A recent article (July 2007) from the American Academy of Orthopaedic Surgeons explores the growing trend of traveling abroad (that is, outside of the USA) for medical care. Staff writer Jennie McKe writes:

As U.S. health care costs continue to increase, many Americans are facing difficult choices. Should a 61-year-old uninsured waitress who needs bilateral knee replacement wait until she’s eligible for Medicare before having the surgery because she can’t afford the $100,000 total cost? Or what about the 46-year-old self-employed construction worker who needs disk surgery, but the $90,000 estimated cost would bankrupt his company?

In both cases, over the objections of their U.S. physicians, the patients became medical tourists, traveling to Bangkok, Thailand, for their surgeries. According to the National Coalition on Health Care, 500,000 Americans went overseas for medical care in 2005. They traveled to locales such as India, Singapore, Thailand, Mexico, and Costa Rica for dental procedures, heart surgery, fertility treatments, and orthopaedic surgery and paid as little as one-tenth of the average charges in the United States.

With 44.8 million Americans currently uninsured and millions more underinsured it’s likely that medical tourism’s popularity will continue to grow. And, as more Americans opt to travel overseas for medical care, their physicians are raising significant patient safety concerns.

What are the implications and opportunities of this massive movement for Barbadian tourism and Barbadian health care?

A Brief History of Health Tourism in Barbados

Well, to begin with, Barbados has had a reputation as a healthy holiday resort for the last two hundred and fifty years! We can claim that it all began with the arrival of the young George Washington, at the age of 19, accompanying his older brother Lawrence, who was advised to come to Barbados in an attempt to cure his tuberculosis. It’s true that they had powerful relatives here, who introduced George to the most influential people in Barbadian society and politics, and almost certainly influenced the course of his life and America’s path to Independence. But at that time Barbados was still, according to eminent American historian George Rogers, the Post Office of the American colonies and movement back and forth was not uncommon.

By the beginning of the nineteenth century the sea cliff at Hastings was chosen as the site of the new military hospital (now Pavilion Court) and the doctors’ residence, the ‘Pavilion’, magnificently restored by Gillespie and Steele for James Blades of Coconut Court. Hastings House, nearby, was chosen as the temporary residence of the popular Governor, Sir Evan McGregor, in 1836, when he found Government House in a state of disrepair and refused to occupy it! In the 1830s the area was developed as a desirable ‘seaside village’ and health resort, with fine villas, such as Villa Franca, the restored home of the offices of Trivial Pursuit, and the splendid orange villa, recently restored, opposite the Caribbee Hotel. Villa Franca was known for over a century as Hastings Bath, and boasted a pair of gents and ladies bath houses, located at the end of a jetty, so that the ladies could descend to the sea from the bath house in complete privacy! In 1830s advertisements it was known as Pairman’s Baths.

By the 1880s there were several hotels and seaside guest houses along the Hastings coast, the most prominent of which were the Seaview Hotel (now the Savannah Hotel) and the Ocean View, now tragically lost. But the big health tourism boost came with the building of the splendid three-storey Marine Hotel by George Whitfield (built in 1887, bull-dozed in 1998), in the same decade of the 1880s as the conversion of the Simpson property at the Crane, Marine Villa, into the Crane Hotel, and the opening of the Atlantis Hotel at Tent Bay, Bathsheba.  These hotels promoted Barbados literally as a spa, where sea bathing, sea air, Crane chubb, red snapper, dolphin, sea eggs and flying fish would ‘rejuvenate the body and refresh the spirits’. And while Bathsheba served local needs and the Crane a mixture of locals and visitors, the Hastings district expanded along the South coast and later the West coast, to produce the rich range of beach-based resorts Barbados now boasts.

Visits specifically for medical treatment evolved in the mid twentieth century with the reputation of Dr. Harry Bayley and the Diagnostic Clinic. This small private clinic developed a Caribbean wide reputation, especially in the southern Caribbean, Trinidad and Venezuela. At a time when our Government’s General Hospital in Barbados was in desperate need of modernisation, in spite of the efforts of our national hero Dr. Charles Duncan O’Neal and others, Dr. Bayley established a modest health tourism movement into Barbados for modern diagnostic methods, from the Pap smear, which he and his wife introduced within weeks of the publication of the technique, to serological diagnosis available only in his laboratory.

