may not attack one’s cancer because the cancer cells produce proteins that blind the immune system cells.

Immunotherapy works by interfering with that process.Immunotherapy treatments are generally reserved for people with advanced lung cancer.

IF YOU SMOKE, 

Get the help you need to quit



Avoid second-hand smoke



See your doctor if you:

Have a cough that will not go away

Cough up blood

Are more short of breath than usual

Lose weight that was unplanned

Develop a hoarse voice

Feel tired all of the time

Talk to your health care provider about screening if you have a history of smoking

Dr. Narayankutty Warrier Medical Director, MVR Cancer Centre & Research Institute A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM PRECISION MEDICINE

PRECISION MEDICINE HAS CHANGED THE LANDSCAPE OF HEALTHCARE AND WHAT CAN IT DO FOR ONCOLOGY Oncologists admit that they have been subjected to some bit of ‘guesswork’ with regards to treating cancerous tumors, which have highly complex and heterogeneous gene structure, says Dr. B S Ajaikumar Chairman & CEO, HealthCare Global Enterprises Ltd.

26 Medical Tourism Oct. - Dec. 2018

COULD IT BE ‘THE’ DEFINITIVE CANCER TREATMENT ALTERNATIVE? As Precision Medicine reforms the landscape of healthcare and medical treatment around the world, experts hope to find in it what could be the finest therapeutic solution to cancer till date. This revolutionary cancer care model, while still primarily active only in research labs, offers exciting new possibilities of technology and innovation and might advance to clinical care in the near future.

Cancer has continued to baffle major research organizations, healthcare practitioners, and government bodies for decades. Estimates indicate approximately 9.6 million cancer-related deaths in 2018, amounting to 1 out of every 6 deaths globally. In India, the number of people suffering from cancer is reported to be at around 2.5 million, with over 7 lakh new cases and 56 thousand deaths yearly. Despite conventional treatment options like surgery, radiotherapy, and chemotherapy, there seems to be a dearth of effective options for patients and healthcare practitioners to choose from. Concerns such as widely experienced side effects of cytotoxic chemotherapy and challenges in making early-stage diagnoses and predicting treatment response only add to the fear of this seemingly untreatable disease.

The inefficiency of the existing medical equipment to gain adequate information about the body’s response to drug treatment, genomic alterations of tumors, and tumor recurrence patterns press the need to intertwine data processing with customized cancer treatment planning. With precision or personalized medicine possibly coming to the clinical table in the next few years, this seems conceivable.

LAYING THE GROUNDWORK FOR A PREDICTIVE AND PREVENTIVE HEALTH CARE MODEL What sits at the core of precision medicine science is devising a tailor-made treatment process for each patient with detailed specifics for the right drugs, doses, medication timing, and course duration, by capturing data about his or her genetic coding, environment, and lifestyle. Laying the groundwork for a participatory, predictive and preventive health care service delivery system, it offers an effective and scalable solution to today’s healthcare problems.

Within the realm of cancer treatment, precision medicine applies the best of micro-physiological systems and gene chip technology, to garner in-depth genomic data on growth status, metastatic potential, and environmental catalysts relating to tumors. Leveraging key

insights from this data, it can predict treatment outcomes, provide prognostic information and indicate predisposition, fundamentally changing the approach to cancer treatment.

The concept of personalized medicine has been brought to mass-attention by Barack Obama’s 2015 Precision Medicine Initiative. Having been under wraps for the few years before, the concept is being explored for the treatment of various chronic and life-threatening diseases. Recent evolvement in bioinformatics such as next-generation sequencing (NGS) has also revitalized its efficacy in studying genetic alterations accurately, thus making it ideal for targetting therapy for molecular cancerous tumors.

Oncologists admit that they have been subjected to some bit of ‘guesswork’ with regards to treating cancerous tumors, which have highly complex and heterogeneous gene structure. But, the capacity of NGS technology to achieve low-abundance mutations and low-level mosaicism detection, will possibly facilitate them to guide more effective treatment plans. Clinical trials directed at helping patients with rare cancer to meet the right drug have shown an initial success. However, it would take genomic probe technologies to extract furthermore data on tumor behavior, and healthcare providers to process all the information so acquired into knowledge for precision medicine to entice clinicians.

TAKING A PERSONALIZED AND TARGETED APPROACH TO CANCER TREATMENT Contrary to the ‘one-size-fits-all’ approach, expecting all patients to get similar results for similar medication, precision medicine focuses on specific treatments by getting to the root of the illness. With digitization and Internet of Things (IoT) coming together with healthcare systems, and costs of genomic sequencing dripping, personalized healthcare may soon be put out in the clinical practice space too.

This field of study cannot be pursued and mastered by one organization – the entire medical research community must collaborate to explore a more dynamic approach to fighting cancer. Patients, research participants should be willing to share their gene and/or lifestyle data and healthcare experts must be roped in to draw useful insights from such data.

Both private and public sector innovators can contribute to counter the technological, financial, infrastructural and process hassles. Academic institutions, medical centers, research organizations, governments must also come together to combine their experience and expertise and invest more time, money and efforts to support new research models that promise more prognostic than diagnostic results.

A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM IMMUNOTHERAPY

IMMUNOTHERAPY IN CANCER TREATMENT

Immunotherapy is a type of treatment that uses body's own immune system to help to fight cancer.

HISTORY William B Coley is known as the father of immunotherapy.

He observed that a number of cancer patients went into spontaneous remission after developing erysipelas. Erysipelas is a bacterial infection affecting skin .

He started injecting mixtures of live and inactivated Streptococcus pyrogenes and Serratia marcescens bacteria into patients tumors in 1891.He could achieve durable complete remission in different kinds of malignancies like sarcoma, testicular carcinoma, and lymphoma. But it failed to get acceptance in medical community because of lack of a known mechanism of action for Coley’s toxins and risks of injecting pathogenic bacteria into cancer patients .

The immunotherapy came into lime light in 1950’s when Thomas and Burnet first proposed the theory of immunosurveillance. They suggested that lymphocytes acted as 28 Medical Tourism Oct. - Dec. 2018

sentinels to identify and eliminate somatic cells transformed by spontaneous mutations.

In 1970 it was observed that the large doses of Interleukin -2 is effective in treating metastatic cancers by increasing the T cell production. But the first drug for immunotherapy was approved by FDA in 1997 only.

Immunotherapy is a type of treatment that uses body's own immune system to help to fight cancer. In immunotherapy the immune system is artificially stimulated i.e. improving the natural ability of ones own immune system to treat cancer. This can be done in two ways 1) Stimulating ones own immune system through immunotherapy 2) Giving man made immune system proteins to fight cancer

TYPES OF IMMUNOTHERAPY

1) Lung Cancer

Many drugs with different mechanism of actions are used in Immunotherapy, they are

2) Melanoma

1) Check point Inhibitors –They block proteins that stop the immune system from attacking cancer cells

4) Bladder Cancer

2) Monoclonal Anti Bodies– These are antibodies produced by identical immune cells that are all clones of unique parent cell 3) Cancer Vaccines –Is the kind of vaccine that either treats existing cancer or it prevent the development of cancer. Some / many of the vaccines are autologous being prepared from the samples taken from the patient and specific to that patient

3) Skin Cancers 5) Lymphoma

SIDE EFFECTS The immunotherapy is not without side effects. The side effects are common, but may not occur in all patients or with all types of therapies.The common side effects include 1) Fever 2) Fatigue 3) Nausea

4)

Cytokines– Is a protein that is important in cell signaling. It is believed that cytokines are involved in autocrine signaling, paracrine signaling and endocrine signaling as immunomodulating agents

4) Vomiting

5)

Adoptive Cell transfer –It is the transfer of cells origi nated from the immune system of the patient or another individual with the goal of improving the function and characteristics of immune system

DIFFERENCE BETWEEN CHEMOTHERAPY AND IMMUNOTHERAPY

MECHANISM OF ACTION OF IMMUNOTHERAPY The immunotherapy works by stopping or slowing the growth of cancer cells or stopping cancer cells from spreading to other parts of the body.The role of immunotherapy is to improve the specificity and memory of the adaptive immune response to achieve long term tumour suppression and possible cure , by administering cytokines and vaccines to increase the frequency of tumour specific T cells and adoptive transfer of tumour of specific effector cells or by using check point inhibitors to overcome the cancer cell induced tumour suppressive mechanisms.

ROUTES OF ADMINISTRATION

5) Skin Rashes or blisters 6) Itching 7) Shortness of breath

The difference between chemotherapy and immunotherapy is in chemotherapy drugs act directly on cancer cells but in immune therapy the drugs act on the immune system of the patient.

EXPENSE The immunotherapy is very expensive, the treatment to be continued for three to six months depending on the condition of the patient, one therapy ( cycle) of immunotherapy is required for 21 days and the cost of one therapy is in the range of 1- 1.3 lakhs or more .

CONCLUSION The immunotherapy is not very poular in India because it is expensive ,not available at all cancer centres and the number of qualified medical oncologists are few in number.

The immunotherapy drugs can be given in different ways 1) Oral – where the immunotherapy comes in the form of capsules or tablets 2) Topical- Here the immunotherapy comes in the form of cream that the patient can rub on to the skin 3) Intravenous- The medicine is given directly into the vein 4) Intravesical- where the drug goes directly into the bladder

TYPES OF CANCER TREATED BY IMMUNOTHERAPY

Dr. P G Balagopal MS, MCh Superintendent Cochin Cancer Research Centre

Immunotherapy is not used to treat all forms of cancers, it is mainly used to treat following cancers A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM REFLECTIONS

INCREASING PREVALENCE OF CANCER CALLS FOR PROTRACTED MEASURES OF TREATMENT; MEDICAL ASSISTANCE AVAILABLE IN PLENTY PRECISION MEDICINE AND TARGETED THERAPY ARE BEING TRIED OUT FOR PERSONALIZED TREATMENT. POSITIVE DEVELOPMENTS ARE WITNESSED IN MANY CASES.

By O.J.George (Consulting Editor)

O

ne would hope even his enemies should not contract cancer, which is the canker eating into the vitals of people, resulting in very tragic situation. There is no distinction between the haves and the have-nots being exempted from the monstrous malady, even as the disease is not considered as contagious.

Even worldly- wise and the high and the mighty, enormously wealthy and all-powerful people cannot bypass fate’s game of ball, in the form of an onslaught of cancer. No one knows when the foot-fall of this horrendous illness would be at one’s door-step.

Modern medicine has been training its guns on this medical enemy, that is cancer, using destructive mechanism against the unwanted growth or development. We know it for a fact that it is a disease in which abnormal cells divide uncontrollably and destroy body tissues.

