If you have got hard currency, you can afford to come to Africa to look good or feel better for less. Fourteen million people, spending between $3,800 and $6,000 per visit, are travelling the world looking for medical treatment with a beach holiday.
It’s a market estimated to be worth between $45 billion and $72 billion, and South Africa is sitting at the top table, according to Patients Beyond Borders (PBB), a US-based firm that has given medical tourism advice for a decade. The country has the advantage of good hospitals, English speaking doctors and breathtaking landscapes.
They call it medical tourism and it’s growing among the wealthy and not-so-wealthy. Even those who don’t have so much money are heading to hospitals in countries like South Africa where their hard currency makes it cheaper and also helps them escape hospital waiting lists in their own land.
Even in these hard times, PBB expects this multi-billion-dollar industry to increase by up to 25% per year over the next 10 years.
One entrepreneur who is banking on this is Cape Town-based Faith Cartwright, who founded Medical Tourism SA three-and-a-half years ago. Cartwright, a hospitality and guesthouse owner, noticed many of her guests were in South Africa for medical procedures.
“Who wouldn’t pay if they knew that they had to go through two years of pain waiting for a knee operation? Imagine you have decided you want children and you are told you can’t go through fertility treatment because you are 39 and cannot get an appointment,” says Cartwright.
“I thought ‘what if medical tourists like these could be given access to private medical care, have their accommodation and travel needs taken care of, and plan safaris and other tourist excursions, all through the same service provider?’”
Sitting by the harbor at the V&A Waterfront, a popular tourist destination in Cape Town, it is easy to see why many decide to find a hospital bed here. Above us are the stunning peaks of Table Mountain and just down the road you can book a tour to see a great white shark, helicopter rides or pirate cruises. All this to the sound of seals, seagulls and many languages, as wealthy tourists from around the world stroll by with their bulging shopping bags.
Cartwright has as many customers as there are tourists on this street on this morning.
“It’s the reason why I’m so busy. Just this morning I was facilitating 65 women from Botswana to meet a doctor in Johannesburg at a fertility clinic. Sometimes you do get a good feeling about the work. But it can also be hard work and frustrating. It is rewarding when you know you are helping someone who has been struggling for years to get pregnant,” says Cartwright.
“Fertility is a big thing here. We get a lot of it from all over the world, but in Africa, there is a particular stigma that if you can’t get pregnant, you can be kicked out of your community. I also see a lot of requests for bone marrow transplants and women looking to slim themselves with gastric bypass surgery.”
It’s the start of the high tourist season in Cape Town and Cartwright is on call 24/7. For this 48-year-old mother, her time needs to be managed down to the minute.
“Thanks to the weakness of the rand, hundreds of medical procedures are available at a comparatively low cost, with most surgeries coming in at roughly a third of the price for an equivalent procedure in the UK. Affordable breast augmentation, for example, costs around $8,000 in the UK, but only about $3,600 in South Africa. More minor treatments, such as botox injections, can be even cheaper – $310 in the UK versus $70 in South Africa,” says Cartwright.
It is not just the rich and famous that makes these journeys either. Cartwright has seen hundreds of clients from all walks of life.
“Our clients range from the ones who can afford to be pampered to those who can barely afford it. We’ve had people staying in Cape Town eating [maize meal] for 21 days straight, because that is all they could afford over their IVF (in vitro fertilization) treatment; they were so desperate to have a child,” she says.
“I had a woman come from Australia who failed 17 rounds of IVF and South Africa was her last option. She now has a daughter and came back to South Africa to try for a second.”
Using US prices as a reference, across a variety of specialties, PBB estimates South Africa to be 25% to 40% cheaper.
“Most nations in Africa continue to struggle to build out their healthcare infrastructure and are thus not yet suitable for the contemporary international medical traveler. South Africa (particularly Cape Town and Johannesburg), are exceptions, offering an array of medical care for regional and long-haul travelers, including cosmetic surgery, cardiology, dental care, joint and spine work, and ophthalmology,” says Josef Woodman, CEO of PBB.
It is not all rainbows and butterflies. Business isn’t helped by the lack of efficiency when crossing borders.
Cartwright tells of a US couple, a husband (the sperm donor) and wife, looking to come to South Africa for IVF treatment. It meant both needed to apply for South African visas. There was an error in the husband’s application, and, because of new visa regulations that required applications in person at a South African embassy, it meant he had to fly to the South Africa embassy twice. By the time they entered their application correctly he missed their window. The wife had to come to South Africa alone, and they had to find another sperm donor.
