CHEERS TO LIFE

Tackling your child’s bed-wetting

Pediatric urology problems are some of the most commonly occurring of childhood conditions. Simple problems like undecided testis and hernias are extremely prevalent occurring in 1 out of every 100 boys. Complex urologic problems in children like, posterior urethral valves, vesicoureteric reflux, bladder exstrophy, hypospadias, ureteropelvic junction obstructions and renal transplantation, need specialized surgical training in the care of children and are best done by a paediatric urologists.

Bed-wetting

Toilet training a child takes a lot or patience, time and understanding. Most children do not become fully toilet trained until they are between 2 and 4 years of age. Some will be able to stay dry during the day. Others may not be able to stay dry during night until they are older.

Causes of Bed-wetting

Night-time bed-wetting, called enuresis, is normal and very common among preschoolers. It affects about 40% of three year olds. All of the causes of bed-wetting are not fully understood, but the following are the main reasons a child wets the bed: bladder is not yet developed enough to hold urine for a full night, or child is not yet able to recognize when his bladder is full, wake up, and use the toilet.

Most school-age children who wet their beds have primary enuresis. This means they have never developed nighttime bladder control. Children who are older when they develop nighttime bladder control often have at least one parent who had the same problem. In most cases, these children become dry at about the same age that their parent(s) did.

Dry to wet

Often, a child who has been dry will suddenly start bedwetting again. When it happens it is usually due to stress in the child’s life. Such stress could be due to change, such as a new baby at home, moving or a divorce. If your child wets the bed after having been dry in the past, your pediatrician should do an evaluation. Bed-wetting may be a sign of stress.

Symptoms

Some parents fear their child’s bedwetting is due to a disease or other physical problem. Actually, only about 1% of bed-wetting cases are related to diseases or defects such as Bladder or kidney infections, Diabetes or defects in the child’s urinary system. With any of these cases, there will often be changes in how much and how often your child urinates during the day. Your child may also have discomfort while urinating. Tell your doctor if you see any of the following signs at any age:

·         Unusual straining during urination, a very small narrow stream of urine, or dribbling that is constant or happens just after urination.

·         Cloudy or pink urine, or bloodstains on underpants or nightclothes.

·         Daytime as well as nighttime wetting.

·         Burning during urination.

Tests

If your pediatrician suspects a problem, he/she may take a urine sample from your child to check for signs of infection or other problem. Your pediatrician may also order tests, such as ultrasound of the kidneys or bladder, if there are signs that wetting is due to more than just delayed development of bladder control. On occasion when a child wets day and night then a voiding cystouretrogram is performed if it is necessary.

Managing bed-wetting

Reassure your child that the symptoms will pass. Until that happens naturally, the following steps might help. *Take steps before bedtime. Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime. *Use a bed-wetting alarm device. If your child reaches the age of 7 or 8 and is still not able to stay dry during the night, an alarm device might help. *Until your child can stay dry, put a rubber or plastic cover between the sheet and mattress. *Let your child help. Encourage your child to change the wet sheets and covers. This teaches responsibility. At the same time it can relieve your child of any embarrassment.

Do Medications help?

When no other form of treatment works, your doctor may prescribe medication. The use of medications to treat bed-wetting is used once all other treatment modalities are exhausted. The type of medication that will be used varies on the child and the history of bedwetting.

Parental support

It is important that parents give support and encouragement to children. They should be sensitive to the child’s feelings about bedwetting. Make sure your child understands that bedwetting is not his fault and that it will get better in time. Reward him for “dry” nights, but do not punish him for “wet” ones. Remember, your child does not have control over the problem and would like it to stop, too!

Do not pressure your child to develop nighttime bladder control before the childs body is ready to do so. As hard as your child might try , the bed-wetting is beyond a childs control, and may only get frustrated or depressed because they cannot stop it.

Set a no-teasing rule in your family. Do not let family members, especially siblings, tease a child who wets the bed. If your child has enuresis, discussing it with your pediatric urologist can help you understand it better. Your pediatrician can also reassure you that your child is normal and that he/she will eventually outgrow bed-wetting.

HALE 'N' HEARTY

LET YOUR HEART NOT SKIP A BEAT. AND TO ENSURE THIS SIMPLY START NOW. A LITTLE REGULAR EXERCISE AND A LITTLE MORE CARE IN WHAT YOU EAT WILL ENABLE YOU AVOID THAT EMERGENCY TRIP TO THE DOCTOR

 The hectic pace of city life and the rapidly changing lifestyles are adding up to cause an alarming increase in the incidence of heart attacks among the upwardly mobile youth. How you think, feel and live your life affects your heart. Unhealthy food habits and a sedentary lifestyle can lead to obesity and a chain of problems. However, working out or adopting a disciplined exercise regimen can help in keeping weight in check.

We all know the risk factors that could lead to a heart attack. However, many of us choose to ignore them, conveniently forgetting their long term consequences. It's time to take a look at your lifestyle, family history and general health.