Precision medicine and targeted therapies are being tried out for better results in the form of personalized cancer care.

Now-a-days even a layman comes to know various types of cancer such as breast cancer, prostate cancer, basal 30 Medical Tourism Oct. - Dec. 2018

cell cancer, melanoma, colon cancer, lung cancer, leukemia, lymphoma, and the list goes on unceasingly.

Allopathy has at its disposal measured protocols to deal with various kinds of cancer growth by way of chemotherapy, and radiation, after surgical removal of growths on human body parts, external as well as internal.

Oncologists have been successful in prolonging the lives of a lot of cancer patients, and in some cases complete remission, using variegated tools. As life is a one-time affair benevolently bestowed on humanity by the supernatural powers-that-be, no stone should remain unturned to realize cure or tapering off of the unsolicited guest.

It would be a relief for the patients and their family members to know that there could be a further stint of life on earth for them.

I have come across a few of the people in the family suffering from bone cancer, blood cancer and pancreatic cancer, some of whom had undergone excruciating pain, no matter how much anti-pain medicines had been administered.

The condition is at once terrible and horrible, and for all of us life is short and there is too much time wasted bearing grudges, ill-will and feelings of cruelty against many members of the humanity. And as life is short and progress is slow, there cannot be one minute wasted without doing some good things for fellow beings at least in an Act of Random Kindness (ARK).

There are treatments targeted at the specific organs or other parts of the body which are affected by cancer, many of which are successful.

Certain types of immune therapy destroy cancer or slow its spread to other parts of the body. Others make it easier for the immune system to destroy cancer cells. Immuno-therapy sometimes results in the immune system attacking healthy cells, causing side- effects. But then that would be taking a chance to survive the malady.

People take extra caution to ward off possible attack of cancer in future.

Study of some genes might be able to predict whether forms of malignancy prevalent in the family might relapse in the future generations.

We know Angelina Jolie had subjected herself to double mastectomy

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(removal of both her breasts), anticipating that the malady may remain in future generations, some sort of family inheritance.

Apple CEO Steve Jobs had pancreatic cancer and he had to breathe his last in his middle ages.

Now Paul Allen, co-founder of Microsoft, had to bid farewell to this world for ever. In fact, his cancer had been arrested eight years ago, but the malignancy managed to relapse.

American professional wrestler Roman Reigns has made it public that he is suffering from leukemia.

Actress Sonali Bendre has been suffering from malignancy and she has been keenly going ahead with procedures to treat it. There is no official word about it, but there is talk about Rishi Kapoor undergoing treatment in the US. It would not be for nothing that Priyanka Chopra had spent some time with Sonali Bendre and Rishi Kapoor in the US. Goa’s Chief Minister Manohar Parrikar had his stint of treatment for pancreatic cancer in the US, followed by stay in the All India Institute of Medical Sciences, New Delhi, from where he has prematurely secured his discharge.

Lena Dunham, American actress, writer, producer, who is only 32 years old, had her ovary removed recently even as she had her uterus gone under the scalpel years ago.

Malayalam film actor and MP Innocent had two spells of radiation treatment for throat cancer. His wife also had onslaught of cancer and she was also saved by treatment, even as both of them had heart problems as well.

In many cases, will power and determination to fight it out had imbued positive results for them, with the help of early detection.

It is said that cancer cells can spread to other parts of the body through the blood and lymph systems. Knowing about many types of cancer could be 32 Medical Tourism Oct. - Dec. 2018

illuminating. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. At the same time, Sarcoma is a cancer that begins in bone, cartilage, fat, muscles, blood vessels or other connective or supporting tissue. Leukemia is a cancer that starts in blood-forming tissues such as the bone-marrow and causes large number of abnormal blood cells to be produced and enter the blood stream. While Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system, Central nervous system cancers are those that begin in the tissues of the brain and spinal cord.

In a nutshell, even a layman can surmise that no part of the human body is free from an onslaught of the deadly mallgnancy.

“New England Journal of Medicine” has reported about research outcome facilitating extension of life for triple-negative breast cancer patients with the help of a combination of immune-therapy and chemotherapy.

Extending the life of an afflicted patient by a few months or a year is good news for researchers, for if the protocol, with revised options in course of time, could offer hope for still further extension of life in future.

One should note the importance given to management of cancer by the Nobel committee in that Nobel Prize 2018 for physiology or medicine has been awarded to two scientists, James P.Allison and Tasuku Honjo, who had done excellent research work separately for taking care of the curse of cancer on human beings.

The statement on their selection says cancer kills millions of people every year and is one of humanity’s greatest health challenges. By stimulating the inherent ability of our immune system to attack tumor cells, the two scientists have established an entirely new principle for cancer therapy.

Allison and Honjo showed how different strategies for inhibiting the brakes on the immune system can be used in the treatment of cancer. The seminal discoveries by the two Laureates constitute a landmark in our fight against cancer.

This means the scientific community is keenly devising ways to control the onslaught of cancer one way or the other.

(ojgeorge@gmail.com)

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MEDICAL TOURISM CANCER HOSPITAL

RCC

THIRUVANANTHAPURAM, A TERTIARY CARE CENTRE FOR ALL TYPES OF CANCER This State-owned premier cancer care hospital and research centre is one among 28 centres in India operating under the 'National Cancer Control Programme' of the Ministry of Health and Family Welfare, Govt. of India.

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RCC, Thiruvananthapuram, in 1985.

RCC has one of the finest diagnostic oncology set-ups in the country. The centre has made much progress in the area of radiological imaging techniques using ultrasound, CT and MRI scanners, mammograms and more dynamic real-time nuclear isotope scanning.

Apart from clinical and scientific achievements, the Centre has pioneered schemes to help the less- privileged socio-economic groups. At RCC, nearly 53% patients receive free treatment and another 27% in the middle income group receive treatment at subsidised rates.

The 'Cancer Care for Life' (CCL) scheme was launched in 1986 to generate a welfare fund for cancer patients. Consequent upon the winding up of the CCL scheme of Rs.101 per policy holder, a new CCL project of Rs.500 per policy was launched in 1993.

The scheme has been stopped in the year 2014 for giving way to a viable scheme in the context of the changed socio-economic environment. With these commendable efforts in over the past three decades, the Centre has carved a unique niche in the health map of Kerala.

CLINICS RCC has constituted Multi-Disciplinary Tumour boards (MDTs) comprising Medical Oncologists, Radiation Oncologists, Surgical Oncologists and Oncopathologists for the management of cancers. There are seven clinics, designated from A to G, each dealing with cancers of various types.

MEDICAL The super-speciality and post- graduate courses conducted by RCC are approved by the Medical Council of India and are affiliated to the Kerala University of Health Sciences. The Academic committee and PG committee help in the review of the curriculum based on the directives of the Medical Council of India and offer real time solutions to any problems faced by students at RCC.

NURSING The Nursing Division at RCC conducts various academic programmes for the training of nurses in the field of oncology nursing. In addition to qualified staff members who are regularly engaged in clinical practice, consultant specialists from other departments, who are experts in their own fields take an active involvement in the programmes.

T

he Regional Cancer Centre (RCC), Thiruvananthapuram, is an internationally- recognised centre providing state-of-the-art facilities for cancer diagnosis, treatment, palliation and rehabilitation and conducts a wide range of research on various type of cancers.

Established in the year 1981 jointly by the Government of Kerala and Government of India, the RCC, Thiruvananthapuram, is a comprehensive cancer centre catering to the population of the State of Kerala and the adjoining parts of Tamil Nadu and Karnataka.

In order to promote early cancer detection, the first Community Oncology division in India was established in A Complete Magazine on Healthcare in Asia

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RESEARCH While patient care is of prime importance at the Regional Cancer Centre, research and education are key components of RCC's mission. The RCC, since its inception in 1981, has focused on Cancer Research, both applied and fundamental research.

REGISTRATION The patient has to report with a referral letter from a doctor and biopsy reports and other relevant details, if available. Any one of the documents to be produced by the patient at the time of registration - Aadhaar Card/Voters Id/Passport/Pan Card/Driving Licence. The Registration Counter is open from Mondays to Saturdays from 8:00 AM till 12:00 noon. After registration, a card containing the registration number, clinic name, address and other relevant details is given to the patient, and subsequently the patient is seen at the clinic concerned.

CREDIT FACILITIES Those having benefits from ESI, CGHS schemes, or employees from government/semi-government organizations and public service undertakings who bring credit references can avail credit facilities. Sufficient funds, if credited in advance in the patient's name at the cash counter, can save several visits to the counter for various payments.

EARLY CANCER DETECTION CLINICS Screening tests for early detection of common cancers of mouth, breast and uterine cervix are conducted on Tuesday and Thursday from 9:00 AM TO 1:00 PM. Behavioural counselling and other tobacco cessation measures are offered in this clinic which is being done under Community Oncology division.

COMMUNITY ONCOLOGY The Division of Community Oncology has started functioning in the Centre since 1985. Over a span of two decades, the Division has taken up innovative initiatives for cancer prevention and control in the State. The programmes are being conducted with the support of Governmental and Non-Governmental Organisations, and also through service-minded volunteers. The Division is located on the ground floor of the main block on the way to the pay ward (Level 2, Block A).

OUTPATIENT CLINICS The Community Oncology Division conducts out-patient clinics on Tuesdays and Thursdays in a week for detection of oral, breast and uterine cervical cancers. (Remaining days except Sundays are devoted to communitybased health education and cancer detection activities).

No referral letter is required for examination in this clinic. Detected cancer cases are referred to the respective departments of the Centre for treatment. Patients with pre-cancer (stage before the formation of cancer) will be followed up in the Division in a time- bound manner.

