It is daunting when you have to leave your environment for some unfamiliar place, with a different culture and language; it is even more frightening when you are in poor health. For whatever it is worth, it is common practice in Nigeria these days to employ the services of an agent, who will help you locate a hospital in the foreign country and assist with travel plans, as well as settling in.
However, while there may exist some need for the services of these agents to smoothen the process of treatment (including travel, accommodation and actual treatment); it must always be kept in mind that these agents are primarily businessmen and women who are driven by the profit motive. Regardless of what they profess, they are not only there because of their passion to help the sick or the elderly, or their need to give back to society. In many cases, they are even not interested in any of the afore-mentioned ideals at all, nor are they NGOs, no matter what name they go by. Since most of our medical tourists are India-bound, it must also be kept in mind that most of these agents are coming from a society not so different from Nigeria’s in terms of poverty and corruption!
One point that cannot be over-emphasized is that an agent is someone appointed to represent the patient; the patient must not give up his/her rights totally to the agent. The patient must not hesitate to ask questions and fully understand what is happening. As much as it is possible, the patient should be part of all decisions affecting his/her case.
There is the case of Mrs. X, a Nigerian, who travelled to India for medical treatment with her daughter as her medical attendant. Her son who resides in the UK connected her to an Indian agent recommended by a friend of his. Note that this lady, though not a University degree holder, speaks passable English and retired from the state civil service in her home state, and that her daughter is a University undergraduate. The agent met them at the airport and took them to their hotel. Once they settled down, he asked for their International Passports which he took away for safe keeping, same for their medical reports. Before they knew it, he started taking them from one hospital to another. The lady went through several hospitals before finally commencing treatment at one of them, but she was unfortunately withdrawn from the hospital mid-way into her treatment because the hospital was exorbitant. The point to note from this account is that the agent should have done his due-diligence on the available hospitals with his client’s budget in mind, even before she left Nigeria. On arrival, the patient should simply have been taken to the already selected hospital to start her treatment without having to be taken through the process of shopping for a hospital, which even turned out to be beyond her financial reach. One unfortunate fact to note is that the agents are paid some commission by the hospitals for patients steered their way, so it is quite possible that the agent in the above example failed to agree terms with the various hospitals that he initially took the patient to, and continued his search until he found an “appropriate” hospital. It must be noted that the patient’s needs became secondary, and more alarmingly, that both the patient and her daughter were held to ransom by the agent, as he had already taken custody of their International Passports. At no point in time should a patient part with his/her International Passport in a foreign land, except if the law enforcement agencies demand it!
Back to the story, eventually the agent decided (on his own) to take his patient to a private Diagnostic Centre and repeated all the tests previously carried out. He also included some more tests on his own, the sole intent being to hike the fees as much as possible. Based on the results of these tests, the Doctor at the Diagnostic Centre recommended three surgeries. This contradicted the verdict of Doctors at one of the hospitals initially visited based on their own investigations: they had ruled out surgery for two of theconditions for which the Diagnostic Centre were now recommending surgery, for the reason that it wasn’t necessary as the conditions could still be treated without surgery. The agent insisted that his patient must perform one of those unnecessary surgeries and was adamant that half of the surgery cost (which came to $2000) must be paid to him as his commission. At this point the woman who was already uncomfortable with the agent’s services decided to talk to a few other Nigerians that she had met, in spite of the fact that the agent had warned them not to disclose her treatment details to any Nigerian, claiming that most Nigerians in India are dubious!
It was at this point that I met the lady and her daughter. It happened to be the birthday of my brother (who was my medical attendant), and we decided to make some noise ( Naija style) with a birthday party for him. It transpired that one of the invited guests had invited them. By the end of the party, they had disclosed their long sad story. Everyone came to the unanimous conclusion that they must terminate the agent’s services. People also volunteered to help her continue her treatment with one of the hospitals she had earlier visited.
The agent was very angry when he realized what had happened. He threatened them with legal action and insisted that they should pay for the surgery. He also refused to let them go, even though they were willing to forfeit the $800 agency fee they had paid him. Some resident Nigerians confronted him, one of them a medical doctor who was also receiving treatment in India. The agent was made to understand that it was beyond his brief to take his clients to a Diagnostic Centre and choose specific medical tests for them contrary to direction already recommended to the patient by qualified Doctors. On his part, the agent argued that the woman had merely panicked, and that his intention was to sit with her and choose which course of treatment to pursue. He was reminded that he wasn’t a medical Doctor and so was not qualified to make such a decision, which at the end of the day had led to unnecessary diagnostic tests being carried out, thereby making the patient to spend more money unnecessarily.
