Dr Ashok S Komaranchath
I am a medical oncologist who started his education in India. Over the years, I’ve managed to earn a few degrees from other countries and a perceived insight into the cancer care landscape of several others. Although my career started in India, I was fortunate to apply for and get a practicing medical license in 3 other countries. Very recently, I took the dubious step of relocating to one of these nations located in the middle east, a ‘Gulf’ country as it is more popularly known. For most Malayalees, this would be a most logical step, one which most relatives and neighbours wouldn’t bat an eye at and probably heartily encourage, let alone think if it was really a good idea after all.
But I did. I thought and fretted over it many countless nights before finally taking the plunge and the flight abroad. To be honest, I am still not sure it was the right decision, although general signs so far have been positive for me. I had many motives to emigrate, but professional growth and quality medical care wasn’t in the top three.
My so-called “perceived insight” into the cancer care landscape of several countries was built on reading third-person accounts from people within those systems and to a small extent, through direct observation. With this, I have come to the tentative conclusion that India, specifically Kerala, has one of the best medical care delivery systems in the world, particularly in the field of oncology. I will attempt to elaborate on this grandiose and borderline unbelievable statement in the next few short paragraphs.
As Yuval Noah Harari noted in his Pulitzer prize winning book, Sapiens, Homo Sapiens ruled the world only because of its adaptability and flexibility in a wide variety of conditions. I feel that medical doctors in Kerala are the embodiment of this principle. We do not treat a patient based on just his physical condition, examination findings, labs and scans. We have to take into account his finances, social history, working status and cultural peculiarities and often tailor-make treatment which will give him the optimal result with the minimum cost and difficulty. Like losing weight, this is way more harder than it sounds.
In almost every developed western nation, a consultation with an oncology specialist would take anything from 2 weeks to 2 months. A recent survey in Cancer Research UK found that within the UK NHS, only 71.4% of people in England received their diagnosis and started their first treatment within 2 months (or 62 days) of an urgent referral.1 Including the services in the government sector, you will be hard put to find a single cancer centre in Kerala which does not start treatment for each and every cancer patient within 2-4 weeks of an urgent referral. Scans like CTs, MRIs and even PET scans can be done within 48 hours in most parts of Kerala. Consultation with any senior consultant can be fixed within a day. There is access to every single form of cancer treatment available in the world today with the exception of highly restricted clinical trials taking place overseas. The costs of medicines are a fraction of the costs overseas, even for the exact same medicine made by the exact same MNC pharmaceutical company in their same factory, the landing cost is always cheaper in India. Not to mention the massive high quality generic market that India is well known for. Today, 20% of all generic drugs in the world are made in India.2 Even cancer drugs that are not available in India and even not approved yet by the central agency DCGI can be imported with a special license and with a compassionate basis program.
Granted, the biggest factor is cost and we know that 90% of our population cannot afford the rising costs of cutting edge medicine, surgery, radiation and other modalities. There are plenty of conversations on this and many people smarter than I are working on this tirelessly to close the cancer care gap. But have we ever taken a step back, looked at the system we have in place and thought, “It’s got its flaws, but that’s a pretty damn good system that many Americans and Europeans cannot even dream about!”?
Medical tourism is already a pretty big deal in India and the world acknowledges it. But why is it then, that a large number of patients still prefer countries like Turkey or Thailand or South Korea for their immediate medical needs which cannot be met by their own countries? I truly believe that with a more focused approach to this, including a dedicated medical health fast track visa for foreigners, liaisons with the top hospital groups in India and the advent of a seamlessly integrated telemedicine facility, we can become the preferred cancer care destination of the world. Many overseas patients I saw in my previous stint at a large corporate comprehensive cancer centre were not only happy with the high level of care they received, but also the opportunity to explore this beautiful state we call our home. Most of them have acknowledged that they feel relaxed and overall better not only in body but also in mind. The revenue generated from this medical tourism could not only help our country’s growth, but a portion of it could be diverted to fund the treatment of the financially challenged patients of our own. One of the biggest objections to this would be the ethical aspect. Sadly and ironically, trust in Indian doctors seems to be lowest in India, whereas they are among the most trusted and sought after in many countries around the world. Movies like ‘Joseph’ has only added to the mistrust, labelling all doctors as greedy individuals who can’t wait to get you on the operating table and pilfer your kidney for the “rich medical tourist from abroad”. The fact that no self-respecting surgeon would sacrifice his good name even at the threat of his life (let alone a few measly dollars) is lost on the public. We already have a very strong ethical framework which must be strengthened and safe-guarded at all costs and demonstrated to the public.
India is a land of paradoxes, with untold riches and indescribable poverty living side by side. But there is no argument that our healthcare system in regards to access, cost, generic medication and excellent clinicians are indeed world-class. Efforts are on to improve the accessibility even more and to bring affordable cancer care to every Indian citizen. I believe that showcasing our healthcare might and bringing in foreign revenue may well be an important path to true self sufficiency and bringing well managed, evidence-based clinical care to all.
1) https://news.cancerresearchuk.org/2025/05/15/cancer-waiting-times-latest-updates-and-analysis/
