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Medical tourism industry

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Medical tourism industry, which is estimated by the World Health Organisation to be worth $100 billion – is projected to grow by up to 25 per cent year-on-year for the next 10 years. This is according to s report by VISA and Oxford Economics. It says that three to four per cent of the world’s population will travel internationally for treatment. Here is a list of the top medical destinations across the globe according to Medical Tourism Index in the International Medical Travel Journal.

SINGAPORE
Singapore is one of the most developed countries in the world, maintaining the top spot in the World Health Organisation’s ranking of healthcare in Asian countries.
According to Bloomberg, Singapore is among the top countries with the most efficient healthcare systems in 2014, above 50 other countries. Seeking health care in Singapore saves a patient 25 per cent to 40 per cent of what they would have spent on the same services in the US.

INDIA
India is one of the key players in the medical tourism industry as it strives to provide health care services with cutting-edge technology. Healthcare in India saves patients around 65 per cent to 90 per cent of the money they would have spent on similar services in the US, making India one of the most visited countries for health care. Additionally, in India, there is close to zero waiting time, as scheduling surgery or intervention is done quickly once the diagnosis is confirmed.

TURKEY
Turkey is a strong contender in the medical tourism market. Turkey boasts zero waiting times, affordable and quality healthcare delivery. It has a huge number of specialists specifically in transplants, radiation therapy for cancer, orthopaedic surgery, neurosurgery, and genomic medicine.What’s more, the country’s national carrier, Turkish Airlines, offers flight rates at discounted prices to medical travellers.
Cost of receiving quality healthcare in Turkey is 50 to 65 per cent lower than in the United States. The European country’s friendly visa regulations have spurred the sector as patients from Asia and Africa also access medi-care in Istanbul or Ankara.

BRAZIL
WHO ranks Brazil as the best in healthcare delivery in Latin America. Brazil has 43 hospitals accredited by JCI and has world-renowned surgeons. Brazil is the third most visited country after US and China for cosmetic and plastic surgery. Brazil offers high quality cosmetic and plastic surgical services at affordable rates. Florianopolis and Sao Paulo are two cities in Brazil best known for cutting-edge medical technology, medical advances, and innovation. Health travellers from the US save 20 to 30 per cent on health cost if they receive their health treatment in Brazil.

Mexico
Mexico is most reputed for advanced care in dentistry and cosmetic surgery. It has 98 hospitals accredited by the country’s Federal Health Ministry and seven JCI accredited hospitals.Medical care in Mexico saves a patient 40 to 65 per cent compared to the cost of similar services in the US. With the availability of a large pool of specialists, trained in US and Canada, this country is fairly well resourced to take care of internal and external patients in need of health services.

Malaysia
Malaysia has won the number one spot in the International Medical Travel Journal’s award for “Health and Medical Tourism Destination of the year” in 2015 and 2016. Malaysia ranks among the best providers of healthcare in all of South-East Asia. Health travellers save 65 to 80 per cent on health cost compared to the cost of treatment in the US.
The Eastern Asian country offers excellent patient comfort with five-star rooms that look more like hotel suites than hospital rooms. In Prince Court Medical Centre, for example, there are indoor pools for hydrotherapy.

Thailand
Having the highest number of internationally accredited hospitals in South-East Asia, Thailand draws a good number of medical travellers each year.
The country has advanced dental as well as cosmetic and dermatological procedures. Bumrungrad International Hospital in Bangkok, accredited by Global Health Accreditation for medical services, is one of the best hospitals in Thailand, providing advanced healthcare services to more than 400,000 medical tourists annually. Medical services in Thailand save a patient 50 to 75 per cent on medical expenses they would have incurred for similar services in the USA.