Risk factors such as age, familial history, high blood pressure, high 'bad' cholesterol, blood sugar levels combined with your height, weight and waist measurement can all be assessed and you can take actions to reduce your risk of suffering from heart disease and stroke.

THERE ARE FIFTEEN MAJOR RISK FACTORS ASSOCIATED WITH HEART DISEASE AND STROKE:

1. Increased cholesterol in the blood
2. Increased triglycerides
3. Decreased HDL in the blood
4. High LDL levels
5.  High VLDL cholesterol
6. Decreased cholesterol: HDL Ratio
7.  High blood pressure
8.  High blood sugar
9.  Lack of exercise and physical activity
10.  Smoking and tobacco consumption
11.  Obesity or overweight
12.  Lack of fiber in food
13.   Lack of antioxidants in diet
14.  Alcohol consumption
15.  Psychological stress

Stress could also be responsible for many heart problems, researchers say. Stress is basically due to five overloads: work overload (excess work), time overload (acute shortage of time), information overload (excess burden of information to the brain), requirement overload (excess desire to excess or material needs) and lastly illness overload (stress due to illness). Each working person should remember these five points every day and try to work on them.

A WORD OF CAUTION

The onset of a heart attack can be detected with a few visible warning signs like chest discomfort while walking, and/or shortness of breath etc. But, it is important to note that many heart attacks can be silent without any symptoms or without much forewarning.

PREVENTION

Although people who are genetically predisposed to heart attacks cannot actually reverse the risk, they can make amends by trying to lead a sensible lifestyle by making a few modifications in their food and exercise habits. Wockhardt Hospitals, one of Asia's fastest growing Super Speciality Hospital groups, has made noteworthy contribution in the areas of medical super specialties like Cardiology, Cardiac Surgery, Neurology, Neuro Surgery, Orthopaedics & Joint Replacement, Urology Surgery India, Nephrology, Minimal Access Surgery, Critical Care, Medical and Surgical Oncology and Endocrinology. Associated with Harvard Medical International - the global arm of Harvard Medical School, USA - Wockhardt Hospitals is the first hospital group in South Asia to be recognised by the American Blue Cross and Blue Shield association in its worldwide network of participating hospitals. The N M Virani Wockhardt Hospital based in Rajkot boasts of being the first NABH (National Accreditation Board for Hospital & Healthcare) accredited hospital in the Saurashtra & Kutch region. This accreditation resembles the highest standards of patient care and quality medical services to one and all.

HEART CARE TECHNOLOGY

"The latest in heart care technology is the non invasive treatments called Natural Bypass and Biochemical Angioplasty. ECP or Natural Bypass (Pneumatically Assisted Natural Bypass or PANB) is the latest gadget developed in USA which gives us the ultimate non invasive treatment of heart disease. In this treatment, using a series of cuffs the muscles of the lower part of the body are squeezed to increase the blood reaching the heart arteries. This opens up millions of small arteries (called Collaterals) in the heart giving a natural bypass. This treatment has become very popular in the USA, China and is being paid by the insurance companies because of the lower cost and results. Biochemical Cleaning or Biochemical Angioplasty (BCA) is another technique which holds a lot of promise. Here a mixture of chemicals including blockage eroding EDTA is infused in the blood stream over three hours. This treatment has also become popular in USA and Govt. has now taken up a big research study to establish this treatment. It can remove the blockages from 5-50% within a span of few months. Both these treatments should be combined with lifestyle changes in order to get maximum and longtime results," says Dr Bimal Chhajer, MD of SAAOL (The Science & Art of Living), which offers a complete solution to heart blockages at its centres through Natural Bypass and Biochemical treatments. SAAOL, which has patient education programmes called HLTP (Heart Life Style Training Program) to educate the heart patients on reversal of heart disease, claims to have treated more than 20,000 patients all over the country by their non invasive methods with 98% results - methods that focus on changing the mentality of the heart patients and enable them initiate a healthy lifestyle, whilst aiming at preventing heart disease.

TIPS TO LIVE A HEALTHY LIFE

• ·       Zero oil cooking: Oil (the other name of Triglycerides) is the main culprit to block the heart tubes
  ·         Check your Lipid profile and control if they are high: Every adult must check his lipid profile once in a year. Heart patients should do it once in three months. If the figures are high - diet should change and if not controlled statins (medicines to reduce Cholesterol) and Fenofibrates (medicines to reduce Triglycerides) must start.
  ·         Practice yoga and stress management
  ·         Thirty five minutes of walk: It is very important to walk at least 35 minutes every day if you want to prevent heart attacks. The speed will vary from patient to patient. Walk should be at a speed below the angina threshold.
  ·         Include plenty of fruits and vegetables: Fruits and vegetables will provide fiber and antioxidants which will protect the heart from Cholesterol blockages.
  ·         Control blood pressure and sugar: Consult your physician if you cannot control these two by lifestyle alone.

With India being promoted as a major health tourism destination

In part of the four-and-a-half year’s of Bachelor of Medicine and Bachelor of Surgery (MBBS) programme and a year’s internship, the main thrust areas include medicine, surgery, gynaecology, paediatric, psychiatric, forensic medicine and toxicology and ophthalmology. Experts talk about the heights the medical profession has reached and those to be accomplished in the near future.

