Medical Tourism

Copyright Medical Tourism Magazine
July 2008
July 2008
Editorial
Where is the Medical Tourism Industry Headed?

On June 16, 2008 the American Medical Association (AMA)
released its Guidelines on Medical Tourism, which set out to
provide parameters for implementation of medical tourism and the
processes that should be involved.
NEW AMA GUIDELINES ON MEDICAL TOURISM

The AMA advocates that employers, insurance companies, and
other entities that facilitate or incentivize medical care outside the
U.S. adhere to the following principles:
a. Medical care outside of the U.S. must be voluntary.
b. Financial incentives to travel outside the U.S. for medical
care should not inappropriately limit the diagnostic and
therapeutic alternatives that are offered to patients, or restrict
treatment or referral options.
c. Patients should only be referred for medical care to
institutions that have been accredited by recognized
international accrediting bodies (e.g., the Joint Commission
International or the International Society for Quality in
Health Care).
d. Prior to travel, local follow-up care should be coordinated
and financing should be arranged to ensure continuity of care
when patients return from medical care outside the US.
e. Coverage for travel outside the U.S. for medical care must
include the costs of necessary follow-up care upon return to
the U.S.
f. Patients should be informed of their rights and legal
recourse prior to agreeing to travel outside the U.S. for
medical care.
g. Access to physician licensing and outcome data, as well as
facility accreditation and outcomes data, should be arranged
for patients seeking medical care outside the U.S.
h. The transfer of patient medical records to and from
facilities outside the U.S. should be consistent with HIPAA
guidelines.
i. Patients choosing to travel outside the U.S. for medical
care should be provided with information about the potential
risks of combining surgical procedures with long flights and
vacation activities.
US that are not accredited by the Joint Commission, yet acceptable

for care. The AMA is implying a higher accreditation standard than
found in many places here in the US.
It is rare for a plastic surgery clinic or smaller clinic to seek
accreditation in the US. But, the vision of the statement is
absolutely correct, meaning, AMAs desire to ensure that patients
are only traveling to hospitals of the highest quality of care. One
problem is their referral to accredited bodies of ISQUA, because
ISQUA accredits accreditation systems and not hospitals. I believe
they meant to say an accreditation system accredited by Isqua is
sufficient.
In July, after almost a year of research and gathering input from
the membership, the Medical Tourism Association is launching a
Medical Tourism Certification program specifically to provide
information to patients about international patient services
offered by Medical Tourism Facilitators. This is not designed to
certify quality, but will serve as a source of information about the
international patient services offered to foreign patients. This will
include things like languages spoken, informed consent forms,
transparency in pricing, transparency in legal recourse and more.
As the industry grows and more hospitals receive international
accreditation for quality, it becomes increasingly more difficult
for patients to know whether a hospital is right for them. If the
hospital has an international patient department, does that hospital
also provide outcomes for its surgeons, transparency regarding
legal recourse, privacy protection for medical records? What about
medical tourism facilitators? Are they more than just a website?
Do they have protocols in place to assist patients with appropriate
aftercare facilities? Do they provide assistance for aftercare? Are
they transparent regarding the price of their services?
The certification for Medical Tourism Programs is valuable
in assisting patients, employers and insurance companies identify
which hospitals and facilitators have benefits suitable for them. The
Medical Tourism Association Certification is not an identification of
the quality of the surgeons or the facility outcomes, rather it focuses
on the international patients services and protocols currently being
utilized and marketed to foreign patients. The certification system
will focus on the Medical Tourism aspect and is not intended to
certify quality or to replace any accreditation system. This new
MTA Certification system complements accreditation systems
currently in place.
These guidelines are not revolutionary, but they provide a very

valuable set of concepts that we all can develop to create a solid
foundation for medical tourism. The Medical Tourism Association
supports these guidelines and intends to communicate with the
AMA to develop them further. From its inception, the MTA has as
its primary tenent, a focus on transparency in quality and pricing,
communication and education. We regularly improve the aftercare
programs of our members and reduce risk of liability for members
by promoting transparency in legal documentation.
The majority of AMA guidelines are common sense, meaning,
it seems obvious that patients shouldnt be forced to go overseas,
that their after care should be resolved prior to traveling and that
the proper disclosures should be made to the patient as to legal
rights and risks. Patients absolutely should have the right to review
information about their proposed surgeons experience and outcomes
and also the hospitals statistics. The new patient is an educated
patient and the medical tourism industry is driven by these educated
patients. This is why transparency is so important.
This is the principal mission of the MTAs Quality of Care
Project, where patients can compare a hospitals quality of care
based upon unified indicators and a uniform methodology. One
problem with the AMAs guideline is found at subheading c,
wherein medical care should only be given by healthcare providers
accredited through internationally recognized accrediting bodies.
The problem with this is there are smaller clinics and facilities in the
Rene-Marie Stephano is Chief Operating

Officer and a Founder of the Medical Tourism
Association, Inc., an international non-profit
organization that serves international healthcare
providers and medical travel facilitators in the
global healthcare industry. Rene-Marie is an
attorney licensed to practice law in the states of
Florida, Pennsylvania and New Jersey and has
a background in litigation and health law. She
is also Editor of the Medical Tourism Magazine, a monthly journal
serving the global healthcare industry by free subscription at
www.MedicalTourismAssociation.com. Rene-Marie may be reached at
Renee@MedicalTourismAssociation.com.
July 2008
The MTA Advisory Board includes
KAREN TIMMONS,
President & CEO of Joint Commission International
JEAN-MARCEL GUILLON,
General Director, FV Hospital, Vietnam
ROBERT K. CRONE, MD,

Former CEO of Harvard Medical International; Huron Consulting, Inc.
DR. PERMYOS RUENGSAKULRACH, MD, PhD,

FRCST, FCCP, Cardiac Surgeon, Bangkok Heart Hospital; Thailand
WILLIAM F. RUSCHHAUPT,
MD, Chairman, Global Patient Services of Cleveland Clinic, Cleveland, Ohio
BOBBY CHIA,
Managing Director, Bangkok Mediplex Co., Ltd., Bangkok,Thailand
JOHN F. HELFRICK,
Senior Consultant, Harvard Medical International; Boston, MA
JOHN A. LINTON,
MD, PhD, Director of International Health Care Center, Severance Hospital,
Yonsei University College of Medicine, Korea
LEE CHIEN EARN,

MD, Senior Director, Healthcare Performance Group Ministry of Health, Singapore
DR. SANDEEPAN BHATIA,

MD, MPH, Johns Hopkins University, Maryland
DR. LEONID ANDROUCHKO,

Professor, International University in Geneva, Switzerland
PRADEEP THUKRAL,
Head of International Marketing at Wockhardt Hospitals Group; Mumbai, India
MASSIMO MANZI,
Chief of Staff, Minister for Competitiveness, Government of Costa Rica
GRANT R. MUDDLE,
Sr. VP of Operations, Apollo Hospitals, Bangalore, India
DR. UWE KLEIN,

General Manager, Europe Health, Munich, Germany
ASHOKE CHAKRABARTTY,
Dy. General Manager - Biomedical Engineering, Indaprastha Medical
Corporation Ltd., New Delhi, India
MERI BAHAR,
Deputy General Manager, Marketing, Acibadem Healthcare Group, Istanbul, Turkey
DATUK MOHD RADZIF MODH YUNUS,
Chief Executive Officer of Institut Jantung Negara SDN BHD, Kuala Lumpur,
Malaysia
URSULA FRIEDSAM,
Managing Director, Pro Health Complete Care Service, Munich, Germany
DR. FAWZI AL-HAMMOURI,
Chairman of the Private Hospitals Association, Amman, Jordan
DR. PREM JAGYASI,
Chief Strategic Officer, Medical Tourism Association, Dubai,
United Arab Emirates
DR. GIRISH JUNEJA,
Managing Director, Life Line Medical Services, Inc., Canada
MICHAEL KELLEN,
Senior Vice President Strategic Development, Assurant
WAYNE BRUCE,
Chief Executive, Ccentric Group, Australia
DR. OTTMAR SCHMIDT,
Director Marketing and PR, Welcare World Health Systems, Dubai,
United Arab Emirates
RENU GIDOOMAL,
Managing Director, Wellness Global Solutions
SEBASTIAN VIRAMONTES,
Commercial Director, Hospital San Jose Tec de Monterrey,
Monterrey N.L., Mexico
JOHN F. P. BRIDGES,
PhD, Assistant Professor at Johns Hopkins Bloomberg School of Public Health;
Baltimore, Maryland
ELIZABETH BOULTBEE,
Head of International Business at HCA International Hospitals; London, U.K.
DR. B.K. RANA,
Deputy Director, National Accreditation Board for Hospitals and Healthcare
Providers (NABH), India
July 2008
KURT WORRALL-CLARE,
Advocate, Hospital Association of South Africa
DR. SHIN-HO LEE,
Executive Director for Industry Support for Korea Health Industry Development
Institute, Seoul, Korea

JULIO CESAR LOPEZ,

Sales and Provider Relations for Hospital Christus Muguerza
Monterrey, N.L., C.P., Mexico
FATMA ABDULLA,
Chief Strategy Officer of Dubai Healthcare City; Dubai, United Arab Emirates
BRAD COOK,
International Benefits Director at Hospital Biblica Clinica; Costa Rica
KENNETH MAYS,
Hospital Marketing Director, Bumrungrad, Thailand
DR. SANJIV MALIK,
Regional Director, Max Healthcare; India
JONATHAN EDELHEIT,
President, Medical Tourism Association, Inc.; Palm Beach, Florida
RENEE-MARIE STEPHANO,
Esq., General Counsel for Medical Tourism Association and
Editor of The Medical Tourism Magazine
CYNTHIA L. CARRION,
Assistant Secretary, Philippines Department of Tourism; Philippines
STEPHEN M. WEINER,
Esq., Chairman of the Health Law Practice of Mintz, Levin, Cohn, Ferris,
Glovsky & Popeo, P.C.; Boston, Mass.
SCOTT A. EDELSTEIN,
Esq., of Counsel at Squire, Sanders & Dempsey, LLP; Washington D.C.
DANIEL BONK,
Executive VP ~ Central Region, Aurora Healthcare; Wisconsin
MARY ANN KEOGH HOSS,
Professor at Eastern Washington University; Washington State
July 2008
Medical Tourism
AT A GLANCE
EDITORIALS
New AMA Guidelines on Medical Tourism
On June 16, 2008 the American Medical Association (AMA)

released its Guidelines on Medical Tourism, which set out
to provide parameters for implementation of medical tourism
and the processes that should be involved.
BY RENEE-MARIE STEPHANO
Defining Medical Tourism or not?
The Globalization of Healthcare or Global Healthcare has so

many definitions it is difficult to remember them all, let alone
list them here. First of all, this term has little or nothing to do
with Medical Tourism, and Medical Tourism is actually a side
effect or after effect to the Globalization of Healthcare.
BY Jonathan Edelheit
FEATURES
Philippine Quality Healthcare: Excellence is the
Standard
21
The countrys world-class physicians and its medical facilities

using modern technology are good banners for its medical
tourism program. Yet, add to this the Philippine brand of health
care one that is summed up as tender loving care, one is
led to conclude that there are more than enough compelling
incentives to seek medical attention in the country through the
medical tourism program.
Medical Tourism Economic Report
32
Exceeding Expectations:
Health and Wellness in the
Philippines
38
In the Philippines it seems as if they are trying to build a

sustainable international Medical Tourism culture. It seems that
the Philippines has many opportunities to take advantage of the
estimated, over $40 billion dollar Medical Tourism industry.
For this country, 700,000 medical tourists and US $2 billion
annually seems very achievable in the very near future.
The availability of evidence-based, customized,

and optimized executive checkup packages that are
designed for the unique health history, habits, and
situations of every individual is what makes The
Medical Citys Wellness Center more effective,
less time-consuming and less expensive. Now
patients no longer need to undergo every medical
test regardless of their specific need.
By The Philippine Ministry of Tourism
By David G. Vequist and Erika Valdez
SEAIR Partners with PMTI to Boost Medical Tourism

in the Philippines
40
SEAIR has partnered with Philippine Medical Tourism,

Incorporated (PMTI) to open the Philippines to the world as
a medical tourism destination. By making the remote islands
accessible, medical tourists have numerous destinations to
choose from, giving them access to the countrys beautiful
islands.
A date with the Villareals for the dream set of teeth
28
The Philippines boasts of a large number of medical and

dental specialists, many of whom are trained in the U.S. at the
highest levels and provide treatment at a fraction of the cost
in developed countries.
By Dr. Hermogenes P. Villareal
CebuMore than the Usual Medical Tourism
44
It is the top tourist destination in the country and, next to the

capital (Manila), the most accessible point in the Philippines
with the most number of air and sea linkages. It is known as
the Philippines Bestseller and, until recently, its best keptsecret for attracting multitudes of tourists, traders, investors,
educators, students, and professionals to the country.
By Cebu Health & Wellness Council
Fortifying Western Healthcare with Traditional

Chinese Medicine
42
The synergy of the research-based Western Medicine and 3,000

years of Traditional Chinese Medicine is the latest approach of
healthcare programs. It is now being used in modern healthcare
commonly known as Integrative Care.
By Dr. Ferdinand P. Lukban
July 2008
July 2008
Medical Tourism
AT A GLANCE
Bone Marrow Transplantation in Downtown Makati
18
Makati Meds BMT Unit, like the rest of the Cancer Center, is
equipped with the latest machines using progressive technologies
and run by doctors and nurses who are all board-certified and
specially trained.
By Dr. Francis F. Lopez
Taking Excellence to Heart
24
A properly designed cardiovascular unit is one of the factors that

spell the difference between procedural success and failure. The
location of the components of a cardiovascular unit, such as the
operating room (OR), cardiac catheterization laboratory (Cathlab)
and intensive care unit (ICU), must be integrated to enable the
unit and its staff to operate smoothly and efficiently.
By Eric Michael Santos
Balance: Mind, body and soul
30
Amid the Philippines easy tropical setting, the Filipino peoples

hospitality and effervescence lighten up the hearts of visitors
who come for therapy and rejuvenation.
By Cynthia L. Carrion
An Unparalleled Legacy
36
COLUMNS
JCI CORNER
JCI Standards Address Physician Competencies
12
The concept of medical tourism in the Philippines was still a

decade away when the Beverly Hills Advanced Surgery Institute
(BHASI), first opened its doors in Beverly Hills in 1996 to
patients seeking safe, state of the art cosmetic surgery.
By The Beverly Hills Medical Group
JCI standards require doctor continually look for any data

suggesting a physician has a high number of undesirable outcomes
such as a large number of patients with surgical complications,
returns to the surgical suite, or post-operative infections, and
determine the cause of these problems immediately.
By Karen Timmons
BINA BUZZ
aBuzz about the Congress
St. Lukes Heart Institute

At the forefront of patient care
34
Patients with heart disorders have entrusted their medical care

to St. Lukes Heart Institute for the past 21 years. It exemplifies
St. Lukes Medical Centers unequalled excellence in expertise,
technology, quality of healthcare outcomes, and service for total
quality patient care.
Eye Republic
46
After weighing pros and cons, its good to know that there are
world-class eye care facilities, offering inexpensive, modern
treatment in the Philippines. When costs may be reduced by half
and a nice vacation in a desirable destination gets thrown into
the deal, Philippine medical tourism is considered for corrective
eye surgery.
By Dr. Manolette Roque
64
July 2008
The Medical Tourism Association has put forth an exciting

invitation to the world for Global Healthcares Coming Out Party.
Up to a thousand attendees from around the world will fill the
seats at the Westin ~ Doctors, Diplomats, Lawyers, Legislators,
Providers and PayersAll, probably, would-be Medical Tourists.
Its going to be great, people. And a great show!
By michael bina
ECONOMICS
Marketing to the U.S. Do you really know how?
13
There are no artificial barriers to marketing your facility,

organization, products and services to the U.S. market; no
government restrictions, no monopolies and no trade barriers. The
only hurdles for providers in the industry are surmountable, if you
know how to get over them that is.
By Alex Piper
July 2008
Medical Tourism
AT A GLANCE
Implementing Medical Tourism into Health Insurance

Plans Six Steps to Success
54
One of the most important steps in any Medical Tourism is to

become informed and educated on Medical Tourism. As an
employer or insurance company moving forward into this space
you need to learn what are the countries that are providing Medical
Tourism, What are the top hospitals providing care in those
countries, and then who the top surgeons are at that hospital.
By Jonathan Edelheit
NEWS AND INSIGHTS

Travel Insurance
58
Travel Insurance covers many eventualities. If your flight is

cancelled and you are stranded or if your bag is missing and you
are in a strange place without even a toothbrush, the insurance
will help to defray your expenses.
By Dr. Michael Moreton
Planning your Medical Trip Abroad
52
Whether it is recommending a restaurant or a tour, assisting with

translation or transportation, a concierge who is familiar with the
Medical Tourists specific needs can make a difference.
By Lourdes Gasparoni
ALTERNATIVE HEALTH
The Age-Old Healing Art of Hilot
16
Oh my aching body
66
Fibromyalgia is called a syndrome rather than an illness due to the

fact that the multiple and varied symptoms lack the clear markers
of a disease such as changes in organ function or blood.
By Sandra Landsman
When the voice doesnt match the sex
60
We are living in an age of communication. However, there are

warning signs ahead for our voice, the most important factor in
communication. The increasing number of thyroid diseases and
lung cancer, and vocal fold paralysis is causing speaking disorders
in humans.
By Dr. Hyung-Tae Kim
Patient, Heal Thyself ~ The Promise of Regenerative

Medicine
48
Regenerative Medicine is an innovative program that involves

the engineering of living cells, tissues and organs to preserve and
enhance organ function and improve the quality of life. Proponents
of the treatment say it can be used to prevent disease and maintain
wellness, as well as restore organ function lost or impaired due to
disease, injury, or aging.
Hilot is a word from the Tagalog dialect meaning

massage-rubbing or touch with soothing strokes. Touch is
the modality of hilot. Initially, one might think it is simply
a massage, but hilot is more. It is energy manipulation.
By Dr. Bibiano Fajardo
The Farm at San Benito: Exceptional Healing

Environment for Holistic Treatment
50
The Farm at San Benito, a multi-award winning health resort

in the Philippines, is one such case of taking an idea far to
prove a point. Here, the point is that the ones appreciation
of oneself holistically brings about and sustains the gift of
wellness.
By Chie P. Blas
Medical Tourism is a Search for Value, not Low

Prices
62
The future for medical tourism and travel looks very

promising in Asia with synchronous business expansion,
reports of increasing traffic and a future that holds healthy,
steady growth. Significant capital investments in facilities
and capacity are evident. Those who plan and execute their
business models and imperatives skillfully will have an
opportunity to earn a healthy return going forward.
BY JAMES MCCORMICK, MD
By Cathy S. Babao-Guballa
July 2008
MEDICAL TOURISM
EDITOR & PUBLISHER:
Rene-Marie Stephano, Esq.
CONTRIBUTING EDITORS:
Jonathan S. Edelheit
Dr. Prem Jagyasi
Jessica A. Leopold
Gabriella Vicua
REGULAR AUTHORS:
Michael Moody
Alex Piper
Jonathan S. Edelheit
Sandra Landsman, Ph D, CHt
Karen H. Timmons
Linda D. Bentley
Dianne J. Bourque
Michael Bina
Lourdes Gasparoni
David G. Vequist
CONTRIBUTING AUTHORS:
Dr. Hermogenes P. Villareal

Cebu Health & Wellness Council
Dr. Ferdinand P. Lukban
Dr. Francis F. Lopez
Cynthia L. Carrion
Philippine Orthopedic Institute
The Philippine Ministry of Tourism
The Beverly Hills Medical Group
Manolette Roque
Dr. Michael Moreton
Dr. Hyung-Tae Kim
Cathy S. Babao-Guballa
Dr. Bibiano Fajardo
Chie P. Blas
ART DIRECTOR:
Rene-Marie Stephano
ART DEPARTMENT:
e-Medsol
MAIN OFFICES:
10130 Northlake Blvd. Suite

214-315,West Palm Beach,
Florida 33412 USA,
Tel:561-627-1520
Fax: 866-756-0811
REGIONAL OFFICES:
San Jose, Costa Rica

Munich, Germany
Seoul, Korea
Dubai, United Arab Emirates
MARKETING & CIRCULATION:
10130 Northlake Blvd. Suite

214-315,West Palm Beach,
Florida 33412 USA,
Tel:561.791.2000
Fax: 866.756.0811
info@MedicalTourismAssociation.com
www.MedicalTourismAssociation.com
Copyright 2008 by Medical Tourism Magazine.

All rights reserved. Reproduction in whole or in part without
permission is prohibited.
July 2008
Defining Medical Tourism or Not?

