"Consider whether you are treating the patient for your own good or for theirs"

Medical Tourism Can Do Harm
By RACHEL A BISHOP and JAMES A LITCH
Published: April 8, 2000
British Medical Journal

This article is actually an editorial, and it is only marginally related to our topic. It is interesting, however, because it explores another definition of medical tourism!

So far, we have been defining medical tourism as Western patients going abroad to seek health care in the cheaper, often more accessible, developing world (this is also a faulty definition because patients from the developing world also go abroad to other developing nations to seek such care; for example, Indian services are also used by Pakistanis and Middle Easterners); medical tourism also encompasses the trend of Western doctors going to developing nations to practice to gain the international experience through altruism.

This editorial, written by two Nepali doctors who have witnessed first-hand the arrival of Western doctors into their communities, discusses the harm that can come of this seemingly helpful practice. Because the travel to established hospital and clinics in a nation is often arduous and expensive, many Western doctors set up clinics right on the outskirts of villages to make care more accessible; instead of being helpful, however, this is detrimental because the Western doctors often know little about the local patterns of disease transmission, the culture, or the language. In addition, these clinics tend to be temporary or have a high rate of turn-over in staff; thus, it is unrealistic to assume that the staff at a clinic can accurately diagnose and treat a condition after just a single consultation.

Also, there is no integration of the temporary clinic with the permanent health care system in a developing country: Western doctors often prescribe antibiotics, setting off huge courses of resistance in very vulnerable communities. Established doctors also don't know how to pick up treatment of patients who once visited Western doctors at a clinic, but now turn to the established route because the clinic is gone.

The two authors of this article argue that the single mandate of medicine is "First do no harm";
Western doctors seeking experience in altruism, then, need to reconsider who they are actually helping, themselves, or the patient.