EMERGING AVENUES

Genetics, biotechnology and pharmaceutical sciences are the emerging disciplines of medicine. The availability of dedicated manpower in these disciplines and also the number of institutions that are capable of meeting the technical demand, make India an attractive destination. Many of the basic research issues for the Indian population remain unexplored. There is a great opportunity for budding researchers and scientists in India.“In the medical curriculum, one should emphasise on practical applications and interpretation of investigations to make the right diagnosis. Emphasis should be on problem-solving based on investigation data and not on clinical data, as practiced for decades,’’ said Dr Anoop Misra, director and head, department of diabetes and metabolic disorders, Fortis Group of Hospitals.

He further said, “Apart from the frontline areas of research, p u b l i c health is an area that has been ignored by policy-makers and teachers of medicine, and even for students it is the lowest priority. The programmes of top public health importance such as Pulse Polio Programme, National Programme for Containment of HIV Epidemic, and the National Diabetes Control Programme cannot run successfully without adequately trained professionals in public health.”

Use of technology in surgery can make it more perfect, so medical professionals are insisting on incorporating such changes in the curriculum. “We need to train our medical students video-technology skills in terms of eye and hand co-ordination, perception of depth, orientation to the magnified anatomy and the assessment of the blood loss during the operating procedure.The robotic surgery is also one of the newest trends in the laproscopic surgery especially done for the radical prostrate anatomy,” said Dr M C Misra, head, division of minimally invasive surgery and in-charge of breast cancer clinic, AIIMS. He added,“There have been path-breaking laproscopic surgeries in liver, thyroid, intestine, esophagus, kidney, pancreas, spleen and rectum. In addition, there have been various techniques developed for the vascular interventions transplant and intra-uterine therapy — all these should be included in the MBBS curriculum.”

In ENT, autology is an upcoming area of specialisation. Dr J M Hans, senior ENT specialist and head of unit, Ram Manohar Lohia (RML) hospital, said: “We need to offer MCh in autology to make medicos retina specialists. Specialised operation theatres should be developed for conducting such surgeries.” An expert in cochlear implantation, Dr Hans, further added:“The other new areas are head and neck cancer surgery, hearing assessment techniques, functional endoscopic series surgery in nose, and cochlear implantation.” With two-third of the infant mortality cases in India comprising neonatal mortality, doctors say that there is an urgent need for training postgraduate students in neonatology.“We have large number of neonates but not the requisite infrastructure and equipment to teach students in the neonatal care including label three ventilation, arterial catheterisation, partial parental and nutritional care and neonatal surgery. At least 25% of the curriculum should comprise neonatology including evaluation,” said Dr A K Dutta, director, Kalawati Saran Hospital and head, paediatrics, Lady Hardinge Medical College and Hospital.

ADVICE TO BUDDING DOCTORS

·         Skill and knowledge

·         Mental agility

·         Human touch and compassion

·         Hard work and sincerity.

·         Observe patients with keen interest

·         Discuss one-off cases with seniors

·         Devote hours in research

·         Read international journals

·         Stay updated with the latest developments in the field.

ON PAR WITH WEST

Dr Dutta said, “The theoretical knowledge of our students are far better than those in the West. And no other country in the world has the variety of patients as we have. Medical students from US and UK have been visiting our hospitals to get a handson experience and to brush up their medical skills by assisting our doctors. We need to address the basic problem of management and we would be far better than the West in all respects.” He added, “There should be a balance of pre and para-clinical teaching in the curriculum. It should be management-oriented with more hands-on experience and observation.”

While Dr Anoop Misra felt that the curriculum should be tailored as per the needs of the country.“Curriculum particularly for clinical subjects should not be compared between US and India as the needs are different in the two countries. Our medical teachers have more clinical experience and they see more number of patients and disease than a clinician sees in the West. Many of them are excellent teachers as well. However, because of paucity of time, comprehensiveness takes a backseat.”

Psychiatry is another important area of concern especially in a country with a population of one billion,where 2% suffers from serious mental morbidness and 5% have common mental disorder and there are only 3,500 psychiatrists and 600 psychologists to treat them. “We are far behind from the West. We need to modernise the mental hospitals and upgrade the psychiatry wings of the government colleges to standardise our mental health service,” said Dr Rajesh Sagar, associate professor, department of psychiatry, AIIMS. He further stressed that excellence would be achieved with more exposure to clinical teaching and demonstration.

Dr Renu Misra, senior consultant, gynaecology, Sitaram Bhartia and Mool Chand Hospital, commenting on her area, said: “There have been a series of developments in HIV, STDs and tuberculosis with a variety of patients pouring in and new medical alternatives to control them.” Counselling and patient guidance are areas both corporate and government hospitals are trying to take up seriously. “Developing communication skills is extremely important, especially to handle cases of medical negligence,” opined Dr M C Misra. 