By Jonathan S. Edelheit
any people have tried to define and re-define Medical

Tourism, and some have even gone to extremes to create new words
to define the industry of patients traveling from one country to
another for medical care. Many of these new definitions or attempts
to change terminology came about a year ago when a few in the
industry felt tourism should never be associated with medicine.
Some even, incorrectly went so far as to say people traveling for
medicine wont engage in tourism. Since, then we have seen a
major shift away from trying to redefine or change what we call
this industry. Most hospitals, insurance companies, employers,
facilitators, doctors and the media have not only accepted the term
Medical Tourism, many have embraced it.
Rather than discussing what Medical Tourism is, why dont we
discuss what it is not by looking at some of the terminology others
have tried to use to define this industry.
Globalization of Healthcare or Global Health/

Global Healthcare
The Globalization of Healthcare or Global Healthcare has so
many definitions it is difficult to remember them all, let alone list
them here. First of all, this term has little or nothing to do with
Medical Tourism, and Medical Tourism is actually a side effect or
after effect to the Globalization of Healthcare.
The Globalization of Healthcare refers to the following:

Developed countries outsourcing medical claims payment
overseas to countries like India.
Technicians in countries like India reviewing X-rays and
Diagnostic Imaging for Doctors in the USA and UK.
Customer Service Operations for Insurance Companies in
developing countries.
Developing countries increasing their exchange of technology
and information technology.
Developing countries investing in medical infrastructure such as
building hospitals and obtaining modern medical equipment.
Developing countries providing more advanced healthcare and
medicine and drugs to their population.
Countries recruiting doctors and nurses from other countries
due to their experience. Basically, more developed countries
attracting nurses and doctors from developing countries because
they have the same education and experience as developed
countries.
Clearly Medical Tourism is the after effect/side effect of
Globalization of Healthcare, which means that because Developing
countries now have advanced medicine and high quality medical
infrastructure, patients are traveling from their own country to other
countries for medical care.
July 2008
MEDICAL TOURISM
Global Health or Global Healthcare
These are terms we should really stay away from. If you search
Google, or receive Google Alerts, you will see that Global
Health and Global Healthcare mainly focus on other issues. For
example, Global Healthcare refers to physician and nurse staffing
internationally, recruitment, staffing and replacement of healthcare
providers internationally and international regulation of healthcare
products. A search of Global Health reveals page after page of
information about issues affecting the health of patients worldwide.
You will find data on HIV/Aids, malaria, natural epidemics such as
global warming, childs health, womens health, infectious diseases,
and even hunger issues.
Bill Gates, the founder of Microsoft, has a non profit organization
called the Bill & Melinda Gates Foundation dedicated to Global
Health/Healthcare issues. It is one of the most famous Global
Health organizations and there website is www.gatesfoundation.
org/GlobalHealth . After you review their website, I am sure you
will agree that Global Health and Global Healthcare clearly are
not medical tourism and have nothing to do with the industry or
terminology.
Medical Travel
Medical Travel has many different definitions.
The first
definition, for which it is commonly known, is doctors and nurses
traveling to other countries on volunteer or missionary work in
developing countries.
Some define Medical Travel as the industry of mobility medical
equipment for those patients that are disabled. Medical Travel
includes electronic wheelchairs and scooters.
Emergency Medical Travel ~ Medical Evacuation

One of the biggest definitions of Medical Travel is the large
industry of Medical Evacuation, where patients are evacuated from
one country to another by air ambulance, which could be a helicopter
or airplane. The reasons for this emergency medical travel could
be due to a severely injured tourist in a foreign country requiring

evacuation home or to a country nearby where high quality trauma
care is available. It may also include a patient in a developing
country with a serious health condition or trauma requiring higher
levels of care than can be found in their own country. Medical travel
provides that patient with life saving opportunities.
Lets Focus on the Real Issues

When we use the term Medical Tourism, do we have any of the
confusion that the above words create? When someone mentions the
term Medical Tourism, one immediately thinks of patients traveling
to another country for more affordable care, or care that is higher
quality and more accessible. I think we can all agree that the terms
described above do not apply to this industry. More importantly,
rather than spending time attempting to re-define an industry or
change terminology, why dont we focus on the important issues,
such as Quality of Care, Patient Safety, Aftercare and Legal Issues.
The industry for the first time is working together through the Medical
Tourism Association to focus on creating higher quality of outcomes
for medical tourists, putting together international credentialing
initiatives and establishing strong protocols for maintaining high
quality of care while increasing patient flow.
How about the US marketplace? The American Medical
Association recently released its Guidelines on Medical Tourism.
The US Senate Committee on the Aging held hearings on the issue
of medical tourism in 2006. The American Society for Plastic
Surgeons, International Society of American Plastic Surgeons,
American Dental Association, American Cancer Association, and
the American Association for Multiple Sclerosis all are developing
their positions on medical tourism. Many of these positions will be
shared at the upcoming World Medical Tourism Congress in San
Francisco, California on September 9-12, 2008.
The search term most commonly used on the internet is medical
tourism. The fact is, patients know it as Medical Tourism as do
employers and insurers. Whether they Google it or look for it online,
this is what they come up with. Almost every single Tourism Board
in the world is referring to this industry as Medical Tourism, setting
budgets and agendas accordingly to promote it. Hospitals and the
media call it Medical Tourism.
What is tourism anyway? Patients are eager to travel to a foreign
country to engage in some form of tourism activity. Whether it is
indulging in local food, sightseeing, or just having coffee or tea at
a local caf, for some people, just leaving their hometown is an
adventure that is only accomplished through vacation. Getting on a
plane may be deemed touristy for these people. Someone recently
told me that patients getting a knee replacement or hip replacement
wont be sipping a soft drink by the pool of their hotel in a foreign
country. Are you kidding? This is exactly what they do once they
become ambulatory and it is crazy to think that they will not take
advantage of the personal service found overseas.
As an example, the short segment from our documentary found
on our website www.medicaltourismassociation.com shows an
American going for a double knee replacement in Costa Rica. The
day after he arrived and the day before his surgery, he was in the
rain forest doing an aerial tram tour. If that isnt medical tourism, I
dont know what is.
Jonathan Edelheit is President of
the Medical Tourism Association
with a long history in the healthcare
industry, providing third party
administration services for fully
insured, self-funded and mini-medical
plans to large employers groups.
10
July 2008
July 2008
11
MEDICAL TOURISM
JCI CORNER
JCI Standards
Address Physician
Competencies
By Karen Timmons
Karen Timmons is President and CEO of Joint CommissionInternational.
Our standards require that they continually look for any data suggesting a physician has a high number of
undesirable outcomes such as a large number of patients with surgical complications, returns to the surgical
suite, or post-operative infections, and determine the cause of these problems immediately.
n the third edition of the JCI standards, which became effective

in January 2008, we strengthened our standards for verifying
credentials of medical personnel. We now require hospitals to
verify the credential with the primary source the organization
that awarded the credential. This requirement is designed to better
help hospitals catch forged credentials, which are unfortunately too
common in the medical field.
Here are some recent reports showing the magnitude of the
forgery problem:
aim to ensure these problems dont just accumulate in a file and go

unnoticed by hospital administration.
We encourage all persons seeking care anywhere to research
the physician they are considering using. Patients should ask their
referring physician about the doctor, research the doctor on the
Internet, and ask the hospital for comparative information. Hospitals
should be able to tell patients if the procedure they are receiving
is a common procedure performed by the physician and if there is
any data suggesting this physician has a high number of undesirable
outcomes, such as post-operative infections.
The Delhi Medical Association pledged in 2004 to work

to make the capital free of frauds after determining that
as many as 40,000 unqualified persons with fraudulent
credentials may be practicing medicine in the city.
The association speculated at the time that every 10
minutes a patient in Delhi loses his life or undergoes
irreparable damage to his health at the hands of a fraud.
In January 2007, the Health Ministry in Saudi Arabia
discovered 4000 forged certificates for various medical
specializations after reviewing 20, 870 certificates.
JCI does not accredit medical personnel; we only accredit
health care organizations, such as hospitals. We have built into our
standards, however, a number of requirements that help hospitals
reduce their risk of having unqualified doctors. Because of the
devastating impact unqualified doctors have on the quality and safety
of care, it is critical that hospitals quickly identify doctors who are
practicing with forged credentials, practicing in an area outside of
their training, or simply practicing unsafe medicine.
To ensure doctors only practice within their competency sphere,
we have standards that require hospitals to assign privileges. These
privileges must limit doctors to practicing only in the areas where
they have received training. To help hospitals quickly identify
physicians practicing unsafe medicine, we require hospitals to
have an ongoing professional practice review instead of a periodic
review. Our standards require that they continually look for any data
suggesting a physician has a high number of undesirable outcomes
such as a large number of patients with surgical complications,
returns to the surgical suite, or post-operative infections, and
determine the cause of these problems immediately. Our standards
12
July 2008
But the reality is that the medical traveler may have a more
difficult time getting this type of information and find it harder to
determine if he has chosen or been assigned a competent physician.
Thats why it is important that the medical traveler choose a JCIaccredited hospital. It is one of the best tools he has to reduce his
risk of having an unqualified doctor perform his surgery.
There will always be risks in medical care, but many hospitals
around the world are working hard to reduce risk and improve
care. Finding these hospitals is the medical travelers best
bet. For more information on JCI-accredited hospitals: visit:
www.jointcommissioninternational.org
Marketing to the U.S.
Do You Really Know How?

By Alex Piper
The good old U.S.A. is the epitome of capitalism, and thats good for the Medical Tourism Industry.
There are no artificial barriers to marketing your facility, organization, products and services to the
U.S. market; no government restrictions, no monopolies and no trade barriers. The only hurdles
for providers in the industry are surmountable, if you know how to get over them that is. Lets look
at a few of the hurdles.
irst, do you know the U.S. market? It

can be classified into two main sections;
business and consumer markets. All other
classifications can fit into one of these
two markets. Government for example,
fits into the business market. Government
entities behave like U.S. corporations and
resemble them in many ways. They have
large numbers of employees, a hierarchy
of management and employ many of the
same management techniques as U.S.
corporations. The fact that most of them are
not operated for profit is not important to
the Medical Tourism Industry and, in fact, is
an advantage in many respects. But thats a
whole other story.lets stay on track.
A sound, disciplined,
well thought out
strategy is essential
in order to spend
an organizations
marketing dollars
wisely.
Second, do you know the target market

in the U.S.? In the business market its
corporations and government entities with
large numbers of employees to which they
have a healthcare obligation. But, its also
the insurance companies who partner with
the corporations and government entities
to design, package, deliver and administer
the healthcare programs. This relationship
is important in more ways than one but
again, thats a whole other story. In the
consumer market, the targets are more
elusive. They include, but are in no way
limited to, residents with disposable
income, people without health insurance,
people with insufficient health insurance,
July 2008
13
MEDICAL TOURISM
people who travel, and people who want to
live life to the fullest. When you think about
it, its very, very difficult to penetrate this
market. Its very complex and diversified in
both geography and profile.
Knowing the
budgeting process
and the gatekeepers
of the budgets are
one of the key pieces
of knowledge to
aid organizations
in marketing to
businesses
in the U.S.
Which leads us to the third hurdle.
Do you know the profile of your target
market; the socio-economic factors that
helps you to define who they are? The
common indicators of household income,
geographic location, age, gender and
financial obligations (mortgage, auto loans,
credit card obligations, etc.) only begin to
scope the consumer market. Likewise, the
common indicators of revenue, headquarters
location, office locations, number of
employees, healthcare insurance carrier,
healthcare benefits enrollment percentages,
executive management, board of directors
and profitability are only the tip of the

iceberg when trying to profile your business
market of corporations, government entities
and insurance companies. The key thing to
remember here is that all your competitors
have the information referenced above; you
need more in order to gain a competitive
edge in the marketplace. How do you get
that edge? Again, thats a whole other story.
Keep reading.
Fourth, do you know their buying habits?
What are the factors that shape their buying
decision? For the business market some
obvious factors to note are how the entities
carve out money from their operations
to reinvest into the business; commonly
referred to as budgeting. Most businesses
and government agencies budget annually
but some assign budgets over longer
periods, and some over shorter periods, due
to the nature of their business. Knowing
the budgeting process and the gatekeepers
of the budgets are one of the key pieces of
knowledge to aid organizations in marketing
to businesses in the U.S. For the consumer
market, knowledge of whether their
spending habits include non-essentials or
luxuries and their appetite for debt are two
key pieces of information that will help any
marketing effort to this group. This article
may be oversimplifying the effort needed
to overcome this hurdle so I must point out
again that these hurdles take considerable
effort and some investment to overcome.
A sound, disciplined, well thought out
strategy is essential in order to spend an
organizations marketing dollars wisely.
Fifth and, for the purposes of this
article, the final hurdle is do you speak your
customers language? I dont mean this

in the literal sense. What I mean is, when
you speak, will they listen? Do you know
what their hot buttons are? Every customer,
both business and consumer, has needs and
wants. They satisfy these needs and wants
through a very complex process. A fair judge
of the complexity, in my opinion, is simple.
Look at how many companies fail. Look at
how few succeed. Even better, look at how
few companies succeed over the long haul.
I recently did some work for a client and
part of my assignment included reviewing
Fortune 100 companies in the U.S. in both
1980 and 2007. I was shocked at how many
of them failed during that period. Some
popular 1980 companies did not make it to
the year 2007, for various reasons.
So, to wrap up, heres my advice. Make
friends with the U.S. market. Engage a
company that has demonstrated success
in attracting and retaining corporate and
consumer customers for their clients.
Also, make sure the company invests in
research and development so that they can
tell your customers about your product
in new ways. Make sure you look at print
advertising, Internet marketing, customized
mail, event marketing and person-to-person
communication to name a few. Try to
create a relationship with your customer.
Americans only buy from people they know.
Do the 50 million uninsured Americans,
the executives of the Fortune 100 U.S.
Companies, the human resource benefits
managers at U.S. Companies, the risk
managers at government agencies, and the
millions of U.S. employees, know who your
organization is? They should.
ABOUT THE AUTHOR

With over 17 years experience in Insurance, Marketing and Employee Benefits Management, Alex Piper possesses
extensive knowledge of the U.S. Healthcare Market and the influence that Insurance Carriers, U.S. Employers,
Hospitals, Physicians, Physician Groups, Healthcare Professional Organizations and Government will have on
the next generation of global healthcare.
As an insurance executive at a top Fortune 50 U.S. company, he spent the last eight years designing employee
and customer benefits programs including healthcare programs for the large supplier and distribution partner
companies of his employer. He was responsible for creating a benefits program that had over U.S. $140 million
in assets and had over 1300 companies enrolled. His latest program grew from zero to $40 million in insurance
premiums in less than two years!
Alexs experience also includes the design of marketing communications plans that grew his company 20% annually, and made it the
12th most profitable company in its industry in America. His skill set is nicely rounded with his experience in being responsible for
complete marketing communication strategy and execution for a growing $156 million company, including public relations, multimedia
advertising, event marketing and Internet marketing.
He is the President of OneWorld Global Healthcare Solutions, a consulting company committed to creating a worldwide healthcare
solution. Alex will be holding a marketing workshop at the World Medical Tourism & Global Health Congress in San Francisco,
California on September 9-12, 2008. For more information please go to www.MedicalTourismCongress.com
14
July 2008
American Hospital Management Company appoints Gregory Ciottone, MD as Chief Medical Officer
merican Hospital Management announced the continue with these appointments while on staff with
appointment of Gregory Ciottone, MD to the position AHMC.
of Chief Medical Officer of American Hospital
I am extremely pleased to welcome Dr. Ciottone
Management Company.
to American Hospital Management Company as Dr.
Ciottone brings significant academic and practical
Dr. Ciottone brings over 15 years experience
experience to our medical facilities and physicians.
in academic, clinical and international medicine
We look forward to working with Dr. Ciottone and
to American Hospital Management Company. Dr.
to continually strengthen and support the physicians,
Ciottone is a Board-Certified Emergency Physician
nurses and other professionals in the communities we
and is an Assistant Professor of Medicine at Harvard
serve while accomplishing our mission in meeting
Medical School, where he currently is the Chair of
healthcare needs locally, stated Randall D. Arlett,
the Disaster Medicine Section. He has served as
President and Managing Director of American Hospital
Director of the Division of International Disaster
Management Co.
and Emergency Medicine and Medical Director for
I am very excited to begin work as the Chief
Emergency Management at Beth Israel Deaconess
Medical Center, where he works clinically in the Medical Officer for American Hospital Management
Department of Emergency Medicine. In addition, Dr. Company. AHMC has firmly positioned itself
Ciottone holds a Visiting Professorship in Disaster as the world leader in hospital management and
Medicine at Vrije Universiteit Brussel in Belgium and administration by creating world class medical centers
the Universita del Piemonte Orientale in Italy, and has that maintain quality as their number one goal. Under
served as the Medical Director for the Office of Security AHMC management, these institutions have flourished
and Investigations, United States Citizenship and by linking the hospital with the community through
Immigration Service, U.S. Department of Homeland local partnerships. It is an honor for me to now join
Security, Washington D.C. Recently, Dr. Ciottone this winning team and I look forward to continuing the
established the Operational Medicine Institute at tradition of excellence AHMC has become known for,
Harvard Medical Faculty Physicians, of which he has stated Gregory Ciottone, MD, Chief Medical Officer
assumed the position of Director. Dr. Ciottone will of American Hospital Management Co.
About The American Hospital Management Company
American Hospital Management Company (AHMC),
a member of the Family Hospital Group of Companies,
is a Longmont, Colorado USA based diversified
international healthcare system whose focus is on
the administration, management, and development
of international hospitals and healthcare systems.
Founded in 1998, AHMC has grown into the leading
international hospital management and administration
outsourcing company. The American Hospital

Management Company provides turn-key, outsourced
administrative and management services to hospitals
and health systems. AHMC currently operates medical
facilities in Antigua & Barbuda, Brazil, Colombia,
Dominican Republic, Ecuador, Ghana, Guatemala,
Honduras, Panam, and Trinidad & Tobago.
For more information

Randall D. Arlett, President & Managing Director
American Hospital Management Company
(303) 772-1433 USA
(303) 389-325-9378 USA Fax
ralrett@americanhospitalmanagement.com
www.americanhospitalmanagement.com
July 2008
15
MEDICAL TOURISM
The Age
Old Healing Art of Hilot

By Dr. Bibiano Fajardo
Whether they are Filipinos, who are returning home from work overseas or are migrants coming home for muchawaited family reunions and tropical vacations, they continue to look for the healing touch of the hilot.
nd while it is common among many Filipinos to seek

the Western mode of medical treatment for ailments, the hilot,
as a remedy, still retains its esteemed and recognized place in the
hierarchy of non-invasive, traditional healing methods.
Hilot is a word from the Tagalog dialect meaning massagerubbing or touch with soothing strokes. Touch is the modality of
hilot. Initially, one might think it is simply a massage, but hilot
is more. It is energy manipulation.
While many popular massages have predetermined sequences
of strokes,hilot manipulates the electrical charges of the body that
creates a biochemical reaction where it is needed. It harnesses bioenergies for balance, harmony, health and wellness. When this is
done properly, the biochemical reaction brings balance once again
to the body.
WHAT IS HILOT?
Hilot is the age-old indigenous Filipino healing practice
associated with elderly healers. It is relatively complex way of
healing complete with philosophy, health concept and healing
methodologies. The Hilot Master or manghihilot could identify
body illnesses or areas of energy imbalance in the body through many
unconventional methods like pulse reading, hot and cold analysis,
16
July 2008
phrenology, stool/urine/perspiration analysis. It is the oldest and the

most secret arts in the Philippines. Due to the secrecy of the art, very
rarely do manghihilot teach this art to the general public. Most
Hilot in the Philippines are either learned from relatives, through
hands on practice, or inherited from their forefathers, passing the art
from one generation to the next.
BRIEF BACKGROUND
The practice of Hilot is a part of the Filipino way of life.
Traditionally, prior to the popularity of modern medical doctors, the
manghihilot was the health care giver of the community. Like all
traditions, it has seen its share of being pushed to the background at
the arrival of new methods, new medicines and new technology.
Lately, in the worldwide resurgence of alternative forms of
medicine and the research and study of the old ways of healing,
Hilot is re-established as the Filipino Healing Art based on scientificuniversal and natural laws.
CONCEPT OF HILOT
Man is considered healthy or at-ease if his faculties (mind,
emotion and body) are in harmony with the Universal Law. This
harmony sets the phase for the balance and precise combination of
manghihilot is holistic, - holistic involving the biological, social,

behavioral and psychological aspects of life and living.
A good hilot practitioner would know the type of ailment his
client is suffering from just by looking at him and sensing his
energy. A good healer can tell if the elements in ones bodyfire,
water, earth and airare in harmony. Fire refers to the bodys
electric impulses; water, the blood; the earth, bone and flesh; while
air corresponds to the air that one breathes.
To correct the imbalance in the patients energy that leads to
a distorted metabolism, a healer would have to give the patient a
massage to create the desired biochemical reactions that helps the
body heal itself.
Spotting a fake hilot should be easy. Anything that did not
conform to the natural law would cause pain, so if one felt sore after
a hilot massage then something was not right.
HILOT JOINS THE BIG LEAGUES

The Association of Traditional Health Aid Givers Inc. (ATHAG)
is at the forefront of the campaign to put the centuries-old Filipino
version of healing under a systematized program, under the banner
of medical tourism. Headed by its president, Bibiano Boy Fajardo,
this group of Filipino healers, herbalists and hilot practitioners have
banded together to take the age-old treatment out of the shadows
of local folklore and into the 21st century.
the Elements of the body (earth, water, fire and air). The unique
combination of the four Elements varies according to mans existing
patterns and programs that are called genes. Furthermore, the unique
combinations are also dependent on mans lifestyle, culture and
environment. This combination has its own individual limitations,
and once limitations are violated, imbalances happen. The imbalance
is called dis-ease.
Imbalances of elements of the body could be corrected by the
introduction of changes through; biochemical, neuro-electrical,
electro-magnetic and bio mechanical means.
MAKING OF A HILOT
The training of Hilot Practitioners or the manghihilot involves
learning the concepts and philosophy of traditional healing,
instilling an individual valuing process and its relevance to Hilot
Healing and understanding the body functions. The education of the
A chemical engineer by profession, Fajardo said a bout

with progressive muscle dystrophy 34 years ago led him to the
manghihilot. Bedridden for eight months, he tried every possible
treatment offered by modern medicine. He said he only got back on
his feet and resumed his work after three months of hilot sessions.
Since then, he added, he made it his personal quest to learn the
science behind hilot.
ATHAG has been going around the country to teach not just
potential healers but local health workers about the benefits of a
hilot regimen. They are deploying more and more healers to the
different parts of the globe as spas abroad are now incorporating the
hilot into their spa treatments.
Hilot recently received international recognition and made it
to the roster of Spa Finders Hot and Getting Hotter List of 2006
trends. In 2005, it was nominated for Spa Treatment of the Year
during the 2005 Baccarat Inaugural Awards in Hong Kong.
Now, hilot is gaining in popularity as this age-old tradition is
being re-discovered to help us all live a healthy and balanced life.
Dr. Bibiano Fajardo is an albularyo and a general practitioner of Hilot. Dr. Fajardo has a vast experience in the practice of hilot
spanning 40 years. The ATHAG is located at the 2nd floor Jacinta bldg., EDSA Guadalupe Nuevo, Makati City, Philippines.
July 2008
17
MEDICAL TOURISM
Bone Marrow Transplantation

in Downtown Makati
By Dr. Francis F. Lopez
Makati City in Metro Manila hosts the Philippines premier business hub. It is one of Asias sterling
examples of self-engineering to provide urban capitals with livable environments, stimulating cultural
fare, contemporary leisure and shopping enclaves for enhanced lifestyles.
While BMT centers are already widespread abroad, Makati Med is

one of the few Philippine hospitals that offer it.
While the needs of every metropolitan site are certainly diverse,

Makatis requirements stand distinct to fully service its daytime
population of highly-discerning groups. The criteria for making it
here in Makati are nothing less than world-class.
Makati Meds BMT Unit, like the rest of the Cancer Center, is
equipped with the latest machines using progressive technologies and
run by doctors and nurses who are all board-certified and specially
trained. Many of the doctors have received further specialization
and certification in foreign universities and hospitals. Aside from
clinical staff, nurses also keep abreast of treatment procedures and
patient care through continuous education and constant training.
he look and feel of Makati reflects the bustling blend of

corporate cores and cozy, tree-lined residential hives, including
exclusive and plush subdivisions for the Philippines privileged and
influential sector of landed employers, self-made entrepreneurs,
esteemed professionals and diplomatic representatives.
Thus, for a medical and healthcare institution to survive at

the heart of the Makati central business district, nothing less than
foremost service is expected. Through its daily challenges, the
Makati Medical Center has proven its mark as a premier institution,
providing treatment and patient care fit to international standards.
The hospital is backed by almost 40 years of experience in
healthcare and staffed by the countrys most competent health professionals. Throughout these years, it has built Centers of Excellence in particular fields.
One of these Centers of Excellence is the Cancer Center, a
facility that offers a holistic approach to healing. The Center, with its
modern equipment, team of medical experts and multidisciplinary
approach, is at par with international cancer treatment practices.
The Cancer Center also has the Bone Marrow Transplant (BMT)
Unit under it. Bone marrow transplantation is a standard treatment
for both malignant and non-malignant blood diseases. It is now
considered frontline treatment to increase chances of survival.
18
July 2008
Hematologic malignancies that are potentially curable

with bone marrow transplantation include acute myelogenous
leukemia (AML), acute lymphoblastic leukemia (ALL), chronic
myelogenous leukemia (CML), myelodysplastic syndrome (MDS),
multiple relapsed lymphomas (MRL), multiple myeloma and
myeloproliferative diseases.
Bone marrow transplantation is also offered as a treatment to
patients with non-malignant blood diseases such as aplastic anemia,
paroxysmal nocturnal hemoglobinuria (PNH), thalassemia, sickle
cell anemia, and immune deficiency disorders.
Abnormalities in the blood occur when there is an arrest in the
development of the red blood cells, white blood cells and platelets ~
cells that originate from the stem cells produced in the bone marrow.
Blood diseases treated in the BMT are classified based on the cell
of origin. The differentiation is important as it determines which
treatment is more appropriate and effective.
Acute leukemia, such as AML and ALL, dictates a preference

for an allogeneic transplant, since it involves the transplantation
of stem cells from a donor. An allogeneic transplant also has the
added benefit of graft-versus-tumor or leukemia effect, where the
donors stem cells recognize the patients leukemia as foreign and
attack these cells. In an allogeneic procedure, immature progenitor
stem cells are harvested from the donor and transfused back to the
patient. In approximately two weeks, the donors stem cells are
supposed to have engrafted.
Siblings are the preferred donors in a bone marrow transplant
since a sibling has a 25 percent chance of having a matched human
leukocyte antigen (HLA). HLA typing, or ascertaining a match
requires a laboratory procedure that takes less than a week to
perform.
In the event that there is no match, an autologous transplant
is also offered as an alternative. Autologous transplant involves
the harvesting of stem cells from the patient himself. The cells are
stored and are to be infused into him.
Both allogeneic and autologous procedures are done in the
Makati Med BMT through an apharesis machine. The machine
is an advanced tool that eases the treatment procedure for both
patients and donors by collecting the necessary cells through a
process similar to blood transfusion. The apharesis machine can
be programmed to extract only the cells needed. The machine is
attached to a catheter that is connected to a donors vein in the
groin. The stem cells are immediately transfused to the patient.
As much as an 80% chance of

success may be hoped for the
diseases treated in the BMT,
especially if they are treated in the
early stages.
Old treatment procedures require an actual harvest and transplant
of the bone marrow from the donor to the patient. That being an
already painful procedure, patients were also required to undergo
intensive chemotherapy or even total body irradiation.
While chemotherapy is not completely eliminated from the
treatment, the apharesis machine manages pain and keeps it to a
minimum by eliminating actual bone marrow transplantation.
Instead, patients now undergo peripheral stem cell transplantation,
which increases comfort of the patients and their families.
Patients who undergo treatment at the Makati Med BMT are
normally released from the hospital after five weeks and are seen
as outpatients twice a week for the next 100 days. Throughout this
period, the patients are supported with medications to help prevent
infection, rejection to the grafted cells and other diseases. Clinic
visits and laboratory tests dwindle eventually, as the patients body
gets accustomed to the transplant.
As much as an 80% chance of success may be hoped for the
diseases treated in the BMT, especially if they are treated in the
early stages.
At a quarter of the cost of services offered by United States
hospitals, Makati Meds BMT provides the same optimum quality
treatment and compassionate care from its people.
Dr. Francisco F. Lopez heads the Makati Med BMT Unit. Certified
by the American Board of Hematology and the American Board of
Oncology, Dr. Lopez has handled 23 of the over 40 cases of bone
marrow transplant in the country.
July 2008
19
MEDICAL TOURISM
20
July 2008
Philippine Quality Healthcare:

Excellence is the Standard
The countrys world-class physicians and its medical facilities using modern technology are good banners
for its medical tourism program. Yet, add to this the Philippine brand of health care one that is summed
up as tender loving care, one is led to conclude that there are more than enough compelling incentives
to seek medical attention in the country through the medical tourism program.
hilippine medical institutions aim for quality health care.