36 Medical Tourism Oct. - Dec. 2018

WHO SHOULD ATTEND THE OUT-PATIENT CLINIC? People who are using tobacco in any form, viz: smoking, tobacco chewing, panmasala and alcohol People having burning sensation in the mouth Patients with red or white patches, ulcers or those with growth in the mouth. Routine oral examination without any signs or symptoms Women having lump in the breast/axilla, nipple discharge, pain in the breast Married women above 30 years of age for uterine cervical examination General examination for persons with lump/swelling in the body, change in the size of the wart/mole

EARLY CANCER DETECTION CENTRES Kaloor, Ernakulam Kerala - 682017 Phone : +91 484 2347531 Kanjikkode West, Palakkad Kerala - 678623 Phone: +91 491 2566124 Natural Background Radiation Cancer Registry Puthanthura P O Neendakara, Kollam Kerala - 691588 Phone: +91 476 2685203 / 2181133 Malabar Cancer Care Society Near Ashoka Hospital South Bazar Kannur, Kerala - 670002 Phoner: +91 497 2705309 District Cancer Centre District Hospital Kozhenchery Pathanamthitta, Kerala - 689641 Phone: +91 468 2279001

REGIONAL CANCER CENTRE Medical College Campus, Thiruvananthapuram Kerala - 695011 Phone: +91 471 2522210/2522610 Email: pro@rcctvm.gov.in Web.www.rcctvm.gov.in

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MEDICAL TOURISM AYURVEDA

ROLE OF AYURVEDA IN

INTEGRATIVE MEDICINE

The one-sided march of scientific progress in the medical world is detrimental to the world ecology and humanity at large. It is a fact that modern medical model, focused on disease, pathology and germs, is difficult to sustain in future. People are seen living longer and at the same time chronic diseases are on the increase mainly due to abuse of pharmaceuticals. The cost of these pharmaceuticals is skyrocketing and becoming unaffordable to even the rich nations. Adverse reactions to prescribed drugs are increasingly taking toll on the patients. Dr. Arvind Kulkarni, world renowned oncologist, talks about what we should fear about the future, in the world of medicine, especially for cancer treatment.

38 Medical Tourism Oct. - Dec. 2018

I

t is understood that today billions and billions of dollars are spent on laboratory animal research for cancer. This type of research may be good for reductionist pharmacological study models. However, besides being unduly time consuming and expensive, very few have translated into real help to the suffering due to cancer. Laboratory pursuit of The Active Molecule is unnecessary when we are dealing with a holistic treatment model. Herbs and phytochemicals have multiple constituents acting synergistically to produce a benefit. Many are time tested therapies which have been found to work over the ages.

While asking for “Evidence Based Medicine” we should not be rigid to enforce our current pharmacological yardsticks of our own self-developed criteria. The round sticks of common-sense evidence may not fit perfectly into the current square boxes of scientific compartments.

Ayurveda is a dynamic science and adaptable to the needs of health care of the world in modern age. Ayurveda forms an integral part of holistic medicine which is the way for future. Holistic medicine does not exclude any evidence based medical methods.

These methods may be from various lands and from various times. These are developed to help maintain health and to fight diseases. Holistic medicine also includes allopathic and all the modern medical scientific developments.

Being a Radiation Oncologist who has worked with cancer patients over the past 40 years, we have examined and recorded detailed analysis and observations of more than 11,000 cancer patients. There is a huge computerized data base, ready to be accessed for current and future research projects. We have developed a very dedicated team consisting of more than 50 doctors and research workers in our cancer clinics in India. Our Cancer Centre has been declared as “ Center Of Excellence” by AYUSH section of the Ministry of Health of Government of India. We also scientifically man-

Sr. No

Collaborative Project Index

1

Effectiveness of Ayurvedic medicine in reducing side effects of chemotherapy and improving quality of life in breast cancer patients.

2

Effectiveness of Ayurvedic medicines in alleviating side effects of Radiotherapy, improving quality of life in oral cancer patients and its relationship with immune status.

3

Study of cause and effect relationship between antagonistic dietary (virudhhanna) and unusual lifestyle related habits and prostate cancer.

4

Ayurvedic principles and methods in predicting and reducing cancer risk in high risk BRCA1/2 gene mutation carriers.

5

Ayurvedic principles and methods in prevention or delay of Recurrence / Metastasis in Breast and Ovarian cancer patients with BRCA1/2 gene mutation.

6

A Prospective Study of Disease Free Survival Rate in Triple Negative Breast Cancer Patients by Ayurvedic Treatment.

ufacture Ayurvedic Medicines at our Atharva Healthcare Product Division in Pune, for our own use and for export across the Globe.

Cancer is a dreadful disease. However, we find that a lot of suffering is related more to current models of treatment rather than to the actual cancer tumor itself. In the pursuit of modern advances and expensive therapies, cost benefit ratio seems to have been ignored by modern medicos. Patients should not be compelled to spend exorbitant amounts and suffer financial ruins. To make life worth living, at certain stage, one has to accept the co-existence with cancer, rather than endless pursuit of eradicating the last remaining microscopic cell of cancer.

Costs of radiation and chemotherapy treatments have skyrocketed all over the world. The actual benefits of these aggressive treatments in cancer are questionable. It is the responsibility of the medical team to discuss various options and suggest an individualized treatment strategy for each patient. Finally, the patient needs to have all valid and unbiased information to make his or her own choice.

Besides helping good health, the

Ayurvedic care can definitely reduce the side reactions associated with radiotherapy and chemotherapy. Occurrence and progression of cancer can be prevented to large extent by following healthy life styles and nutrition. Ayurveda should not be looked as the last resort of terminal cancer care after other things have failed.

Ayurveda should be resorted to right from the beginning. We do not claim that “Cancer can be cured by Ayurveda alone”. However, Ayurveda surely helps to improve quality of life and reduce suffering at every stage of cancer.

For further information about Integrated Cancer Treatment and Research Centre, Wagholi, Pune , Please contact 020-67346000 Refer to www.ayurved-for-cancer.org ARVIND KULKARNI M.D., Director Oncology, Integrated Cancer Treatment & Research Centre (ICTRC), Wagholi, Pune, 411207, INDIA Phone: 022-22183851 Cell: 9223279491 kulkarni_arvind@hotmail.com www.ayurved-for-cancer.org A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM FOOD

ADDING FRUITS AND VEGETABLES TO YOUR DIET REDUCES CANCER RISK

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E

ating lots of fruits and vegetables can help reduce your cancer risk. That’s one reason the American Cancer Society recommends eating at least 21/2 cups of these foods every day. These foods contain important vitamins, minerals, phytochemicals, and antioxidants and they’re usually low in calories. In general, those with the most color – dark green, red, yellow, and orange – have the most nutrients. .

BREAKFAST If you usually have cereal, slice a medium or half a large banana on top. For an alternative to cereal, pour half a cup of frozen berries into a cup of plain low-fat yogurt. Slice a banana on top or eat it on the run. Prefer something more savory than sweet in the morning? Add spinach and tomato to your morning omelet, or keep sliced red, orange, and yellow peppers and hard- boiled eggs, or individual cottage cheese cups in the fridge. With more than 1 cup taken care of at breakfast, you’re on your way.

MID-MORNING SNACK Snack time is a great time to work in more fruits or vegetables. A single-serving container of apple-sauce, 5 or 6 baby carrots, or a small orange will add another 1/2 cup. It’s only the middle of your morning, and you’re more than half way there!

LUNCH When you need a quick lunch, try a pita sandwich or wrap loaded with vegetables, or a cup of hearty vegetable soup. Either of these gives you at least half a cup – some will give you a whole cup. Add a small side salad with low-fat dressing, and your count just jumped to more than 2 cups for the day so far.

DINNER Even if you only have a few minutes, dinner veggies are easy. Heat canned or frozen veggies (without added salt or sauces) in the microwave for a quick side dish. Microwave a sweet potato and add a teaspoon of butter, a splash of apple juice or squeeze of lemon, and a light sprinkling of cinnamon and brown sugar. Any one of these will add another cup-size vegetable serving to your day, and now you’re getting more than the minimum recommendation!

DESSERT Savor a frozen treat made from 100% juice or put 1/2 cup of melon slices, peaches, or other favorite fruit on a toasted whole-grain waffle and you’ve added even more healthy fruits to your day. A splash of maple syrup can add extra flavor.

OTHER TIPS TO HELP YOU REACH YOUR GOAL:  At each meal, fill at least half your plate with fruits and vegetables.  Layer lettuce, tomatoes, beans, onions, and other vegetables on sandwiches and wraps.  Add tomato sauce and extra vegetables to pastas and vegetable soups.  Choose a vegetarian dish when eating out.  Challenge yourself to try new vegetables from the produce aisle, frozen foods section, or your local farmer’s market.  Keep dried fruits in your desk drawer and glove compartment (but watch the sugar content!)  Keep a bowl full of fresh veggies and fruits on your kitchen counter for quick snacking.  If you’re short on time, look for pre-washed, pre-cut vegetables, such as baby carrots and broccoli florets, at the grocery store.

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MEDICAL TOURISM NUTRITION

NUTRITION DURING AND AFTER CANCER TREATMENT

S

tudies suggest that people who eat more vegetables and fruits, which are rich sources of antioxidants, may have a lower risk for some types of cancer. Because cancer survivors may be at increased risk for second cancers, they should eat a variety of antioxidant-rich foods each day.

(Second cancers are new, different cancers, not the same cancer coming back.)

So far, studies of antioxidant vitamin or mineral supplements have not found that they reduce cancer risk. The best advice is to get antioxidants through foods rather than supplements.

Many dietary supplements contain levels of antioxidants (such as vitamins C and E) that are much higher than the recommended Dietary Reference Intakes for optimal health.

Many cancer doctors advise against taking high doses of antioxidant supplements during chemotherapy or radiation. There is a concern that the antioxidants might repair the damage to cancer cells that these cancer treatments cause, making the treatments less effective. But others have noted that the possible harm from antioxidants is only in theory. They believe that there may be net benefit in helping to protect normal cells from damage caused by these cancer treatments.

Whether antioxidants or other supplements are helpful or harmful during chemotherapy or radiation treatment is a major question without a clear science-based answer right now. Until more evidence is available, it’s best for cancer survivors getting these treat-

42 Medical Tourism Oct. - Dec. 2018

ments to avoid dietary supplements except to treat a known deficiency of a certain nutrient, and to avoid supplements that give more than 100% of the Daily Value for antioxidants.

Although it’s not clear that total fat intake affects cancer outcomes, diets very high in fat tend to be high in calories, too. This can lead to obesity (being very overweight), which is linked to a higher risk of many types of cancer, a higher risk of certain cancers coming back after treatment, and worse survival for many types of cancer.

Good sources of fiber are beans, vegetables, whole grains, nuts, and fruits.

Eating these foods is recommended because they contain other nutrients that may help reduce cancer risk.

They also have other health benefits, such as reduced risk of heart disease.

At this time we don’t know if fiber intake can affect cancer risk or survival.

The American Cancer Society guidelines on nutrition and physical activity for cancer prevention recommend limiting your intake of processed and red meats and discourage cooking these and other higher fat sources of protein at high temperatures. Cancer survivors may also want to follow this

recommendation for general good health.

There are no studies in humans to show whether organic foods are better than other foods in terms of reducing the risk of cancer, the risk of cancer coming back, or the risk of cancer progression.

Phytochemicals are a wide range of compounds made by plants.