Jayanti Ghose goes globe-trotting and discovers the finer nuances of the booming travel and tourism industry

THE tourism industry is a mega factor contributing to the wellbeing of a nation. It brings in loads of moolah and job opportunities for its people. The basic job of tourism is to commercialise the natural beauty and resources of a country and to help its inhabitants broaden their minds by learning from other cultures. It is also responsible for improving the various facilities of a place such as transportation, civic amenities, communication, hospitality and recreation facilities.

Categories

Over the last decade, tourism has evolved in scope and direction and is no longer relegated to traditional activities such as business and pleasure. Today, tourism is spread over a wide range of activities and can broadly be categorised into sport and leisure, adventure and eco-tourism. People are increasingly travelling for a variety of unconventional reasons such as medical or health; pilgrimage or spiritual yatras; wildlife; culture and heritage; political trips; na ture/ eco tourism; and to learn/ experience the different festivals, cuisines and crafts across the globe.

The travel industry is vast and involves a plethora of specialists / organisations looking into the various aspects such as transport (airlines, railways, shipping, bus service, etc); accommodation (hotels, resorts, etc); travel agencies and tour operators; tourist information bureaus; curio, crafts and mementoes, duty free shops and recreation providers etc.

Skills: Being friendly and informal is important as this is key to attracting people. You should have a natural liking for people as this job involves extensive dealings with different kinds of people. The industry also demands excellent organisational skills; great sense of imagination; creative abilities to problem solving, excellent customer service and communication skills. Ability to work long hours and on holidays, eye for detail and capacity to work under stress are other requisites. Being in tune with social customs always helps.

Education and training:

You could choose from a variety of courses including ticketing and reservation; hotel or destination management (class 12/ 10+2/ equivalent) or do a postgraduate diploma and degree course (for graduates) in tourism and travel management. Additionally, IATA and City Guilds offer a variety of international qualifications.

Those trained in art (fine arts, crafts, dance, music, theatre, etc) can offer tourists a view of the traditional arts and crafts of the nation. Graduates passionate about the country’s history may become travel guides while those trained in adventure sports, wildlife care or event management can provide specialised tourist activities and experiences. Photographers and travel writers, museologists and curators are also part of the industry. Foreign language interpreters help international tourists in India.

Institutions (indicative listing):

·         Indian Institute of Tourism and Travel Management, Gwalior (www.iittm.org).

·         Ashok Institute of Hospitality and Tourism management, New Delhi (www.itdcidea.com).

·         Kerala Institute of Tourism and Travel Studies (KITTS), Thiruvanthapuram (www.kittstour.org).

·         School of Management Centre for Tourism Studies, Pondicherry University, Pondicherry (www.pondiuni.org/scho.html).

·         Garware Institute of Career Education and Development, Kalina, Mumbai.

·         Sophia-Shree Basant Kumar Somani Memorial Polytechnic, Mumbai (www.sophiacampus.com)

·         National Institute of Tourism and Hospitality Management , Hyderabad (www.nithmtourismuniv.or g)

·         IATA/ UFTAA Travel and Tourism courses (www.iata.org/training/trav el_tourism)

·         City and Guilds International (www.cityandguilds.com)

Placements and prospects:

Travel and tourism represents a broad range of related industries and services such as hotels, restaurants, retailing, transportation, travel agencies, tour companies, cruise lines, tourist attractions, leisure, recreation and sport and cultural organisations.

Dotted with religious spots for different communities, religious/ pilgrimage tourism is becoming a major sector. Kerala pioneered in the health tourism sector in India through Ayurveda. Other forms of health tourism include yoga, massages, ayurvedic medicine etc.

A clutch of state-of-the-art, but relatively low-cost hospitals like Escorts Heart Institute and Research Centre, New Delhi, Apollo Hospital Chennai, PD Hinduja National Hospital and Medical Research Centre, Mumbai and Indraprastha Apollo Hospital, New Delhi have become a centre of the booming medical tourism industry and atleast a dozen more including Wockhardt, Breach Candy, CARE, etc.are considered equally good.

The department of tourism, government of Karnataka, has ambitious plans for the state in medical tourism while the Federation of Indian Chambers of Commerce and Industry,Western Region Council (FICCI-WRC) has set up a task force for the promotion of health and medical tourism in Maharashtra.

A study by CII and McKinsey has estimated that medical tourism could bring Indian an additional revenue of Rs 50-100 billion by 2012.The Ministry of Tourism has identified 40 locations in rural areas for development and promotion. Each has its own USP such as Pochampalli in Andhra Pradesh is known for its traditional weave saris while Raghurajpur village in Orissa is famous for its crafts and Odissi dance. Rural tourism will attract those craving for knowledge in the traditional ways of life, arts and crafts and aims to boost employment opportunities in rural areas. It will offer a ready market to rural artisans and hasten development in these areas. 

How To Bounce Back

The tourism industry could convert crisis into opportunity

The economic downturn and the terror attacks in Mumbai have adversely impacted tourism. But in many ways tourism is an antidote to terrorism; tourism is a catalyst for employment creation, income redistribution and poverty alleviation. One of the best ways to fight the terrorists is to support India’s beleaguered tourism industry.