They go through rigorous procedures using standards that are
internationally acceptable.
is granted by the international affiliate of the Joint Commission on

Accreditation of Healthcare Organizations (JCAHO), the agency
charged with accrediting US hospitals.
They forge partnerships with external agencies, who themselves

have to go through licensing and accreditation, to ensure that carrying
out the task of delivery of quality healthcare is very thorough.
Recognition in the international arena is also provided via ISO

9001 Certification, an international quality management framework
that is applied to hospitals as a whole or to component service units
of institutions. ISO-certified Philippine hospitals include the Makati
Medical Center and the National Kidney and Transplant Institute.
Accreditation with the two groups is currently being sought by other
Philippine medical institutions.
To accredit partners, a list of requirements is presented to the

medical institutions to check their capability to deliver optimal
healthcare on a consistent basis. Their record on improvement,
experience and attainment of expertise are examined to ascertain
their achievement levels.
On the local front, the Department of Health (DOH) is tasked
to grant licenses to hospitals according to service capabilities on an
annual basis. Specialized bureaus of the DOH check compliance
with standards on personnel, equipment and physical environment.
The Philippine Health Insurance Corporation (PHIC) accreditation
enables participation in the National Health Insurance Program
and claim reimbursements for health services rendered to eligible
members.
Requirements for PHIC accreditation include DOH licensing
for the part three years, acceptance of NHIP programs on quality
assurance and utilization review and operation of Internal Quality
Assurance Programs, Therapeutics committee and Infection Control
Committee.
Accreditation by the Joint Commission International is
recognized as a gold seal of service quality and patient safety. It
These processes by which medical institutions in the Philippines

acquire good local and international standing and recognition were
outlined by Dr. Alfredo Bengzon, former Philippine Secretary of
Health and current President and Chief Executive Officer of The
Medical City, in his presentation before the Public-Private Partnership
Task Force on the Quality Healthcare in the Philippines.
On the part of the medical practitioners, licensing for doctors,
nurses and other staff is provided by the Philippine Regulatory
Commission while specialty certifications are provided by individual
specialty societies.
A systematic approach to assess a medical doctor's professional
competence and conduct is through credentialing which includes
a review of relevant academic training, experience, licensure,
certification and registration to practice. Another method is through
privileging which is the process by which a hospital determines
what procedures may be performed and which conditions may be
treated by each physician, based on his established qualifications.
July 2008
21
MEDICAL TOURISM
These credentialing and privileging mechanisms ensure the
continuing technical proficiency of and adherence to ethical
standards by medical doctors, and thus, promotes the quality and
safety of patient care.
Externally and internally-driven Quality Improvement (QI)
programs prompt the improvement of the design, documentation,
implementation and monitoring of hospital processes and their
efficiency. QI programs are initiated by external regulatory agencies
like the PHIC and through institutional collaboration with the
Philippine Society for Quality in Healthcare (PSQua).
Within the medical organizations, the conduct of peer audits,
sentinel event monitoring, the tracking of Hospital Quality Indicators
and launch of Quality Circles are ways by which self-improvement
are undertaken.
Among noteworthy developments as a result of tracking of
Hospital Quality Indicators include the finding, from a sampling of
Philippine hospitals, which infection rates are in the lower range
or levels, per the International Nosocomial Infection Control
Consortium (INICC).
From an INICC low of 1.7 to a high of 12.8, the sample
Philippine hospital scored a low of 1.9 in the monitor for Foley
catheter-associated infection. From an INICC low of 7.8 to a high
of 18.5, the studied hospital manifested a low 8.9 in blood stream
infection. In ventilator-associated infection, with a low of 10.0 and
a high of 52.7, the count for the model hospital was 13.2.
institutions, including the Freie Universitat Berlin in Germany, the

University of Wisconsin in the U.S. and the Montreal Neurological
Institute in Canada.
As Secretary of Health in the Cabinet of former President
Corazon Aquino, he pursued the landmark Philippine National Drug
Policy and associated Generics Drug Law. He earned in 1991 the
prestigious international Ramon Magsaysay Award for Government
Service.
Back as a private citizen, he was appointed Vice President for
the Professional Schools and Social Development of the Ateneo
and served as the Dean of the Ateneo Graduate School of Business
(AGSB), a position he occupied up to June 2007. In 2007, Dr. Bengzon
launched his latest enterprise the Ateneo School of Medicine and
Public Health (ASMPH), an institution that puts forward a bold and
novel model of health education. Aimed at developing a physician
who is simultaneously an expert clinician, a skilled manager and
a catalyst for social change, the ASMPH promises to be a medical
school like no other in the country.
At the Asian Hospital and Medical Center, Dr. Jorge Garcia holds
court as one of the world's best cardiovascular surgeons. He has led
his team in the performance of some 750 cardiovascular procedures
in a span of five years. With most of them in the category of high-
Presented side by side with the finding that death from infection
is listed in the Top Three causes of deaths, these remarkable scores
of sampled Philippine hospitals are undoubtedly excellent indicators
of patient care and safety.
Patients are not left out in the process of achieving quality
health care. As vital partners for growth and quality management,
Patient Education Programs are carried out, empowering patients
to demand quality service and safety. Feedback mechanisms
through e-newsletters and web-based forums are new venues for
active engagement of patients in the care process. Other forms used
in Patient Rights Programs are individual counseling and group
sessions.
The surge of managed care in the Philippines, with a count of
18 Health Maintenance Organizations (HMOs) since 1981, has also
figured in the quest for quality health care. Awareness of hospitals
of length-of-stay issues from HMOs and the Philhealth has upped
the bar for efficiency in processes. It has also affected hospital
compliance with documentary requirements for speedy claims
processing.
All told, the current Philippine scene for the achievement,
maintenance and continuous upgrading of quality health care is set.
The recognition of the value of maintaining high marks in health care
delivery and safety, with the onset of medical tourism, is providing a
fresh drive for increased efficiency through focused and innovative
schemes that address medical tourism requirements.
With quality health care and patient safety as vital elements
for a growing medical tourism industry, the distinguished Filipino
medical doctors and heads of institutions have nothing less than the
best reasons to continue raising the bar in their respective fields.
Dr. Bengzon, who led his organization, The Medical City, to
obtain the highly-coveted JCI accreditation is a multi-faceted leader.
He is described as a brilliant doctor, savvy manager, dedicated
educator, courageous public servant and visionary leader. He is
constantly driven by the quest for excellence and the passion for
service.
A practicing neurologist, Dr. Bengzon completed his residency
in Neuropsychiatry at the Philippine General Hospital and further
honed his specialist expertise in several renowned medical training
22
July 2008
risk operations, Dr. Garcia has carved a splendid track record of

successes, making him a highly sought after global consultant for
the setting up of state-of-art cardiovascular units. Dr. Garcia, who
is also a Clinical Professor of Surgery at Georgetown University in
Washington DC, is a perfect example of a Filipino medical expert
who straddles the continents, providing his remarkable expertise for
both the Eastern and the Western worlds.
Over at the National Kidney and Transplant Institute is Dr.
Dante P. Dator, chair of the department of urology and currently
the president of the Asia Pacific Association of Pediatric Urology. A
graduate of the University of the Philippines College of Medicine,
he did a Pedriatric Urology fellowship in 1990-1991 at Harvard
University, Children's Hospital in Boston. Well-recognized for his
work on pediatric urology and recently, for the experimental work
on immunological treatment of cancer using dendritic cells a
novel form of immunotherapy which harnesses the body's immune
system, specifically using dentritic cells and fusing it with known tumor
antigens to create a tumor vaccine or as a direct injection into the prostate
cancer. Dr. Dator is often invited as lecturer in international meetings
The bio-data of the Dr. Samuel Bernal, The Medical City Consultant,
veritably reads like a list of advanced course offerings. With a passion for
knowledge not only in the medical field but also in other related disciplines,
Dr. Bernal is Board Certified in Internal Medicine and is a Diplomate of the
American Board of Internal Medicine. He completed his training as Fellow
in Internal Medicine at the Harvard Medical School, as Fellow in Medicine
at the Peter Brent Brigham Hospital in Boston. He completed his Doctor
of Jurisprudence degree at the Loyola University Law School and now
specializes in Regulatory Law and Medical Malpractice. He completed
his M.B.A. degree in a business program for company presidents at the
Pepperdine University in Malibu, California.
With quality health care and patient safety as

vital elements for a growing medical tourism
industry, the distinguished Filipino medical
doctors and heads of institutions have nothing
less than the best reasons to continue raising
the bar in their respective fields.
He is currently Professor of Medicine, Director Emeritus of the
Cancer Center of the Greater Los Angeles VA Health Care System, Chief
of Cancer Research Laboratory and Attending Physician at Cedars-Sinai
Medical Center, Century City Hospital and Enrico-Tarzana Hospital. He
has published several books including one on Lung Center Differentiation
and Drug Resistance in Oncoloy. He is an active member of the American
Association of Clinical Oncologists, a researcher-member of the American
Association of Cancer Researchers.
Dr. Felipe Tolentino, President and Medical Director of the Asian Eye
Institute, pursues his track in ophthalmology and couples his achievements
in medical science with clear focus on helping the poor through the
Ophthalmological Foundation of the Philippines which he founded and
through the establishment of a Mobile Eye Clinic that serves indigent
patients of cataract surgery.
Dr. Tolentino is a member of the School Faculty, Senior Clinical Scientist
at the Schepens Eye Research Institute and Surgeon in Ophthalmology at the
Massachusetts Eye and East Infirmary and Consultant at Tufts University
at the Medical Center/New England Eye Center. He also authored over 100
peer-reviewed papers in Ophthalmology, published in prestigious journals
in the US.
These leaders in Philippine medicine and healthcare facilities
management are but only a few of the many Filipino medical doctors
with inspiring backgrounds, common as it is among Filipino graduates
of medical degrees to seek affiliations with US medical associations for
continuing programs for career development and specialty-building
A good number of those who have served in prestigious US hospitals
have returned to the Philippines to cascade their knowledge to younger
practitioners and to head the departments of the renowned medical hospitals
and centers.
The country's world-class physicians and its medical facilities using
modern technology are good banners for its medical tourism program. Yet,
add to this the Philippine brand of health care -- one that is summed up as
"tender loving care," one is led to conclude that there are, indeed, more
than enough compelling incentives to seek medical attention in the country
through the medical tourism program.
July 2008
23
MEDICAL TOURISM
Taking Excellence to
Heart
By Eric Michael Santos
Dr. Jorge Garcia is the man behind the excellent cardiovascular surgery success rates of the Asian Hospital
and Medical Center. The track record of the man and the hospital speaks for itself.
hen it comes to heart surgery, Dr. Jorge Garcia knows that the
harmony of details is what creates the symphony in every successful
surgery. Thats why one of the best cardiovascular surgeons in the
world took an active role in designing the Asian Hospital Medical
Center (AHMC) in the Philippines.
Dr. Garcia, a Clinical Professor of Surgery at Georgetown University

in Washington D.C., worked with an American architect in drawing
up floor plans for the state-of-the-art AHMC cardiovascular unit.
He has also designed cardiovascular units in hospitals in China,
Egypt and the U.S., after which the AHMC cardiovascular unit was
patterned.
A properly designed cardiovascular unit is one of the factors

that spell the difference between procedural success and failure.
The location of the components of a cardiovascular unit, such as the
operating room (OR), cardiac catheterization laboratory (Cathlab)
and intensive care unit (ICU), must be integrated to enable the unit
and its staff to operate smoothly and efficiently.
Aside from an optimally designed cardiovascular unit, successful

cardiovascular surgery requires teamwork and repetition, reveals
Dr. Garcia, who completed his cardio-thoracic surgery fellowship
training at the Cleveland Clinic in Ohio and is currently Senior
Attending Cardiovascular Surgeon at Washington Hospital Center
in the U.S. capital.
24
July 2008
Surgeons, anesthesiologists, intensivists, nurses, and

technicians need to work together as a team to perform a particular
cardiovascular procedure in the same manner every time with no
or minimal variation, he explains. A set routine done repeatedly
helps minimize mistakes.
Excellent Success Rates

Dr. Garcias trademark of meticulousness and dogged adherence
to quality control, have paid off. From March 2002 to December
2007, his team at AHMC performed 750 major cardiovascular
procedures ~ most of them high-risk operations ~ with a very low
overall mortality rate of 2.9%. The U.S. Society of Thoracic Surgeons
(STS) Database, the global benchmark for heart surgery outcomes,
has a 3.09% mortality rate covering six procedures involving
bypass surgery and heart valve replacement or repair. When limited
to the same number of procedures covered in the STS Database,
the AHMC mortality rate goes down to 1.4%. To date, Dr. Garcias
team at AHMC has done over 800 cardiovascular procedures.
Life-Saving, Innovative Techniques

Aside from the standard range of cardiovascular procedures, Dr.
Garcias team also performs a lot of newer procedures.
OPCAB
Off-pump coronary artery bypass (OPCAB) is a surgical technique
in which surgeons operate on the patients heart while it continues to
beat and circulate blood throughout the body. Maintaining a highly
controlled operative environment, surgeons use advanced operating
equipment to stabilize portions of the heart and bypass the blocked
artery or arteries. OPCAB is indicated for high-risk cardiovascular
patients with other existing diseases (e.g. diabetes) or blood clotting
problems. It reduces the risk of complications commonly associated
with conventional heart surgeries that require a heart-lung machine
and minimizes blood transfusions.
Endovein Harvest
For the past 5 years, Dr. Garcias team has been routinely
performing EndoVein Harvest, a minimally invasive procedure to
harvest the saphenous vein. Other local hospitals are just starting
to do this. Located in the inside part of the leg and extending from
the ankle to the groin, the saphenous vein is often used as a conduit
during bypass operations. This innovative technique dramatically
reduces complications commonly associated with the usual open
technique of harvesting the saphenous vein, such as pain, edema and
swelling, hematoma (bruising), and infection.
EndoVein Harvest is definitely more aesthetic for and less
traumatic to the patient because the saphenous vein is removed
through a one-inch incision on the middle part of the knee, explains
Dr. Garcia. It is the method of choice in major cardiac surgery
centers in the US.
Mitral Valve Repair
Instead of replacing the hearts defective mitral valve, the usual
procedure done in most Philippine hospitals, Dr. Garcia and his
team repair it. The mitral valve is the valve that lies between the
left atrium and left ventricle, the main pumping chamber of the
heart. This valve allows blood to flow from the left atrium into the
left ventricle and then prevents the backflow of blood into the left
atrium during ventricular contraction. Valve repair maintains the
natural anatomy of the mitral valve, which is why it is now the
method of choice for the surgical treatment of mitral valve disease,
Dr. Garcia says.
Left Ventricular Remodeling
Dr. Garcia and his team can surgically restore or remodel the
left ventricle in patients who otherwise would have required a
heart transplant. A heart attack can leave a person with a scarred
left ventricle. With each heartbeat, this scar can thin and bulge out,
eventually forming a dangerous aneurysm. These changes, along
with other damage to the heart, may result in heart failure. Initially,
the heart is able to cope with having to pump harder; but over time,
the extra work load causes the left ventricle to enlarge and lose its
ability to pump effectively. Reconstructive surgery restores the left
ventricle to a more normal shape thereby enhancing its pumping
capability, explains Dr. Garcia.
MAZE
Dr. Garcia utilizes a cutting-edge technique called the Maze
procedure to surgically treat atrial fibrillation, the irregular beating
of the heart caused by faulty conduction of electrical impulses. In
the Maze procedure, an energy source (radio frequency, microwave
or cryothermy) is used to scar heart tissue in order to block
abnormal electrical impulses and restore the hearts optimal impulse
conduction.
July 2008
25
MEDICAL TOURISM
Other innovative procedures performed by Dr. Garcias team at
AHMC include thoracic aneurysm repair and implantation of the
left ventricular assist device (the bridge to transplantation) in
critically ill patients who have no other recourse but to undergo a
heart transplant.
Affordable, High-Quality Care

Before the advent of medical tourism, Dr. Garcia knew of many
Filipino patients who initially wanted to go to the US for a heart
operation but ultimately decided to undergo the procedure at AHMC.
He also tells of many American patients with health insurance that
would have subsidized up to 80% of the cost of a heart operation
who chose instead to undergo the procedure in Asian Hospital.
Dr. Garcia believes patients make this choice for two
reasons. They want world-class quality medical care at a
significantly lower cost and the world-renowned compassion and
personalized care of Filipino health professionals. As medical
tourism takes shape, more and more candidates will be exploring
the option of going to the Philippines for their heart surgery.
About the Asian Hospital and Medical Center

Asian Hospital and Medical Center is partly owned and is an
affiliate of Bumrungrad International of Bangkok. It is recognized
to be a regional quality leader in healthcare. The hospital is run by
a team of experienced professionals from around the globe such
as the United Kingdom, Australia and Switzerland. Asian Hospital
and Medical Center is a one-stop center of medical services ranging
from checkups to cardiac surgeries. These services are delivered by
over 700 internationally trained doctors in a high-class facility. We
offer affordable world-class quality care when you need it. This, in
a nutshell, is Asian Hospitals affirmation of its regard for quality
medical care.
Eric Michael Santos is a freelance medical journalist based in Manila, Philippines. He has been writing about medicine
and health since 1997. His work has been published in Medical Tribune, a monthly newspaper for health professionals,
and HealthToday, a monthly consumer magazine, among others. He may be contacted at ericmichael.santos@gmail.com.
Requirements to become a physician

Must hold a bachelors degree: some schools require courses in the sciences in undergraduate study
Must take the NMAT (National Medical Admissions Test)
Must pass an interview with the specific medical school admissions board
Must complete 4 years of medical schoolMost medical schools focus their curriculum on the clinic aspect of patient
care, following a holistic approach to treating patients, and placing an emphasis on respect of patients rights and the
dignity they possess as such. Things that are highly stressed in US medical school today. Medical school students
are also encouraged to undertake socially relevant research with an emphasis on the utility of traditional and herbal
medicine. Many medical schools are now including bioethics and integrated coursework in their programs.
Must complete a clinical aspect and medical licensure examinations

Sources
http://www.hsc.dlsu.edu.ph/cm/index.htm
http://www.cebudoctorsuniversity.edu/colleges/medicine/admission.html
http://travel.state.gov/travel/cis_pa_tw/cis/cis_999.html
Requirements to become a nurse
Must have a high school diploma or the equivalent
Must complete science and math coursework in high schools
Must be able to express themselves in English

Sources
http://www.hsc.dlsu.edu.ph/cnm/BSN.htm
http://www.ceu.edu.ph/schools_and_colleges/nursing_academic.asp

26
July 2008
July 2008
27
MEDICAL TOURISM
A Date with the Villareals

for a Dream Set of Teeth
By Dr. Hermogenes P. Villareal
Models flash them with wide, beaming smiles. On billboards, they help sell products, from shirts to perfumes, and
appliances to homes. Movie stars and celebrities wont be caught without a perfect set of pearly white teeth for those
unexpected glamorous close-up shots.
ut for ordinary folks, simply having a good set of teeth is just

the right element to boost confidence in day to day life. For those
living in developed countries, one is better off being born with a
good set of teeth if they have not obtained excellent dental insurance
to cover the cost of the best possible service.
In reality, most western residents are not able to avail themselves
of the first-rate dental services they need because their insurance
does not cover it. They would have to pay out of their pockets for
procedures that are so expensive that they end up not having even
basic services performed.
This sad state of affairs has given rise to a boom in this aspect
of medical tourism, wherein Westerners venture abroad, finding it
more affordable to seek dental services from specialists all over the
globe. One of the top places in the world where admirable dental
procedures can be obtained is in the Philippines.
The Philippines boasts of a large number of medical and dental
specialists, many of whom are trained in the U.S. at the highest
levels and provide treatment at a fraction of the cost in developed
countries.
Well regarded among competent and capable dental specialists,
is the family of dentists running the renowned Villareal Dental
Clinic, Inc. With five clinics strategically located all over Metro
Manila, they are able to render service to patients with a wide range
of dental requirements.
28
July 2008
The Villareal Dental Clinic Inc. was founded by Dr. Hermogenes

P. Villareal in 1974. Since then, it has been rendering quality service
to individuals such as Philippine presidents, ambassadors, consuls
and dignitaries of other countries, employees of private companies,
HMOs and hotels, presidents and chief executive officers,
multinational companies and movie stars. Their mission is to provide
high quality dental services and excellent care to patients.
Patients are given a thorough evaluation and holistic treatment
from their first appointment. According to Dr. Villareal, his guiding
principle in life, which he has taught his children, is to treat your
patients with love and care as if youre treating your own father,
mother, brother or sister. Always give them the best quality dental
care.
Dr. Hermogenes P. Villareal is an active practitioner and one
of the outstanding leaders in the dental profession, with a career
spanning over 30 years. With his three children, Dr. Villareal
oversees the management and operation of his dental firm.
His eldest child, Dr. Maria Sheryl Villareal-Borja, specializes in
Prosthodontics, Cosmetic and Esthetic Dentistry. Dr. Sheryl always
remembers her dads reminder in treating patients, Do it once and
do it right. Also a Britesmile (whitening system) consultant, Dr.
Sheryl says patients will love and remember you the way you treat
them.
The pain-free Britesmile procedure entails using a

cool blue light and a proprietary gel. It gives clients
a lasting effect of 6 to 8 shades whiter teeth and an
impressive smile after only about an hour of the
process.
The second of the three children, Dr. Maria Shervy
Monica J. Villareal, specializes in Periodontics. She
takes on a holistic approach to oral health care from
prevention to treatment and the maintenance phase.
Periodontics deals with the teeth, gums and bone as well
as oral hygiene. There are different modes of treatment
depending on the patients needs. But most importantly,
this specialty ensures patients general oral health.
In reality, most western

residents are not able to avail
themselves of the first-rate
dental services they need
because their insurance does
not cover it.
Dr. Sherwin J. Villareal, the youngest of the three,

specializes in Implant Dentistry. Meanwhile, the
matriarch of the family, the only non-dentist, ensures
that the clinics are running smoothly and up to par with
standards.
With a family-run dental clinic to tend to dental
needs, one is assured of receiving tender loving care,
much like what one would get from his own family.
Everybody in the clinic lives by Dr. Villareals principle
of care, If you treat a patient with utmost care, the
patient will be happy and satisfied, thus gaining lifelong friends along the way.
Dr. Villareals achievements and contributions
in both the local and international industry have not
remained unnoticed. He is recipient of various awards
for his selfless sharing of expertise in the dental
profession and socio-civic involvement.
Dr. Hermogenes P. Villareal
was a past President of the
Philippine Dental Association.
He has a diploma from the
International Congress of Oral
Implantologists, fellowships from
renowned international and local
professional organizations, such
as the International College of
Dentists, Pierre Fauchard Academy, International
Congress of Oral Implantologists, American College
of Dentists, Federacion Dentaire International, and
the Philippine College of Oral and Maxillofacial
Surgeons. An Honorary Fellow of the Philippine
Academy of Implant Dentistr, Dr. Villareal took
International Implant Advanced Course at Loma
Linda University, USA, Calcitek Implant Surgery
and Prosthetics Training Course at San Diego,
California USA, and Surgical and Prosthetic
Management of Implant patients at the University of
the East College of Dentistry in Manila. His three
children have all taken their post graduate specialty
programs at the New York University.
July 2008
29
MEDICAL TOURISM
Balance: Mind, Body and Soul