Costa Rica
The Central American country has been ranked high in dentistry and cosmetic surgery, above Canada and US, consistently in the last few years.
The country is also building a name in the fields of eye surgery, cancer therapy, and bariatric surgery.TheCheTica Ranch, located in San Jose, provides exotic recovery retreats for medical travellers who relish recovery in a relaxing ambiance.This ranch is also staffed with highly-trained nurses to cater to the medical needs of these patients as they recover. Cost of healthcare services in Costa Rica is 45 to 65 per cent lower than in the US.

South Africa
South Africa has highly skilled medical personnel and advanced healthcare infrastructure. It has been making medical advances, with statistics showing that in 2014, between 300,000 and 350,000 tourists from Africa travelled to SA for medical treatment. For Europeans and travellers from the Americas and Asia, South Africa offers an affordable alternative for many cosmetic procedures, thanks to the weak rand. For example, a breast augmentation procedure that costs $8,000 (P85, 948.00) in the UK would cost about $3, 600 (P38, 676.60) in SA, according to Medical Tourism SA, a consultancy firm that offers health care information for medical travellers.

Kenya
The East African country might be a small player in the big health league, however, its centrality and more advanced economy is a plus.
The capital Nairobi has some of the continent’s excellent health facilities, that is, Aga Khan, Nairobi and Karen hospitals who have employed highly skilled personnel and invested in training their employees.
With the planned Universal Health Care earmarked as a major pillar of the Big Four agenda, at least 50 per cent of the more that 150 million people in the region could benefit in the long term.

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Sun Health

SNAKE BITES AMONG TOP KILLERS

Rachel Raditsebe

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Snakebite venom has been placed on the list of neglected tropical diseases that should be given priority. Being in the World Health Organisation’s category A means that snakebites will now get more support, including funding, to assist those afflicted by the potentially fatal bites.

Intensive care specialist at Princess Marina Hospital, Dr Alexei Milan, welcomed the move, saying that snakebite victims will now get more attention and that there will now be more resources to fight snakebites, which kill up to 32,000 people in sub-Saharan Africa every year.

It is estimated that 2.7million bites happen annually, a fifth of these in Sub- Saharan Africa. Apart from this, a quarter of the world’s 400,000 bite-related fatalities occur in the region. These figures are likely conservative as a few snakebite victims make it to statistic-reporting hospitals.

In fact, figures by an NGO – Health Action International (HAI) show that 70% of the cases go unreported. Snakebites can cause paralysis that may prevent breathing; bleeding disorders that can lead to a fatal hemorrhage; irreversible kidney failure and tissue damage that can cause permanent disability and which may result in limb amputation for those who survive the ordeal.

Dr Milan said the biggest challenge is getting the correct anti-venom in a given facility and the risk of stock-outs. Children often suffer more severe effects than adults, due to their smaller body mass.
According to local snake handler, Aaron Tsatsi, antivenoms work depending on the type of snake that bit you and where it is found. The science of producing antivenom, according to experts, involves extracting venom from snakes and injecting it into animals, such as horses.

The injected animals’ immune systems produce antibodies that neutralise the venom. These can be extracted and stored for later use on human victims who are bitten by that particular snake species.

Botswana has about 72 species of snakes and while about 80 percent of them are not venomous, a number of them are deadly including like the Puff adder, Black mamba, the poisonous Mozambique Spitting Cobra and Boomslang among others,.

Tsatsi says health workers should be aware of these in order to offer effective treatment. “To be able to help, health workers need to know what snake bit a person depending on the symptoms that they show.

“We are not telling them to go into forests and start searching for snakes,” he says,” but they need to know that for some bites you do not need any treatment because it was a dry bite or they are just not poisonous”.

Tsatsi advises people to try as much as possible to avoid bites first by changing their attitude of attacking and killing snakes when they spot them. He explains that most of the snakes, even the most poisonous, are peaceful and will not strike unless provoked.

He recommends that people move away once they spot a snake. If it spits venom in one’s eyes, he adds, they should be rinsed immediately with water. He says once bitten, all tight items on one’s body should be removed and the wounded area left alone.