The Indian tourism industry will be resilient and bounce back as it did post-September 2001. The present crisis presents an opportunity. There was an even bigger crisis in Indian tourism in 2001-02. The attacks on the World Trade Center in New York, war in Afghanistan, withdrawal of flights, attack on Parliament House in New Delhi and troop mobilisation on the India-Pakistan border meant that Indian hotels had just 20-25 per cent occupancy. International tour operators had removed India from their sale brochures and inbound Indian tour operators had switched to outbound operations.

Then tourism was positioned as a major driver of India’s economic growth and its direct and multiplier effects were harnessed for employment generation, economic development and providing impetus to infrastructure development. At a time, when the national tourism boards of Thailand, Singapore and Malaysia had stopped their advertising, promotion and marketing budgets, the ‘Incredible India’ campaign was launched to bring back consumer demand, generate momentum and enhance growth in the tourism industry. This was also a period when the tourist infrastructure around Ajanta Ellora, Mahabalipuram, Kumbalgarh, Chittorgarh, the Buddhist circuit and at Humayun’s Tomb was improved.

The Indian tourism sector had been crippled by the limited air services, seat capacity and high ticket prices. Changes were ushered in this sector. It started with the permission to ASEAN carriers to operate to seven Indian metros, permitting low-cost carriers to launch operations, liberalisation of charter policy, the opening up of the UK bilaterals, granting approvals to new airlines and permitting private airlines to operate on international routes. One of the most closed sectors of the Indian economy was suddenly opened up and it unleashed huge growth in both India’s GDP and higher tourism flows.

This was also the time when young entrepreneurs launched travel portals. These changed the way Indians booked their travel. It is now projected that online channels would continue to outpace the total travel market and online penetration would be nearly one-fourth of the travel market by 2010. New products like medical tourism, value, cruise and rural tourism were conceptualised and implemented in partnership with the private sector and the community.

The 2008 economic slowdown and terror attacks require another such response. The terror attacks were restricted to Mumbai. Other regions and states such as Kerala, Rajasthan, Karnataka, Tamil Nadu, Madhya Pradesh, Himachal and UP remain safe, calm and normal.

Long haul markets still make for 95 per cent of India’s international traffic. There is a need to focus on China and Japan, which will emerge as the biggest source of tourists in the coming years. Kerala as a tourism destination was unheard of almost a decade back. Its emergence was largely on account of travel diversion from terror-prone Jammu & Kashmir. Kerala, of course, had developed new products like backwaters and Ayurveda, its entrepreneurs had created experiential boutique resorts and infrastructure had been spruced up. There is a need for new states to emerge as tourism destinations by enhancing the quality of experience and improving infrastructure. In fact, the next year should see focused attention on infrastructure deficiencies which have threatened to derail India’s aim to become a world-class global destination.

The imbalance in demand and supply of hotel rooms and a near-total absence of the two- to four-star category of hotels have led to escalating prices thereby reducing India’s price competitiveness. India needs to create an additional 1,50,000 rooms in the next three years to penetrate large volume markets like China. Domestic tourism can help balance both the present adversity and the seasonality of inbound tourism. The strategy necessitates creating awareness among the rising Indian middle classes about new experiences (chasing the monsoons), new attractions (plantation holidays) as well as pilgrim circuits, heritage and monuments.

To drive growth, we need to push five critical C’s: civic governance (improving the quality of tourism infrastructure),capacity building of service providers (taxi drivers, guides and immigration staff), communication strategy (constant innovation of the ‘Incredible India’ campaign and penetration in new markets), convergence of tourism with other sectors of the Indian economy, and civil aviation (continued opening of the skies, improved airport infrastructure and rationalisation of taxes).

In the context of India, the vast potential of tourism as an employment creator and wealth distributor still remains untapped. The size of the tourism industry worldwide is $4.6 trillion whereas the software industry globally is a mere $500 billion. The tourism industry globally generates over 250 million jobs whereas the software industry generates only 20 million jobs. In India, in 2007, revenue from foreign tourists was $10.7 billion and 53 million people were employed in the tourism sector.As India grows and expands its base in travel and tourism, it will generate many more jobs and the sector will become a major catalyst for India’s growth with employment creation.

A Paradigm Shift

DESPITE THE SLOWDOWN THAT THE TRAVEL AND TOURISM INDUSTRY IS FACING CURRENTLY, IT IS PROJECTED AS ONE OF THE WORLD’S BIGGEST INDUSTRIES. SHEETAL SRIVASTAVA GIVES AN OVERVIEW

By the year 2020, projection is that there would be six billion tourists worldwide and tourism receipts would touch USD 2 trillion creating one job every 2.5 seconds. The Indian Government’s travel and tourism policy has given the sector further impetus. One can see many more hotels, tourist resorts, beach resorts, as well as promotion of new avenues of tourism like medical tourism, adventure tourism, rural tourism, holistic tourism, sports tourism and cultural tourism.