By Cynthia L. Carrion
Picture yourself walking down the beach, with sparkling sands massaging your feet and the sun prompting a dose
of sweat, as your leg and arm muscles get their fix of desirable motion. All of this, as your senses take in a spellbinding view of forests and mountains and the fresh whiff of sea air.
magine the relaxing experience of being enthralled and living

in the moment. Imagine the healing of your aches and pains and the
leveling off of your anxieties and stresses, your natural responses
surrounding you. And you beam with joy at having responded to the
call to visit the Philippines.
With a backdrop like this repeating itself in most of the
Philippines 7,107 islands, truly the Philippines is a wonder to
behold as a destination for wellness and healing of the mind, body
and spirit.
The Philippine Department of Tourism (DOT), the government
arm mandated to develop and promote the Philippines as a tourist
destination, includes the Philippine Health and Wellness Program as
one of its anchor strategies to attract visitors who can both benefit
from its noteworthy offerings for wellness and medical procedures,
as well as its health-oriented tourism packages.
Through the Public-Private Partnership Task Force on Globally
Competitive Philippine Industries, the Philippine Department of
Tourism collaborates with internationally-acclaimed medical service
providers, as well as Philippine based medical service providers, for
the growth of the Philippine Health and Wellness program.
30
July 2008
The DOT is fully convinced that its host of health-enhancing

travel packages, coupled with the value for money proposition of
medical treatment and procedures in the country and the excellent
facilities and world-class levels of expertise of its medical
practitioners altogether present the Philippines as a major player in
global health and wellness tourism.
Tourism Secretary Ace Durano says, The Philippines welcomes
guests to discover and take advantage of the value for money offered
by the health and wellness tourism program through high quality
medical services. These services are offered with a distinctive kind
of care that allows visitors to feel the compassion and hospitality of
the Filipino people.
Clients who have experienced these medical and value for
money advantages echo this vital lure of the country - the warmth
and friendliness of its people. Amid the Philippines easy tropical
setting, the Filipino peoples hospitality and effervescence lighten
up the hearts of visitors who come for therapy and rejuvenation.
The mindset for de-stressing and rest, likewise comes easier for
clients who appreciate the tremendous savings on treatment and
procedures that are only from one-tenth to one-third of the usual
costs in North America, Europe or Australia. With cost-savings as a

major attraction for Philippine health and wellness tourism, it is not
surprising that the countrys top medical institutions are putting in
their energies to promote the industry overseas.
The DOT, likewise, sets a precedent in promoting and developing
wellness tourism programs for its establishment of the Office of
Sports and Wellness Tourism, headed by Undersecretary Cynthia
Carrion.
Reconnecting Roots ~ Discovering Clues from Nature
The mantra of taking breaks from routine and, oftentimes,
sedentary work only presents its fullest benefits when the right
choices for vacation sites are made. In this travel front, clients
who are coming over with the medical aspect in mind can choose
from the wide array of destinations and experiences offered by the
Philippines.
Those whose families originate from the Philippines would do
well to reestablish or reconnect with their roots, providing them
better psychic balance through the understanding and appreciation
of their past in relation to their present. Heritage and cultural tours
bring travelers to eras gone, but where hidden memories remain.
The Vigan cultural heritage tour in Ilocos Sur province, listed
as one of UNESCOs World Heritage sites, showcases the highest
concentration of ancestral homes (180 of them) of unique Filipino
architecture, blending influences from Mexico, Europe and China.
Many of these homes now operate as souvenir shops, museums, and
inns. Farther up in the same province is Laoag, which is lined by
excellent beaches in Curimao and Pagudpud and more remnants of
the rich Ilocano past.
In the mountainous Cordilleras are the famous Rice Terraces,
an ancient architectural wonder also listed as World Heritage site. A
magnificent work of the Ifugao tribe, it is a tribute to the ingenuity
of the Philippine tribal population. Tours that link up to the tribal
cultures abound in the country; provide exhilarating experiences of
ethnic sounds, dances and traditions that remind man of the salient
principles of respect, co-existence and living in harmony with
nature.
Eco-tourism and adventure packages are available for closer

encounters with exquisite delights from nature. Enjoyment of
butanding whale shark sightings in Donsol, Sorsogon, exploration of
mysterious caves, admiration of exotic flora and in richly endowed
Palawan, trekking on Mt. Pinatubo in Luzon and Mt. Apo in Davao,
diving off the Tubbataha reef for a glimpse of amazing numbers
of coral species and genra are only some of the possibilities for
travelers seeking a breather from boxed-in contemporary living.
Clients who have experienced

these medical and value for
money advantages echo this vital
lure of the country ~ the warmth
and friendliness of its people.
Since many physical ailments and emotional maladies can be
traced to a state of spiritual barrenness, enriching and uplifting
spiritual outreach in the Philippines can take place in profound ways.
Pilgrimage sites in the country, especially for Catholic devotions,
are now offering retreats and reflections that go well beyond the
mere physical appreciation of beautiful and age-old shrines and
churches in the country.
Put together, well-selected travel experiences go beyond
sensory stimulation. They dwell into life-changing re-alignments of
priorities and attitudes to return to health and promote wellness in
the holistic sense.
Cynthia L. Carrion is the Undersecretary for the Sports
and Wellness Industry of the Philippine Department of
To u r i s m . S h e m a y b e re a c h e d b y c o n t a c t i n g t h e
Department of Tourism at http://www.philippinetourism.us.
Do you have
Errors & Omissions - Liability Insurance
when Dealing With Patients?

If you are a Facilitator sending patients overseas, you may

obtain an E&O Policy
Please contact : medtour@bellsouth.net
(615) 444-8859
July 2008
31
MEDICAL TOURISM
Medical Tourism Economic Report

By David G. Vequist IV, Ph.D. and Erika Valdez
In the Philippines it seems as if they are trying to build a sustainable international Medical Tourism culture. It
seems that the Philippines has many opportunities to take advantage of the estimated, over $40 billion dollar
Medical Tourism industry. For this country, 700,000 medical tourists and US $2 billion annually seems very
achievable in the very near future.
hen it comes to Medical Tourism, the Philippines have

been getting a lot of attention recently. The country not only offers
services and prices that medical tourists are looking for, but also is
improving upon its level of healthcare competence and investing in
medical technology in its facilities. The Philippines hopes to take
advantage of its hospitable people, English-speaking population,
high quality medical labor force and the competitive price of
services. The Filipino government envisions the country as the new
hub of wellness and medical care in Asia. In fact, the government
announced in 2004 that their 6 year Medium Term Philippine
Development Plan (MTPDP) included goals to enhance and promote
health tourism. The government believes that they have the potential
to earn US $2 billion annually in the next several years.
In October of 2004, as part of an executive order by President
Gloria Macapagal-Arroyo, the Philippine Medical Tourism (PMTP)
program was created. It is a private-public initiative aimed at
attracting foreign clients into the Philippines with a focus on health
and wellness services for medical tourists; including tours, vacations
and shopping packages. This program incorporates a variety of
relevant government agencies, hospitals, private medical centers,
and businesses in the retail, wellness, spa, health, and tourism
industries. The program intends to attract about 700,000 medical
tourists annually to the Philippines as early as 2010. In addition,
the Filipino government is in discussion with the US to try and
persuade them to make healthcare expenses by Americans eligible
for Medicare reimbursements.
32
July 2008
The country has historically

had a higher percentage of
healthcare professionals (such
as nurses), than many other
developing countries which
only aids in keeping labor
costs lower.
Economic Facts
The countrys economy has been helped by growth of Private
Services (which include healthcare services) which were up 8.9%
in 2007. The Filipino government reports that the country has
capitalized on the growing trend in medical tourism in 2007, and
overall the performance of the Medical & Health Services sub sector
increased sharply (around 8% and up from 2.4% in the previous
period). They attribute this recent trend to the rising cost of health
care in developed countries, coupled with improving medical
technology and human resources in the Philippines. In 2005, the
countrys health and wellness tourism was estimated to be at about
1.26% of total GDP or $68.5 billion Filipino Pesos (approximately
$1.65 billion US dollars in 2008).
In the Philippines it seems

as if they are trying to build
a sustainable international
Medical Tourism culture.
The country has historically had a higher percentage of

healthcare professionals (such as nurses), than many other
developing countries which only aids in keeping labor costs lower.
For example, it was estimated that in 2000, there were over 330,000
nurses in the Philippines for an average ratio of around 4.4 nurses
per one-thousand citizens (still less than many developed nations
that average around 8.6). However, the country has been very
concerned for many years with the brain drain in which thousands
of Filipino healthcare practitioners leave to find better-paying jobs
abroad. Medical Tourism has already had an impact on keeping
some of these medical professionals in the country, because it is
estimated that employment in health and wellness tourism had
increased 13.2% from 2003 to 2005 to around 238,955 employees
(or about .73% of total employment in the Philippines). With its
reported numbers in 2003 of just over 95,000 doctors and a ratio of
1.2 doctors (high in the Asia-Pacific region; but still low compared to
developed nations which have an average of 3.0) per one-thousand
citizens (approximately 81 million total population), these increased
employment numbers are good for the country.
Impacts to Other Industries

Healthcare Facts
There are a total of 1,723 hospitals with more than 85,000 bed
capacity in the Philippines. The national Department of Health
administers 72 hospitals and the other 559 government hospitals
(about 36.4% are public facilities) are managed and supervised by
the Red Cross and its Chapters and the provincial, municipal, or
city governments under the Department of the Interior and Local
Governments (DILG). The Philippines has two JCI accredited
hospitals St. Lukes Medical Center (a 650-bed facility located
in Quezon City; it was the 2nd facility accredited by JCI in Asia)
and the Medical City hospital (located in Pasig City). The Filipino
government also offers a Gintong Sigla seal (Gold Seal or Golden
Enthusiasm) for national accreditation (which is ISO based) as well.
In addition, laboratories in the Philippines are monitored by the
international Asia-Pacific Laboratory Co-operation (APLAC), which
has standards similar to the European Laboratory Accreditation
(EAL) agency.
The growth in Medical Tourism has also created many

opportunities for international sellers of medical equipment and
instruments because this industry in the Philippines is almost totally
dependent on imports. In 2005, it was estimated that the Philippines
total imports of medical equipment was $119 million, up 32% from
the previous year. Of this market, the U.S. had a dominant 34%
market share, followed by Singapore with 12% (however, it is
suspected that a large volume of Singaporean exports originate in
the U.S.). Overall the Philippine medical market and the many U.S.trained Filipino doctors are partial to the high-technology American
medical equipment and instruments although these US companies
face competition from Singapore, Germany and Japan.
Summary
In the Philippines, it seems as if they are trying to build a
sustainable international Medical Tourism culture. The government
encourages private hospitals to give at least a 10% share of the medical
facilities and treatment to patients that are unable to pay. In addition,
the PMTP is involved in the creation of international medical zones
(IMZs) to encourage economic development in Medical Tourism.
Other trends to watch are the .5 to 3 million Filipino-American
retirees who may choose to settle in the Philippines sometime in
the years 2010 to 2020. It seems that the Philippines has many
opportunities to take advantage of the estimated, over $40 billion
dollar Medical Tourism industry. For this country, 700,000 medical
tourists and US $2 billion annually seems very achievable in the
very near future.
David G. Vequist IV, Ph.D. is an Associate Professor

of Management in the H-E-B School of Business &
Administration at the University of Incarnate Word in San
Antonio, Texas, USA. He is also a consultant, author and
speaker on topics such as healthcare trends and technologies.
He can be reached at vequist@uiwtx.edu.
Erika Valdez, is a student in the MBA program in the H-E-B
School of Business & Administration at the University of

Incarnate Word in San Antonio, Texas, USA. She is a promising
speaker and author in the area of economic development in
developing nations. She can be reached at
evaldez@uiwtx.edu.
July 2008
33
MEDICAL TOURISM
St. Lukes Heart Institute
At the Forefront of Patient Care
t. Lukes Heart Institute provides the best possible care to

patients with cardiovascular diseases. It exemplifies St. Lukes
Medical Centers unequalled excellence in expertise, technology,
quality of healthcare outcomes, and service for total quality patient
care.
This influenced Mr. Tjahjar Hendradinarta, a 69-year-old

businessman from Indonesia, when he needed to undergo a procedure.
When my doctor instructed me to undergo a comprehensive
heart check-up, I decided on St. Lukes Cardiac Catheterization
Laboratory in the Philippines, he says.
The topnotch cardiologists and surgeons of St. Lukes have the

most advanced medical equipment in the Philippines at their disposal.
With a 99 percent success rate in percutaneous cardiac intervention
and 99 percent procedural success in open-heart surgeries, the
Institutes superior diagnostic efficiency and clinical success rate is
comparable with the best medical centers in the world.*
The Cardiac Catheterization Laboratory or Cathlab is an integral

part of St. Lukes Heart Institute. Its diagnostic procedures can
comprehensively assess and confirm the presence of coronary artery
disease. Early detection will significantly reduce the heart attack risk
and raise the chance of successful treatment. Cardiac catheterization
also reveals valuable information within the heart, such as oxygen
levels, blood pressure levels and the heart muscles pumping ability.
34
July 2008
The first step was for Mr. Hendradinarta to undergo cardiac

catheterization. Doctors insert a long, thin, flexible tube (catheter)
into an artery or vein usually located in the groin area. They then
thread the catheter through major blood vessels into the coronary
arteries or heart chambers. A television screen monitors the catheters
progress through the artery.
Mr. Hendradinarta was next given a procedure called
intravascular ultrasound (IVUS) using a device embedded on the tip
of the cardiac catheter. This is an imaging technique that uses highfrequency sound waves to produce detailed images of the heart and
its arteries, enabling doctors to detect the presence of plaque and the
degree of narrowing in heart arteriesthe culprits of heart attack.
Using the same catheter, doctors also performed a coronary
angiogram. This involves injecting a dye into the hearts arteries
through the catheter. The dye makes all arteries and their potential
blockages visible to X-ray. Coronary angiograms are safe and
straightforward, and are performed as an outpatient procedure where
patients are completely awake.
The IVUS and Coronary Angiogram provided my doctors an
accurate measure of how much my arteries had narrowed, which
helped them come up with a targeted treatment plan, says Mr.
Hendradinarta.
Trusted by heart patients for two decades

Patients with heart disorders have entrusted their medical care to
St. Lukes Heart Institute for the past 21 years.
The Joint Commission International (JCI), the worlds most
prestigious healthcare accreditation body, affirmed St. Lukes
unequalled excellence in healthcare delivery in 2003. In 2006, it
was the first hospital in the Philippines and only the second in Asia
to receive JCI re-accreditation among only 32 institutions in the
region.
St. Lukes is committed to continuously delivering excellent
healthcare, says Mr. Jose F.G. Ledesma, President and CEO of St.
Lukes Medical Center. We constantly strive to exceed customer
expectations.
St. Luke's Heart Institute also offers cutting-edge cardiac
diagnostic imaging tests such as Thallium Stress Testing with Single
Photon Emission Computerized Tomography (SPECT). The latter
involves injecting radioactive thallium, which serves as a tracer,
into the bloodstream, where it attaches itself to the muscle cells of
the heart for the gamma-imaging camera to take pictures of the heart
muscles. This provides a nuclear scan to reveal areas of the heart
that are not getting enough blood.
Based on data from 30-day post-operative survival rates recorded by St. Lukes Heart Institute Cardiovascular Disease Information System
(CVDIS), US National Medicare experience, latest Morbidity and Mortality Statistics on Coronary Bypass Surgery and Angioplasty, and The
Best Hospitals for Heart and Heart Surgery 2005-2006.
July 2008
35
MEDICAL TOURISM
An Unparalleled Legacy
By The Beverly Hills Medical Group
Beverly Hills Advanced Surgery Institute (BHASI)s legacy found continuity in the other half of the world, in the
wake of the creation of the Philippine Medical Tourism Program, the countrys stepping stone to the development
of a medical tourism infrastructure that is distinctly its own and at par with world standards.
he concept of medical tourism in the Philippines was still a

decade away when the Beverly Hills Advanced Surgery Institute
(BHASI), first opened its doors in Beverly Hills in 1996 to patients
seeking safe, state of the art cosmetic surgery.
In the cosmetic surgery capital of the world, BHASI, under the
direction of President and CEO Maria Rebujio, blazed a path in the
landscape of professional patient care as a multi-specialty center
accredited by the California Department of Health Services and
Medicare certified by the US Federal Government.
From the beginning, the practice counted as advantages its
expert doctors and cutting-edge medical technology, but what
ultimately distinguished BHASI from its competitors and sustained
it for twelve years was a clear-cut mandate to place patient safety
above all. It wasnt long before its solid presence and its remarkable
surgeons caught the eye of American media icons the Oprah Winfrey
Show, Extreme Makeover, Dr. 90210, Discovery Channel, The
Lifetime Channel The Tyra Banks Show, Montel Williams, Extra,
Inside Edition, Entertainment Tonight, Access Hollywood, CNNs
Larry King Live among others, confirming BHASIs status as an
industry giant.
36
July 2008
Nurses assigned to the

operating rooms are
trained in advanced
cardiac life support,
and the lighter but
similarly valuable job
of making patients
comfortable by
accommodating the
simplest of requests.
BHASIs legacy found continuity in the other half of the world,

in the wake of the creation of the Philippine Medical Tourism
Program, the countrys stepping stone to the development of a
medical tourism infrastructure that is distinctly its own and at par
with world standards.
Rebujio cast her gaze towards the country of her roots and set out
to realize her goal of providing the finest outpatient multi-specialty
surgical care services in the Philippines, coincidental to the boom
in medical tourism services.
Backed up by the impeccable reputation of its California based
parent company, the Philippine facility, christened Beverly Hills
Medical Group (BHMG), has reached unprecedented heights as the
largest US based, managed and operated multi-specialty surgery
center in Asiaarming the Philippine medical tourism industry
with an unrivaled advantage.
A Stable of Firsts
The integrity of services is undiluted, she adds, such that BHMG
facilities meets the US gold standard for multi-specialty ambulatory
surgery centers. The center provides a variety of outpatient surgical
procedures in the areas of regenerative medicine, cosmetic surgery,
plastic and reconstructive surgery, cosmetic laser and dermatology,
general and vascular surgery, gastroenterology, gynecology surgery,
otolaryngology, podiatry, orthopedic and sports medicine, pain and
cancer pain management, and urology and mens health. Its cancer
pain management program is one of the few venues in the Philippines
where cancer sufferers can receive much welcome relief.
What ultimately distinguished

BHASI from its competitors
and sustained it for twelve
years was a clear-cut
mandate to place patient
safety above all.
The BHMG holds the distinction of being one of only two multispecialty ambulatory surgery centers in the Philippines licensed
by the Department of Health (DOH), the principal agency in the
countrys medical tourism drive. It also holds a medical tourism
facility accreditation from the Department of Tourism (DOT),
and is poised to receive Joint Commission International (JCI)
certification.
From its inception, going the easy route was never part of the
equation. We did everything by implementing U.S. Standards,
Rebujio says. The DOH was so impressed with the policies and
procedures we wrote and our adherence to them, that we were
issued a license a day after inspection. The policies extend to
dealings with other qualified agencies for ambulance transportation,
laboratory work, pathological, bio-medical, pharmaceutical services
and medical waste disposal. No costs were spared in the construction
of a medical facility that is also part haven. Occupying an expansive
space in Manilas business district, the one-storey facility has four
U.S. standard operating rooms and sizeable recovery, treatment,
consultation and private waiting rooms. But it is nevertheless a quiet
place in the eye of the urban storm, designed to still the fears of the
most apprehensive patients. Any type of surgery is frightening,
Rebujio concedes, Our place has the atmosphere of a home in a

truly professional environment to make our patients comfortable
and relaxed.
Its luminous interiors were fashioned out of high-grade materials
from the US, from the aluminum doorframes to the elegant bamboo
flooring. Likewise, all the medical equipment, instruments and
supplies, down to surgical thread and bandages, are imported from
the US. To truly build a US facility, other than concrete and paint,
everything was imported from the US.
BHMG takes pride in having operating rooms that rival the best
in the world, outfitted with state-of-the-art equipment, piped-in gas,
and emergency medication, notably Dantrolene to counter malignant
hypothermia (an allergic reaction to anesthesia) in emergency
caseswe are the only medical facility in the country that carries
the cure for malignant hypothermia. In the event of an emergency,
we are fully prepared, Rebujio says. We wont compromise our
patients safety.
BHMG also marks a first in the Philippines by being the first
and only facility with High Efficiency Particulate Air (HEPA) and
Laminar Air flow filtration systems, which purify air especially
in the operation rooms, maintaining an optimum environment for
sterile procedures, and patient health.
The Countrys Best Medical Staff

The excellence of Philippine-trained doctors with medical
experience abroad is a strength BHMG has maximized. Over
100 Board Certified Surgeons and over thirty Board Certified
Dermatologists practice in the facility. Whether recommended or
handpicked, Board Diplomates in their Specialties must apply for
accreditation at BHMG which outlines their extensive education and
training, board certification, qualification to perform procedures in
his or her specialization, sufficient experience in a hospital or medical
facility, and membership in a professional medical organization. .
We make sure we have doctors with both the right credentials and
compassion, Rebujio says. Our doctors have excellent judgment;
they will never advise you for surgery if you are at any risk.
BHMG also takes pride in its highly trained nursing staff. Our
nurses know our U.S. based policies and procedures like the backs
of their hands, Rebujio says. Nurses assigned to the operating
rooms are trained in advanced cardiac life support, and the lighter
but similarly valuable job of making patients comfortable by
accommodating the simplest of requests.
A Response Unparalleled
In the eight months it has been operational, the volume of clients flocking to the BHMG has been unparalleled primarily due to
its comprehensive website. The costs of surgery, says Rebujio
counting expenses spent to recover in one of the most beautiful
tropical settings in the worldare a fraction of US prices. We
have brought the same technology and quality to the Philippines at
a fraction of the cost, Rebujio says.
If plans call for surgery sandwiched in between trips to the beach
or rounds of golf, BHMG is happy to oblige. We work with worldclass concierge agencies from all over the world, one of which is
Philippine Medical Tourism, Inc. (PMTI), that provide travel needs
from A-Z.. Nothing less can be expected from BHMGthe only
company able to infuse the Philippine medical tourism industry, a
serious contender in the Asian arena, with a dose of world-class
expertise.
The Beverly Hills Medical Group

Maria M. Rebujio is the President and CEO of both Beverly Hills Advanced Surgery Institute, Beverly Hills CA and
Beverly Hills Medical Group, Makati City Philippines. A graduate of the University of Michigan, she has over 27 years
of management experience in the operation of Multi-Specialty Surgery Centers.
www.beverlyhills.ph
July 2008
37
MEDICAL TOURISM
Exceeding Expectations
Health and Wellness in the Philippines