Then, he adds, the patient should also be made to lie on the ground with the side that has not been bitten to limit movement of the affected area. He warns against lying on the back or use of unsaf traditional treatments. To protect yourself against bites ensure that all holes in your house are closed, cut grass around the house and watchyour steps when in the bush.

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Know Your Specialist

Dr. Emily Shava explains the Antibody-Mediated Prevention (AMP) study

DR Emily Shav

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Enrolment is ongoing in the Antibody-Mediated Prevention (AMP) study. Tell us about that. What is AMP and how exactly does it work?

AMP is a multicentre study being conducted in different countries by two global networks known as HIV Prevention Trials Network (HPTN) and HIV Vaccine Trials Network (HVTN). The AMP study in Sub-Saharan Africa is enrolling women and is also known as HVTN 703/HPTN081 Study. Women because in Africa they are among those at highest risk of HIV infection because of their physiology and gender based imbalances. In this study broadly neutralising antibodies (Bnabs) known as VRC 01 are being studied to see to what extent they can prevent acquisition of HIV-1(efficacy) and to what extend VRC01 can be tolerated by participants (safety).

This is a follow up of previous studies which showed that VRC01 is generally safe and well tolerated (HVTN 104).
It is a double blind randomised placebo controlled trial. This means that participants do not choose which group they are to be on. The study has 3 groups, high dose VRC01, low dose VRC01 and a placebo group. They will NOT know which group they are in and the clinicians consulting them will also not know which group the participants are in. Only the site pharmacy personnel are unblended – they know which product is which. This is important to prevent bias. BHP has engaged and continues to engage various stakeholders (including Ministry of Health and Wellness, DHMT, clinics) and communities through the BHP community advisory board since 2015 when we were selected to take part in this important study. The success we are talking about now would not have been possible had the different stakeholders and communities not been on board.

What is your role in the Study?
I am the study coordinator for the project, responsible for day to day running of the study clinic. The person with overall responsible for the study in Botswana is the site investigator, Dr Joseph Makhema.

Who are the participants in the study? How many people are required and how many have you enrolled so far?
The participants are healthy HIV negative women at risk of acquiring HIV, aged between 18 and 40 years and willing to take part in the study. They should not be pregnant or breastfeeding and should be willing to use effective contraception to prevent pregnancy since the effect of VRC01 on pregnancy is unknown. In Sub-Saharan Africa a total of 1900 participants will be enrolled from Botswana, Kenya, Malawi, Mozambique, South Africa, Tanzania and Zimbabwe. 1555 participants have been enrolled as of the end of April. From Botswana a total of 150 participants will be enrolled.In Botswana the AMP study was activated in July, 2016. The first participant was enrolled on August 16, 2016. To date 236 participants have been screened/checked for eligibility to participate in the study and from these, 122 women have been enrolled and are on study as of May 4, 2018.

Willing participants provide written informed consent after discussion of all procedures, and their risks. The informed consent forms together with the protocol (document that explains how the study is conducted) and other pertinent documents for study conduct are submitted for approval by the Ministry of Health and Wellness, Institutional Review Board (IRB) known as Health Research and Development Committee (HRDC). This is the committee responsible for approval of research conducted in country.

What are the fundamental questions about HIV prevention that the AMP Study is designed to answer?
Are people able to “tolerate” the antibody without becoming too uncomfortable? Does the antibody lower people’s chances of getting infected with HIV? If the antibody does lower people’s chances of getting infected with HIV, how much of it is needed to provide protection from HIV?
When did it begin and when is it expected to end?
In Botswana the study started in July 2016.Total duration of study is 5 years. Each participant stays on study for about two years.