Commenting on the notable differences in the industry from what it was a decade back, Shubhada Joshi, chairperson, Indian Travel Congress, London says, “There are lot many products and destinations to sell.” She further adds, “Today, with open sky policies and the roads and railways getting better, there are more opportunities for people to travel. Affluence is growing and hence the spending capabilities of customers are also growing. Such situations are very rare in the history of any industry and therefore it is the best time to be in the industry.”

Talking about the industry numbers, Sanjay Narula, co-chairman, Indian Travel Congress, London notes, “Travel and Tourism, directly and indirectly accounts for 11 per cent of world’s GDP, 9 per cent of global employment and 12 per cent of global investments.”

Today, India is an emerging world power. If the world really wants to know what India has achieved in the last few years, the travel and tourism industry is the answer to that. “India being multi-cultural, there is a never ending scope in the industry. Domestic travel has been growing at 15-20 per cent p.a. Innovative sales pitches, marketing strategies and adoption of newer technologies are leading to increased sales within travel retail services especially for packaged holidays, flights and accommodation , all of which is giving us a newer global market perspective,” says Rajinder Rai, vice president, TAAI.

Challenges Faced

CV Prasad, President, TAAI says, “Very little has been done to grow domestic tourism. Lack of infrastructure is the gravest issue posing a challenge to Indian tourism and acts as a deterrent.” Domestic short haul problem is very popular. Lack of quality manpower is another serious challenge which the industry is currently facing. “There is not enough skilled manpower. The need for training institutes is a must,” Prasad stresses. Other areas where improvement is a must in order to give a boost to tourism is the need for improved roads between some tourist destinations. “There is no proper road transport quality. People above 60 travel a lot. Unfortunately, India is not equipped for them. There are no proper sidewalks,” adds Prasad. India is not positioned in many ways as far as tourism is concerned.”

 Here comes the travel agent

There is no doubt that a travel agent has become an essential factor in the travel and tourism industry today. We all know that a travel agent helps travelers sort through vast amounts of information to help them make the best possible travel arrangements. They offer advice on destinations and make arrangements for transportation, hotel accommodations, car rentals, and tours for their clients. They are also the primary source of bookings for most of the major cruise lines. In addition, resorts and specialty travel groups use travel agents to promote travel packages to their clients.

Going to a full-service travel agency that sells standard travel agency goods and services, including airfare and travel packages is like a one-stop shop to the travel needs. Most travel agents provide additional services which include passport assistance, providing access to top-of-the-line equipment and supplies and a superior offering that includes access to better than average terrain and activities, accommodations, and entertainment. “The value added offerings by a travel agent is his knowledge and expertise, competitive rates, and specialty focus on various segments of travel, which translate into increased satisfaction for the customer,” adds Prasad. “Destination knowledge is a very critical aspect. The most important role that travel agents play is planning the trip. Very few people today have mastery over destinations. So a travel today has become a destination expert,” notes Shubhada. Leisure travelers can be broadly classified according to the type of trips they take, income or age. Heritage and Culture tourism, Adventure tourism, Special-Interest, Honeymoon & sight-seeing trips High-Income Travellers Budget-Conscious Travellers Families, Students & Seniors Pilgrimage Tourism, Medical and Wellness Tourism

Need for trained personnel

Like every other industry, there is a need of skilled personnel in this industry too. Besides the IATA certificate which is only academic, the personnel need a lot of soft skill training. Clients today need a host of services and not just an air ticket. It may be product knowledge, visa, insurance or foreign exchange or about a self driven car or only the weather.

 “Our job is not complete unless and until we don’t give all the information to the clients. A client can get to buy an air ticket on the net. But it is still cumbersome for him/her to get all the related information. Hence, we need to be travel consultants and not just ticketing agents,” asserts Mamta Nichani, chairman, managing committee member, TAAI.

It has become imperative today to change the mindset in order to forge successful careers in the travel and tourism industry. Hitherto, the travel distribution role was performed by traditional travel agents and tour operators. They were supported by global distribution systems or tour operators’ videotext systems (or leisure travel networks). The coming of the Internet created the conditions for the emergence of interactive digital televisions and mobile devices selling directly on the Internet by allowing users to access the airline reservation systems, web-based travel agents and travel portals. This has gradually intensified competition. Consequently, traditional travel agents must re-engineer their business processes in order to survive and remain competitive. Research findings point out to the evolving nature of business in a globalised environment and the necessary strategic adjustments in human resources management.

Future of the industry

Expressing his views on the future of the travel and tourism industry and of the travel agents Prasad says, “The future is very bright. A 15-20 per cent growth can be seen in the next 5-6 years. Tourism revolution has yet to begin in India. Interest in India is beginning to catch up and it certainly has a long way to go.”

He further adds, “The internet can never replace personal contact. Travel agents are here to stay provided they adapt to the changing environment, adopt emerging technology and understand customers as well as cater to their needs.”