By The Philippine Ministry of Tourism
Living in todays stressful and fast-paced modern world, health has apparently taken the back seat in favor of
meeting work deadlines, catching up with payment of bills, keeping up with glitzy and power lifestyle trends.
Checklists to take care of business unfortunately have overlooked to a certain degree vital health-related
concerns. The increasing back-to-basics awareness and the keen realization of the sensitivity of the human
body to abuse are, however, changing attitudes toward wellness and the pursuit of health care.
olicies to address availability of wellness programs in various

sectors are now in place. Manifestations of the shift in mindsets
are seen all over in the Philippines. Today, we find well-conceived
spas in many places, from seaside resorts to plush hotels in business
centers. Health as wealth, is the buzz and a whole new range of
services to address the care demand has emerged. And, for more
systematized providers of medical and health care services such as
hospitals, well-conceived Wellness Programs are in place.
Importantly, Wellness Programs find avid supporters in the
government sector which believes in the gospel of health. On the
part of the Philippine Department of Tourism, encouragement and
aggressive support has come in the form of the Public-Private
Partnership Task Force on Globally Competitive Philippines
Industries or PPPTF. The group is composed of private and public
sector leaders from different disciplines and includes doctors,
hospital directors and related agency representatives and is focused
on steering Health and Wellness cum tourism growth. One of its
strategies is information awareness on programs that are related to
the promotion of health and wellness.
38
July 2008
One of its members, The Medical City, is a private, tertiary

care hospital that has been running now for 40 years. The Medical
City boasts of a Wellness Center that provides complete health
and wellness programs for all ages. The Medical City's Wellness
Center also offers optional packages at reasonable rates. These
include cardio- tests, stroke evaluation, pulmo-check for smokers,
bone densitometry, diabetes mellitus, colonoscopy, gastroscopy,
endoscopy and diagnostic tests for snoring and sleep disorders.
The availability of evidence-based, customized, and optimized
executive checkup packages that are designed for the unique health
history, habits, and situations of every individual is what makes The
Medical City's Wellness Center more effective, less time-consuming
and less expensive. Now patients no longer need to undergo every
medical test regardless of their specific need.
Outside of hospitals, the surge for the provision of services to
improve quality of life is found in upscale hotels and resorts. Calm,
therapeutic and relaxing, The Spa at Mandarin Oriental, Manila
offers personal spa journeys in the four treatment rooms designed
for different character needs. Over at the Peninsula Spa, the setting
is aligned for rejuvenation. A refreshing dip in the pool, an hour
of relaxing Thai massage or a detoxifying sauna bath are all made
available with special touches for the client.
Aside from breathtaking views

and crystal blue waters, the
Philippines top beach resorts
also have exciting spa services
to present.
Chi-Spa at EDSA Shangri-La Hotel allows one to enjoy the

luxury of the largest spa suites in Manila complete with sunken
spa tub, spacious relaxation area, herbal steam room and showers.
With a lush tropical setting, Chi embraces a holistic philosophy for
restoration of balance and harmony to mind and body.
Aside from breathtaking views and crystal blue waters, the
Philippines' top beach resorts also have exciting spa services to
present. Cebu's Plantation Bay rewards visitors with Moogambo
Springs, a health and relaxation spa constructed with its own
waterfalls, creek and fog-like mist, enough to send you off to sweet
paradise.
Nurture Spa in Tagaytay City is a destination spa set in a tropical

garden amidst coffee tree orchards and pineapple plantations. It
offers a range of Filipino and international standard spa treatments
using primarily natural ingredients and botanicals. Also in Tagaytay
City, tucked in the mountains with a view of Taal Volcano, is Le
Petit Paradis, with world-class accommodations, a relaxing spa and
a team of professionals. With vitalizing spa experiences like these,
the sense of having a more complete connection with inner selves
now becomes more pronounced, giving visitors the much-deserved
pampered and cared for feeling.
Another way of seeking renewed health includes a trip to The
Farm at San Benito. Located in Lipa City, Batangas, The Farm at
San Benito is a private sanctuary that offers everything from medical
therapies and spa treatments, to spiritual development activities.
Also called the Hippocrates Health Resort of Asia, The Farm at San
Benito is an excellent venue to begin the healthy lifestyle people
aspire for.
The Farm at San Benito's warm and welcoming staff is ready
to assist visitors through the offering of optimum health-supporting
diet, and through a series of detoxifications: physical, mental and
spiritual. Guided by their belief that true nutrition comes from
"living" food, their Vegan Restaurant, headed by world-class chef
Felix Schoener, serves food that are almost completely uncooked to
maintain the enzymes in food that are necessary for every function
of the body.
Professionals behind wellness services in the Philippines are
continuing to raise the bar and visitors are finding amazing touches
that not only delight the senses but reach their inner core that seeks
to be nourished by essential care.
July 2008
39
MEDICAL TOURISM
SEAIR Partners with PMTI to Boost Medical

Tourism in the Phillipines
outh East Asian Airlines (SEAIR) is the Philippines distinctive

leisure airline. In 1995, it started with flights to Boracay and Palawan
and now, it flies to 17 destinations in the country. Most, if not all of
its destinations are considered paradise.
At the same time, the Philippines is gearing up for the increasing
arrivals of medical tourists. With the countrys many beautiful
islands, it is fast becoming an ideal place for de-stressing and for
recovery after cosmetic or aesthetic surgery and dermatologic
procedures. Nothing beats sitting on the beach with the sound of the
waves and cool tropical breezes lulling you into a state of healing
and recovery.
SEAIR has partnered with Philippine Medical Tourism
Incorporated (PMTI) to open the Philippines to the world as a medical
tourism destination. By making the remote islands accessible,
medical tourists have numerous destinations to choose from, giving
them access to the countrys beautiful islands.
SEAIR has made traveling easier and more convenient for
medical travelers, tourists, businessmen and commuters alike, said
Patrick Tan, Vice President for Commercial Affairs of SEAIR. With
SEAIR, recovery in paradise is only a short plane ride away.
SEAIR has added four new destinations: Basco in Batanes, Baler
in Aurora, Daet in Camarines Norte, and Tablas in Romblon.
The picturesque Batanes is now being hailed as the next best
destination in the Philippines. With green pastures overlooking the
Pacific Ocean, windmills on sprawling countryside and lighthouses
guarding immaculate shorelines, Batanes is often compared to
European landscapes like Ireland. Aside from rolling hills and steep
cliffs, Batanes is also known for its stone-walled houses withstanding
strong winds and typhoons. It has a population of less than 20,000
people and a crime rate of zero ~ making it a perfect hideaway for
travelers seeking a tranquil break from the hustle and bustle of city
life.
provides its passengers with as many as 28 daily flights to Boracay.

Undoubtedly one of the Philippines main attractions, the island of
Boracay has charmed visitors far and wide with its palm-fringed
white sand beaches, crystal blue waters, beautiful sunsets, and
lush marine life. This is hardly a surprise -- after all, Boracay has
already established over the years a reputation for being one of the
best beaches in the world.
The airline uses a fleet of state-of-the-art turboprop aircrafts
which allows it to fly its passengers from Manila to Boracay in only
35 minutes ~ the fastest flight offered by a local airline. SEAIR also
offers the fastest flights and most flights to Palawan and has set a
standard in traveling by being the first to introduce paradise-toparadise routes with its Boracay - Palawan flights. Sun worshippers
can have the best of both worlds: the exciting sights and flavors of
white-sand Boracay as well as the natural beauty and rich diversity
found in the marine sanctuaries of Palawan.
SEAIR has flown almost 3 million passengers to 17 local
tourist destinations in the countrys 3 major islands, connecting the
islands, and with its partnership with PMTI, connecting the rest of
the world.
To know more about the Philippine Medical Tourism

Incorporated (PMTI), please visit www.philmedtourism.
com. For inquiries and reservations, please call
SEAIR Reservations at (632) 849-0100 or visit
www.flyseair.com.
Considered the most progressive town in the province of Aurora,

Baler is known for historical sites such as the home of former President
Manuel L. Quezon and the picturesque Baler Catholic Church. Baler
also boasts of scenic landscapes and beaches. The waters of Baler
also serve as site of the Aurora Surfing Cup, an annual event where
local and foreign surfers compete.
Some of the best beaches suitable for surfing may also be found in
Daet, Camarines Norte. Popular among foreign tourist surfers, waves
in Daets beaches are perfect for beginners with swells reaching as
high as six feet. Daet is also known for its annual Pineapple festival
which features the Formosa, one of its sweetest varieties growing
abundantly in the region.
Known as the Marble Country of the Philippines, Romblon is
famous for its rich marble deposits as well as unspoiled white sand
beaches, bountiful marine life, waterfalls, and its unique inland salt
lake. Although it may not be as frequented as other local tourist
destinations such as Boracay and Palawan, Romblon is a haven for
visitors seeking raw, pristine beauty and the comfort of paradisiacal
solitude.
SEAIR is doing a unique service to the country in support of
its medical tourism development goals as more and more tourist
destinations are being developed in different parts of the country. It
40
July 2008
July 2008
41
MEDICAL TOURISM
Fortifying Western Healthcare with

Traditional Chinese Medicine
By Ferdinand P. Lukban
With huge, mainland China at the northeastern side of the Philippine archipelago, it is not surprising to
find significant Chinese influences in Philippine culture. Trade between the Chinese and Filipinos has been
chronicled since the ninth to 12th centuries. Today, some ten percent of the Philippines entire population is of
Filipino-Chinese descent.
his racial mingling has brought forth the noteworthy presence

in the Philippines of Traditional Chinese Medicine (TCM), which
has a rich history of 3000 years of ancient practice and experience.
For this reason, there are a number of doctors in the Philippines
who have also acquired expertise in Traditional Chinese Medicine
as they opt to find a balance between the Western and Chinese mode
of cure.
TCM has a distinctive approach to diagnose and cure illness.
In TCM, the understanding of the human body is based on holistic
view of the universe and treatment of illness is based primarily on
the diagnosis and differentiation of syndromes.
42
July 2008
Having no sign of illness does

not mean that a person is
healthy. The goal of Chinese
Medicine is to figure out the
root cause of lack of health.
TCM approach treats zang-fu organs as the core of the human

body. It is known that tissues and organs are connected through a
network of channels and blood vessels inside the human body. The
Qi (chi) acts as some kind of carrier of information that is expressed
externally through jing luo system. A dysfunction of the zang-fu
organs may be reflected pathologically on the body surface through
a network affecting the related zang-fu organs hence manifesting
diseases of the body surface tissues. An affected zang or fu organs
may also influence each other through internal connections. TCM
treatment begins with analyzing the entire system, before focusing
on the connection of pathological changes through readjusting the
functions of the zang-fu organs.
Evaluation of a syndrome not only includes the cause,
mechanism, location and nature of the disease but also the
confrontation between the pathogenic factor and body resistance.
Treatment is not based solely on the symptoms, but differentiation
of syndromes. Therefore, those with identical diseases may be
treated in different ways, and, on the other hand, different diseases
may result in the same syndrome and are treated in similar ways.
The universal diagnosis and treatment in TCM are mainly based
on the yin-yang and five-element theories. These theories apply the
phenomena and laws of nature to the study of the physiological
activities and pathological changes of the human body and its
interrelationships. The typical TCM therapy includes acupuncture,
herbal medicines and qigong exercises. Treatment is usually done
stimulating certain areas of the external bodies called trigger points
or acupoints. Herbal medicine acts on zang-fu organs internally
while qigong resuscitates the dysfunctional information flow inside
the network through the regulations of Qi. These therapies appear
very different in approach yet they all share the same holistic
understanding in the universe.
The synergy of the researchbased Western Medicine and

3,000 years of Traditional
Chinese Medicine is the
latest approach of healthcare
programs.
TCM believes that human life is a physiological process in
constant motion, and changes. Under normal conditions, the waxing
and waning of yin and yang are within certain bounds reflecting
a dynamic equilibrium of the physiological processes. When the
balance is broken, disease occurs. Typical cases of disease-related
imbalance may either include excess of yin, excess of yang,
deficiency of yin or deficiency of yang.
The Convergence of Eastern and Western Medicine

The world is more acquainted with the conventional Western
medicine. For years it has known and trusted its benefits, and
believed that it is the only tried and scientifically tested medical
system. In recent years, healthcare development is encompassing
new horizons. Though we have latest medical discoveries and
develop new techniques for healthier and longer life, still many
questions are left unanswered by Western medicine. This situation
gives rise to the emergence of alternative medicine.
The convergence of Western and Eastern Medicine is now being
practiced in several parts of the world. The synergy of the researchbased Western Medicine and 3,000 years of Traditional Chinese
Medicine is the latest approach of healthcare programs. It is now
being used in modern healthcare commonly known as Integrative
Care.
The greatest value of Western Medicine is in trauma care and

therapies for acute problems. TCM on the other hand targets chronic
problems incorporating preventive care cultivating the internal life
force and increasing immunity against illnesses thus increasing
resistance to diseases. The integration of these two medical systems
results in the highest success in patient care. Recently, there has
been an increasing awareness and interest in alternative therapies.
Alternative, complimentary or holistic medicine is a
common terminology nowadays. More and more people embrace
some form of alternative therapy coming from herbs or through
acupuncture, acupressure and meditation. Exercise techniques
which are uncommon to us before, like tai-chi and qi-gong, are also
incorporated with much enthusiasm and acceptance.
Moreover, as cities witness the rise in stress and lifestylerelated illnesses, the overall cost to achieve and maintain health
also increases. It is with this concern that preventive medicine
plays a major role in promoting wellness. It is more economical and
promises long-term healthy living. Preventive medicine can ensure
continued good health of the populace.
Traditional Chinese Medicine tackles the gray area between
sickness and health. Having no sign of illness does not mean that a
person is healthy. The goal of Chinese Medicine is to figure out the
root cause of lack of health.
The convergence of Chinese Medicine, which centers on
cultivating the internal force of our bodies, and the value of
Western Medicine, which centers on trauma care and acute problem
therapies, fortifies the strength of the modern healthcare approach
the Integrative Care.
Ferdinand P. Lukban is Managing Director of

We Medicus. We MEDICUS is an Integrative
Care boutique located at 118 Jupiter st.
Brgy. Bel-Air, Makati City, Philippines
1209. You may contact them at wemedicus@
pldtdsl.net, wemedicus@gmail.com.
July 2008
43
MEDICAL TOURISM
CEBU ~ More than the Usual

By Cebu Health & Wellness Council
Boasting 7,107 sun-drenched islands, diverse flora and fauna, rich marine life, the worlds best beaches, crafts
and arts, easy access to sea and mountains, and abundance of fresh fruits and vegetables, the Philippines is
one of the most desired tourist destinations in the world. At the center of the Philippine archipelago is Cebu an island, a province and a city.
t is the top tourist destination in the country and, next to the

capital (Manila), the most accessible point in the Philippines with the
most number of air and sea linkages. It is known as the Philippines
Bestseller and, until recently, its best kept-secret for attracting
multitudes of tourists, traders, investors, educators, students, and
professionals to the country.
Cebu has always been a unique proposition: it melds the rustic
charms, relaxed and laid-back atmosphere, and tropical beauties
of lush island life - with that of a bustling, progressive metropolis,
bursting with a dynamic entrepreneurial base and a multi-ethnic
people highly receptive to international business and tourism.
Consistently a net exporter and top foreign exchange earner, Cebu
makes no secret of its desire to learn from the development models
of Singapore and Hong Kong. It is the one area in the Philippines
that can seriously pursue the viability of converting and proclaiming
its entire island as a special economic zone.
44
July 2008
Cebu and tourism has long been a perfect match: convenient

infrastructure, hospitable people, beautiful beaches and dive sites,
world-class resorts, secure location. And because Cebu attracts the
best of its people, it has a culture for innovation and adapting to
changing environments, and access to a veritable trove of talents and
resources. It is poised to offer another attraction that heretofore had
been kept out of the spotlight in investment and tourism promotions
~ Cebus healthcare and wellness industry.
It is a fairly new and growing sector with medical and wellness
services increasingly appreciated and sought by locals (who come
from different cities and provinces in the country), balikbayans
(Filipinos residing/working abroad and visiting the homeland)
and foreigners (mainly tourists, retirees, expatriates and students)
in Cebu. As an investment priority industry entitled to receive
government incentives with a largely under-tapped market, the health
and wellness sector is also an investment opportunity for those who
wish to partner with Cebus healthcare and wellness providers.
Tourism in Cebu
Cebu is the business, educational, medical, transport and
tourism center in Central and Southern Philippines. Facilities
and infrastructures are well-placed, resorts and hotels enjoy high
occupancy rates, Foreign Direct Investors (FDIs) number by
the hundreds, and multi-million dollar investments are poured in
yearly. Foreign visitors have continually set record highs - eager to
experience the resorts and dive spots, the mix of rural-cosmopolitan
lifestyle, and even enroll in the English as a Second Language, or
ESL schools that populate in this province.
It is very strategically located at the heart of the Philippines, the
Central Visayas Region, which was declared by Philippine President
Gloria Macapagal-Arroyo as the Supra Region for Tourism in
the country. In her speech during the opening of the Philippine
International Tourism Fair (PITF) last year, the President hailed
Cebu as the "tourism mecca" of the Philippines. Stakeholders know
that, in due time, Cebu has what it takes to be a well-known worldclass destination being a strategic gateway accounting for 50% of
foreign arrivals in the country, and a vibrant, self-sufficient economy
that remains largely immune to any adverse political upheavals in
the nations capital.
There are more than 200

day-spas, smaller
locally operated healing and
massage centers and
wellness establishments that are fre
quently used bythe locals, partly,
and also by tourists
Its international airport, the Mactan-Cebu International Airport is
the countrys second major international gateway, the busiest airport
outside Metro Manila, and the most important transport facility in
Central and Southern Philippines.
Cebu also has a wide array of hotel, convention and resort
facilities that include international names such as the Shangri-la,
Marriott, Hilton, Waterfront, Marco Polo, Microtel, and others.
Moreover, it is endowed with natural and ecological sites that are
conducive to healing and restoration of health and well-being. More
investments in accommodation facilities are urgently needed as
Cebu expects sustained growth in the tourism sector. Cebu currently
has 12,500 rooms, contributing about 4.5 million room nights. But
the demand by 2012 calls for twice that inventory.
Cebu is not only a world-class beach-oriented destination but,
as the oldest city in the Philippines - it is also a historical, cultural,
religious and heritage destination.
Medical and Wellness Tourism

Cebu has state-of-the art medical facilities that can deliver the
same services as in other countries, not only in the field of surgery
but also in other medical services.
Dr. Philip S. Chua, VP-Far East Operations, Cardiovascular
Hospitals of America and Chairman-Cardiovascular Surgery, Cebu
Cardiovascular Center, Cebu Doctors' University Hospital points
out that "The Philippines, Cebu in particular, could be a center for
Medical tourism, a potential Health mecca, and earn for our country
and this city an enviable international prestige as a world-class
haven for quality healthcare in the Far East.
Cebu has a viable network of public and private hospitals,

specialty clinics other health facilities. The Philippine Department
of Health has licensed and accredited the following medical
institutions in Cebu: 27 private-licensed hospitals, 29 government
hospitals and 2 ambulatory surgical clinics.
There are 25 schools in Cebu producing around 4,000 health
professionals annually.
Hospital and specialty clinics services

Cebu has three major hospitals in Metro Cebu that continue
to invest in modern facilities and equipment, employ competent
healthcare professionals, and deliver quality service at par with
international medical institutions: the Cebu Doctors University
Hospital; Chong Hua Hospital; and Perpetual Succour Hospital.
From cardiologists to orthopedic surgeons, dentists to cosmetic
surgeons, ophthalmologists to physical therapists Cebus 3 major
hospitals can provide the whole range of services.
Post-Operative Care / Recuperation

As the top tourist destination in the country, Cebu hosts a large
number of spas, massage centers and other wellness services to
facilitate recovery and relaxation. Even as the medical tourist or
patient is undergoing diagnosis or treatment, his or her companion
can avail of this wide range of wellness options.
There are about 10 hotel/resort-based luxury spas that already
cater to the international market such as the Chi Spa Village of
the Shangri-La 's Mactan Isalnd and Resort & Spa; the Mogambo
Springs in Plantation Bay; The Spa at Cebu Hilton Resort; Amuma
of Maribago Bluewaters Resort; the Alegre in the north of Cebu; the
Pulchra Beach Resorts Undina Spa and the Badian Island Resort &
Spa in the southern part of Cebu.
There are more than 200 day-spas, smaller locally operated healing
and massage centers and wellness establishments that are frequently
used by the locals, partly, and also by tourists. Upmarket day spas
receive a more significant number of tourists (Japanese, Koreans)
for treatment, mostly via tour agencies and guides, such as the 1.5
hectare (15,000 sqm) The Spa at Cebu, one of the biggest indoor
spas in Cebu with over 100 beds. At Cebus AsiaTown IT Park, there
is also a new retail complex with health spa and pamper centers
such as the Alibyo Boutique Spa, which specializes in the authentic
Filipino massage therapy called the Pinoy Hilot.
So, when youre thinking of combining your health treatment
with a vacation on a tropical island, think Cebu. Definitely more
than the usual Medical Travel come to Cebu to experience the
unique Filipino touch of Healing hands, Caring hearts.
CEBU HEALTH AND WELLNESS
COUNCIL - TECHNICAL WORKING GROUP
c/o Ms. Nelia V. Flores-Navarro, Provincial Director
DEPARTMENT OF TRADE AND INDUSTRY (DTI) - Cebu
Provincial Office:
3rd Floor, LDM Bldg., corner Legaspi Street and M.J. Cuenco
Avenue, Cebu City 6000, Philippines
Tel: (63-32) 253.2631, 255.7082, 412.1863
Fax: (63-32) 412.1856, 254.0840
E-mail: dticebuphil@yahoo.com; dticebuphil@gmail.com
Created last January 2008 in Cebu City, Philippines, the Cebu
Health and Wellness Council (CHWC) is a Private-Public sector
coalition of industry stakeholders that shall set the directions in
developing and promoting the Health and Wellness industry in
Cebu. It is currently represented by the following sectors in Cebu:
Hospital / Medical services; Dental services; Spa and Wellness
services; Hospitality services; Travel and Tours services; and the
government sectors Department of Health (DOH), Department of
Tourism (DOT) and Department of Trade and Industry (DTI).
July 2008
45
MEDICAL TOURISM
Eye Republic
By Dr. Manolette Roque
People are very particular about their eyes, which are poetically referred to as windows to the souls.
These organs are so sensitive that even the smallest bits of intrusions can cause immense discomfort.
t is not surprising therefore that successful medical practice

involving the eyes could only take place with testimonials of patients
who benefit from the gentle but expert touch of eye doctors.
The EYE REPUBLIC Ophthalmology Clinic is a Philippine
network of hospital-based, sub-specialty practice eye clinics around
Metro Manila, and one such organization that grew out of referrals
of clients.
Prominent ophthalmologist Dr. Manolette Roque presents
EYE REPUBLICs vision for excellence in service and its path to
growth.
Word-of-mouth
EYE REPUBLIC introduced multi platform, multi center laser
and non-laser vision correction in the Philippines in 2003. People
from all over the Philippines, the U.S. and over 30 countries
worldwide come to us for treatment. But no matter how good we
are at it, if the procedure isnt right for you, you can trust us to tell
you.
We have built upon a word-of-mouth clientle desiring the
flexibility that we offer while providing a single high standard of
46
July 2008
eye care for all. Clients satisfied with our services serve as our
ambassadors spreading goodwill all over.
We work on a pay it forward dictum, believing and
understanding that providing excellent service to each of our clients
generates an exponential increase in referral.
In good time, health care providers, consolidators, travel
agencies, and government institutions, began to take notice of our
patient-centric services and successful results. By linking up with
fellow stakeholders, such as the Philippine Medical Tourism Inc.
(PMTI), a company that provides convenient packaged services
designed for the individual who is seeking cost-effective medical
and wellness programs outside his country of residence, our network
has expanded exponentially.
Multiplatform, multicenter
By aligning ourselves with other major stakeholders in eye care
service and delivery, our practice currently offers laser refractive
surgery using four different platforms: VISX STAR S4 with IR and
WaveScan CustomVue System, Carl Zeiss Meditec MEL 80, Bausch
& Lomb Technolas 217 Z100 Zyoptix System, and CustomVis
PULZAR Z1, located in different centers of excellence.
Our clients are very pleased to know that they have options with
respect to platforms and locations. Having access to the popular
platforms used in the US, Europe and Australia, provides our global
clientle with the unmatched flexibility to take charge of their
refractive journey.
After weighing pros and cons, its good to know that there
are world-class eye care facilities, offering inexpensive, modern
treatment in the Philippines. When costs may be reduced by half
and a nice vacation in a desirable destination gets thrown into the
deal, Philippine medical tourism is considered for corrective eye
surgery.
Corrective eye surgery