Eventually, to the disappointment of the small Nigerian community involved in this particular case, the lady underwent the surgery. She claimed the man constantly threatened them with legal action, and even got police involved. We later discovered that the so-called policemen were uniformed security men at one of the hospitals.
A lot of issues arise from situations like this, and the story is different for each medical tourist. Basic common sense is generally advised for would-be medical tourists, but the few guidelines below should be followed in addition, if a medical tourist is not to suffer at the hands of unscrupulous middlemen.
- Know your rights: You have a right to information. Be sure to ask for clarifications and make sure you understand your treatment plan every step of the way. Indians are very particular about their language, and many of them are not comfortable speaking the English language (this includes the educated ones) and so it’s easy for them to unintentionally lapse into Hindi when you make a hospital visit with your agent. Insist that they carry you along at all times. Do not put up with a situation where the agent comes to explain what the doctor said to you. Remember you can ask for a change of doctor/nurse within the same hospital, or even change hospital entirely as the case may be.
- Be involved in decisions affecting you: Don’t be lazy! With the information you gathered from all the sources, including your agent, come to a decision with them about your treatment. This applies even to your accommodation. Normally your agent would already have booked specific lodgings for you. If you do not like it, ask him to show you other options. You may eventually be surprised to get something better at the same rate! The same practice of some agents collecting commission on hospital fees also extends to accommodation!
- Due diligence in estimating cost: Do a good job of estimating the total cost of your treatment before travelling. This includes your financial obligation both to the hospital and to your agent. Obviously, an exact figure cannot be possible without examination/diagnosis by the foreign hospital. However, it is possible to do a worst-case scenario with the hospital and plan towards that. This assumes that you must already have selected a hospital while still in Nigeria. This is essential if you are not to be at the mercy of your agent. It will also facilitate online checks on the quality of the hospital and its staff by you. Remember that your costs estimate is only an estimate, and will probably need to be reviewed upwards after initial diagnosis. Therefore plan for contingency funding, as that will very likely become necessary. It is a most unpleasant experience to run out of money in a foreign land!
- Keep your valuables and documents: Under no circumstances should you relinquish custody of your travel documents to anybody, except it is demanded by law enforcement agents! Your hospital records will be progressively given to you as your treatment progresses. They are your private property, and must not be given to anyone! Not even the law enforcement agents have a right to take them from you! Dubious characters are everywhere, one cannot be too careful.
- Legal Issues: If in spite of all the above, you are unfortunate to fall into the hands of unscrupulous people, do not hesitate to contact the Police! Your permission by the Government of India to seek medical treatment in India is implicit in their granting you your medical visa. It is the duty of the Indian Government and her agents to protect you from criminals and miscreants, but they cannot do this if you do not report the criminals to them.
- Money Transfer: Develop proactive procedures, while still in Nigeria, for handling money transfers from the person funding your treatment in Nigeria to you in India if it should be required. Most hospitals have the facility for receiving funds directly to their Indian accounts from your Nigerian bank, through bank-to-bank foreign exchange transfers. The bank charges and official exchange rates could work together to make this an exorbitant option though. You could also explore informal arrangements, through your Nigerian agent, where you pay him Naira and he asks his Indian colleague to pay you Rupees. This would usually lead to a more reasonably exchange rate, from your perspective, but it is also a route which is fraught with the danger of the fraudulent loss of your money. In general, this latter option should be used to transfer only small amounts of money at a time. No more than $3000 at any given time should be transferred through this method. If you need more money, please break it into transactions of no more than this amount each, and do not initiate a new transaction until the previous one is safely concluded. This limits your exposure to fraud. My preference would be the first option, despite the cost.
In conclusion, all I can say is “Caveat Emptor”! Let the medical consumer beware! Protect yourself! There are quacks and dubious characters everywhere. Nigeria also has a High Commission in India. If you find yourself in a very difficult situation, you should also contact them for assistance. Let us take all the precautions that we can, until we get health care right in our beloved country. Be safe, and good luck!
*Rebecca Ilodibia, a Lawyer based in Lagos, recently returned from India after medical treatment.