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.

Faith Cartwright, the founder of Medical Tourism SA. (Photo by Jay Caboz)

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.

READ MORE: Suffering And Waiting On the Wrong Side Of The Divide

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.

READ MORE: ‘Healthcare Has Got To Be Available To Everybody’ 

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.

Golden Oldies

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