We offer a wide variety of vision correction procedures. For
most people, refractive surgery produces a lifestyle change; its not
simply a medical procedure. We perform standard and customized
(wavefront) PRK, LASEK, EpiLASIK, and LASIK for myopia,
hyperopia, astigmatism, and presbyopia.
A relatively new technique that

we offer to our younger patients
involves the insertion of an artificial
lens in front of the natural lens
without removing the natural lens.
Reshaping the cornea using laser or radiofrequency is the
more common method of vision correction. Laser eye correction
reshapes the cornea by removing part of the corneal tissue. The
technical term for this is ablation but vaporizing is a good
way to describe what happens. This can be done on the surface of
the eye as in photorefractive keratectomy (PRK) or it can be done
underneath a flap as in laser in situ keratomilieusis (LASIK). There
are other procedures available which are variations of PRK or
LASIK. Millions of laser vision correction procedures have been
performed worldwide and tens of thousands have been performed in
the Philippines. This is a testament to the relative safety and efficacy
of laser vision correction procedures.
For people who actively engage in contact sports and lead a
highly physical lifestyle, advanced surface ablation or PRK and
its variants, LASEK, EpiLASIK, and no-alcohol Amoils epithelial
brush PRK, are the preferred methods of laser vision correction. The
outermost surface of the cornea is directly treated with the laser. The
initial discomfort during recovery associated with the procedure is
justified by the excellent safety profile and postoperative visual
acuity which equals or surpasses levels achieved with LASIK.
For people who demand instant gratification, LASIK provides

quicker recovery. LASIK starts with creating a flap out of the
outermost surface of the cornea and folding the flap over the same
way one would open the cover of a book. This is followed by laser
ablation of the inside of the cornea and then replacement of the flap
(like closing a book) to cover the laser treated area. Because the
area treated with laser is covered there is minimal discomfort and
patients can usually go back to work the next day. Our patients are
so happy that they can see clearly so soon after the procedure.
LASIK and PRK, either standard or customized, can be used
for people with low to moderate hyperopia, low to high myopia,
and low to high astigmatism. High and extremely high hyperopia,
extremely high myopia and extremely high astigmatism might not
do well with laser eye correction.
There are other treatment modalities available for those
individuals whose errors of refraction are so extreme that corneal
laser treatment is not possible.
These people may be candidates for treatments that modify the
lens instead. The traditional method for this has been to remove the
persons natural lens and replace it with an artificial lens inside the
eye, the power of which has been calculated to give the person good
vision without glasses. Called clear lens extraction and replacement
or refractive lens exchange, the surgery is performed in exactly
the same way as a cataract operation except that in this case the lens
being removed is still clear and without cataract. The availability
of premium lenses (aspheric, toric, multifocal, accommodative) for
implantation provides each person with numerous choices to fit their
specific needs.
A relatively new technique that we offer to our younger patients
involves the insertion of an artificial lens in front of the natural lens
without removing the natural lens. The proper term for this is a
phakic intraocular lens but it has been called implantable contact
lenses by some. This leaves the natural lens intact so the patient can
still accommodate naturally so a multifocal lens implant or reading
glasses are not needed.
Presbyopia can be treated by reshaping the cornea with laser
or radiofrequency (via conductive keratoplasty) or by surgically
replacing the lens. The usual technology of LASIK or PRK can be
used to correct one eye for distance and one eye for near. This is
called monovision or compromise vision. Not everyone can tolerate
this type of vision and it is not recommended for those who need
stereoscopic vision for their work or hobbies.
Western versus Asian

The most common experience that all our medical tourists
share with us is the inherently unique personalized care that they
receive from all health care providers in the Philippines. It is this
universal experience that attests to the sincerity by which this care
is delivered.
Manolette Roque, MD, MBA, FPAO

Dr. Manolette Roque is a prominent ophthalmologist in the Philippines whose practice includes general ophthalmology
and cataract surgery with subspecialty work in uveitis and ocular immunology, cornea and external disease, and
refractive surgery. Together with his team, Dr. Roque oversees a practice spanning four clinics spread over Metro Manila.
Dr. Roque trained in ophthalmology at the University of the Philippines-Philippine General Hospital
and went on to the Harvard Medical Schools Massachusetts Eye and Ear Infirmary for fellowship
training in Ocular Immunology and Uveitis and observership in Cornea and Refractive Surgery. He
is certified by the Philippine Board of Ophthalmology and is a Fellow of the Philippine Academy of
Ophthalmology. Dr. Roque practices at Asian Hospital and Medical Center and St. Lukes Medical Center, and is affiliated
with numerous hospitals and eye centers in Metro Manila. He may be contacted at manolette.roque@eyerepublic.com.ph.
July 2008
47
MEDICAL TOURISM
Patient, Heal Thyself

The Promise of Regenerative Medicine
By Cathy S. Babao-Guballa
In a comfortably furnished room at The Medical City in Pasig City, Metro Manila, Inaki Ugarte, looks out
the window and smiles. I was diagnosed with liver cancer in 2004. By the time I was ready to have a liver
transplant, they found out that it had already spread to my lungs, he says. The doctors gave me about 3 to
4 months to live.
hey told him that over a year ago. Today, the 65-year old
businessman is enjoying an extended lease on life, thanks to the
very promising field of Regenerative Medicine.
The Patient as Healer

Regenerative Medicine is an innovative program that involves
the engineering of living cells, tissues and organs to preserve and
enhance organ function and improve the quality of life. Proponents
of the treatment say it can be used to prevent disease and maintain
wellness, as well as restore organ function lost or impaired due to
disease, injury, or aging.
48
July 2008
Regenerative Medicine is
an innovative program that
involves the engineering of
living cells, tissues and organs
to preserve and enhance organ
function and improve
quality of life.
It is a procedure that allows the patient to, quite literally, be his

own healer.
The key lies in stem cells ~ master cells, ~ which have
the ability to grow into any one of the bodys 200 cell types or
sensitized to attack diseased cells, including malignant tumors.
They can replicate themselves many times over and theoretically,
do so without limit, so long as the person is alive.
Therein lies the power of the treatment. Were working with
the patients own living cells. Thats what makes this different from
other treatments using conventional, often toxic, drugs and devices,
explains Dr. Samuel Bernal, consultant adviser on Regenerative
Medicine for The Medical City.
With Regenerative Medicine, the

approach is even more personalized,
as it responds to the patients
uniqueness at the level of his own
cells.
Mr. Ugarte was initially advised by doctors in Singapore to
undergo a liver transplant. He declined, knowing that the likely
donors would be his own children. Friends and relatives then referred
him to The Medical City, a pioneer in this new medical field.
The unique properties of stem cells have spurred worldwide
interest in research on possible treatment for disease such as
cancer, kidney failure, Parkinsons and Alzheimers, spinal cord
injury, stroke, burns, heart disease, diabetes, osteoarthritis, and
rheumatoid arthritis. With stem cell treatment, healthy unspecific
or undifferentiated cells are extracted from the patient and, under
complex laboratory conditions, induced to transform into cells with
highly specialized functions. These are then reintroduced into the
body as organ repair agents or, as in Mr. Ugartes case, cancerfighting cells. Instead of relying on toxic chemicals to combat
disease or donated organs to restore lost function, were using
the patients cells to combat their cancers or regenerate their own
organs, explains Bernal.
But the purpose of Regenerative Medicine is not only to treat
patients who are already ill but also prevent disease, says Dr.
Bernal. Thus, wellness and aesthetic applications of Regenerative
Medicine are also available.
service of great worth. It offers diagnostic and treatment services that

address a broad range of diseases using state-of-the-art technology
such as computed tomography, magnetic resonance imaging and
cardiac catherization and interventional services.
While research into Regenerative Medicine forges on, Dr.

Bernal stresses that the patients wellbeing is the doctors foremost
concern. This is not an academic exercise. This is about making
patients lives better.
It has a regular medical staff of 350 physicians, all of whom

are experienced, recognized and established experts in their various
fields of specialization. They are complemented by 610 visiting
consultants. This core of professionals is supported and assisted
by a 1,400-strong human resource complement, composed of
administrative, finance and support services.
The Patient as Partner

Indeed, with the ever-growing range of treatments available,
constant dialogue between patient and doctor allows each to
consider the unique circumstances of the case, and agree on a plan
of care most appropriate to these circumstances. With Regenerative
Medicine, the approach is even more personalized, as it responds to
the patients uniqueness at the level of his own cells.
Having completed six treatment sessions, Mr. Ugarte proudly
reports his AFP count (alpha fetoprotein, an indicator of the presence
of cancer cells) is down to 110 from a high of 42,000. What the
charts dont show is a bright confidence in the future. I just keep
feeling better and better, he says.
About The Medical City

The Medical City is a JCI-accredited private tertiary hospital
with the mission of putting the patient at center stage and delivering
Cathy S. Babao Guballa is a Corporate

Communications Consultant with The
Medical City. She was previously Editor
in-Chief of "Health Today" a regional
health magazine distributed in several
Asian countries.
Concurrently, she is the parenting
columnist for the Philippine Daily
Inquirer, the Philippine's most widelyread newspaper.
July 2008
49
MEDICAL TOURISM
The Farm at San Benito
Exceptional Healing & Holistic Treatment

By Chie P. Blas
The Farm at San Benito, a multi-award winning health resort in the Philippines, is one such case of
taking an idea far to prove a point. Here, the point is that the ones appreciation of oneself holistically
brings about and sustains the gift of wellness.
ake an idea, and take that idea to the hilt, one is certain to find
great chances of remarkable successes.
The Farm at San Benito, a multi-award winning health resort
in the Philippines, is one such case of taking an idea far to prove a
point. Here, the point is that ones appreciation of oneself holistically
brings about and sustains the gift of wellness.
The Farm, which traces its roots to organic farming in Lipa,
Batangas province, came about as the world witnessed a stronger
surge of return-to-nature initiatives.
In the assessment of The Farm owners, the nature of man is not
one-dimensional, limited to his physical being. The physical aspect
is only part of his totality which includes the other facets of his
being the spiritual, mental and emotional.
50
July 2008
The Farm is Asias center of

excellence for the promotion
of wellness, the prevention of
illness and the holistic treatment
of health-related conditions.
From this concept, The Farm laid out its holistic approach to
healing, with programs addressing health issues at various levels.
And setting the programs amid the backdrop of poetry-inspiring
natural environment, The Farm was well on its way to inviting its
clients to benefit from this concept -- to the max.
health: Tai Chi, fitness programs, yoga, guided meditation, Tibetan

exercise, Rotational Meridian exercise, stretch classes, breathing
and walking exercise classes, meditation and spiritual development
classes.
The Farm is an easy two-hour drive south of the capital of

Manila. With over 48-hectares of verdant tropical landscaping, this
sprawling resort offers an exceptional healing environment for the
holistic treatment of the body, mind and soul.
The Wellness program is intended to offer an introduction to

their approach to health. The program offers an enjoyable nutritional
program rich in fiber and live enzymes to stimulate and support the
body in eliminating stored toxins. Spa treatments offer relaxation to
support the bodys inherent healing ability.
The Farm is Asias center of excellence for the promotion of

wellness, the prevention of illness and the holistic treatment of
health-related conditions. Their team of experts includes licensed
medical doctors, nurses and therapists.
Their Wellness programs may include a medical consultation to

offer you an assessment of your state of health. Medical treatments
may also be added to your Wellness program with approval from the
medical doctor who completed your assessment.
Whether one is healthy and would like to be healthier or are

seeking relief from a chronic disease, their role is to provide
expertise, knowledge and clinical care through applied natural
therapy modalities, both traditional and cutting-edge and to guide
clients in achieving health goals.
The Farms Medical Programs are tailored to clients specific
needs and goals. Its expertise includes, but is not limited to, weight
loss, diabetes, hypertension, infertility, autoimmune diseases,
kidney, liver, gallbladder, colon and body detoxification, digestive
dysfunctions, allergies and food sensitivities, cellulite, and
cardiovascular dysfunctions.
Upon receipt of client inquiry, they will provide a Guest Medical
Intake form. The information clients provide will be reviewed by
their medical doctors to formulate a treatment plan relevant to their
specific needs and goals. Their standard programs are offered for
varying lengths of stay. In addition to the application of medical
modalities, their programs include activities intended to enhance
The program offers an enjoyable

nutritional program rich in fiber
and live enzymes to stimulate
and support the body in
eliminating stored toxins.
Their Cuisine ~ founded on the theories of Hippocrates,
The Father of Medicine, supports their wellness and medical
programs. They offer only vegan food (no animal protein: no dairy,
no eggs). Their meals are prepared using only the highest quality
organic, unrefined and wholesome, all-natural ingredients, and are
prepared so as to retain to the fullest the nutritional qualities of the
ingredients.
A great number of their vegetables and herbs are grown
organically in their own garden, and served fresh. Their food
preparations are either raw or cooked at very low heat to preserve the
integrity and efficacy of vitamins, minerals and enzymes essential to
your bodys health.
The environment provides sensory inputs to which the body
and mind respond. The Farms environment is intended to support
relaxation, rejuvenation and healing. Nature, mountains, water,
fresh air replenish energy and boost health.
They utilize water from their own natural water source: the water
present underground is of uncommon purity. It is made available to
all their guests and is used in the preparation of their foods.
Their gardens include a variety of medicinal herbs and tropical
plants. Rocks adorn the gardens and enhance the energy of the
grounds. Reserved sitting areas located throughout the gardens may
be enjoyed for meditation, reading, relaxing and being quietly with
nature. Their facilities include a gym, four swimming pools, jogging
trails, and walking paths.
An inherent quality of their employees is the love to serve and
care for people. Being nurtured is an essential element of health.
They continuously strive to provide superior service in delighting
their guests. You will always be warmed by a candid smile from
every employee greeting you.
For more information on their spa and medical services and

other inquiries, you may contact The Farm Manila Sales Office
at Tel. No. (63)2 884 8074 or visit their website at
www.thefarm.com.ph.
July 2008
51
MEDICAL TOURISM
Planning Your Medical Trip Abroad
The Concierge
By Lourdes Gasparoni
When I first meet a Medical Tourist at the airport, my goal is to make them feel comfortable and
assure them that I am familiar with what they are doing. I want them to know that I will be there for
them throughout their entire trip.
hen the Medical Tourist begins their research, much of

the focus is on the medical component of the trip.
While the quality of care received and the physician selected
are of utmost importance, the dynamics of being a medical tourist
doesnt stop there. A main component of the psyche involves feeling
comfortable in the environment of the chosen destination.
money, and if not, how do I exchange currency?; Will my cell

phone work?; Should I be concerned about eating the local food
or drinking the water?; How will I feel when I step off of this
airplane?. The gamut of emotions, from excitement to anxiety,
regarding the impending surgery can cloud ones ability to be
prepared for many aspects of the medical journey.
When the plane first touches down, many questions may pass
through ones mind: Will I be safe?; Will they understand
me?; How will I get around the country?; Will they accept my
The role of the local concierge can be invaluable to address these

issues and add a level of personalized service to help put the traveler
at ease.
52
July 2008
While many doctors and lodging options offer transportation,

this may not be sufficient. Carlos Salas, owner of a concierge service
in San Jose, Costa Rica, explains that there are many differences in
services. Many doctors offer no more than a taxi service. In this
case, the traveler may have five or six different people that they are
dealing with. Some may not be as fluent in English or are too busy
to understand why they are visiting. When I first meet a Medical
Tourist at the airport, my goal is to make them feel comfortable and
assure them that I am familiar with what they are doing. I want them
to know that I will be there for them throughout their entire trip.
Whether it is recommending a
restaurant or a tour, assisting with
translation or transportation, a
concierge who is familiar with the
Medical Tourists specific needs can
make a difference.
Salas adds that he has learned through his experience, that there
can be big challenges faced by the Medical Tourist, but they are
not insurmountable. Its as simple as seeing the relief in their eyes
when they see me waiting with a sign with their name on it when
they pass through customs. Also, they appreciate the help I provide
them when checking in and getting settled at their hotel.
He believes one of the most critical parts of his service involves

getting the Medical Tourist in and out of the clinic or hospital. The
hospital can be a very overwhelming experience for many reasons.
When they see that I am there through the check-in, helping translate
if needed, and waiting for them when they have completed their
surgery, it eliminates some of their nervousness.
Whether it is recommending a restaurant or a tour, assisting with
translation or transportation, a concierge who is familiar with the
Medical Tourists specific needs can make a difference. I recently
assisted a bariatric patient who wanted to go on a canopy tour. The
first thing I asked her was if her doctor had any restrictions? Its
important for me to understand their diet and physical restrictions
before and after surgery.
Many factors can determine the level of concierge services
needed by the Medical Tourist. If you are traveling with a companion,
if you are fluent in the primary language of the destination, or if you
have already been to the country, will influence your decision.
The best advice is to do your homework and research to
determine whats best for you in order to make your experience a
positive one.
Lourdes Gasparoni
Director, International Operations,
Premier MedEscape LLC
www.premiermedescape.com
1-866-776-8414
July 2008
53
MEDICAL TOURISM
Implementing Medical Tourism into Health Insurance Plans
Six Steps to Success
By Jonathan Edelheit
t is amazing how many insurance companies and employers

have already implemented medical tourism or are in the process of
implementing medical tourism. Without anyone knowing about it
or hearing about it, Medical Tourism is about to become one of the
biggest trends in US healthcare. The reason is simple. No other
consumer driven solutions are working. Employers and insurance
companies have implemented HSAs, moved to high deductible
plans, shifted more out of pocket expenses to the employee, and
basically tried every trick in the book, with the end result being that
healthcare costs and premiums still keep skyrocketing. Nothing
seems to be working. Medical Tourism is the ultimate consumer
driven tool. It provides the employee the choice to make an educated
decision on where they will receive their care, whether overseas or
domestically, based on cost and quality, and is the only consumer
driven tool that actually gives the employee the tools to make that
decision.
However, as all these insurance companies and employers are
implementing Medical Tourism how many are really thinking it
through and taking the time to do it right? Prior to running the Medical
Tourism Association, I ran a large national healthcare administrator
54
July 2008
in the US. I was the first person to implement Medical Tourism into
both fully insured and self funded health plans years ago, creating an
affordable solution for my client to waive deductibles, coinsurance
and reimburse travel expenses for the insured and a companion.
This is the current trend for implementing medical tourism.
What is the real difference in how I implemented Medical
Tourism and the mistakes many organizations are making today?
First, make sure you really think this through, do your research
and engage in due diligence. There are three ways to implement
a Medical Tourism Program. First, simply put, is to implement it
successfully and professionally. The second way is to implement
it improperly and simply no insured or employee ever makes the
choice to go overseas. The third option, is implementing it with the
wrong company, and encounter high risk of liability for an employer
or insurance company. I have seen many companies implement it
correctly and others do it wrong by simply picking horrible partners
to communicate to employees, to the insured and to coordinate
care overseas. Every aspect of a Medical Tourism program must
be carefully planned in advance in order to achieve successful
outcomes. Proper planning equals positive outcomes.
Six Steps to a Successful Medical

Tourism Program
1. Educate Yourself About the
Industry
One of the most important steps in any Medical Tourism Program

is to become informed and educated about the Medical Tourism
Industry. As an employer or insurance company moving forward
into this space you need to learn which countries are providing
Medical Tourism. Which are the top hospitals that are providing
care in those countries, and then who are the top surgeons?
2. Choosing Your Middle Man or

Medical Tourism Facilitator
While some insurance companies and employers are partnering
directly with the hospitals, many are looking to partner with a
Medical Tourism Facilitator, which is a company that coordinates
all aspects of the patient journey and is the intermediary between the
patient, the patients domestic doctor and the patients foreign doctor.
It is very important for you to choose your intermediary carefully.
Some are focused on patient safety, quality of care, and successful
outcomes, while others are strictly concerned with receiving high
commissions and do not prioritize quality over pricing. Do not rest
your decision on a referral from a third party, or reading about a
company in a newspaper and magazine. Research and do your own
due diligence, because this aspect can be the difference between a
successful medical tourism program and a failure.
It is very important for you

to choose your intermediary
carefully. Some are focused on
patient safety, quality of care,
and successful outcomes, while
others are strictly concerned with
receiving high commissions.
Does the Medical Tourism Facilitator have the experience to

send patients overseas and do they have medical staff working for
them? Have you done research to see how many patients they have
sent overseas so you can judge their expertise and if they can handle
the volume that you will send through their organization? Do they
have medical staff to check patients records and make sure they are
good candidates for traveling overseas and to receive the proposed
surgery? Also, do they even have the staff and manpower to handle
a large volume of patients?
Has the Medical Tourism Facilitator actually visited the hospitals
they are referring patients to, and do they have contracts in place with
the hospitals, or is it a lose relationship with the hospital? Do you
really want to use a company that has never set foot in the hospital
they are recommending patients to go to? Without a contract in
place with the hospital, pricing and services are up in the air.
Some other simple questions are: Does the company have
Errors and Omissions insurance? Errors and Omissions insurance
is now very easily attainable and the Medical Tourism Association
just launched and Errors and Omissions Insurance specifically for
Medical Tourism Facilitators, as we recognize the importance of
reducing the risk of liability for services offered by the facilitator.

Without a policy, does the facilitator have the assets to defend
themselves in a suit for negligence?
How about patient referrals? It would be a good idea to contact
some of the patients the companies have assisted to get an idea of the
quality of services offered. It will also be helpful in developing the
menu of services you will expect from the facilitator. The Medical
Tourism Association performs a level of due diligence on its member
companies. This means that we have identified these companies as
being more than a shell or a pretty website. We provide a detailed
questionnaire as a prerequisite to membership which results in
transparency and provides a basis for our approval. We believe
members should operate with a standard of best practices and ethics
that support the tenets of the Association. Assuring patient safety
and quality of care is of the utmost concern.
3 . Understand the Different

Accreditation Systems
Do you understand the different accreditation systems, such
as Trent, Joint Commission International (JCI), and ISQua. Do
you understand the difference between the US Joint Commission
accreditation and the international version called Joint Commission
International? Joint Commission International is a less stringent
form of accreditation than the US Joint Commission as it has been
adapted to account for cultural differences. ISQua is the umbrella
organization that accredits accreditation systems and des not accredit
hospitals. Have you heard that hospitals accredited under other ISQua
accredited accreditation systems may have the same, if not better
quality of care as those accredited though JCI? ISQua accredits the
Australian, New Zealand and Taiwanese Accreditation Systems, to
name a few. This could imply that those hospitals accredited under
those systems could be comparable in quality. Have you heard of
the Trent Accreditation Scheme, which is UK based and accredits
hospitals in the UK and Hong Kong? Trent is expanding globally
and you will be hearing more about them. Are you familiar with
each countrys own specific accreditation systems, some of which
may have been modeled after the Joint Commission? What are the
standards you are looking for to assure you of quality?
Remember accreditation is only the first step. Just because
the hospital is accredited does not mean that all of the doctors and
surgeons at the hospital are accredited by the same agency, they
are not. These organizations do not accredit physicians. Most of
them do not accredit small clinics either. All doctors and surgeons
are not necessarily expert surgeons with the best outcomes. How you
choose the physicians in your network directly affects the outcomes
for your insureds and employees. It is important that once you have
selected your hospital, you must drill down further and search out
the best surgeons at the hospital and make sure your insured or
employees are getting their care by only the surgeons with the most
experience and best surgical outcomes for the procedures being
sought. Do not leave it up to the hospital to choose your doctors for
you. This is your Medical Tourism Program and you need to take
charge of it or bring in a consultant or company that will take charge
of it and manage it for you.
4 . Choosing a Hospital
How are you selecting hospitals? Are you taking recommendations
from third parties or choosing based upon the most impressive
websites? Or, have you done your own research and due
diligence and perhaps even visited the hospital personally?
Language and Culture

There are many considerations you have to look at when selecting
an international hospital to send patients to, and just accepting the
word of a third party isnt the answer. First and foremost, it is
important to know if the hospital has an established International
Patient Department dedicated to dealing with foreigners, whether
they speak the language and understand the customs of the
patients you are sending. Many patients will require religious
accommodations or special dietary needs. Having those options for
July 2008
55
MEDICAL TOURISM
a patient may directly impact the overall patient experience. Then
you would like to know whether the doctors and nurses also pass
the language and understand the customs of foreign patients. Why
is this so important? What if the patient is in pain and needs to
communicate to the nurse or doctor about the pain or some other
important need, and the nurse or doctor doesnt understand them?
The language issue is probably one of the most important aspects of
a successful medical tourism program, so make sure you choose the
right hospital that has these processes in place.
Privacy
Does the hospital have privacy regulations in place to protect the
privacy of the patient in accordance with the privacy laws in their
home country? Remember if you are based in the US you are very
familiar with HIPAA, you will quickly notice that no other country
has the privacy laws as stringent as those found in the US and many
hospitals have no idea what HIPAA is, how they should comply,
or if they could even put the administrative procedures in place to
comply. Each country has their own definition of privacy and how
they deal with medical information. Are you aware of the hospitals
privacy procedures?
Dont just rely on third party.