Some have either antioxidant or hormone-like actions. Only a few studies have looked at the effects that phytochemicals (or the plants that contain them) may have on cancer coming back or getting worse (progressing).

There is strong evidence that a diet rich in vegetables, fruits, and other plant-based foods may reduce the risk of some types of cancer. And some recent studies suggest there may be a helpful effect on recurrence or survival for breast, prostate, and ovarian cancers. But there is no evidence at this time that supplements can provide these benefits. Many healthful compounds are found in vegetables and fruits, and it’s likely that these compounds work together to create these helpful effects. Food is the best source of vitamins and minerals.

Yantra Ayurvedic Beach Resort is located in the village in Nattika Beach, Triprayar, Yantra Ayurvedic is an ayurvedic resort located by the sea which combines the pleasure of a beach holiday with authentic ayurveda treatment and welllness therapies. The resort has all the facilities to make your stay relaxed, comfortable and rejuvenating. Yantra is providing Panchakarma treatment with well experienced and dedicated Ayurvedic doctors and efficient therapists. Also provide Yoga classes and meditation for good health. The resort is located at very close to gold sand beach frontage with lash green lawn, the ambience of cottages make it in a traditional Kerala style with all modern facilities. We also make number of huts to watch the sun set and sun rise for our valued guests. We are providing Ayurvedic and authentic food in our traditional restaurant and also you can see the beautiful sea view from our restaurant while having your healthy food. Yantra is the epitome of peace tranquillity. We look forward to having you at our beautiful resort.

Nattika Beach, Thrissur 680566, Kerala, India

Phone: +91-99619-75000, Mobile: +91-99951-25000 Email: yantraresort@gmail.com

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www.yantraayurvedicresort.com

MEDICAL TOURISM FITNESS

RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND CANCER

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M

aking moderate to vigorous physical activity a part of your lifestyle lowers your risk of cancer and that of other chronic diseases, such as heart disease and diabetes. Moderate to vigorous physical activity is exercise that makes you sweat and your heart beat faster. It includes walking, swimming, cycling, or running. A growing body of research suggests that doing any kind of activity to avoid too much sitting can help lower cancer risk.

Colon cancer is one of the most extensively studied cancers in relation to physical activity. Studies that examined the association between physical activity and colon cancer risk found that the most physically active individuals had a 24% lower risk of colon cancer than those who were the least physically active .

A pooled analysis of data on leisure-time physical activity (activities done at an individual’s discretion generally to improve or maintain fitness or health) from 12 prospective U.S. and European cohort studies reported a risk reduction of 16%, when comparing individuals who were most active to those where least active.

Incidence of both

distal colon and proximal colon cancers is lower in people who are more physically active than in those who are less physically active . Physical activity is also associated with a decreased risk of colon adenomas (polyps), a type of colon polyp that may develop into colon cancer. However, it is less clear whether physical activity is associated with lower risks that polyps that have been removed will come back.

Many studies show that physically active women have a lower risk of breast cancer than inactive women and the average breast cancer risk reduction associated with physical activity was 12%. Physical activity has been associated with a reduced risk of breast cancer in both premenopausal and postmenopausal women; however, the evidence for an association is stronger for postmenopausal breast cancer. Women who increase their physical activity after menopause may also have a lower risk of breast cancer than women who do not.

For a number of other cancers, there is more limited evidence of a relationship with physical activity. In a study of over 1 million individuals, leisure-time physical activity was linked to reduced risks of esophageal adenocarcinoma, liver cancer, gastric cardia cancer (a type of stomach cancer), kidney cancer, myeloid leukemia, myeloma, and cancers of the head and neck, rectum, and bladder. These results are generally corroborated by large cohort studies or meta-analyses.

Nearly all of the evidence linking physical activity to cancer risk comes from observational studies, in which individuals report on their physical activity and are followed for years for diagnoses of cancer. Data from observational studies can give researchers clues about the relationship between physical activity and cancer risk, but such studies cannot definitively establish that being physically inactive causes cancer (or that being physically active protects against cancer).

That is because people who are not physically active may differ from active people in ways other than their level of physical activity. These other differences, rather than the differences in physical activity, could explain their different cancer risk. For example, if someone does not feel well, they may not exercise much, and sometimes people do not feel well because they have undiagnosed cancer.

Research indicates that physical activity may have beneficial effects for several aspects of cancer survivorship--specifically, weight gain, quality of life, cancer recurrence or progression, and prognosis (likelihood of survival). Most of the evidence for the potential benefits of physical activity in cancer survivors comes from people diagnosed with breast, prostate, or colorectal cancer.

Another prospective cohort study found that women who had breast cancer and who engaged in recreational physical activity roughly equivalent to walking at an average pace of 2 to 2.9 mph for 1 hour per week had a 35% to 49% lower risk of death from breast cancer compared with women who engaged in less physical activity.

Findings from epidemiologic studies cannot completely exclude reverse causation as a possible explanation of the link between physical activity and better cancer outcomes. That is, people who feel good are more likely to exercise and be physically active than people who do not feel good.

BENEFITS OF EXERCISE Prevent bowel and breast cancer Keep a healthy weight Improve mood Boost energy Improve mobility and strength Reduce risk of dementia and osteoarthritis

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MEDICAL TOURISM CANCER HOSPITAL

TATA MEMORIAL CENTRE DELIVERING WELL-ESTABLISHED CANCER TREATMENT The TMH was the first Centre in the country to initiate Bone Marrow Transplant in 1983. This has been possible due to better total supportive care using better antibiotics, nutritional, blood transfusion support, nursing and other areas.

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T

he Tata Memorial Centre, Mumbai, constitutes the national comprehensive cancer centre for the prevention, treatment and research on Cancer and is comparable to any similar centre in the world. This achievement has been made possible due to the far-sighted and total support of the Department of Atomic Energy, responsible for managing this Institution since 1962.

Nearly 64,000 patients visit the clinics annually not only from all over India but also from neighbouring countries.

Nearly 60% of these cancer patients receive primary care at the Hospital, of which over 70% are treated free of any charges. Over 1300 patients attend the OPD daily for medical advice, comprehensive care or for follow-up treatment. The Hospital has expanded from an 80- bed Hospital covering an area of 15,363 sq. metres to a 629-bed one, spread over 53,890 sq. metres.

Nearly 18,500 minor operations, 11,500 major operations and 200 laser surgeries are performed annually.

The robotics surgery was introduced in 2014 and since then 50 procedures have been performed. About 6,200 patients are treated with Radiotherapy and Chemotherapy annually in multi-disciplinary programs delivering well-established treatment. Robotic surgeries were initiated in 2014.

The strategies for early diagnosis, treatment management, rehabilitation, pain relief and terminal care have been established in a comprehensive and multi-disciplinary approach for a total cancer care programme.

Radical surgeries have yielded place to more conservative surgery, with the very important objective of quality of life, conserving function and organ without compromising the overall survival outcome. This has been very clearly proven in the early stage cancer of the breast or tumours involving the soft tissue or bone, where amputative surgery has been replaced by less radical procedures. Radiation therapy has also made rapid advances with high technology, precision, comput-

erization and newer isotopes for therapy. Chemotherapy has played a very major role, with many new drugs and clinical protocols investigated in clinical trials.

The TMH was the first Centre in the country to initiate Bone Marrow Transplant in 1983. This has been possible due to better total supportive care using better antibiotics, nutritional, blood transfusion support, nursing and other areas.

Another important area of progress over the last few years has been radiological imaging techniques using ultrasound, CT Scanners and more dynamic real- time nuclear medicine scanning.

Pathology has progressed from basic histopathology to molecular pathology with emphasis on predictive assays for identifying the high- risk prognostic factors.

Today, state-of-the-art equipment is available in every Department, including the latest Spiral CT Scanners, Gamma Cameras, Ultrasound, Microscopes, Linear Accelerators, Simulators, Bone Marrow Transplantation facilities, ICU for critical care of patients, updated Operation Theatres, sophisticated Blood Bank facilities and laboratories. The Hospital is in a position to render high immunological, histo-chemical, technological level of biochemical, cytological and pathological services.

The Programmes for Cancer awareness, prevention, and control are well recognized and established with a satellite Rural Cancer Centre at Barshi.

Recently, awareness campaigns highlighting the cancerous effects due to the sustained use of tobacco, banning the use of tobacco in the entire Hospital complex, targeting school and College children by educational programmes highlighting the terrible effects of smoking and preventing them from even starting the habit, are some of the activities in progress in the Department of Preventive Oncology.

The Cancer Research Institute plays an important role with understanding of the molecular basis of cancer , Cell biology, molecular epidemiology, laboratory medicine with predictive assays and molecular pathology.

Advances in developmental therapeutics with drugs, with different modalities of treatment using different strategies, such as gene therapy, vaccine, biological therapy and chemo prevention are being evaluated with exciting possibilities for the future.

TATA MEMORIAL HOSPITAL Dr. E Borges Road, Parel, Mumbai - 400 012 India Tel. +91-22- 24177000, 24146750 - 55 E-mail : msoffice@tmc.gov.in Web: tmc.gov.in

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MEDICAL TOURISM RESEARCH

NEW BLOOD TEST DEVELOPED FOR EARLY DIAGNOSIS OF OVARIAN CANCER

R

esearch on a bacterial toxin first discovered in Adelaide has led to the development a new blood test for the early diagnosis of ovarian cancer - a disease which kills over 1000 Australian women and 150,000 globally each year.

The new blood test has the potential to dramatically improve early detection of the disease, although it will require further testing before it is available for clinicians.

A research team from the University of Adelaide and Griffith University have been studying the interactions between the toxin and an abnormal glycan (sugar) expressed on the surface of human cancer cells and released into the blood.

48 Medical Tourism Oct. - Dec. 2018

The team has now engineered a harmless portion of the toxin to enhance its specificity for the cancer glycan and used this to detect it in blood samples from women with ovarian cancer.

test is therefore a potential game changer," says Professor James Paton, Director of the University of Adelaide's Research Centre for Infectious Diseases.

A paper published in Biochemical and Biophysical Research Communications has shown that the new test detected significant levels of the cancer glycan in blood samples from over 90% of women with stage 1 ovarian cancer and in 100% of samples from later stages of the disease, but not in any of the samples from healthy controls.

Professor Michael Jennings, Deputy Director of the Institute for Glycomics at Griffith University, said: "Detection of this tumor marker may also play a role in a simple liquid biopsy to monitor disease stage and treatment."

"Ovarian cancer is notoriously difficult to detect in its early stages, when there are more options for treatment and survival rates are better. Our new

The team is currently seeking scientific and commercial partners to further test the technology with larger numbers of patient samples and to adapt it for mass screening.