What HIV preventive care do volunteers receive and how are you ensuring the safety of study participants?
Participants come for study visits monthly. During these visits, we do what is called “history taking” from the participants to find out how they are feeling and have been feeling. We examine them and we conduct laboratory tests to ensure safety. To prevent HIV infection, we provide risk reduction counselling and HIV prevention package per Botswana Standard of care

What impact will this study have in the future of HIV prevention?
We generally liken HIV prevention options to a tool box. We currently have various behavioural modification options in this tool box, including abstinence, use of condoms effectively and consistently. It is therefore important to also add more biomedical interventions in this tool box. bNabs would then be an important addition if proven to be effective. This would lead to more combination prevention options. The idea of a toolbox with more tools in it is important because we know that when people have more choices, it increases the chances that an individual will find one tool that fits their needs and circumstances. Those decisions can be influenced by many factors – cost, ease of use, availability/easy access, partner agrees to use, etc. –so having more tools will mean increasing the chance of serving more people’s needs for HIV prevention.

How will the findings benefit Batswana?
I would say that it is too soon to say what direct benefit there may be to Batswana. This trial is about proving the concept that bNabs can prevent HIV. More trials will be needed to find the best antibody, or combination of antibodies, how to best administer them as a public health strategy amongst other things.

We know the strides science has made in the war against HIV/AIDS. There are very effective drugs and that is great news. But what do you say to young people that would say to you that it’s no big deal to get HIV and that there are already good drugs to control the disease as if it’s diabetes?
Prevention is ALWAYS better than cure. We are truly grateful for the strides that have been made in science to avail great treatments for HIV treatment. We do not yet have all the answers about the various great treatments available, time generally brings things to light. Additionally, prevention is more cost effective than treatment or a cure. (Note that in the question, diabetes isn’t cured – it is treated as a chronic illness.) That is important to individuals, and to countries/public health systems.

From your experience, do you believe that there will be an effective vaccine and/or cure for HIV in our lifetime? Is that an achievable objective you think?
Please note that in AMP study, the study agent VRC01 is NOT a vaccine but broadly neutralising antibodies (bNabs). This study could help us develop a safe and effective HIV vaccine more quickly. An HIV vaccine developed more quickly because of this study could essentially teach the body to make antibodies like VRC01 (without getting the VRC01-like antibody through an IV/drip). To develop a vaccine like that we need to understand more about how VRC01 may work, and how much is needed to “work” (to prevent HIV infection). This study should help us learn that. My answer on vaccine in our lifetime would be YES. The Thai Trial, RV144, showed us a vaccine regimen could reduce new infections by about 32%. That wasn’t strong enough to license, but it paved the way for a great deal of additional research. There are 2 efficacy trials currently underway in sub-Saharan Africa testing different vaccine strategies (one of which builds on the Thai results), so we have come farther than ever before.There are various international organisations with scientists whose main focus is the development of the HIV vaccine such as the HVTN, International AIDS Vaccine Initiative(IAVI) etc.

I understand that the HI virus lives not in the blood but lymph nodes and some organs. Is there any research
currently being done to try and flush out HIV from these compartments so that it can be killed by the antiretroviral drugs?
To clarify, when a person is on antiretroviral therapy, the amount of virus also known as viral load in blood will reduce. Generally, if a person is not on treatment the viral load will remain high. For people on treatment with low/undetectable viral load, scientists are looking into ways of flushing out HIV from its hiding places like the lymph nodes termed the “shock and kill” strategy.Currently I am not aware of any such study being conducted in Botswana.

HIV was around for decades before it was discovered and diagnosable and infecting humans during that period. Has anything been learnt from that to prevent a recurrence with another type of retrovirus?
This is a difficult question, yes human beings are capable of learning to better themselves in the future, to what extent, time will tell.

What good news can you give readers of this interview who are living with HIV/AIDS?
If someone knows they are living with HIV, it means they have been responsible enough to take the test and know their status. This needs to be commended. Currently we have available in this country potent antiretroviral treatment with minimal side effects, which means that people living with HIV can have improved quality of life, including sexual reproductive health and live longer.
I would also like to take the opportunity to highlight the importance of universal test and treat and for all HIV infected people to be on treatment and to take the treatment diligently. This is important because a persistently undetectable virus is not transmissible.

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