“As she was walking off the plane I asked her where her husband was. It was only then that she told me their story. Not only was it a huge waste of money for two flights to the South African embassy, but they lost out on their flight tickets and reservations in South Africa, which need to be paid for in advance before applying for your visa,” says Cartwright.
“This is where the medical tourism industry can help, resolving issues when you hit a brick wall. I would have been able to help them both get here. The process of IVF is incredibly stressful without worrying about the technicalities of international travel,” says Cartwright.
Another challenge is putting Africa on the map. Many patients know little about the country they are visiting and often make the mistake of booking doctors in Johannesburg with their accommodation in Cape Town, 1,500 kilometers away.
“Abroad, people still think we’ve got lions and elephants in our backyards. It’s very seldom I hear a good story about South Africa. Most of the things people know are about our crime, our president and that we have no water in Cape Town.”
“We need to tell the good story. South Africa is an amazing place. It’s got first-class treatment. What really stands out is that we are English speaking. It’s a calling point and a huge thing. Imagine when you go to a country like Thailand and you can’t read the road signs. Now imagine trying to be a patient there who needs medical treatment.”
While the costs for those traveling into Africa may seem affordable, it is a different story for those living in it. In South Africa’s case, the recently tabled White Paper on National Health Insurance (NHI) wants to give medical aid to all South Africans to make healthcare accessible to the poor. Its implementation has been hotly contested.
Many fear this will be the tipping point that brings the country’s health system to its knees and results in qualified doctors emigrating. The uncertainty surrounding the impact of the NHI on the private sector, and other compounding issues like an overburdened public healthcare system, could be why medical tourists choose not to come to South Africa.
“There are a huge amount of doctors in South Africa. The NHI only affects South Africans and not my clientele. In fact, I think it will encourage more doctors to work in the [medical tourism] industry.”
“The healthcare industry needs to look at more innovative ways of looking after its patients. I get calls from lots of South Africans trying to get help [with surgeries]; most don’t even know where to find a good doctor. Most South Africans can’t afford to go overseas and pay for a surgery. My uncle died of a brain tumor while he was waiting for a date to operate,” says Cartwright.
Ultimately, the success of medical tourism will depend on exchange rates, prices, quality of medical care and hospitality services on offer to tourists. Even Cartwright is keeping an eye out for opportunities elsewhere.
“I’ve been thinking seriously of emigrating to the United Kingdom and setting up base there. My plan would be to fly down to South Africa once a month and check up on the base here. Working from South Africa is too far away. Moving to the UK is quite a good move for the business. It’s central, with access to clients from Europe and America. It’s an hour’s flight to many of the medical conventions and conferences, which are great places to network. It’s also a good idea because there has been a rise in wellness travel, doing yoga retreats and all that. It’s taking off in the UK and Europe and I’d like to get in on this wave. South Africa would be an awesome destination for wellness tourism.”
Cartwright remains optimistic. She believes that medical tourism can offer a window of opportunity for doctors who still want to work in the private sector.
“I’ve found the Tanzanians to be the most sincere and humble. I’ve found that Nigerians, if you look after them, they will become part of your family for life. The people come and go. I try not to remember their names because I am so afraid of breaking their confidentially. But when they leave, we become a huge part of their lives.”
For Cartwright there is no time to stop, relax and watch the waves. She leaves the Waterfront with a phone to her ear, as usual, talking to her next medical tourist with money to spend.
A 2014 study by VISA found the United States to be the largest hub for medical tourism. Thailand, Singapore, Germany, Korea, and Spain are quickly catching up.
Their data showed by 2025, travelers over the age of 65 will more than double their international travel to 180 million trips, accounting for one in eight international trips globally. Older travelers can afford bigger trips and are more focused on comfort and health than saving money.
The ageing traveler will transform travel and one area that is already growing in response is the medical tourism industry as more travelers opt to combine medical treatments with vacation.
“We believe that medical tourism is primed for accelerated growth as more of these older travelers seek new treatments, as well as lower-cost or higher-quality care not available in their home country,” the report concludes. – SOURCE: Mapping the Future of Global Travel and Tourism (2014) VISA
Forbes Africa | 8 Years And Growing
As FORBES AFRICA celebrates eight years of showcasing African entrepreneurship, we look back on our stellar collection of cover stars, ranging from billionaires to space explorers to industrialists, self-made multi-millionaire businessmen and social entrepreneurs working for Africa. They tell us what they are doing now, how their businesses have grown, and where the continent is headed.