MEDICAL TOURISM TECHNOLOGY

PURDUE UNIVERSITY RESEARCHERS DEVELOP TECHNOLOGY TO FIND TUMOUR

P

urdue University researchers have developed a technology aimed at making it easier to deliver cancer treatment to the right “address” in the body while also easing the painful side effects of chemotherapy on patients.

One of the big issues with chemotherapy is that most treatment approaches focus on the tumour itself without paying significant attention to the microenvironment surrounding the tumour. The new method is detailed in the nanotechnology journal Small.

“The traditional approach is similar to a delivery driver trying to drop off a package to a certain person without knowing their specific address,” said Yoon Yeo, a professor of industrial and physical pharmacy at Purdue, who is leading the research team. “Our new approach provides directions to find the specific address to deliver the chemotherapeutic drugs.”

The Centers for Disease Control and Prevention reports that each year, about 650,000 cancer patients receive chemotherapy in an outpatient oncology clinic in the United States.

Patients receiving chemotherapy are at risk for various side effects that may lead to hospitalization, disruptions in chemotherapy schedules, and even death.

The Purdue method uses nanoparticles, which are considered promising carriers of drugs needed for chemotherapy to target tumours. The researchers developed a technique to prepare polyol-modified nanoparticles so they locate cancerous cells and tumours by checking out blood vessels surrounding the tumours.

The nanoparticles then interact with the vascular lining to enter tumours and destroy them. The Purdue researchers said their method helps the nanoparticles to exit from the circu-

lation and enter tumours and better treat the cancer. They have tested the method on breast cancer and melanoma models and believe it also will prove effective for many types of cancerous tumours.

“Chemotherapy can be almost unbearable for most patients and we want to change that,” Yeo said. “Our method better targets tumours so lower dosages are required and the drugs do less damage to normal tissues.”

Their work aligns with Purdue's Giant Leaps celebration, acknowledging the university’s global advancements in health as part of Purdue’s 150th anniversary. This is one of the four themes of the yearlong celebration’s Ideas Festival, designed to showcase Purdue as an intellectual center solving real-world issues.

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MEDICAL TOURISM ACHIEVEMENT

NARAYANA HEALTH CITY SUCCESSFULLY COMPLETES 1000 BMT

T

he state-of-the-art bone marrow transplant (BMT) unit at Mazumdar Shaw Cancer Center at Narayana Health City has successfully treated 1000 patients, which is the largest number in Karnataka and one of the largest in the country.

This unit has emerged as a referral centre for national and international patients for both autologous and allogeneic stem cell transplants. 1000th BMT patient is a 10-year-old boy from Kolar, Karnataka who was diagnosed with aplastic anaemia. He found a matching donor after persistent search by Narayana Health team at 50 Medical Tourism Oct. - Dec. 2018

the Germany registry and his treatment was funded by ESI and partly by crowdsourcing.

Over 100 unique BMT cases were felicitated at the event by Dr. Kiran Mazumdar Shaw, Dr. Devi Shetty, Dr. Sunil Bhat and Dr. Sharat Damodar.

According to Marrow Donor Registry India, at any time, all over the world, there are about 3,000 patients searching for a donor for a Stem Cell transplant and less than 30% of those find a suitable donor within their family.

Rest of the 70% depend on unrelated donors which indicates that very

few people receive best possible treatment. To address the deficit, a cord blood banking facility was established two years back in collaboration with Rotary International, which functions both as a public and private cord blood facility. Today at its current strength Narayana Health has 30 beds across Bangalore, Kolkata and Mumbai with a capacity to conduct 150 BMT’s per year.

Dr. Kiran Mazumdar-Shaw Chairman & Managing Director, Biocon Limited, said, “I am proud to be part of this journey to build one of India’s largest Bone Marrow Transplant Centre. This

centre today has become a case study for many and we hope to play a crucial role in eradicating blood related diseases in the near future by offering world class treatment.”

Bone Marrow Transplant has evolved over a period of time and is safer with outcomes continually improving.

Dr. Devi Shetty, Chairman and Executive Director, Narayana Health, said, “In India there are over one lakh patients with serious blood related disorders diagnosed every year and the only long-lasting line of treatment for them is Bone Marrow Transplant. We started this unit in 2004 with a vision to offer world class treatment and today I am proud that our Bangalore unit alone has successfully treated 1000 BMT cases. This is just the beginning and the journey to provide BMT treatment to all the beneficiaries still has a long way to go."

BMT procedure helps in the treatment of various non-cancerous diseases like Aplastic Anaemia, Immunodeficiency disorders, congenital storage disorders, congenital errors of metabolism and Haemoglobinopathies such as Thalassemia and Sickle Cell Anaemia. Few cancerous conditions like acute and chronic Myeloid and Lymphoblastic Leukemia, Hodgkin’s and Non-hodgkin’s Lymphoma, Myeloproliferative Neoplasms, Primary Myelofibrosis and Multiple Myeloma also require BMT as a solution for treatment.

na Health City, said, “There is a huge demand supply gap for Bone Marrow Transplant in our country. Currently we have close to 2 lakh registered donors and to address the current demand deficit we need at least 10 Lakh donors to register."

“In the current capacity, our unit can treat 150 patients per year. Our vision is to increase the current bed capacity from 18 to 25 in next two years which will help us in treating close to 300 patients per year. We also plan to start Cellular Immunotherapy, a process that harnesses the body’s own immune system to fight cancer by 2020 to further strengthen our treatment facility. From the first treatment of a 4-year-old thalassemia child way back in 2004 to the 1000th treatment of aplastic anaemia 10-year-old boy from Kolar, Mazumdar Shaw Cancer Centre has emerged as a centre of excellence for BMT in our country." adds Dr. Sharat Damodar.

India treats approximately 1500 BMT cases every year which is far less as compared to other countries like China, Japan, Korea who are treating approximately 8000 cases every year.

Dr. Sunil Bhat, Head – Paediatric Oncology, Haematology and Bone Marrow Transplant at Mazumdar Shaw Cancer Centre, Narayana Health City, said, “The number of haematological disorders is on a rise in our country

and every year at least 80,000 to 1 lakh kids are born with serious blood related disorders. Out of the overall blood related disorders diagnosed every year almost 5-8% cases are from the Karnataka region. Out of the 1000 BMTs performed at our center, approximately 60 percent are paediatric cases (with babies as young as few weeks old) as there are more indications for bone marrow transplant in children. These indications range from cancerous conditions like leukemia to non-cancerous genetic conditions like immunodeficiency and thalassemia."

“The conditions which can be potentially cured with BMT are on a rise.

One of major advances has been use of unrelated donors and haplo-identical (half matched) donors for those lacking full matched family donors.

We have one of the largest experiences of half matched transplants using never techniques like TCR Alpha/Beta depletion with excellent results, adds Dr. Sunil Bhat.

Currently, BMT is not covered under government health schemes like Vajpayee Arogya and Ayushman Bharat and a fraction of the support is available only through the PM / CM fund.

Narayana Health is working towards making a representation to the state government to include BMT under the national health scheme that will help bring a larger group of beneficiaries under the treatment modality.

Dr. Sharat Damodar, Clinical Director – Mazumdar Shaw Medical Center and Sr. Consultant Hematologist & Head – Bone Marrow Transplant Unit, NarayaA Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM SURGERY

NEW TECHNIQUE DEVELOPED

BY INDIAN DOCTORS TO IMPROVE TREATMENT OF PTOSIS

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new study published in the top American Journal ‘Plastic and Reconstructive Surgery’, published by the American Society of Plastic Surgeons, has shown that outcomes in Ptosis or droopy eyelids can be significantly improved by modifying current surgical approaches and performing an additional procedure on the upper lid of the eye.

The study conducted by eminent facial plastic surgeon Dr Debraj Shome and researchers at The Esthetic Clinics from India also points out that commonly performed techniques may not yield results which are as good as the new technique.

The study was carried over a period of 5 years between 2011 and 2016 on 100 patients, with ptosis (droopy eyelid) in one eye, since birth. The surgeries were conducted on 2 groups of 50 patients each with only one group receiving the newly modified surgery, incorporating an eyelid crease. By incorporation of an additional lid crease incision, the modified surgery technique addressed symmetry between the eyes and enhanced medical outcomes resulting in superior aesthetic appeal and greater patient and doctor satisfaction rates.

Dr Debraj Shome said, “While many surgeries have been performed in the past to rectify Ptosis, our technique is unique as it suggests modifying the commonly performed current surgical approaches, to include a carefully crafted eyelid crease. This makes the eyelids look more symmetrical, thereby lending both eyes a more balanced look. In droopy eyelids, Ptosis surgery gets the upper eyelid to be elevated and the Upper eyelid margin position is very important to grade the success 52 Medical Tourism Oct. - Dec. 2018

of Ptosis surgery. However, that is not and should not be considered the only gradient in determining the successful outcome of the surgery. Patients, who undergo product surgery, want symmetrical eyes and a look which appears natural and unoperated! Before our research, the surgery for Ptosis did not involve creating an eyelid crease which meant that while the eyelid would open wide post the surgery, the muscle on the top would bunch up creating multiple folds. This would hamper symmetry with the normal eyelid on the other eye, which would have an eyelid crease. This actually made the operated eye look worse and lowered confidence and satisfaction post-surgery, in patients.”

Dr Shome’s modified surgical technique combines the Tarso-frontal sling surgery (attaching a band to the forehead muscle) to raise the droopy eyelid, along with eyelid crease formation performed to address symmetry between the eyelid creases.

Dr Shome warns, “Babies born with severe Ptosis are especially at risk of permanent vision damage, unless timely corrective surgery is undertaken. Children with milder Ptosis without impaired vision can wait till 5, but surgery is imperative if the parents don’t want their children to grow up with permanent visual impairment.”

Ptosis or when the border of the upper eyelid sags to a lower position than normal is a common condition that afflicts people of all age groups. It occurs due to presence of a weak eyelid muscle as a result of which lifting the eyelid becomes difficult. While it might not always be a cause for worry, it does spoil the overall look of the face making the eyes look asymmetrical and crooked. However, when the drooping eyelid covers all or part of the pupil, it can interfere with vision.

Ptosis can be caused by many factors ranging from natural to more serious medical conditions. Anyone can get droopy eyelids—there are no substantial differences in prevalence between men and women or between ethnicities.

Dr Shome explains, “When the levator muscle, responsible for lifting the upper eyelid, stretches and weakens due to age it causes the eyelid to droop. In babies, the muscle is dystrophic or does not develop properly, so it doesn’t work at all.”