As an employer or insurance
company, you have a duty to
educate yourself, understand
the issues and come up with
solutions and answers.
Transparency in Quality and Pricing
Hospitals should undertake protocols to provide transparency in
quality and pricing. Are patients provided with prices that are bottom line prices, or are their hidden costs that a patient could not anticipate before they arrive? Does the pricing include transportation,
meals, aftercare such as rehabilitation and a hotel or recovery resort
for recovery? Some hospitals are allowed to change prices within
24 hours notice. In the area of quality, hospita+ls with policies in
place to disclose quality information, outcomes and experience will
find patients more receptive than hospitals that do not disclose. It
is imperative that any hospital you work with be open and honest
when it comes to quality and pricing or it will lose the trust of the
patients, employees and insureds.
5. Aftercare
Where the patient will recover after surgery and what happens
when the patient returns home is directly related to a positive patient
experience. Does the hospital have an aftercare program in place?
Has aftercare in the home country been pre-arranged? How long is
the recovery time?
For recovery directly after the surgery, each hospital has their
own policies, so you need to be aware of country specific practices. For example in most hospitals in India, patients recover in the
hospital, specifically because the costs of hotels are too expensive.
Decent hotels can cost $400+ per night, which are unaffordable for
many patients and the price of the extended hospital stay is usually
included within the hospital package. But in other regions, such as
Latin America, after the appropriate recovery time in the hospital
the patient is moved to a hotel or recovery resort where they will
continue rehabilitation before they return to their home country.
56
July 2008
The costs for the hotel or recovery resort are normally not included
within the hospital package price for the surgery. So, then you need
to ask the question of what hotel or recovery resort are they recovering in and what procedures are in place? Does the recovery resort or
hotel have nurses and rehabilitation services available?
Once you deal with aftercare within the country of surgery, one
of the most important aspects of the patient experience is follow-up
care when the patient gets back to their home country. In reality,
this issue needs to be resolved before the patient ever steps onto
a plane. Prior to an overseas journey, the patient or a third party
should get involved to assure their local, domestic provider understands where the patient is traveling to, what procedure they are
getting, and clears the patient for travel. It would be best to have
the physician agree to treat the patient upon his return. If this is not
in place, patients should not be traveling overseas! Also, this is not
something that can be coordinated when the patient is in the foreign
country for their surgery or just before their return, it is a necessary
detail to be resolved prior to departure from their home country.
6. Communicating to Employees
One of the most overlooked aspects of any successful medical
tourism program is how will you communicate the program to your
employees and their dependents? Most organizations have absolutely no idea, and to not think this through before implementing a
medical tourism program can be a waste of time. Simply put, you
cant hand an employee a brochure showing a pretty picture of a
hospital and expect that now they will be convinced there is high
quality of care available overseas and that they will jump at the opportunity. You must educate the employee or their dependent about
the quality of care overseas.
Ethnic Insured?
One of the major aspects that most employers or insurance
companies do not think about is an ethnic insured patient. This
refers to an insured or employee who is from another country or
a descendant of another country, meaning their parents or grand
parents are from another country. Currently under most insurance
plans this type of employees or insureds are forced to get care in the
country they live in, when in reality they would rather go for care
to their home country and recover with extended family. This
segment of employees or insureds does not need convincing of the
quality of care available in their home country. This is one of the
biggest opportunities in Medical Tourism. A Filipino, Mexican,
Indian, Colombian, Costa Rican, Vietnamese, or Salvadoran (for
example) employee or insured would jump at the opportunity to
go to their home country and, if they had an incentive such as
waiving deductible, coinsurance and travel, they would not hesitate
to travel overseas.
Conclusion
Dont just rely on third party. As an employer or insurance
company, you have a duty to educate yourself, understand the issues
and come up with solutions and answers.
Your employees or insured are assuming you have done the due
diligence for them, and that if you are recommending a hospital,
you have done your research on the hospital and on the actual doctors as well. Dont disappoint them. They are looking to you to put
together the whole package, and a package that they as the end user
can use without complications or problems. A successful medical
tourism program is easy to implement, but needs proper planning
and strategic analysis.
Jonathan Edelheit is President of the
Medical Tourism Association with a
long history in the healthcare industry,
providing third party administration services
for fully insured, self-funded and minimedical plans to large employers groups.
July 2008
57
MEDICAL TOURISM
TRAVEL INSURANCE
By Dr. Michael Moreton
These three patients were all fit young people with no previous medical illnesses who had no reason to believe
that they would need hospital care during their vacation. That is the whole point about insurance - it is there
to help you when the unexpected happens.
our vacation is coming up; its all so

exciting you can hardly sit still. Passports
found and checked, flights booked and
confirmed, hotels selected and reservations
made, clothes chosen and packed, travelers
checks purchased, arrangements made
for friends to feed the dog and check your
house. Is there anything you have forgotten?
What about Travel Insurance?
Oh sure, travel insurance, thats dull
stuff, do you really need that? Youve never
lost a bag and you have a good feeling
about things, there is no need for Travel
Insurance.
WRONG! There is a very definite need
for Travel Insurance. Just because you
have good Insurance coverage when you
are at home does not mean you have good
coverage when overseas.
Travel
Insurance
covers
many
eventualities. If your flight is cancelled and
you are stranded or if your bag is missing
58
July 2008
and you are in a strange place without even a

toothbrush, the insurance will help to defray
your expenses.
These, however, are not the most
important or expensive eventualities that are
covered. The most important is Health Care
Insurance for you while you are out of the
country. British, Canadians, Australians and
other travelers from countries with universal
government schemes are more negligent
about purchasing this type of insurance than
are Americans or Europeans. These plans,
with all their faults, are always available
so they do not think much about additional
health coverage. This is spite of the fact that
government plans have no legs at all and are
of almost no help when you are away from
home.
The concept of the uninsured patient is
not part of the experience of many travelers.
Neither is the phenomenon of patients
being turned away from hospitals as they
had no insurance or could not document
their coverage. But if you are taken ill or

injured in a foreign country and you do not
have travel insurance, you are an uninsured
patient and may have trouble getting care.
Robert Jackson was looking forward
to his visit to South East Asia. He spent
several months planning his trip. He read
the history of the countries that he would
visit and created a demanding schedule for
himself. He was planning to travel to the less
visited areas in Northern Thailand and visit
as many of the holy sites as he could and
cram into his schedule. He was not planning
on visiting the Intensive Care Unit of the
Bangkok Hospital Medical Center, he also
was not planning on spending over fortyeight hours unconscious, and he certainly
was not planning on multiple surgeries, or
the intensive rehabilitation, he ended up
receiving.
In spite of the fact that he was not too
agile and had not ridden a motor-bike in
over ten years, he decided to rent a motor
bike and ride around the back roads in Thailand. A truck that he
was following too closely suddenly pressed his brakes. Robert flew
through the air and landed on his face in the road.
Fortunately he was transported into the city quickly and
brought to the Bangkok Hospital Medical Center, a tertiary care JCI
Accredited facility and admitted to the Neurological Intensive Care
unit, as he was unconscious.
His family was contacted and consent for treatment obtained.
They were not aware if Robert had any Health Insurance and were
reluctant to guarantee payment for the care. In spite of this he
received excellent care and is now on his way to full recovery after
multiple surgeries for his facial fractures and skin grafting to other
wounds. He was obliged to take out a considerable bank loan to
cover his care.
Melanie Albert was working as a volunteer in a childrens care
home in Cambodia. After eating a very spicy dinner one evening
she started to have abdominal pain. Thinking it was indigestion she
ignored the pain initially but by the following morning realized that
this might be something more serious than an upset stomach. She
had not obtained any insurance when she left home and naively
thought that her patents policy would cover her medical expenses
while out of the country. After been seen in the clinic she was flown
to Bangkok and admitted to the Bangkok Hospital Medical Center.
A diagnosis of Appendicitis was made and she had an operation on
the same day. Her family came out to be with her and was able to
have funds transferred to cover the cost of her care.
She was particularly fortunate as she had been able to get to
Bangkok on a commercial flight. If she had needed to have a special
air-ambulance the cost would have been enormous. One of the
features that is always included in Travel Insurance is Evacuation
Insurance, that covers the cost of you being transported to a good
medical center close to your accident or where you were taken ill.
It also covers the expense of getting you home after treatment

has reached that point that you are ready to travel. Another patient
needed to be transported back to Britain after Surgery and Intensive
Care treatment for a collapsed lung, which had happened quite
spontaneously and without warning. He needed a nurse and a doctor
to travel with him as he was taking anti-coagulants and there was
the possibility that he might need extra oxygen on the flight. He was
flown from Bangkok to Frankfurt and from there to Manchester. He
traveled Business class with his two attendants. Luckily he had good
coverage for this very expensive journey.
These three patients were all fit young people with no previous
medical illnesses who had no reason to believe that they would need
hospital care during their vacation. That is the whole point about
insurance - it is there to help you when the unexpected happens.
Travel Insurance is surprisingly inexpensive and for a young
person may be as little as $40 for a three week vacation. I would
suggest that you purchase this before you leave home. The
Information Center that the insurer provides can also be very useful
to you, as they will be able to direct you to the best Medical facility
wherever you are in the world. Whatever insurance you have, keep
the details of the policy and call center number with you, on your
person, at all times. I hope you have a wonderful trip and do not need
any medical services, but it is best to plan for all eventualities.
Dr. Michael Moreton graduated from Medical School in the UK,
he then trained in Ob/Gyn in the McGill program in Montreal. He
practised in Ontario and Florida before going to China in 1997. In
his ten years there he was the founding Ob in the first western style
Maternity unit in China and later opened another in Shanghai.
He is now the International Medical Coordinator at the Bangkok
Hospital Medical Center in Thailand. Moreton@bgh.co.th
July 2008
59
MEDICAL TOURISM
When the voice doesnt

match the sex
By Yeson Voice Center
There are males with womans voice, and females with mans voice. This does not happen to just a few people.
The difference between a man and a womans voices is distinguished by the tone which is determined by the
vocal fold. Men are lower-pitched than women because they have larger and longer vocal folds. It works the
same way in an instrument. Instruments with longer and thicker strings have lower sounds. Hz(hertz) is the
unit of measuring the pitch of a sound. The fundamental frequency in a males measures 100~150 Hz, and
200~250Hz in females.
oice feminization can be achieved

by shortening the vocal folds and increasing
the voice frequency. The surgery is quite
simple, actually. Using very thin equipment,
the surface of the upper side of the vocal
folds - the mucous membrane - is removed
and then the vocal folds are tied together.
As the surfaces of the vocal folds are healed
and attached, the length of the vocal folds
becomes short. By shortening the length
of the vocal folds, the voice tone of a male
eventually becomes higher. This method was
introduced by Dr. Hyung-Tae Kim, director
of Yeson Voice Center, for the first time in
60
July 2008
In cases when a male

is high-pitched like a
female, the procedure is
relatively simple.
the world and its effectiveness and safety

have been proved at the Voice Foundations
Annual Symposium, which was held in
Philadelphia, U.S.
This voice surgery can help people
with androgenital syndrome, an abnormal
secretion of hormone in children causing
masculinization of women, as a result of
the side effects of hormone therapy for
aplastic anemia. Based on the principle
that one can change the length of the vocal
fold as desired, hoarse or weakened voices
due to aging can be recovered. Your vocal
frequency may go down by 70 Hz. Neither of

the two methods requires general anesthesia
or thyroplasty. However, Botox injection is
not permanent, and injections are required
every 3~6 months.
We are living in an age of communication.
However, there are warning signs ahead
for our voice, the most important factor in
communication. The increasing number of
thyroid diseases and lung cancer, and vocal
fold paralysis is causing speaking disorders
in humans.
Vocal fold paralysis is an obstinate
disorder which causes serious voice changes
that hinder the communication. Vocal fold
paralysis may be caused by an injury, trauma,
or operations of various kinds. In this case,
even cancer can be treated and it is not life
threatening, its aftereffect, voice disorder,
will disturb your social life and lower your
quality of life.
folds become wrinkled and thinned just

like your skin. However, pulling the vocal
folds and tightening them can permanently
bring your voice back to youth. After the
surgery, you should not use immoderate
voice for 2 months in order for the scars to
heal. Also, through the 4-week therapy and
rehabilitation program, you will learn how
to make sounds properly with the reduced
vocal folds and have better results of voice
feminization.
In cases when a male is high-pitched like
a female, the procedure is relatively simple.
Injecting Botox into the vocal fold muscle
can increase the tone of voice, and paralyzing
the muscle can prevent the production of
high-pitched sounds. Another way to make
small vocal folds bigger is to insert the
instrument into the vocal fold muscle using
percutaneous injection laryngoplasty. The
Voice is produced when the two vocal

folds come together and vibrate. In vocal fold
paralysis, the vocal folds do not make contact
and make a hoarse voice that even the other
side is impossible to catch. Someone who
has vocal fold paralysis appeals discomfort
that they are almost disabled due to the
difficulty in conversation and often choking
because food and drink slip into the lungs.
If you let the food slip into the lungs, it may
develop into pneumonia, causing depression
of lung activity or other complications. The
causes are various, but mostly paralysis
can result from the symptom of cancer
or other diseases on the geal nerve track
which controls the vocal folds and runs the
brain, thyroid, lungs, larynx, heart, cervical
vertebral and so on. It is usually a symptom
of thyroid cancer, lung cancer or larynx
cancer. However, if your voice changed
after a trauma, you should hold a doubt
about having vocal fold paralysis.
Vocal fold paralysis can disturb your
social life and make you want to avoid a
meeting or conversation. At a VHI(Voice
Handicap Index) research held at Yeson
Voice Center in 408 vocal fold paralysis
patients, 94.1%(384 persons) of the patients

said People have difficulty understanding
what I say, and 86.5%(353 persons) felt
their social activities are restricted because
of their voice. 70.6%(288 persons) answered
I feel ashamed of my voice, I try to avoid
meeting people because of my voice and
55.9%(228 persons) said their voices have
caused a decrease of income.
Now, it is no longer hard to treat
vocal fold paralysis. It can be treated with
a simple shot. Injecting a biocompatible
material such as Calcium hydroxylapatite
into the paralyzed vocal fold to increase the
volume could help the vocal folds to make
closer contact. It is a simple operation which
only takes 15~30minutes, and requires no
general anesthesia or hospitalization. Also,
the recovery is so fast that you can eat right
after the operation. Some patients might
feel uncomfortable in the throat or bring up
phlegm for a short while; these after effects
disappear in a few weeks, without causing
difficulty in the daily activities.
It usually recovers with only one
operation. If left for too long, it becomes
harder to treat because the atrophied vocal
folds muscles are just like unused body
muscles. Severe vocal fold muscle atrophy
may require additional operations. Therefore
if you notice sudden changes in your voice
lasting more than 2 weeks, you should
consult an otolaryngologist for detailed
examination and proper treatment.
Yeson Voice Center
The Institute of Performing Art Medicine
#638-13 /Ssangbong Bldg.
2nd fl., Shinsadong, Gangnamgu, Seoul,
135-896, South Korea
Tel: 82-2-3444-0550
Fax: 82-2-3443-2621
Web : www.yesonvc.com/eng
E-mail: master@yesonvc.com
July 2008
61
MEDICAL TOURISM
Medical Tourism is a
Search for Value, not Low Prices
By James McCormick, MD
From my perspective, I saw synchronous business expansion, reports of increasing traffic and a future that
holds healthy, steady growth. Significant capital investments in facilities and capacity were evident at all the
facilities. Those who plan and execute their business models and imperatives skillfully will have an opportunity
to earn a healthy return going forward.
fter returning from a trip through Asia these past few weeks, I
can happily report that the future for medical tourism and travel looks
very promising. My thanks go out to all the providers and facilitators/
concierges who were extremely gracious with their time. We were
able to visit active facilities and ones undergoing new construction.
Government officials, executive leadership in private institutions,
and leading facilitators all expressed convincing arguments for a
favorable future. From my perspective, I saw synchronous business
expansion, reports of increasing traffic and a future that holds
healthy, steady growth. Significant capital investments in facilities
and capacity were evident at all the facilities. Those who plan and
execute their business models and imperatives skillfully will have
an opportunity to earn a healthy return going forward.
All the facilities offer clear value propositions (high quality
care and customer services for lower prices) to clients now and
are improving such services for the future. As both a physician
and an MBA student, I wondered about a focus on pricing and cost
62
July 2008
savings. In my view, value propositions are a much better method

of conveying what is offered to patients. Slashed costs and Internet
pricing pages may not be the best method of transferring value
propositions to the public at large. If anything we sell ourselves
short. When I see low price, an immediate question arises: what
was trimmed in order to achieve that price? The answer for this
industry is complex but involves structural differences that do not
cut quality corners. This equates to value propositions, not simply
lower prices. Alternative marketing messages may likely yield better
receptivity in the viewers mind.
From a country perspective, challenges exist, but they appear to
be getting attention. In the country itself, is the front door (airport)
the best that it can be? Do the streets en route to facilities ensure
peace of mind as you approach the buildings? Almost as important
is the hospitals immediate exterior surroundings. Would the exterior
surroundings opening into an oasis, revealing the exotic nature of
these destinations, yield more favorable impressions? Urban centers
appear to have a greater challenge here. Understanding how the

visual experience of entrances impacts new client arrivals may
improve the reception. Do the surveys cover these components of
the patients experience? Improving these variables would likely
have a positive effect.
When I see low price, an

immediate question arises: what
was trimmed in order to achieve
that price?
Collective dialogue within countries should lead to coordinated
improvements in infrastructure. Some gaps may be due to
fragmented areas of responsibility and unclear oversight. There
appear to be several constituencies that if aligned, would reduce
barriers and obstacles. Internal cooperation to improve a particular
countrys image can lead to robust and healthy competition for the
entire region. This becomes a win-win proposition for providers,
consumers and governments.
We heard stories of solitary patients searching the Internet and
happening upon a facility, making selections due to financial pressures,
and then venturing abroad for very significant and invasive medical
procedures. This may not be the best marketing story. I wholly and
actively support this industry, but these scenarios of an Internet flight
of fancy can be a high-risk proposition for everyone involved. These
relationships can result in bad experiences, adverse public relations
releases and generally negative media reports. These cases can be
very difficult to unwind the public relations damage, resulting in
restrained growth, and more costly media rebuttals for each case
that surface. No doubt, prevention is more effective and less costly
than the cure. In healthcare, bad experiences and outcomes can be
overly magnified. Constituencies who do not support this industry
take advantage of such outcomes in media releases. They maximize
the effect of incorrect assumptions about poor quality, misguided
attitudes of fear and pre-existing negative bias. The effects of such
releases on the mindset of the tentative healthcare traveler can be
difficult and costly to reverse.
The consumers psychological state should be moved carefully
and methodically from an existing state of concern, fear and
hesitancy: to positions of acceptance, enthusiasm and hopeful
anticipation. I believe that this mechanism can fully accelerate the
growth rate of traveling US patients.
Solutions are complex and require a careful analysis of many
factors. Assumption about US patients and about international
providers can lead to both parties not fully understanding the
customer base and marketing approaches. The market is vital and
provides an essential service that will grow. Engaged discussion,
understanding cultural gaps in viewpoints, and continued dialogue
will only continue to grow a brighter sustainable future.
Dr McCormick is originally from New York and now lives in Los Angeles. He is a practicing Emergency Medicine physician in Los
Angeles. He has remained Board Certified for the last 10 years. Prior to that, he served for over 20 years in pre-hospital emergency
services, both ground and air based operations. He graduated from medical school at the State University of New York Downstate in 1993.
His residency in Emergency Medicine at the prestigious LAC+USC Medical Center was completed in 1997. Dr McCormick is a founding
member and co-inventor of the NuMask IntraOral Mask, a breakthrough medical device for ventilating patients. His next direction is a
more strategic solution to the US healthcare challenges with the launch of a medical tourism business called Premier Medical Travel
this fall. He is convinced that combining his MD and MBA will help to unleash the tremendous benefits this industry has to offer: our
patients, our payers, our country and our future generations. He may be reached at jjmccormi@earthlink.net.
July 2008
63
MEDICAL TOURISM
BINA BUZZ
aBuzz about The Congress

By Michael Bina
Conventional Thinking? Leave your heart elsewhere! After reviewing the agenda for The First World Medical
Tourism and Global Health Congress in San Francisco in September 2008, I said to myself, Selfdo you
know the way to San Jose (or thereabouts)?
n a word, this is going to be Outstanding! The venue, the speakers,

the agendawhats not to like?
The Medical Tourism Association has put forth an exciting
invitation to the world for Global Healthcares Coming Out Party.
Up to a thousand attendees from around the world will fill the seats
at the Westin ~ Doctors, Diplomats, Lawyers, Legislators, Providers
and PayersAll, probably, would-be Medical Tourists. Its going to
be great, people. And a great show!
Most impressive for a fledgling Association was their skill in
attracting a lot of movers and shakers in the insurance industry.
64
July 2008
In the same room, there will be representatives and speakers from

Aetna, Assurant, CIGNA, Great West, Guardian Life and even
United Healthcare, for crying out loud.
The last time these many Big Name insurance companies were
in the same room together was 1993, when Hillary Clinton was
running the country. She was in charge of the Health Care Task
Force, (force being the operative word), and scared the living
bejesus out of the insurance industry, the medical industry, and
virtually all industry in the US. Fortunately, HillaryCare fell apart
because, as University of Virginia Professor Martha Derthick said,
In many years of studying American social policy, I have never
read an official document that seemed so suffused with coercion

and political naivetwith its drastic prescriptions for controlling
the conduct of state governments, employers, drug manufacturers,
doctors, hospitals and you and me! (Ouch!)
The insurance industry is famous for partying (should I say

infamous?). Conventions; Meetings; Product Kickoffs; Incentive
Trips; even CE Classes are an excuse to Party by those of us in the
insurance industry.
Anyway, The Medical Tourism Conference will be a reunion of

sorts. Not only will all the Big Carriers be there, but where theres
Big Carriers, theres always a lot of insurance brokers, agents,
consultants and assorted insurance groupies in tow. Among the
many, Towers Perrin will not only be there, but also be presenting
from the podium.
MORE FULL DISCLOSURE: Its not fair to say that all

carriers are prone to party at the drop of a hat; just some of us were
always looking for an excuse. I used to work for two companies
where The Party was always on. Honestly, its how the agents and
brokers got to know us and a major reason why we were able to
grow so quickly. They sold us because they loved us, not because
we had great rates or great products. Certainly, not all my brothers
and sisters in the industry, partied like a Rock Star, but we did. We
were proud, and loud.
And where those birds of a feather flock, youll also find an

assortment of TPAs, HMOs, PPOs, EPOs and other wannabees
including suppliers like Actuarial Consultants, Marketing
Consultants, IT Consultants, Legal Consultants and the like.
FULL DISCLOSURE: I used to be part of The Evil Empire.

