By Yusef Taylor, @FlexDan_YT
Gambian President Adama Barrow announced earlier this week that his government has entered into an agreement with Israeli company International Medical Services to build a €220 Million state of the art hospital in The Gambia. At this stage little is known about the agreement, however, it appears as though this is the type of investment that the country needs. Currently, many Gambians travel abroad for health services. According to IMS President Ovadia Yardena, her group is committed to promoting health tourism in The Gambia and will build a modern 350-bed hospital. Ms. Yardena has a good relationship with the Government of Equatorial Guinea.
On the IMS official website, it highlights their “long-standing activity” with the people of Equatorial Guinea. This led to the appointment of Ms. Yardena as an Honorary Consul of Equatorial Guinea for Israel. Equatorial Guinea is currently the country of refuge for former Dictator Yahya Jammeh and their President is one of the longest-serving Dictators in West Africa having taken power since 1979. This may be irrelevant to the subject matter but the involvement of an Israeli medical company IMS in The Gambia requires significant attention, especially from Gambian health professionals.
Figure 1 – President Barrow and representatives of IMS
Medical tourism is when foreign nationals travel to other countries for cheaper, quality health services. These services range from cosmetic surgeries, low-cost dental services, and organ transplantation. These services are primarily provided by the private sector and payments are mostly out of pocket. Private healthcare providers have little incentive to consider population-wide based services, however, the general public must be served through public health interventions focused on the health needs of the entire population or population groups. Individual healthcare, population health, and public policy decisions must, therefore, be premised on best available evidence to avoid poor and inappropriate interventions. This article aims to highlight the pros and cons of health tourism and the involvement of Israel in this booming industry.
Pros of Medical Tourism
There are significant benefits in favor of medical tourism in The Gambia. Patients traveling to Gambia for treatment helps to clear backlogs in sending countries and eases pressure on the demand for health services in sending countries. New health services will now be available to Gambians that can afford it. Previously such services would have to be accessed abroad.
For receiving countries, it will create a new stream of revenue via private-public partnerships and helps to stimulate trickle-down economics by increasing the inward flow of foreign currency. The delivery of construction services for the €220 Million hospital will have a positive impact on the local economy especially if Gambian businesses can feature prominently in construction projects. Revenue generated can be used to improve public health services for the greater population.
Another advantage of health tourism is the importation of new medical technology. The presence of a state of the art hospital can help to provide best practice benchmarking for local health services. A state of the art medical facility will also attract the latest medical technology to The Gambia which could benefit the University and public health delivery.
A thriving health tourism industry will require experts to manage and run daily operations of the hospital. Although this is a private venture Gambian medical experts working abroad could be lured back home, thereby reversing the brain drain of the country’s medical professionals.
Cons of Medical Tourism
In receiving countries, medical tourism contributes to the creation of dual health delivery system, one for rich foreigners and one for poor locals. It leads also to draining of public sector funds and implementation of policies biased to commercial medicine. There are many risks around health tourism such as no congruent treatment and continuity and patient follow-ups. It opens up the possibility of illicit medical practices like illegal organ trade. There are many advantages and disadvantages but the most serious concern is that medical tourism encourages illicit organ trade in poor countries.
According to the WHO’s Veronica Riemer, “while most countries in the developed world have a legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply. As a result, a black market has arisen in many poorer countries enabling those who can afford to buy organs to exploit those who are desperate enough to sell them. Sometimes, people travel to other countries specifically to buy organs they can’t find at home.”
The Royal Society of Medicine highlights the “many risks accompany the inclusion of organ transplant packages among the medical procedures sold to international patients. These dangers are magnified in countries where kidneys are purchased in underground economies or black markets. In these settings, promoting organ transplant packages to international patients’ risks escalating the number of kidneys purchased from poor citizens. Growing demand for transplants prompts organ brokers to increase the number of kidneys bought from impoverished individuals and sold to international patients.”
According to the Royal Society of Medicine study, in the Philippines, poor organ donors sell their kidneys for as little as $2,000. Proponents of commercial organ transplantation argue that poor individuals should be allowed to profit from selling a kidney. However, several studies indicate that the money poor individuals expect to obtain from selling a kidney goes to debt collectors.
Figure 2 – Typical seller and buyers
In 2014 the New York Times published a report headlined “Transplant Brokers in Israel Lure Desperate Kidney Patients to Costa Rica”. The demand for organ transplants is on the rise and this demand will follow hospitals that offer cheap organ transplantation. Many organ transplant experts and journalists highlight that Israel contributes significantly towards the highest receivers of organ transplants. They also have a thriving organ brokerage business with networks across the globe.
According to “a Times analysis of major trafficking cases since 2000 suggests that Israelis have played a disproportionate role. That is in part because of religious strictures regarding death and desecration that have kept deceased donation rates so low that some patients feel they must turn elsewhere. “When someone needs an organ transplant, they’ll do everything in their power,” said Meir Broder, a top legal adviser to Israel’s Ministry of Health.”
In South Africa, the Guardian reports that “Netcare, which also runs hospitals in Britain, took part in an international scam that allegedly saw poor Brazilians and Romanians paid $6,000 (£3,840) for their kidneys to be transplanted to wealthy Israelis.” It’s reported that kidneys “were initially sourced from Israeli citizens, but later Romanian and Brazilian citizens were recruited as their kidneys were obtainable at much lower cost than those of the Israeli suppliers.” This took place in “South Africa’s biggest private hospital group” which admitted to “receiving R3.8m (£342,000) from an illegal organ trafficking scam that included the removal of kidneys from five children.”
Although there is no reason to assume that IMS has or will conduct organ transplantation in The Gambia, significant evidence indicates a heavy Israeli presence in the illegal organ trade. The Gambia has a youthful population and an unemployment problem. This makes them an easy target for organ hunters who usually target young healthy people. It’s not uncommon to read of migrants exploited for their organs. According to the Journal of the Royal Society of Medicine, “selling purchased organs to medical tourists, organ transplant facilities and transplant procedures should be excluded from medical tourism initiatives. Including organ transplants among the procedures marketed to international patients risks undermining health equity and reducing the number of citizens who have access to organ transplantation.” Countries like Israel that conduct organ transplant have strict rules incorporated in their Organ Transplant Act. This helps to regularise the activities of organ transplant and deters illegal black market activities.
Figure 3 – Kidney Donors in Philippines
Could it be that the Government, Health and Tourism Ministry, in particular, are not aware of the pros and cons of health tourism? A thorough review of the impact could help the executive make an informed decision for The Gambian people. Health tourism should not be promoted to the disadvantage of public health services. It is possible to strike a balance, however, the dangers of exploitation and the health impact it can have on poor people who donate their organs due to financial constraints can be significant and poses a moral and ethical problem.
Most countries that practice organ transplantation only permit altruistic organ donations and ban commercial donations. This often leads to a black market prompting experts to recommend legislating and regulating commercial organ donations to eliminate the black market. What is certain is that the Gambia will need the right legislation and vigilant monitoring if organ transplantation will be permitted. For The Gambia to make this public-private venture a success, commercial organ transplantation should be excluded from health tourism packages. The government will also need to designate revenue generated from this venture toward improving the delivery of public health services.
Even with rigorous monitoring and the right legislation, there are concerns raised by the Guardian that Israeli pathologists harvested organs without consent. This does not give confidence that Israeli Investors will play by the rules. After all, a €220 Million investment will be expected to generate significant profit.