Dr Debraj Shome is a celebrity facial plastic/ cosmetic surgeon and director, The Esthetic Clinics, Mumbai. He recently performed the first ever nasal reconstruction on a patient suffering from a rare genetic disease known as ‘ectodermal dysplasia’ using the rib cartilage.

Facets Dental, Kochi, Kerala, India Tel. +91 90 20 20 2000, +91 90 20 160 160 drsebys@gmail.com, www.thefacets.com

Dr. Seby Varghese

Zirconia Crown/Cap

Ceramic Crown/Cap

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Cleaning

Filling

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MEDICAL TOURISM HEALTH

PREVENTION AND TREATMENT OF LIVER CIRRHOSIS

Liver is the largest organ in the body having wide range of functions. It will keep working even if badly damaged, and can continue to repair itself until it is severely damaged. Dr. V. Anantha Narayanan, Retired Professor of Gastroenterology at Amritha Medical Institute, Kochi explains the diseases that affects the liver with particular focus on Cirrhosis.

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he liver is the largest organ in the body and it is located in the right upper abdomen. It is a vital organ and has a wide range of functions. It helps digest food, stores energy and removes poisons. It has a major role in metabolism, including regulation of glycogen storage, decomposition of red blood cells, plasma protein synthesis especially albumin and proteins necessary for coagulation functions, production of certain hormones, and detoxifica54 Medical Tourism Oct. - Dec. 2018

tion of toxic substances and their removal. Bile necessary for fat digestion is synthesised by the liver.

There are many kinds of liver diseases that affect these functions. Viruses can cause acute hepatitis; drugs and poisons can damage liver. Non-alcoholic fatty liver diseases due to overweight, lack of exercise, diabetes, etc., are causes affecting the liver.

Heavy, regular and long-term drinkers are much more likely to develop cirrhosis, compared to other healthy people. It is a myth that only alcoholics are at risk – regular and heavy social drinking is also linked to a higher probability of developing cirrhosis.

Typically, heavy drinking needs to be sustained for at least 10 years for cirrhosis to develop. The period varies according to each individual. Regular heavy female drinkers are more likely to develop symptoms compared to men who consume the same amount.

END-STAGE LIVER DISEASE Alcohol can damage the liver in three ways: fatty liver where complete abstinence reverses the condition; alcoholic hepatitis; and cirrhosis of the liver.

ALCOHOL AND LIVER This is a chronic progressive disease of liver in which normal liver cells are replaced by scar tissue. The disease comes on slowly over years and all parts of the liver can be affected. The commonest cause of cirrhosis is alcohol, viral hepatitis B or C, and non-alcoholic fatty liver disease.

Over 40 grams of alcohol for over 3 years can damage the liver in 25% to 30% of drinkers. 10 grams of alcohol is equivalent to 30 ml of hard liquor (whisky, rum, brandy, etc). 10 grams of alcohol is equivalent to 100 ml of wine and 225 ml of beer. World Health Organisation (WHO) reports about 2 billion alcohol consumers worldwide, and 76.3 million people with alcohol-related liver disease.

In India, Kerala is the number one state in terms of alcohol-related cirrhosis. Alcohol causes 2.5 million deaths (3.8 % of total deaths) and 69.4 million disability adjusted life years (DALY), according to WHO. One DALY is equal to one year of totally life lost and is a measure of the burden of the disease.

Heavy drinkers will eventually develop fatty liver. The liver breaks down alcohol into carbon dioxide and water, causing fatty liver. As soon as excessive drinking stops, the symptoms of fatty liver go away. However, 20% to 30% of those who continue drinking heavily will develop alcoholic hepatitis, the next stage. About 10% of heavy drinkers will subsequently develop cirrhosis – the third stage of alcoholic liver disease.

According to National Health Service (NHS), of the United Kingdom, excessive alcohol consumption is when a man drinks over 21 units, and when a woman drinks over 14 units a week.

Toxins, including alcohol, are broken down by the liver.

However, if the amount of alcohol is too high, the liver will be overworked, and the liver cells can eventually become damaged.

In cirrhosis, the liver tissue is replaced by scar tissue and liver functions are deranged. The symptoms and signs of the disease are due to either failure of the liver-cell functions or the result of portal hypertension. The portal vein feeds the liver with absorbed nutrients, and, because of scar formation (fibrosis), the portal vein meets with resistance and the pressure in the portal vein is raised – and this is called portal hypertension. Raised portal pressure causes collateral blood flow and the blood vessels become enlarged, which is called varices, and are more likely to bleed, causing vomiting of blood.

NO SYMPTOMS Cirrhosis often has no symptoms or signs until the liver damage is extensive. The earliest symptoms are fatigue and loss of appetite. Vomiting of blood can occur. Yellowish discolouration of eyes (jaundice), fluid accumulation in abdomen (ascites) and swelling of feet are other symptoms.

If toxic substances are not removed by the liver, substances like ammonia and product of protein metabolism (normally removed by healthy liver) can accumulate and derange cerebral functions and cause personality changes, altered bravery and behavioural changes.

Diagnosis is usually by blood tests. In the case of cirrhosis, liver function tests are deranged. Albumin level goes down (normal above 3.5 g/ dl). Platelets go down, and bleeding time and prothrombin time increases. Ultrasound scan shows a coarse liver with altered echotexture with enlarged spleen, and endoscopy shows varices. Liver biopsy confirms diagnosis, but may not be necessary if there are varices with deranged liver function tests.

CAUSES It is important to determine the cause of cirrhosis because treating that underlying cause can help prevent further liver damage. A wide range of diseases and conditions can damage the liver and lead to cirrhosis. Some of the causes of cirrhosis are inherited or thought to be inherited. They are: A Complete Magazine on Healthcare in Asia

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• Iron buildup in the body (hemochromatosis) • Cystic fibrosis • Copper accumulated in the liver (Wilson’s disease) • Poorly formed bile ducts (biliary atresia) • Inherited disorders of sugar metabolism (galactosemia or glycogen storage disease) • Genetic digestive disorder (Alagille syndrome) • Liver disease caused by the body’s immune system (autoimmune hepatitis) Others occur later in life. They are: • Chronic alcohol abuse • Hepatitis C • Hepatitis B • Fat accumulating in the liver (nonalcoholic fatty liver disease) • Destruction of the bile ducts (primary biliary cirrhosis) • Hardening and scarring of the bile ducts (primary sclerosing cholangitis) • Infection by a parasite common in developing countries (schistosomiasis) Some people may have more than one cause for cirrhosis, such as alcohol abuse and viral hepatitis. If doctors cannot find a cause for the condition, it is called cryptogenic cirrhosis. Up to 20% of people with cirrhosis have cryptogenic cirrhosis.

TREATMENT The treatment of cirrhosis is removal of the cause. If due to alcohol, complete abstinence is a must. If due to viral B or C antiviral treatment, cautiously as in damaged liver, the patient may not tolerate antiviral drugs. Along with that, give liver support with low-fat and easily digestible diet, drugs like Ursodeoxycholic Acid and laxatives for good bowel movements. Amino acids and vitamin supplements as needed.

Once the liver tissues are replaced by scar tissues, the aim of treatment is to arrest progression of fibrosis and preserve the normal liver tissues.

The severity of liver damage is assessed by levels of albumin and coagulation function derangement. There is a scoring system based on the tests called MELD score, and if it is higher than 15, it shows severe damage to liver. And, in end-stage liver disease, the only option is liver transplantation.

PREVENTION Primary prevention aims at increasing awareness, prevention programmes, striving to educate communities about the risks associated with alcohol, and giving clear message about the consequences of drinking. For viral B, immuni56 Medical Tourism Oct. - Dec. 2018

sation is available, and vaccination against Hepatitis B is a must in high-prevalence areas. For Hepatitis C, safe sex practice is necessary. Disposable syringe should be used for injection.

For non-alcoholic fatty liver disease, lifestyle modification, safe diet, avoiding too much of fat, eating plenty of vegetables and fruits, daily exercise, optional control of sugar (if diabetic), and anti-cholesterol drugs (if cholesterol is high) may help in preventing fatty liver.

Liver cancer occurs as a squeal in about 20% of cirrhosis, and, therefore, periodic checkup and taking treatment to arrest progression of disease is vital. With increased awareness among the public, liver health can be improved and cirrhosis prevented to a large extent.

Remember that your liver is very tough. It will keep working even if badly damaged, and can continue to repair itself until it is severely damaged.

POINTS TO NOTE • Cirrhosis is scarring of the liver. Scar tissue replaces healthy liver tissue.

• Some common causes of cirrhosis include heavy alcohol use, hepatitis infections, and non-alcoholic fatty liver disease.

• In the early stages of cirrhosis, one may have no symptoms. As the disease gets worse, cirrhosis can cause serious problems.

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MEDICAL TOURISM STRESS

TACKLE STRESSFUL ENVIRONMENTS AT WORK PLACE Yoga is great for stress as it engages the mind and body. By focusing on the physical poses it allows that inner chatter of your mind to fade as you concentrate on controlling your movement.

S

tress is something that affects us all on a day-to-day basis and it can take many forms, ranging from missing a flight to discovering your favourite supermarket sandwich has sold out.

In severe cases, it can provoke a number of psychological and physical symptoms, such as headaches, chest pain, nausea and anxiety. One of the most common causes of work-related stress is having a challenging relationship with your boss.

A recent study conducted by the US polling company Gallup found that one in two employees have actually left a job “to get away from their manager at some point in their career.”

Some bosses can be particularly demanding, which may result in a fractured work-life balance that can exacerbate pre-existing stress. In a bid to alleviate work-related stress, learning mindful skills such as meditation, which you can use in the office, to help calm yourself down.

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Mindfulness involves being as conscious as possible of your surroundings and has been said to boost productivity, curb anxiety and even improve romantic relationships.

When conducted properly via things like meditation, mindfulness can elicit feelings of calmness that may enable you to drown out some of the stressful work-related noise in your head.

Similar to the concept of work-out buddies, building a community of like-minded people and co-workers who share your passion is important for long- term behaviour change .Employees can champion these efforts by gathering an informal group together and encouraging others to join along.

If we can learn to reframe challenges at work into opportunities to build resilience rather than create stress, we can have a really positive impact on our health and happiness.

If you’re feeling stressed, the best thing for it is to sweat it out. The logic behind it is sound – exercise can clear your

head and release mood-boosting endorphins that will energise you and help you feel less stressed.

Therefore, the best thing to do when you’re stressed is to choose exercises that complement your stress levels. Your exercise should be more mindful, like an active form of meditation – you could try a fast walk, a jog along the river, or try a Yoga class. All can help in trying to centre yourself again. If you’re working with a trainer, you should let them know how you’re feeling so they can adapt your session, depending where your energy is at.