Yes, I was on the payer side of the insurance industry for many
years, and still consult with a few agencies and provider systems.
In 28 years, Ive been to more Insurance Conventions, Seminars,
Trade Shows and Junkets than you can shake a stick at. Ive been to
LIMRA, LOMA, NAHU and WAHOO and a few YAHOOs along
the way, too! For HIAA, I served four years on PR and two years
on the Education Committee in DC, and helped stopped Hillarys
takeover of Healthcare in 93. Suffice it to say, its a sordid tale; a
checkered past.
Most impressive for a fledgling

Association was their skill in
attracting a lot of movers and shakers
in the insurance industry.
That said, the biggest reason to attend The World Medical
Tourism Congress is because of the presence of all the carriers,
brokers and insurance hanger-ons like me! First of all, they wouldnt
be in San Francisco en masse if they didnt believe something big
was going on, really big; something they should be a part of.
The insurance industry is anything but stupid. They know how
to make money. When theyre lining up at the door and or stacked
up behind the podium, you know somethings happening here, or
about to be happening very soon.
And thats been a very dramatic about face for the industry. Two
years ago, I was making a sales pitch to a high-placed executive
at one of the largest health insurance companies in the world. My
company had just completed a study of CEOs and Business Owners
about their knowledge and attitudes on Medical Tourism and
I was interested in sharing or trading some proprietary data with
the executive at the Worlds Largest Carrier. (Actually, I was only
interested in making a sale and thought my data would be my foot
in the door.)
He said, Ive never heard of the term Medical Tourism and
were not watching it all. (So much for that sales strategy.) Anyway,
this was just two years ago. Today, theyre on the stage as an industry
expert! (I must have been talking to the wrong executive, or it just
shows you how quickly the industry can move once it smells the
money.) Maybe I should go back to the company and retry my pitch?
Better yet, I should go to San Francisco and, work the room. Work
it hard! Itll be one-stop shopping for insurance networking and,
hopefully, sales!
Theres blood in the water in San Francisco Bay, and the sharks
are gathering. Besides all the money-making opportunities, the next
best reason to attend The First World Medical Tourism and Global
Health Congress is the networking. Back in the old days, we used
to call it partying.
So, if youre going, to San Francisco, be sure to wear some

Flowers in your hair, and be sure to sign up for anything sponsored
by or attended by an insurance company, TPA or large brokerage
operation ~ the pre-conference workshops, post-conference party,
the Gala Dinner and any cocktail receptionsanything. Sign up for
it all. If the insurance industry is coming, you know the food will be
good and the refreshments flowing.
If any insurance company is holding a smaller, private party
in a suite somewhere, get an invitation! Dont be shy and dont be
afraid ~ they wont try to sell you any insurance. Its just an excuse
to network. Ive found that the private parties in the Suites are
generally more fun, with better quality food, and drink, and higherlevel executives to meet. Thats the way we used to do it, anyway.
FINAL, FULL DISCLOSURE: Im ashamed to admit I

attended a medical tourism-type conference a couple years ago in
Las Vegas. I was really excited to be there but apparently, no one
else was. There were no insurance companies; there were no TPAs;
there were no alphabet houses. Obviously, it wasnt the Real
Deal! NO insurance companies means NO good parties. Thank God
we were in Vegas. What happened there, stayed there.
Dont get me wrong. I met a lot of nice people in Vegas. A
gentleman from the Salvadoran Export Chamber offered to trade
homes with me for a week this winter, I want to see snow, he
said. Youll see it alright in Green Bay, Wisconsin, I said in my
best Spanish accent. Give me your phone number, Gerardo, Im
booking my flight to El Salvador in January!
And dont get me wrong, considering where the market was
two years ago, there was also decent information coming out of
Vegas. Its just that the players just werent there. And word has it
that the Vegas event this year, with its same information and faces,
disappointed most, as they looked out over empty chairs where
players should have been.
The good news that the Players will be out in San Francisco.
Are you in?
Obviously, the author of this article has a

little problem. Fortunately, his friends and
colleagues say an intervention is forthcoming
(but probably not until after the Congress
in San Francisco). In the meantime,
Michael Bina will continue as Managing
Director of IntellectualMarketing, LLC., ~
staying as close to the ever ~ changing insurance industry as
he can. Feel free to invite him to your next party (he could
just be the life of it) michael@intellectualmarketing.com
July 2008
65
MEDICAL TOURISM
OH MY
ACHING BODY
By Sandra Landsman, Ph D, CHt
No body, but no body, has the flu or feels like they have the flu for months or years on end. That is what it feels
like to be one of the 6 to 10 million Americans who suffer from the chronic pain of Fibromyalgia. And who
knows how many others suffer the same around the world. They range in age from about 30 to their 60s and
are predominately women. In the past this has often granted them a pat on the head from their physician and
a trip to the psychiatrists office because there has been no clear cause. Fibromyalgia is called a syndrome
rather than an illness due to the fact that the multiple and varied symptoms lack the clear markers of a disease
such as changes in organ function or blood.
he real problem is that there really isnt any specific test at

this time for Fibromyalgia or Chronic Fatigue Syndrome either, for
that matter. Some researchers do believe that they are one and the
same illness. But back to fibromyalgia, since that is our focus in this
article.
First and foremost, though this may seem to be obvious, please
engage the services of a primary physician to oversee your care.
That would be someone who is a reasonably good diagnostician and
not reluctant or fearful of consulting with other doctors or accepting
their opinions. This is important because Fibromyalgia comes
with a cluster of maladies that may send a patient off to a variety
of specialists. That may further compound and compartmentalize
the problems. When you are fortunate to have one medical doctor
oversee or monitor all of what is currently available there is less
likely to be a redundancy in procedures or a conflict in the multiple
medications prescribed by diverse medical specialists. If you are
one of the many with fibromyalgia you will know what this is all
about. If not, just hang on to your hat as the symptoms roll out.
Sleep deprivation. With all the time that is spent in bed, how can
anyone still have trouble falling asleep? Sleep is elusive. After hours
of tossing and turning, having just barely gone to sleep, people with
fibromyalgia may wake up several times during the night or early
in the morning feeling as if they havent slept at all. No wonder
exhaustion is the word of the day. Deep restorative sleep is needed
for the muscles to rebuild during the night. For some of the victims
of this insidious malady, employment is no longer an option. Often
these are women that are Type A personalities, who have had top of
the ladder positions. Oh yes, often the high stress and well paying
positions have long since faded from their agenda like a washed out
pair of jeans. These people are not malingerers! They are just stuck
in the muck and mire of their own debilitating, exhausting pain.
Fibromyalgia Symptoms
Depression takes over daily thought and keeps these sufferers

from moving beyond their own walls. They feel as though they are
prisoners in their own bodies. Some days, just the thought of having
to deal with personal hygiene such as showering or figuring out
what to do with a toothbrush becomes an ordeal. The water spray
of a shower hurts the skin on the body. Soaking in a tub is better but
only somewhat soothing.
Fatigue, as a symptom, is number one on the hit parade list. This

is not just the kind of tired that makes you think that a nap or going
to bed for the night is a good idea. It is the kind of exhaustion that
says, I never want to get out of bed again and even then that is too
soon.
Memory has been fading over the years as the anxiety has been
ever increasing. They feel as though they are sitting on teeter-totter
or see-saw and no matter what they do, they can not bring the board
into balance. Their entire life is out of balance.
66
July 2008
Today may be a sinus infection,

tomorrow it is leg cramps and restless legs
syndrome. Here comes a bladder infection
that usually follows with an endless series
of yeast infections and Candida. Feel free
to create your own list of maladies since
not everything that men and women have
endured has been reported or discussed.
Fibromyalgia Diagnosis
The American College of Rheumatology
has maintained that prior to making a
diagnosis of Fibromyalgia there has to have
been muscle pain for at least 3 months.
There is a simple, but crude test that is made
to determine if you are one of these souls.
There are 18 individual tender sites on the
body that cluster around the neck and back.
A positive diagnosis is made if pressure is
applied to an individual and they respond to
11 of those 18 painful spots. Then you will
be considered positive for fibromyalgia.
Fibro Fog is the term that is often used
when they cant remember something
that is simple or obvious that they should
know. Fibromyalgia patient fears that their
brains and value left as the water went
down the bathtub drain. Lets also add heart
palpitations to the mix.
Headaches come in a variety of sizes
and consequences from mild, which come
and go, to monster migraine headaches
that have their own arsenal of medication.
Then of course, there is the neck pain that
is a whole new epidemic unto itself. Often it
contributes to the headaches, but who knows
which came first?
Vertigo or dizziness can be added to top
things off, as if things were not bad enough.
Now terrified to drive, even if they had
the energy to get up and go, this energy is
drowned in a flood of awful fearful thoughts
about hurting oneself or others in a car
wreck. The projection can come fast and
furiously with images about vehicles piling
up and hurting others all over town. The
mental exhaustion takes its toll and these
individuals surrender to the bed or couch for
another day of being a prisoner in their own
home.
And the list goes on with motion
sickness as another symptom. This can
make for impossible traveling. Here is a
little item that the divers and boaters use
for motion sickness that is available most
any where in the world; it is an inexpensive
over the counter tablet, Meclizine with the
brand name of Bonine. So traveling locally
or globally is in the realm of comfort and
possibility. It works wonders.
Intestinal Disturbances have a couple
of more ugly items that will usually find
themselves on the list. These can be bouts
of diarrhea followed by constipation,
flatulence or even leaky bowels. By the time
these symptoms are done, your body is on to
another set of symptoms perhaps in another
location entirely.
The truth of the matter is most people

wait a lot longer than three months before
they get a diagnosis of fibromyalgia. They
drag themselves from physician to physician
presenting multiple issues and all the while
looking very good on the outside. What
appears to look good on the outside may not
speak to what is going on internally. These
individuals may also not relay the full tale of
what, where and when they have been treated
or if they have been self medicating with
herbs, vitamin supplements and alcohol.
The truth of the

matter is most people
wait a lot longer than
three months before
they get a diagnosis
of fibromyalgia.
Sometimes these women and men just
cant remember their own medical history.
They often have been in discomfort for
many years not just a few months looking
for a sympathetic ear while physically in
agony, chronically depressed and living on a
chemical cocktail that is often not monitored
properly and could cause a variety of side
effects that may be harmful or lethal over
time.
Fibromyalgia Research
The issue of chronic pain and depression
are taken very seriously by Pedro Montoya,
PhD, and his research team in Spain.
They are gravely concerned regarding
the negative effects and the influence on
brain processing of physical and sensory
information an illness such as fibromyalgia
may have over time. Another research group
has been looking at our hereditary influence.

They believe that the presence of a chemical
alpha1-Antitrypsin (AAT) circulates in high
serum concentrations and is found in most
the body tissues. It has a very important job
as an anti-inflammatory agent, as it must
react to most attacks on the body. If there is a
deficiency of AAT, it may be due to heredity.
The person was diagnosed with fibromyalgia
if given intravenous infusions of purified
human AAT controlled the symptoms in a
very small study.
Recently researchers have turned up
several interesting factors that may play a
part in the development of Fibromyalgia.
One that led the field for many years because
of the fatigue factor is serotonin. It plays such
an important role in fibromyalgia because
this marvelous chemical is not only found
throughout the body, but is instrumental in
controlling pain and regulating sleep. Blood
tests indicate that people with Fibromyalgia
have low serotonin levels. The pain that is
reported is muscle and ligament pain, not
joint pain as in an arthritic individual. The
lack of sleep reflects a very, very serious
problem. When deprived of deep restorative
sleep, the body cant recover from the
previous days activity. It doesnt matter
how many hours a person lies in bed unless
they get deep uninterrupted sleep, they will
be unable to restore and rebuild their body.
As researchers at Georgetown University
Medical Center in Washington, D.C. started
to look deeper into spinal cord fluid of people
with Chronic Fatigue Syndrome and related
illnesses (i.e. fibromyalgia), they found a set
of 16 proteins that were not present in healthy
people. Of the 50 individuals examined,
there were 5 proteins that were in every
person tested, but in not one of the controls
or healthy people tested. James Baraniuk,
MD, lead researcher, admitted that perhaps
the study was small; however, it was a start,
a place to begin to look at a biosignature for
the diagnosis of fibromyalgia.
Dr. Robert Bennett of Oregon Health
& Science University in Portland posits
that there is also a link between the chronic
psychological stressors and the group of
inflammatory disorders. It may appear far
fetched that stress affects the production of
fluid in the central nervous system. Many
years ago Hans Selye, a pioneer in the field
of stress research, wrote about what would
and could affect each and every person. He
charted how to predict how much stress and
how long it would take to make to make
someone ill. Good and happy events such as
weddings, graduation, and promotions were
also classified as stressful events, along with
deaths, divorce and financial reverses. Today
we are in the process of developing many of
the tools to prove his theory. Some of them
are already available and can tell us the story
of glucose or cortisol hormone levels in our
blood. Stress can and does cause those levels
to rise or drop and play havoc with many
systems in the body.
July 2008
67
MEDICAL TOURISM
Taking an entirely different tack,
we have R. Paul St. Armand, MD, a
practicing physician and endocrinologist by
profession. He is one of the few men and his
three daughters who all carry fibromyalgia
syndrome. He proposes that fibromyalgia,
chronic fatigue syndrome, systemic
candidiasis are all one and the same things,
energy deficient syndromes, and may
have a hereditary cause.
These conditions all result as phosphates
build up within the cells in the body. There is
a failure of the phosphate ions to be excreted
from the urine so they then become trapped
in the bloodstream, and eventually get
stored in the bones, tendons and muscles.
When the build-up is great enough, it will
interfere with the energy production within
each of our cells. This is where everything
gets very, very complicated. The phosphate
ion is needed to help to convert the calcium
that comes from storage and all of this take
fluid. There is a portion of the kidneys that
just doesnt pump properly. As that happens,
over time the excess fluid will be stored in
many areas throughout the body which over
time causes pain. Specifically, this is the
very pain that is experienced at the surface
of the body and at the 18 pressure points.
Dr. St. Armands protocol for cleansing,
balancing, and restoring individuals is to
divest themselves of all salicylates, aspirin,
mint and various other herbs while going on
a regimen of Guiafenesin to help flush out
the body.
Fibromyalgia Treatment
So now that we know what is under the
medical spotlight, what do we do about it?
Can we drug it into submission? Well, we
can not do that exactly. There are a range of
anti-depressant, sleep and pain medications,
muscle relaxants anti-seizure medications
that have been prescribed often off-label for
this malady. This means it was given with
the hope and blessing that it would help
people with fibromyalgia. Of course lots of
aspirin and Tylenol also have been taken for
help.
68
July 2008
For the first time there is a medication

that has been approved Food and
Drug Administration just this year for
fibromyalgia, called Lyrica.
What about your diet? For some people,
limiting carbohydrates to whole grains has
been an important change in their daily
eating habit. Pain often limits activity
and women tend to become carbohydrate
resistant as they celebrate more birthdays.
Eat more of those colorful foods. Think of
rainbow red, orange, yellow, green, blue,
and purple as you select salad and vegetables
and fruit to cook. Try new foods, flavors,
fish, seasonings, nuts, poultry, beans, and
eat them raw if you can. Turmeric is the new
thing in seasoning and is good for every
part of your body, from brain to connective
tissue and skin. It just adds color and very
little flavor, so use it freely.
Exercise! Just do it. Thank you Nike,
but lets do it in moderation. You may have
been a marathon runner, but that was a thing
of the past. Start with a simple pedometer
that will let you know how many steps you
have taken. Yes, the ones that you have taken
around your home as well as those on your
walk, all count. A good pair of walking shoes
is all that is needed to go for a short walk.
So how far did you really walk today? Most
people dont have any sense of the distance
they walk daily until they measure their
steps daily with a very simple pedometer.
Yes walking is still a great exercise.
If you are feeling well enough, a low
impact weight training workout about three
times a week that allows your muscles to
heal between workouts is fine. Find a trainer
that understands the problems and works
with you to build strength and stamina.
Qi Gong is a wonderful series of
Oriental exercises that helps to develop
physical, emotional and spiritual balance.
It is excellent for helping people learn to
focus, calm, and distress. Yoga in any form
would also fit here.
Water aerobics is wonderful, but because

water often feels so delightful, it is easy to
overdo and increase pain rather than gain
the relaxation and flexibility that is desired.
Dont forget that less is much better for
you.
Hypnosis is a wonderful addition for ones
for tool box. The Hypnotherapist teaches
self-hypnosis to each individual so they can
manage to deal with their own discomfort.
Insomnia can now be managed simply and
easily with hypnosis. As can many of the
other major symptoms of fibromyalgia.
Acupuncture can often be a very good
alternative to many medications. It has
been known to relieve pain, particularly at
specific sites.
THREE EASY BREATHS. Wow, this
was a lot of material. What a lot to digest,
while staying in touch with the body. It is
important to know what you need from a
position of calm and clarity.
Take THREE EASY BREATHS before
you do another thing. Breathing is not
optional. Breathing is always on the top of
your to do list! This will allow for the clarity
to make decisions that are right for you. So
Breathe, three easy breaths releasing tension,
toxins and negativities so you can stay calm
relaxed and think clearly as you settle into a
wonderful adventure.
Dr. Sandra Landsman may be

contacted at:
810 Saturn Street, Suite
Jupiter, Florida 33477 U.S.A.
561.575.0547
Mobile 561.512.1002
DrSandyLandsman@bellsouth.net
www.DrSandy.biz
July 2008
69
World Medical Tourism & Global Health Congress

September 9th - 12th, 2008 Westin St. Francis - San Francisco, California
SPEAKERS
Joseph M. Heyman, MD
Chair-elect, Board of Trustees
Mike Kellen
Senior Vice President, Strategic
Development
Assurant Health
Lee Chien Earn

Senior Director
Healthcare Performance Group
Ministry of Health, Singapore
Robert Germain
Vishal Bali
CEO
Wockhardt Hospitals, India
Dr. B.K. Rana

Deputy Director
NABH, Quality Council of
India
Grant Muddle
Sandra G. Morris
Proctor & Gamble
Dr. med. Uwe Klein

Chairman of the Congress
Europe health GmbH
Arturo Garza
CEO,
Christus Muguerza,
Monterrey, Mexico
William F. Ruschhaupt, MD
Chairman, Global Patient Services
Cleveland Clinic, Ohio
Curtis Schroeder
CEO
Bumrungrad
James Lee
Wooridul Spine Hospital,
Korea
Frank Lasee
Wisconsin State
Representative
COO & General Counsel

Medical Tourism Association
Robert Crone
Former CEO,
Harvard Medical International;
Managing Director,
Huron Consulting Group
John Blalock
Guardian Life Insurance
Company Of America
Steve Green
Director
Trent Accreditation
Kemal Canlar
Senior Sales Executive
United Healthcare, USA
Sharon Kleefield
Harvard Medical School
Dan Bonk
Executive VP, Central Region
Aurora Healthcare,
Wisconsin
Adv. Kurt Worrall-Clare

Hospital Association of
South Africa
Jay Savan
Towers Perrin
Alex Piper
Former Buyer of Healthcare
Chrysler (Formerly
DaimlerChrysler)
Mohd Radzif Yunus

CEO
National Heart Institute,
Malaysia
Peter Hayes
Hannaford Brothers
Ilyas Benvenyste
Acibadem Hospital
Dr. Kushagra Katariya

Artemis
American Medical Association
Former Director of Global Health

Aetna Insurance Company
Senior Vice President of Operations

Apollo Hospitals Group, India
Dr. Sanjiv Malik

Max Healthcare, India
Renee-Marie Stephano, Esq.
70
July 2008
Brad Cook
International Department Director

Clinica Biblica Hospital,
Costa Rica
Medical
Medical Tourism
Tourism Association
Association
www.MedicalTourismAssociation.co
www.MedicalTravelAuthority.comm
Info@MedicalTourismAssociation.co
Info@MedicalTravelAuthority.comm Copyright Medical Tourism Magazine

SPEAKERS
Edward Watson, MD
CEO
MedTral, New Zealand
Jonathan Edelheit
President
Christi de Moraes, BA
Founder
MedNetBrazil Services, Inc.
Fred Hagigi
Professor
UCLA School of Public
Health
Alexandra Jung
Aon Consulting
Brent T. McCallum, CPA

Professor
The American University,
Washington, D.C.
Shin-Ho Lee
Ph.D. Executive Director for
Industry Support
Elizabeth Boultbee
Head of International Business
Stuart Rowley
CEO
Prince Court Medical
Center, Malaysia
Korea Health Industry

Development Institute
HCA International Hospitals
Dr. Prem Jagyasi
VP of Select Benefits & Worksite
Dr. Jorge Cortes Rodriguez

Medical Director
Christine Leyden
VP & GM of Client Services,
Chief Accreditation Officer
URAC
Dr. Fawzi Al-Hammouri

Chairman
Private Hospitals
Association - Jordan
Chartered Management &

Medical Tourism Consultant
Group Director - Marketing,
Lifeline Healthcare, Dubai - UAE
Scott A. Edelstein, Esq.
Partner
Squire, Sanders & Dempsey,
LLP, Washington, D.C.
Michael Kent
Senior Regional Director
Great West
Ernesto Dieck Assad

CEO
Hospital San Jose Tec de
Monterrey
Maureen Connors Potter

VP for International Services
HCPro, Inc. - Former
Executive Director - JCI
Dr. Carlos Dueas Garcia

President - Mexican Private
Hospital Association
Representative - International
Hospital Federation
Jim Follett
Director, Global Sales Latin
America
InterContinental Hotels Group
(Holiday Inn & Crowne Plaza)
Alma Jiminez
President
St. Frances Cabrini
Philippine Medical Tourism
Association
Michael G. Meissner, Esq.

Partner, Tax Practice
Squire, Sanders & Dempsey,
Ohio
Stephen M. Weiner, Esq.

Chairman of Health
Mintz, Levin, Cohn, Ferris,
Glovsky & Popeo, P.C
Jim McCormick, MD
Board Certified Emergency
Medicine
Mary Ann Keogh Hoss, PhD

Professor
Eastern Washington
University, Washington
Robert Frary
Symetra Financial
Leann Reynolds
Homewatch International, Inc.
Clinica Biblica, Costa Rica
Margaret Ball
Founder
Health Links International
David G. Vequist
Professor
Professor J D Frame
International Society of
Aesthetic Plastic Surgery
Charles Cutler, MD
Chief Medical Officer for Aetna

Info@MedicalTourismAssociation.com
July 2008
71

72
July 2008

Info@MedicalTourismAssociation.com Copyright Medical Tourism Magazine
Final Auction on September 10th, 2008.

Auction will take place at
The World Medical Tourism & Global Health Congress
at the Westin St. Francis in San Francisco, California.
This website is be auctioned off on behalf of a group of investors who no longer wish to own this website. The owners of
medicaltourism.com are allowing the Medical Tourism Association to auction the website at its annual meeting. A private purchase
prior to the conference is available, otherwise it will be auctioned off to the highest bidder meeting the reserve price set by the seller.
For any information or questions on bidding, registering to bid or to make a private offer to purchase the site beforehand please
contact the Medical Tourism Association at info@medicaltourismassociation.com or 561-791-2000.
www.MedicalTourismCongress.com
July 2008
73
JOIN
THE MEDICAL TOURISM ASSOCIATION
info@MedicalTourismAssociation.com
74
July 2008

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St. Lukes Heart Institute

Patients with heart disorders have entrusted their medical care

The Medical Tourism Association has put forth an exciting

There are no artificial barriers to marketing your facility,

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Implementing Medical Tourism into Health Insurance

One of the most important steps in any Medical Tourism is to

NEWS AND INSIGHTS

Travel Insurance covers many eventualities. If your flight is

Planning your Medical Trip Abroad

Whether it is recommending a restaurant or a tour, assisting with

The Age-Old Healing Art of Hilot

Fibromyalgia is called a syndrome rather than an illness due to the

When the voice doesnt match the sex

We are living in an age of communication. However, there are

Patient, Heal Thyself ~ The Promise of Regenerative

Regenerative Medicine is an innovative program that involves

Hilot is a word from the Tagalog dialect meaning

The Farm at San Benito: Exceptional Healing

The Farm at San Benito, a multi-award winning health resort

Medical Tourism is a Search for Value, not Low

The future for medical tourism and travel looks very

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