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Concerns About A Medical Treatment in India
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Poor Infrastructure
The country’s infrastructure is poor and leaves much to be desired. A first time visitor when landing at any of India’s major airports is often shocked when confronted by the poverty, poor hygiene and low availability of facilities that US residents take for granted.
But like anything else about India, this first impression will tell part of the story. India has a 300 million strong, vibrant and demanding middle class and a small but more demanding upper class. A recent article in Business Week magazine tells us that "Some 83,000 Indians today have liquid assets greater than $1 million, up from 71,000 two years ago, American Express Co. AXP estimates, and their numbers are increasing by 13% a year."
Services are fast emerging to cater to this select section of society. World Class airlines, hospitals, shopping malls etc are coming up right next to the third world facilities that still exist. A visitor to India has to know how to navigate the country making use of the world class facilities. This site can help guide you.
Problems navigating the legal systems
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. Victims of a crime in India, including loss or theft of a passport, should obtain a copy of the police report (called an "FIR" or "First Information Report") from local police at the time of reporting the incident. A copy of this report is helpful for insurance purposes in replacing lost valuables, and is required by the Indian Government in order to obtain an exit visa to leave India in the event of a lost or stolen passport.
The US State Department has additional information on its web site
Language issues
Each Indian state has a distinct linguistic identity. Hindi is most commonly spoken in Northern India. Then there are countless number of dialects. The good news for a traveler is that one of the legacies of British rule for almost 150 years, the use of English is also widespread. For example, two Indians who don’t have a common Indian language between them will be very likely to speak in English.
However, do not assume that everyone speaks English or is comfortable speaking with you in English. It’s always a good idea to ask if the other person speaks a little English. However, in the big cities, you should always find yourself close to a person who speaks sufficient English. Don’t be surprised even if everyone you meet does speak perfect English.
Distance from you primary care physician back home
You will probably feel much better if you stay connected to your Primary Care Physician (PCP) back in the US. You will need to plan for this. Make sure your doctor has a copy of your medical file and all the ways to contact you. Alternately, make sure you review your case with him and ask if you may call him on his cell phone from overseas if needed.
Given the increasing popularity of medical treatment in India, your doctor may be able to help make the selection. Also, since a large number of doctors in the US were born in India and maintain close ties to relatives in India, they may be familiar with the hospitals you are considering and may be able to guide you further.
Other diseases and potential infection risks
There are currently no REQUIRED vaccines or immunizations that you need prior to leaving. However, the CDC makes the following recommendations for India. (Visit http://www.CDC.gov for more information).
- Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
- Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants.
- Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis.
- Malaria: your risk of malaria may be high in these countries, including cities. See your health care provider for a prescription antimalarial drug.
- Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities.
- Typhoid. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors Vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region. There have been recent reports of typhoid drug resistance in India and Nepal.
- As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults.
However, all these risks should be taken in the right perspective. A report in 1999 by the Institute of Medicine that found nearly 100,000 people die accidentally in U.S. hospitals each year.
But Consumer Reports warns that people "should know the risks" involved in having surgery in a foreign country, such as "uncertain regulation, lack of background information on surgeons, lack of follow-up care and difficulty suing" a foreign physician or hospital.
In subsequent chapters, we will provide the information that will guide you to perform your own research to minimize some of these risks as much as possible.
Unknown hospitals (to you anyway!)
It’s perfectly natural to be apprehensive about the hospitals and facilities that are on the other side of the world. Our section on Researching your options gives you a checklist of the attributes to look for in a hospital. If it is a quality hospital, it should have some accreditation. If that information is not easily available on the web site, ask the hospital.
Accreditation is a process in which an entity, separate and distinct from the health care organization, usually non-governmental, assess the health care organization to determine if it meets a set of standards requirements designed to improve quality of care. Accreditation is usually voluntary. Accreditation standards are usually regarded as optimal and achievable. Accreditation provides a visible commitment by an organization to improve the quality of patient care, to ensure a safe environment and to continually work to reduce risks to patients and staff. Accreditation has gained worldwide attention as an effective quality evaluation and management tool.
The Joint Commission was founded in 1910 with a mission to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.
In response to growing interest in accreditation and quality improvement worldwide, the Joint Commission launched its international accreditation program in 1999. Joint Commission International accreditation standards are based on international consensus standards and set uniform, achievable expectations for structures, processes and outcomes for hospitals. The accreditation process is designed to accommodate specific legal, religious and cultural factors within a country.
Joint Commission International (JCI) accreditation can help international health care organizations, public health agencies, health ministries and others to evaluate, improve and demonstrate the quality of patient care in their nations.
The Joint Commission evaluates and accredits nearly 15,000 health care organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation’s predominant standards-setting and accrediting body in health care. Since 1951, The Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commission’s comprehensive accreditation process evaluates an organization’s compliance with these standards and other accreditation requirements. Joint Commission accreditation is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. To earn and maintain The Joint Commission’s Gold Seal of Approval™, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. (Laboratories must be surveyed every two years.)
(Source: JCI International web site)
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