Recent Developments

Caribbean medical tourism to the Queen Elizabeth Hospital has been studied in more recent times, with a paper by Walters, Alleyne and Fraser in the West Indian Medical Journal, reporting on the use of QEH by visitors in 1990. Cost of visitor care was more than 2 % of the hospital budget (more than a million dollars a not insignificant sum nearly 20 years ago!) with two thirds of these visitors being Caribbean patients referred chiefly for cancer treatment, but also for obstetric care and other investigations. Major specialty areas for referral have included cardiology, plastic surgery, renal failure and neurological problems, and more recently orthopaedic and fertility problems. Expansion of our resources would attract those thousands who currently go to Miami, Orlando, New York and Toronto for specialty care, both from Barbados itself and from our neighbouring islands.

The Barbados Fertility Centre is an outstanding example of a Centre of Excellence which has been developed recently and is serving both a Caribbean and an international clientele. The Centre has achieved outstanding results, which can be seen on its website (www.barbadosivf.org). Pregnancy rates now exceed those quoted as averages for both the UK and the USA (54% for the under 37 age group, 39% for the 38 – 41 and 22% for the 42 and over, compared to UK and USA figures of 41, 26, 12, and 25, 15, 4 respectively.

What I particularly like about the success story of the Barbados Fertility Centre is the fact that it is located in a refurbished villa at Marine Gardens, Hastings, overlooking the sea at Hastings Rocks and right in the heart of the historic Hastings hotel district. This ostensibly serendipitous location could not be more appropriate – a modern medical tourism version of the original, ages-old Hastings health tourism! The difference is that the best of modern medical methods are being applied in a health spa setting, rather than a combination of mythology and alternative panaceas. (On a personal note, the original house, Seaton, was built around 1912 from the materials of my grandfather’s home at Grazettes, but that’s another story, or medical saga!)

Global Health Tourism

Meanwhile, global health tourism has reached the huge figures described in our opening paragraphs. The half a million Americans takes no account of the several hundred thousand Canadians in need of orthopaedic and other treatments, and the unknown, even larger numbers, from Britain and the rest of Europe. Where do they all go? To 28 countries on four continents, but the leading providers are India and Thailand, followed by Singapore and Malaysia, Dubai and South Africa. The outstanding international experts in health management are the Apollo Group, headquartered in Chennai, India.

In the Americas, only Costa Rica and Mexico appear to have taken advantage of the huge North American market. But at the recent Heads of Government Conference in Washington, several speakers, including World Bank Senior Health Economist Dr. Logan Brenzel, made a very strong case for the development of health tourism specialist facilities in the Caribbean. And all the evidence shows that the market is clearly growing. In the UK many investigations, such as CT scans and MRIs, and referral to many specialists, have a waiting list of many months under the National Health Service, and speaking to senior health administrators in the UK recently, while many conditions formerly referred to specialists are, under new guidelines of the Health Trusts, not referable! In Canada there is no chance any time soon of introducing a mixed health system, and Canadians therefore choose the USA at horrendous costs or the far East, at far lower costs. A US $ 50,000 hip operation will be done in India for $7,000, and travel and stay will not even double the total cost.

Our Golden Opportunity

In the Caribbean, salaries and other costs of care will obviously be higher than in the far East, but far lower than in the USA. Cultural and language similarities, and far shorter distances, will make a destination like Barbados far more attractive to Canadians, who are likely to have been here, have friends and family here, or even have emigrated from here!

Yet the potential capacity of Barbados, while it may be expanded to be hugely valuable to us, would be only a drop in the huge pool of the global health tourism figures!

There is, therefore, based on the track record of our modest Caribbean referrals, particularly for cancer treatment, our outstanding Barbados Fertility Centre, and the huge market in Canada and the UK, our major tourism partners, a ‘Golden Opportunity’ for a rapid expansion of health tourism in Barbados. This can be best exploited with high class private specialist tertiary care services and redevelopment of key services at the QEH. The QEH will in turn benefit from expanded specialist resources and skills on island. The proposed Barbados Specialist Hospital (Project Care), recently presented at a public Town Hall Meeting at Queen’s College, and probably to be known as the Apollo St. Luke’s Hospital, could provide the turning point for Barbados and its health care centres to become a global Mecca (although tiny!) for health care in the Caribbean.

Wouldn’t George Washington, Dr. Harry Bayley and Dr. Charles Duncan O’Neal be pleased and proud!

About the Author

Senator Henry Fraser
Senator Henry Fraser -

Senator Professor Emeritus Sir Henry Fraser is retired Dean, Faculty of Medical Sciences; Founding Director, Chronic Disease Research Centre, UWI; author of 110 medical papers and many books; Sunday columnist, former UWI and National Public Orator, writer, artist, architectural historian, TV film maker / presenter (Treasures of Barbados, Pillars of Worship & Parliament 375 for CBC-TV); Past President, Barbados National Trust.