Since its inception in 2011, and despite the changing trends in the publishing industry, FORBES AFRICA has managed to stay relevant, insightful and sought-after, unpacking compelling stories of innovation and entrepreneurship on the youngest continent, in which 60% of the population is aged under 25 years.
Many of those innovations have been solutions-driven as young entrepreneurs across the continent seek to answer questions that have burdened their communities.
Always on the pulse, FORBES AFRICA has chronicled and celebrated those innovations – prompting the rest of the globe to pay attention and be fully engaged.
A prime example of this is the annual 30 Under 30 list, which showcases entrepreneurs and trailblazers under the age of 30 from business, technology, creatives and sports. In 2019, we had 120 entrepreneurs on the list, finalized after a rigorous vetting and due diligence process to well laid down criteria.
We have always maintained the highest standards of integrity in all our reporting.
As we transition into the next milestone, FORBES AFRICA reflects on the words of civil rights activist Benjamin Elijah Mays, who once said: “The tragedy of life is not found in failure but complacency. Not in you doing too much, but doing too little. Not in you living above your means, but below your capacity. It’s not failure but aiming too low, that is life’s greatest tragedy.”
With the transformation in the media landscape, the recent awards given to the magazine for the work done by a hard-working, determined and youthful team, serve as a reminder that we are doing something right.
Early this year, FORBES AFRICA journalist Karen Mwendera received a Sanlam award for financial journalism as the first runner-up in the ‘African Growth Story’ category. In January, FORBES AFRICA’s Managing Editor, Renuka Methil, received the ‘World Woman Super Achiever Award’ from the Global HRD Congress.
In reflecting on the last eight years, this edition revisits a few of the strong, resilient men and women who have graced our covers.
For some, fortunes have literally changed, as witnessed in the fall of gargantuan African empires such as Steinhoff. Of course, there have been massive moments of triumph too, which have seen some new names feature on the annual African Billionaires List. There have also been moments of tragedy with former cover stars passing away.
Africa is ripe for the taking and is seen as the next economic frontier. The unique position the continent finds itself in will no doubt give FORBES AFRICA plenty to report on. Here’s to more deadlines and debates for the next eight years.
– Unathi Shologu
Mastercard: Diligent About Digital In Africa
Mastercard knows only too well that technology can drive inclusive financial growth with simpler and more efficient ways to do business and life. And Raghu Malhotra, the man spearheading this trajectory in Africa, is also focused on social progress.
In many ways, Raghu Malhotra is like the brand he works for, leaving his footprints in different parts of the world, and in some cases, the most unlikely corners.
On a scorching summer’s day in June 2016, Malhotra traveled 100km east of Jordan’s capital city Amman, to a camp with white tents named Azraq built for the refugees of the Syrian Civil War.
In the desert terrain and hot, windy conditions, people had to queue for hours on end for plates of food handed out of visiting trucks. But some of them, displaced and homeless overnight, expressed their gratitude to Malhotra, President for Mastercard in the Middle East and Africa (MEA).
Mastercard, a technology company that engages in the global payments industry, had distributed e-cards, as part of a global collaboration with the World Food Programme, to the refugees that they could now use to purchase food and other supplies from local shops.
“I spoke to the people myself and saw what their lives were… Even those who were doctors with their families and were displaced… They said to me ‘you have restored dignity to our lives; you have no idea how demeaning it is to queue up to be given food’… We actually digitized how that subsidy for food was given. Some of these things go beyond economics,” says Malhotra.
That very simply sums up Malhotra’s mandate for Africa as well.
The New York-headquartered Mastercard, ranked No. 43 on Forbes’ list of the World’s Most Valuable Brands, with a market cap of $247 billion, which connects consumers, financial institutions, merchants, governments and business, is fostering key partnerships across the African continent to help drive inclusive economic growth.
The idea, Malhotra says, “is to get our global skill-set to operate in its most efficient form in every local economy, at the same time, we must do good, and it must be sustainable.”
He calls Africa the next bastion of growth for various industries.
“As a company, we have stated we are going to get 500 million new consumers globally. And Africa plays a big part of that whole story… We want to be an integral part of various economies here,” says the man responsible for driving Mastercard’s global strategy across 69 markets.