HIIT – high intensity interval training - can help with stress because of its short duration and allows you to get rid of all the nervous energy that you have stored up through excess adrenaline. Yoga is great for stress as it engages the mind and body. By focusing on the physical poses it allows that inner chatter of your mind to fade as you concentrate on controlling your movement.

Lifting weights allows you to focus on the moment and forget any worries or stress you may have and will allow your feel- good hormones out.

MEDITATION TIPS 1. Stop whatever it is that you're doing.

2. Take some deep breaths and focus on the sensations of your breathing.

3. Observe what is going on and ask yourself four questions: "Who am I? What do I want? What is my dharma or purpose? What am I grateful for?"

4. Proceed with your day and continue to think about your answers to those questions.

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MEDICAL TOURISM DIET

ZERO CALORIE FOODS

21 FRUITS & VEGETABLES TO LOSE WEIGHT

60 Medical Tourism Oct. - Dec. 2018

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besity can be calculated by measuring a person’s body mass index (BMI), a number derived from weight and height which provides a reliable indicator for inferring potential health problems. A BMI above 25 is considered overweight, and anything higher than 30 is considered obese, both of which are at-risk categories.

Eaten as a side dish, in a salad, or simply as a snack, there are plenty of good reasons why so many health professionals urge you to eat your veggies: they’re low in calories, high in fiber, and loaded with essential vitamins. Like fruits, all vegetables impart certain health benefits, so it’s hard to go wrong with them.

ZERO-CALORIE FOODS

Spinach and Leafy Greens, Carrots, Red Bell Peppers, Tomatoes, Celery, and Onions can be considerd zero-calorie.

These six vitamin-rich veggies have an enormous amount of vitamins A and C, and good levels of folate, which aids in cell growth and the synthesis and repair of DNA. They also contain potassium, which is an important electrolyte key in efficient nerve transmission.

A food is considered “zero-calorie” when the calories burned through its consumption and digestion are less than or equal to the total calories in the food itself. Put simply, if a mushroom only has five calories but your body expends 10 calories digesting it, it’s a zero-calorie food.

FRUITS

Many fruits, including Grapefruits, Apricots, Oranges, Tangerines, Strawberries, Watermelon, and Apples, are excellent sources of dietary fiber, which naturally helps your body break down any sugars contained within the fruit itself. Because dietary fibers are more difficult than other food matter for your body to digest, you expend more energy in the digestion process which, in turn, means that more calories are burned.

MUSHROOMS

Apart from being a great pizza topping, mushrooms are excellent is soups, salads, and a bevy of cuisines from East to West. Their high level of vitamin D aids in the absorption of the calcium in that pizza cheese, and they also contain loads of B vitamins, which lighten your mood and give you energy and focus that lasts hours after you’ve eaten.

KELP

All of these fruits are great sources of vitamin C which promotes a healthy immune system and acts as an antioxidant, and a couple (grapefruits and apricots) are excellent sources of vitamin A, which improves vision and skin health. Furthermore, while these seven fruits are all part of a healthy, balanced diet, citrus fruits provide an added benefit in that they may help reduce your risk of stroke.

VEGETABLES

Kelp, a form of marine algae, may be a foreign food to many inland, but it’s truly delicious incorporated with other vegetables, used in soups, as a garnish, or even on its own. Kelp has a unique, salty, and fresh taste with a bite similar to al dente linguine noodles.

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ASPARAGUS, GREEN BEANS, BROCCOLI, AND CAULIFLOWER These four veggies are all great sources of vitamin A, C, and B. Asparagus contains several anti-inflammatory compounds that can help protect you from type-2 diabetes and heart disease. The magnesium and calcium in broccoli can help regulate your blood pressure. Its glucoraphanin, which the body processes into the compound sulforaphane, is also a natural cancer fighter. Cauliflower has anti-oxidant and anti-inflammatory properties, and green beans are so high in calcium that they can satisfy your requirement if you happen to be lactose intolerant.

ZUCCHINI AND SUMMER SQUASH The manganese in zucchini and squash helps the body process fats, carbohydrates, and glucose. In addition, zucchini can help lower your cholesterol and prevent prostate cancer in men with its phytonutrients. Squash lends itself to improving the health of your colon, eyes, and bones.

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MEDICAL TOURISM MEDICAL TOURISM

HUGE SCOPE FOR MEDICAL TOURISM IN INDIA The Indian Medical tourism market is expected to grow from its current size of USD 3 billion to USD 9 billion by 2020. India currently accounts for around 18% of the Global Medical Tourism market. In 2017, India received 4.95 lakh Medical visitors, says E M Najeeb, member of National Tourism Advisory Council & Executive Director, KIMS

W

ellness was a motivating factor for travel among the ancient civilizations. From ancient times Romans, Greeks and other cultures had the quest for wellness. Locations of mineral water springs and sea-side spas were the beginning of wellness travel. India is known for its holistic medicine systems, Ayurvedic spa, Naturopathy, and other wellness therapies. Holistic health management has been accepted widely as a wellness and lifestyle choice. The global wellness sector contributes USD 3.7 trillion to the economy and continues to grow by 10.6%. Now Medical Value Travel has established as a major segment in the wellness tourism sector.

For a country like India with excellent hospitals, world-class doctors, experienced paramedics, Medical Tourism is a great oppor-

64 Medical Tourism Oct. - Dec. 2018

tunity. Knowing its importance the tourism industry and the Government are enthusiastic in promoting Medical Tourism in the country. Agents in India can have tie-ups, associations, and packages from leading Medical Tourism offering hospitals and get on to their own marketing efforts.

The CII - McKinsy report shows that Indian Medical Tourism sector is expected to grow 30% annually. According to a CII White paper, cost is a major factor driving 80% of the Medical Tourists around the world. The comparatively economical medical cost and accredited medical facilities have led to several medical destinations like Singapore, Thailand, India, Malaysia, Taiwan, Mexico and Costa Rica to emerge. Among these locations India is ranked as the second largest in terms of accredited facilities. The Indian Medical tourism market is expected to grow from its current size of USD 3 billion to USD 9 billion by 2020. India currently accounts for around 18% of the Global Medical Tourism market.

In 2017, India received 4.95 lakh Medical visitors.

India has 28 JCI accredited hospitals.

Chennai, Mumbai, Andhra Pradesh, and the National Capital Region are the most favored Medical Tourism destinations in India. Kerala is emerging as a major Medical Tourism destination. Kerala attracts 5-7% of the Indian Medical Tourism and is expected to grow to 10-12%.

In India, 34% of the total Medical Value Travel is from Bangladesh and Afghanistan. Africa, GCC and CIS regions constituting 30% of current share, create maximum opportunity for the Indian Healthcare sector. Medical tourists from these countries favor the South-East Asian Medical Corridors. For Kerala, the GCC countries and Maldives are major sources. The CII White Paper suggests to attract the African, Asian and Middle East Patients and also the domestic Medical Tourist from other regions of the country through effective marketing campaigns supported by the GovernA Complete Magazine on Healthcare in Asia

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ment. Kerala has advanced and sophisticated hospitals of international standards offering world-class treatments at lower cost. Kerala has 26 NABH accredited hospitals and 13 Medical Colleges. Kerala has a great Information Technology advantage. Also the state has most advanced data-com and telecom infrastructure.

Medical Tourism has a great future. Government should give more support to this industry.

Hospitals should be given industry status for power, import of machinery and equipments to make it cost effective. Public Private Participation (PPP) Model should be followed in promoting Medical Tourism. Central Government should help to popularize Medical Tourism through Embassies, and Health Ministries in various foreign countries. Special efforts should be targeted at SAARC countries. We have to do the needful to develop reliable referral contacts to route travelers from across the globe. Top priority should be given to the safety and security of the travelers.

The ‘e-Visa-on-Arrival’ Scheme for tourists from select countries facilitate foreign nationals stay in India for 30 days for medical reasons. In 2016, citizens of Bangladesh, Afghanistan, Maldives, Republic of Korea and Nigeria availed maximum number of medical visas. The Union Government and most of the state Governments are supporting Medical Tourism and are carrying out campaigns.

Kerala has a great opportunity to grow as a recuperative leisure destination in the years to come. The state also has a reputation of its alternative medical therapies like Ayurveda, Sidha, and traditional medicines.

Connectivity to Kerala is excellent through its four international airports and that will support and facilitate Tourism and Medical Tourism in Kerala. Trivandrum and Cochin airports have e-Visa arrival facility offered to about 161 countries which would support Medical Tourism in Kerala.

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Vol.3 | Issue No.2 | Oct - Dec 2018

LUNG CANCER

WHAT YOU SHOULD KNOW?

IMMUNOTHERAPY

ZERO CALORIE FOODS

21 FRUITS & VEGETABLES TO LOSE WEIGHT PREVENTION AND TREATMENT OF

LIVER CIRRHOSIS

IN CANCER TREATMENT

TACKLE STRESSFUL ENVIRONMENTS AT WORK PLACE 1

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MEDICAL TOURISM MEDICAL TOURISM

SHAPING MVT FOR INDIA

There is an opportunity for our country to earn a sizeable amount of foreign exchange by leveraging infrastructure, clinical expertise and quality for the international medical traveller, says Dr. Harish Pillai, CEO – Aster Hospitals & Clinics, India. Aster DM Healthcare. The clear rationale for supporting MVT in Indian hospitals is not just to earn the valuable foreign exchange but also to cross subsidize the domestic patients.

A

s the seventh largest country in the world, India stands apart from the rest of Asia, marked off by mountains and the sea, which give the country a distinct geographical entity. It is bounded by the snow covered Great Himalayas in the north, stretches southwards towards tropical rain forests and tapers off into the Indian Ocean between the Bay of Bengal on the east and the Arabian Sea on the west. Therefore, the country offers a vast range of tourism choices, diverse in land and nature, people, cuisine, faiths, music, arts, dance forms, crafts, adventure, sports, spirituality, history; which vary from one state to another. The World Travel & Tourism Council estimated that tourism generated an amount 68 Medical Tourism Oct. - Dec. 2018

equivalent to 9.4% of India’s GDP and 8% of total employment of India in 2017. With the sector predicted to grow at the rate of 6.9% per annum, revenues from tourism is are expected to touch USD 450 Bn. While the Ministry of Tourism maintains the Incredible India! campaign focused on promoting the tourism in India, concerted efforts are being made to promote niche tourism products such as rural, cruise, medical and eco-tourism.

