Dr. Prativa Pandey obtained her medical degree from New Delhi, India and did post graduation in Internal Medicine from Boston, USA. She worked for 10 years in the Boston area and returned to Nepal in 1993. She is the Medical Director of CIWEC Hospital and Travel Medicine Center in Kathmandu and in Pokhara. She has served as the President of the International Society of Travel Medicine and is the founding President of Nepal Society of Travel Medicine. She has volunteered one season at the Himalayan Rescue Association (HRA) aid post in Pheriche at 4200m in the Everest trekking route and serves on the medical advisory board of the association in Nepal. She has over 50 publications in peer reviewed journals and book chapters on travel medicine related topics.

In an interview with Manisha Balami of New Business Age, she spoke about the prospects and challenges of medical tourism in Nepal. Excerpts:

You have been involved in tourism as well as medicine for 28 years. How do you see the prospect of medical tourism in Nepal?
When you say medical tourism, it implies that people will come to Nepal to receive medical care. I think we are not there yet in many areas. There are people who are coming across the border and using services like cataracts. But people are not coming to Nepal right now for things like hip replacement, fixing knee or cosmetic surgery. I think it’s because our neighbours are doing a better job right now. India and Thailand are doing much better in medical tourism and promoting it.

In Nepal, I think we should focus on providing  all the medical services to the tourists when they come to Nepal and get medical difficulties. We ought to be able to provide the best of care to these people. We used to send people to Bangkok a lot in the past but that number has reduced a lot because we are able to take care of problems like fractures, complicated surgeries, and even cardiac problems now in Nepal. However, foreigners here question the quality of blood products so they don’t want to get blood transfusions. They will opt for blood transfusions in dire emergencies. Otherwise, they feel that our blood products may not be safe, and infection rate may be very high in Nepal. So people still have those concerns. I think in a few years, we’ll get there. But right now I feel that taking care of travellers who get into medical difficulties when they are in Nepal is the way to go with. Now a  lot of things have been taken care of, but for people to come here for medical tourism, I think we are not ready yet, for many reasons.

Do we have enough medical infrastructures to cater the medical tourists at the moment?  
With new private hospitals coming up, I think we do, but not everywhere. There are sections that are good in certain private hospitals but not every specialty is good. If I am not able to take care of a certain problem, I would like to send them to a certain hospital for one problem, and for another problem, I’d like to send them to another hospital. So, even tertiary care has not developed as much as we would like to in the private hospitals. I think the government hospitals provide the best tertiary care but they are so overcrowded that people feel that problems like infection control and cleanliness are not taken care of well. The government hospitals are not appropriate for the foreign travellers yet but the private hospitals that are here are working hard but we are not there yet.

I don't think many international tourists will come for treatment right now. Maybe some people from the Middle East are coming for it.

At the moment, there is a big market of Nepalis who live overseas coming here for dental care. Some people are coming here to get operated especially those who don’t have insurance in other countries. But the hardcore foreigners coming to Nepal for medical tourism, I don’t see that is happening in the next few years.

So, in what areas do we have to focus on? Is it infrastructure, immigration or any other things?
It is really a quality of care that matters most to the people. People want the best care. They don’t want to go back home and have an infection after they got operated in Nepal. We have all the necessary infrastructures in the country. But well trained manpower in specialties is what we require today.

There are so many well trained Nepali doctors living abroad who are willing to serve in Nepal. What I mean to say is that, we haven't approached the subject of dual citizenship or facilitate NRNs to work here in Nepal. The skilled or trained manpower wants to come to Nepal but the government regulations right now make it hard for them to come back here and work. I think the government should remove the issues on labour certification and could really facilitate the NRNs to be able to work and get paid here in Nepal.

I feel it's the biggest roadblock that we have. A large number of trained people are outside the country who cannot come to work here because of the system here. We ought to facilitate that population to move back to the country and work. Until that happens, there is a big exodus of Nepali doctors overseas.

The government can do a lot in promoting medical tourism by facilitating that group to  come back and work, since there's a shortage of quality manpower in Nepal.

Even the nurses are going out at present and we take big pride in saying that European and other countries will take thousands of nurses from Nepal. We must retain our nurses to serve the nation by providing lucrative incentives. The well trained nurses are going to Australia, the UK, and the US. Why would they stay in Nepal if they are getting paid well? So the focus should be on how do you bring this trained manpower back to Nepal and retain the ones who are already here.

At the moment, maybe in short period of time, what kind of medical tourists can we cater?
I think, right now, our focus should be on taking care of people such as travellers and trekkers who become ill in Nepal. I think giving them reassurance that we provide the best care is the best way that we should go. Again, bringing back the trained Nepali manpower back to Nepal is important. We don’t lack infrastructure, we lack trained manpower.

Compared to our competitors like India, Thailand, Malaysia, Singapore , how expensive is Nepal in medical care?
We are just as expensive as our competitors. When we try to provide the best of service, I don’t think Nepal is cheaper than any other countries. May be we are cheaper than Singapore, and some hospitals in Bangkok.

People want the best care, and if you want the best care, you have to be able to pay for it because the equipment such as beds, monitors and other things are very expensive as we have to bring them from outside the country. So, I feel that good quality health care is going to be expensive everywhere.

What is the comparative advantage of Nepal?
Nepalis are very friendly people, kind, care giving, and compassionate and people like this side of Nepal. In addition, other advantages are that we might be a bit cheaper than some of these other countries. People like to be here in Nepal and we have that on our side but the trained manpower is what we are going to lack, it’s going to get worse. We are promoting our nurses to go out and doctors are going out already in any way.

In 2016 you had organised a conference on travel medicine. Can you share a little bit on the results?
The focus of the conference was  to take care of travellers. So that was very well received and very well done. We had excellent speakers. There were around 500 participants from Asia, Africa, Europe etc. where around 300 were international and others were Nepali. It was very well attended and people loved it. People loved being in Nepal and they were very happy with the conference. They also did trekking and different activities after the conference, so they were extremely happy.

I think we have a big potential in promoting something like medical conferences. But we’re not able to bring big conference here because we don’t have proper infrastructure for that. Such conferences would be something that should be promoted because people would love to come to Nepal, especially if we have another international airport so that coming in here would be easier. I think we could really promote international conferences.

To promote medical tourism of Nepal, the government has a big role to play. In your opinion, in what areas should the government facilitate so that it would be easier?  
Having worked for 28 years in this field, I feel that the big hospitals spending a lot in big infrastructure really need well trained manpower, as I said earlier. Right now, we don’t need to look for foreign doctors. Look for Nepali doctors who are living overseas and allow them to work here and get them paid well. They are dying to come back. If the government facilitates that NRNs to come here and work, a lot of them would come to Nepal. Also facilitate for nurses as well. Make it such that the salary of nurses at par with other service holders, even a little higher.

So, we really need to bring quality, trained Nepali manpower from overseas because they all are working as specialists in different countries. If the government makes it easy for NRNS to come and work, even for some years, it would make things a lot better for many hospitals to cater medical tourism because all the specialised people are outside the country.