“It probably took us over 20 years to get the first 50 million new consumers, in my part of the world, which is the Middle East and Africa (MEA). It took us probably five years to get the next 50 million, and last year alone, we put over 50 million consumers [in the formal economy] in MEA. That is part of our whole African story, so this is just not rhetoric; we are actually building our business on that basis.”
Home to four of the world’s top five fastest-growing economies, Africa has the fastest urbanization rate in the world, the youngest population, and a rapidly expanding middle class predicted to increase business and consumer spending.
It’s a continent of opportunity for global players like Mastercard with an eye on the potential of a booming consumer base and small and medium entrepreneurs, most of whom are still not a part of the formal economy. A large proportion of Africa is still unbanked. There is enough business opportunity in offering people digital tools so they can lead respectable financial lives.
But it is in knowing that financial inclusion is not just about technology, but more about solving bigger problems, as the World Bank says in its overview for Africa: “Achieving higher inclusive growth and reaping the benefits of a demographic dividend will require going beyond a business as usual approach to development for Africa. Going forward, it is imperative that the region undertakes the following four actions, concurrently: invest more and better in its people; leapfrog into the 21st century digital and high-tech economy; harness private finance and know-how to fill the infrastructure gap; and build resilience to fragility and conflict and climate change.”
And in order to enable financial access, Mastercard has a balanced strategy in place, with the right partnerships for inclusive growth on the continent, Malhotra tells FORBES AFRICA.
“Every emerging market has different segments of people and you need to get the right product for the right segment. What we do is a balanced growth strategy across the continent based on timing, opportunity etc… Of course, because the bottom of the pyramid is much bigger, I think what we need is to adapt things differently; that is where the inclusive growth story comes from. That is where the opportunity is, but there is a second part to it…” And that, he summarizes, is advancing sustainable growth, doing good and bringing more transparency and efficiency.
The new pragmatic dispensation of governments in Africa towards ideas, technology and innovation has surely helped open up the stage to newer segment-driven products, especially as Africa already has such global laurels as Safaricom’s mobile money transfer and micro-financing service M-Pesa that took financial access to a whole new level. Also, sub-Saharan Africa remains one of the fastest-growing mobile markets in the world.
Malhotra says he finds African governments consistent in how they are rolling out their digital vision, and in trying to collaborate towards creating better ecosystems for their economies, though each is unique with its own dossier of problems.
“When I speak to various governments around Africa, I see a commonality of what their needs are and I also see a commonality in how they are trying to respond. So I think a lot of them realize running cash economies is a very inefficient way of doing things… Also, the consumer base is much more open to new technology because there is no bedded infrastructure or legacy infrastructure. I think where governments need to start thinking a bit more is how much do they want to do completely on their own.”
Part of this transformation on the path to financial progress is alleviating the burden of cash. Cash still accounts for most consumer payments in Africa. Mastercard, which started out as synonymous with credit cards, continues its efforts to convert consumers from cash to electronic transactions, and move beyond plastic.
Pioneer For Women In Construction Thandi Ndlovu has died
The cover of the August (Women’s Month) edition of Forbes Africa beautifully captures the essence of the woman I interviewed only a few weeks ago. Gracious, soft-spoken, brimming with life and energy. Dr Thandi Ndlovu impressed the entire Forbes crew on that afternoon cover shoot with her broad smile, and open yet powerful demeanor.
It is with great sadness that Forbes Africa heard of the accident that took her life on Saturday the 24 August 2019.
READ MORE |COVER: Feisty And Fearless Pioneers Thandi Ndlovu & Nonkululeko Gobodo
She had given so much to South Africa and its people – through the apartheid years and during the 25 years of democracy, literally building a better future, first through her medical practice at Orange Farm and then through her company, Motheo Construction Group and the scholarships for tertiary education granted by her Motheo Children’s Foundation.
That sunny winter’s afternoon, I asked her if she, at the age of 65, was considering retirement, and she laughed. A lively, amiable laugh. She told me she was healthy and strong and easily worked 12 to 13 hour days.
She loved hiking, and has climbed Kilimanjaro twice, reached the base camps of Mount Everest and Annapurna in Nepal. At the time of the interview, she was training to climb Machu Picchu, the famed ruins in Peru’s mountains.
One of her biggest passions was to make a difference in people’s lives and to motivate people to achieve the best they could. The other was to redress the racial tensions that still remained in South Africa.
Dr Thandi Ndlovu, South Africa is poorer for your passing.
-Jill De Villiers
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