Medical tourism is the convergence of foreign tourist arrivals and the requirement of medical assistance wherein the leisure aspect as well as the healthcare experience have an equal weightage. In October 2015, India's medical tourism sector was

estimated to be worth US$3 billion, and it is projected to grow to US$7–8 billion by 2020. Unaffordable costs of healthcare and limited coverage for all treatments in countries like US, UK, despite having the best of facilities, drive underinsured and uninsured patients to seek medical assistance in other countries. There is also the factor of increased waiting times of healthcare facilities in regions such as the Middle East, portions of Africa, etc., that can pay but lack quality care and talent. Additionally, accreditation amongst healthcare facilities provides quality conscious patients confidence and security on clinical outcomes. While the JCI is considered the gold standard in healthcare and is globally recognized, hospi-

tals certified by the national boards like NABH also tend to meet global standards in clinical outcomes and processes.

A Medical Value Tourist is required to interact with multiple stakeholders right from the point of referral till returning to his / her home country.

These stakeholders can broadly be identified as providers, facilitators, accreditation agencies, government, insurers and regulators. They have a major role in determining the quality of experience of MVT patients and their family members. India is also considered as a preferred destination for cardiology, orthopaedics, transplant and ophthalmology in curative care. India also enjoys high credibility in wellness, preventive and

alternative medicine. The Medical Tourism Market Report: 2015 found that India was "one of the lowest cost and highest quality of all medical tourism destinations, it offers wide variety of procedures at about onetenth the cost of similar procedures in the United States. Chennai, Kolkata, Mumbai, Hyderabad, Bangalore and the National Capital Region receives the highest number of foreign patients primarily from South Eastern countries. Russia and the Commonwealth of Independent States (CIS) accounted for 30% share of foreign medical tourist arrivals. Other major sources of patients include Africa and the Middle East, particularly the Persian Gulf countries.

nity presents itself for the country to earn a sizeable amount of foreign exchange by leveraging infrastructure, clinical expertise and quality for the international medical traveller.

The clear rationale for supporting MVT in Indian hospitals is not just to earn the valuable foreign exchange but also to cross subsidize the domestic patients. The incremental revenue offered by international patient facilitates better investments in infrastructure, technology, and staff training what will naturally benefit all domestic patients. If you look at some of the recent legislative changes that have taken place, while overall it is for the benefit of the common man, the lack of consensus amongst all stake holders, especially the providers do pose a practical challenge. In the recent past, policies implemented by the National Pharmaceutical Pricing Authority on Cardiac Stents; the implementation of minimum wages in the health sector are some that may pose to be detrimental for this sector.

We hope that the Government of the day will relook at the impact of such policies frequently and tweak it appropriately for the benefit of the sector overall. Some of these decisions puts India at a distinct disadvantage versus free market competitors of MVT such as Thailand, Singapore or Malaysia. If the perception grows that good quality and new trends in healthcare are not available in the Indian market, we are bound to lose a sizeable amount of niche market to competition in the neighbourhood.

Unfortunately, the current level of pricing prevalent for a medical value traveller must be revised, thus substantially reducing the gap between us and the competitors. The sector is still struggling overall despite a few positive policy changes being made by the Government of India to attract more Medical Value Travel visitors to enter our country. All stakeholders need to have a unified vision and not look at short term gains to make our country an effective Asian giant in the field of MVT

It is therefore clear that an opportuA Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM HEALTHCARE

DESTINATION KERALA Kerala is fast becoming the favourite healthcare destination for foreigners seeking treatment abroad. The south indian state is already well recognized for its much advanced hospital facilities with well-qualified doctors and paramedical staff. Modern and traditional medical treatments,, moderate weather, ideal locations for a relaxing holiday and a high standard of hygiene make the state more attractive for a visitor.

Dr. Arun oommen looks at the potentiality of kerala becoming soon the most sought-after healthcare hub in asia.

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hanks to a multitude of ultramodern superspeciality hospitals and other healthcare facilities cropping up in different parts of Kerala, it is becoming a leading healthcare hub, capable of catering to any sort of health problems on earth. More over Kerala is blessed with highly experienced doctors and well-trained healthcare personnel in all ultramodern modalities of healthcare. Kerala is one of the largest producers and suppliers of staff nurses round the globe.

Thanks to the exponential growth of healthcare institutes in the state there is a noticeable increase in the number of Malayali doctors and other health personnel who were serving abroad returning to their homeland, which is really an encouraging sign. Along with all these, a mix of modern and alternative treatment systems, medical staff members who speak English fluently, affordable cost and low waiting time, definitely help Kerala to emerge as the perfect destination for health tourism in the world.

STANDARD OF HEALTHCARE Kerala is one of a few regions in the developing world, which has achieved substantial progress in the realm of education and health . The demographic. morbidity, mortality, epidemiological and health transitions have been substantial and follow a pattern similar to many advanced countries.

The state has become a model Indian state viewed in terms of low birth and death rates, infant and maternal mortality rates. high life expectancy at birth, favorable sex ratio and achievements in public health surveillance.

It is difficult to identify a single factor responsible for the demographic, epidemiological and health transitions in Kerala . Kerala has nurtured progressive policies, social reform movements that had succeeded in awakening a collective consciousness to principles of equity, equality, public policies that involve land reform, welfare schemes, public distribution system and investments in social sectors

such as health and education. Apart from the socio-economic factors, the universally available public health system in Kerala has also contributed to this much acclaimed health system of the people.

Human development Index of Kerala is the highest among Indian states.

It’s because it has the highest literacy rate, highest life expectancy and the lowest sex ratio(male:female).

CAN IT BE A PROMISING HEALTHCARE DESTINATION FOR OVERSEAS PEOPLE? Kerala has emerged as a healthcare destination because of its low cost medical procedures with world class and state-of-the-art treatment facilities. It’s in a position now to provide any advanced surgical and other medical treatments in a cost effective way. Many hospitals in Kerala have the best possible treatment facilities and with the availability of highly qualified and renowned doctors and well trained health personnel, the results produced are at par with developed nations. Globalisation and economic liberalisation have given a boost to the medical service sector in Kerala.

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knee cap replacements, brain and spine surgeries, liver transplants, and cancer treatments are some of the most sought out medical tourism procedures opted by foreigners.

THE ADVANTAGES As of now Kerala is capable of handling any sort of healthcare problems.

The results produced are also at par with the best in the world. Moreover this world class treatment is done at only 15-20 per cent of the cost of treatment in the US, UK and other European countries which is remarkable. For e.g, a liver transplant surgery which costs around $2,50,000 in the US can be done here at 1/6th of the cost there, producing similar results. Similarly a major brain tumour surgery which can cost around $50,000 in the West can be done here at just 1/10th of that cost with similar results if not better. A bone marrow transplant costs around $3,00,000 in the US but here it can be done at 1/10th of that cost. An open heart surgery which costs $50,000 72 Medical Tourism Oct. - Dec. 2018

can be done here at 1/10th of that.

A knee replacement surgery costing $20,000 can be done at 1/4th of that cost.

Medical tourism to Kerala is not just cost savings or the high standard of medical care facility, but even the waiting time for surgery treatment procedures in Kerala is much lower than in any other country.

There is an extensive network of medical care institutions practising homeopathy, Ayurveda , Unani, Acupuncture, Naturopathy, Holistic care and Yoga therapy. The indigenous medical systems particularly Ayurveda has been dominant and contributed significantly to public health and overall health transition in Kerala. Kerala is one of the very few areas in the world practising Ayurveda authentically.

Many foreigners are aware of the natural and herbal rejuvenation therapies of Ayurveda and are seeking treatment in large numbers. The Ayurve-

da resorts and Yoga centers are best in the world and pamper the tourists physically, mentally and emotionally.

As we all know Kerala is a unique destination for all types of tourists visiting this beautiful state. Along with medical tourism you can also tour the wonders of Kerala , experience the beauty of backwaters and cruises, exotic wildlife ,multitude of hill stations, sea kissed beaches, lush green forests, archaeological monuments, ancient places of worship, shopping extravaganza and mouth-watering cuisine . Availability of a multitude of budget-friendly accommodation options near to the best hospitals for the family members accompanying the patients is an added advantage. The state is well connected with different parts of the world. There are four international airports. There is a well connected rail , road and water transport system.

It has a moderate weather throughout the year, The tropical climate of Kerala is best suited for any medical

treatment and rejuvenation therapy.

It also maintains high standard of hygiene.The people of the state are wellversed in English, hence foreigners may not find any language problem.

Also there are professional language translators in Arabic. French, German, Italian etc , whose services can be availed easily. Health insurance companies are beginning to play a major role in promoting Kerala’s healthcare.

In an attempt to rein in exploding medical costs, a growing number of health insurance companies are offering their customers, both individuals and employers, an opportunity to get their healthcare in places like Kerala where treatment cost is much less but without compromising on quality and facilities. Those who have a high deductible plan which covers both treatment and transport cost may find medical tourism economically worthwhile, and the savings to them is considerable as well.

Kerala NRIs are spread all over the world and can function as goodwill ambassadors and advisors to the foreign patients. They have always played a pivotal role in the health tourism sector of their native land. Innumerable health group giants have already made their mark in the state by setting up numerous health care institutes thereby contributing to the overall improvement in the standards of healthcare services available in Kerala. With only 3 per cent of India's population, the tiny state provides twothirds of the country’s palliative care services. The Kerala government has a palliative care policy (it is the only Indian state which has such a policy) and funding for community-based care programmes. Kerala has also extended the definition of palliative care to include the longterm chronically ill and even the mentally incapacitated.

At present medical tourism in Kerala is growing at the rate of 30 per cent each year. With more and more hospitals getting accredited and recognized internationally Kerala is gearing up to become the undisputed health hub of India by 2020.

WHAT KERALA OFFERS …  Medical history emailed and discussed  Patient received at the airport, an escort takes over.  Transferred to a hotel or resort.Escort takes the patient to the hospital as per appointment with doctor and admits into the hospital.  Surgery or treatment conducted. Discharge and recuperative holiday at a resort.  Post treatment check up, transfer to airport and departure.  Billed as a package all inclusive for the patient and accompanying person.

Dr. Arun Oommen is a renowned Neurosurgeon working at Lakeshore hospital and research centre, Kochi, India. Here he gives a brief outline regarding the ‘Upsurge of medical tourism in Kerala, India’.

Dr Arun Oommen MBBS, MS ( Gen Surgery), Mch( Neurosurgery), MRCS Ed, MBA Consultant Neurosurgeon VPS Lakeshore Hospital and research centre www.arunoommen.com A Complete Magazine on Healthcare in Asia

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