Says Ashwani Kakkar, CEO, Mercury Travels, “Globally, the travel and tourism industry is the single largest industry in the world. It is the best wealth distributor as an industry.”

The list is endless, for you can find many a reason and more to travel. All of these have a specific need and require knowledge of the local customs and people besides information on the destination which can be attained in a limited way from the internet. The Travel agents fulfil this very need and create not just a holiday or a trip but an experience to remember.

World flies to India for cheap cure

Travelling far and wide for health care that is often better and certainly cheaper than at home, appeals to patients with complaints ranging from heart ailments to knee pain. Why is India leading in the globalisation of medical services? Q&A with Harvard Business School’s Tarun Khanna

What used to be rare is now commonplace: travelling abroad to receive medical treatment, and to a developing country at that. So-called medical tourism is on the rise for everything from cardiac care to plastic surgery to hip and knee replacements. As a recent Harvard Business School case study describes, the globalization of health care also provides a fascinating angle on globalization generally and is of great interest to corporate strategists.

 “Apollo Hospitals-First-World Health Care at Emerging-Market Prices” explores how Prathap C Reddy, a cardiologist, opened India’s first forprofit hospital in Chennai in 1983. Today the Apollo Hospitals Group manages more than 30 hospitals and treats patients from many different countries, according to the case. Tarun Khanna, a Harvard Business School professor specializing in global strategy, co-authored the case with professor Felix Oberholzer-Gee and Carin-Isabel Knoop, executive director of the HBS Global Research Group. The medical services industry hasn’t been global historically but is becoming so now, says Khanna. There are several reasons that globalization can manifest itself in this industry:

Patients with resources can easily go where care is provided.

High quality care, state-ofthe-art facilities, and skilled doctors are available in many parts of the world, including in developing countries.

 Auxiliary health-care providers such as nurses go where care is needed. Filipino nurses provide an example.

 “From a strategic point of view you can move the output or the input,” explains Khanna. “Applying this idea to human health care sounds a bit crude, but the output is the patient, the input is the doctor. We used to move the input around, and make doctors go to new locations outside their country of origin. But in many instances it might be more efficient to move the patients to where the doctors are as long as we are not compromising the health care of the patients.”

Khanna recently sat down with HBS Working Knowledge to discuss the globalization of health care in the context of India and Apollo Hospitals.

Q: What led you to research and write this case?

A: I came across the company during some of my travels in South India. It was so unusual to find “first-world health care at emerging-market prices” as the case says. Often better care—by which I mean technologically first-rate care with far greater “customer service” and accessibility—is available in parts of India than in my neighborhood in Boston.

Felix Oberholzer-Gee, Carin-Isabel Knoop, and I decided to write the case just because health care is such a primal thing—it arouses a lot of emotions and insecurities. After all, it’s one’s life and health that one is dealing with. And the prospect of entrusting health care to a developing country had a pedagogical “shock value,” too.

The fact that the cost of living is so much lower in India means that the same service is possible at a fraction of the price elsewhere.

Q: The term “medical tourism” is fairly new, but how new is the phenomenon of going overseas for medical treatment?

A: When I was a college student in the United States I discovered that dental care was very expensive. Even back then, many of my international classmates essentially engaged in medical tourism—they would simply bundle up the care they needed, make a trip to their country of origin, and take care of it. India was certainly one of those countries I was aware of due to my own personal background.

We didn’t have a term for medical tourism, but in a sense it was all around us. It took a set of entrepreneurs to begin to make it happen. By the late 1990s, when I was teaching courses in global strategy, some of my Thai, Malaysian, and Singaporean students were perfectly aware of the term, because these countries of Southeast Asia already had very good tertiary-care hospitals.

Medical tourism usually refers to the idea of middleclass or wealthy individuals going abroad in search of effective, low-cost treatment. But there is another dimension of medical tourism that is not called medical tourism. Narayana Hrudayalaya, a heart hospital in India, treats indigent people from neighbouring countries — Pakistan, Bangladesh, Burma—who suffer from heart disease and can’t afford surgery. Treatment for them is free. The hospital is able to provide it because surgical methods are efficient enough that pro bono care doesn’t hurt the bottom line.

Q: Why is India gaining prominence for medical tourism?

A: India is encouragingly less “scary” now. I think a lot of entrusting medical care to different locations is about a psychological fear of the unknown. An important strategic challenge for developing-country hospitals is to reduce the psychological fear.

In India, the same depth of pool of engineering and mathematical talent for software, offshoring, and outsourcing is there for medicine, too. In the 1950s and ‘60s, the Indian government invested a lot in tertiary education. By now there is at least a small handful of medical institutes that are really first-rate, and the doctors they produce are extremely well trained.

Q: What are the recruiting challenges for staffing these hospitals with doctors?

A: In the case, Prathap C Reddy, the founder and chairman of Apollo Hospitals, says he spent a lot of time studying specialists almost like an executive search firm would, to identify their pleasure points and pain points in terms of building a successful practice in the West and potentially in India. He wanted to understand not just medical training and specialties but also family circumstances, since it is always a family decision to relocate.

In the past, Indian doctors left India so they could multiply their incomes. But now we’re seeing the reversal of that. India is booming so why leave, and by the way, patients can go there.

Q: How does growth in private hospitals affect public health care in India?

A: There is an assumption in the view often expressed in the media in India and Europe, for instance, that when private hospitals in India provide care to heart patients from England, the hospitals are somehow taking care away from poor people in India. The assumption seems to be that if medical tourism was banned, the doctors in question who were catering to wealthy patients would suddenly, as a practical matter, move to a village. It takes a different set of individuals, a different set of infrastructure circumstances to create that scenario.

My guess is that the bulk of India’s problem is primary health, and has nothing to do with tertiary care. And the primary health problem is not going to be addressed by a private hospital for the most part anyway.

Healing Touch

 
Medical Tourism Could Address India’s Health Crisis

A foreign resident needing surgical treatment is put into an international flight to India. As soon as he arrives, he is driven straight to a super-speciality hospital where he is immediately attended to by world-class doctors aware of the patient’s medical history. This trend, known as medical tourism, is already in evidence, albeit on a minuscule scale. For this to become a commonplace in a matter of a few years, medical entrepreneurs, associations of medical professionals, insurance companies, third party administrators (TPAs) and the government need to make a cogent intervention.

Like the information technology (IT) industry, India has a comparative advantage in services like healthcare. The cost differentials in healthcare between developed nations and India are reckoned to be even higher than in the IT industry. But cost is only one of the drivers. Sophisticated medical facilities in India can draw people from the neighbouring countries. In the past, trade in services implied healthcare personnel migrating to developed countries. Now, the situation has reversed, with consumers moving abroad temporarily. If this emerging potential is harnessed it could shower unprecedented economic gains on the medical community and at least a section of our society, in effect replicating the IT success story.

However, while aspiring to become a world-class supplier of healthcare services, India cannot wish away its ailing masses who lie unattended for want of decent healthcare. Indeed, the current healthcare situation in India is dismal. The number of hospital beds per 1,000 population, for example, is around one, which is well below the WHO prescribed norms, or even the low-income countries’ average of 1.5. The same shortage extends to the availability of medical and paramedical staff — this, despite India’s high disease burden. India, for example, loses 274 disability adjusted life years (DALYs) — an indicator of disease burden that reflects the total amount of healthy lives lost, to all causes — per 1,000 population compared to the developing countries’ average of 256.

No wonder India trails in healthcare outcomes. For example, life expectancy at birth in India is 63 years, compared to the developing countries’ average of 65. Likewise, infant mortality rate in India is 70 compared to the developing countries’ average of 56. A similar picture emerges in other standard indicators of health outcome. The reasons are not difficult to understand. Indian government (at all levels) spends less than 1% of GDP in as important a social sector as healthcare. Besides being highly inadequate compared to other developing countries, this limited public spending is not for the lowincome people only, as one would expect. The richer segments too benefit from it.

Furthermore, most of private spending, as much as 4.3% of GDP takes the form of out-of-pocket spending and not prepaid risk pooling arrangements, and this is highly iniquitous. Notwithstanding the insurance regulator’s announcement to grant concessions to any standalone health insurer interested in entering Indian market, the development of private health insurance has not been very inspiring.

Given all this, does it make sense to promote medical tourism? To be sure, the development of medical tourism will alter India’s healthcare landscape. While it will give a boost to the private healthcare industry by catering to wealthy foreign and domestic consumers, it could adversely hit the low-income population. Medical personnel and infrastructure would be geared to serve the elite. Medical tourists will end up driving up healthcare costs. However, the adverse effect can be mitigated through appropriate interventions, that include greater public outlay for healthcare as well as restructuring public healthcare infrastructure, especially in rural areas. The increase in public financing of healthcare is not forthcoming, given the fiscal pressure.

It is here that promotion of medical tourism can prove to be a blessing. A part of the higher private healthcare revenue can be tapped to increase public health spending. Besides, promotion of medical tourism would have positive spillover effects. Some of these are: Benchmarking and streamlining healthcare delivery (this includes the development of treatment protocols, standardisation of costing of various procedures, accreditation of hospitals and so forth); checking brain drain from India; increasing employment opportunities; and concomitant expansion of the aviation sector.

The promotion of medical tourism requires a multi-track approach. In the international arena, it requires providing an impetus to trade liberalisation in this sector within the multilateral (or General Agreement on Trade in Services) framework, seeking harmonisation of health standards, facilitating cross-border mobility of consumers and promoting health services trade with neighbouring countries. Progress on these fronts is bound to attract greater FDI into this sector. On the domestic front, this calls for enhancing coordination between states to develop uniform regulation of healthcare, which is essentially a state subject.



The very nature of these interventions enjoins upon the government to play a pivotal role in the promotion of medical tourism, at least in the initial stages of its development. The logic of investment and profit-making in healthcare, which is no different from any other sector, will ensure a repeat of IT in healthcare, which can be made to work for the betterment of all — foreign and domestic residents alike.