Nicaragua has not only become popular as a destination for leisure, rest and recreation but also for medical treatment, as more and more foreigners visit the country in search of excellent quality and low-priced treatments.

It is enough just to sit in the waiting room at Hospital Metropolitano Vivian Pellas  (HMVP) to see with your own eyes the number of foreigners who visit for medical attention, even more so now that the hospital has added another five story tower to its installations to provide services in new specialties including neuroscience, vascular intervention, diabetes, pediatric wards and intermediate care.

During the inauguration of this tower, Carlos Pellas, president of Grupo Financiero Pellas, said that the investment (14 million dollars) is geared toward developing medical tourism and that world class medical attention is available in Nicaragua.

Its quality is supported by the Joint Commission International (JCI), an organization that identifies and measures to the highest standards the best practices related to quality and patient security.

Most foreign patients are from the United States, and arrive from Miami, California and Houston. What’s news is that they are also arriving from Central America, Panama and Spain. “Even from Costa Rica, our biggest competition”, says Maite Soto, Medical Tourism executive for the hospital.

The increase in patients seeking medical services at Hospital Metropolitano is reflected in its sales figures, which were 190,799 dollars in 2013; the following year they were 252,536 dollars, and in 2015 the number went up to 548,639 dollars.  In the first trimester of 2016, sales were at 215,863 dollars, according to the hospitals’ Medical Tourism Department.

ACCOMPANIMENT

According to Soto, this increase in foreign patients is due mainly to the security that the hospital provides as it has JCI accreditation, which gives foreign tourists a measure of confidence in it.  The other premise is the low costs of surgery, which are at times up to 70 percent below what is charged in other countries.

“We put together special packages, and we try to make sure that the price given during the very first consultation is maintained unless a complication or unexpected situation arises.  But we try to keep the same price, and if it has to be increased, the difference is not significant.  Our prices are very competitive; for example, gastric sleeve surgery, one of the most sought after services, costs 7,500 dollars in Nicaragua, while the same procedure costs 15,000 dollars in other countries in the areas and 30,000 dollars in the United States”.

She explains that often gastric sleeve surgery is associated with hernia or gallbladder surgery, but the increase in price for these cases is only up to 500 dollars more.

Soto says that the Medical Tourism Department assists the patients from their first telephone contact.  “They are provided with information and advice, and a personalized package is put together for them. If patients need to be picked up at the airport and have reservations made at a hotel, this is done for them.  We make sure that patients receive comprehensive care.  This care continues until patients are completely satisfied, even after they have left the country. If they require information, support, copies of bills, or if they have questions, we are always ready to serve them with the same level of care as we gave them on their first day with us”.

The Medical Tourism Department at HMVP works in conjunction with some hotels, which provide discounts and transportation to the airport and to the hospital as part of their rates.

“They are offered special rates because they are patients at the hospital.  We can also provide tour packages if they want to see the country.  We can even help them find apartments if they come with their families”, adds the executive.

MARKET STRATEGY

The Metropolitan Hospital took on the challenge of medical tourism in 2012. That year, 200 foreign patients who came to the country seeking medical attention were seen. In 2013, there were 344; the following year, 463 patients were seen; in 2015, 553 foreign patients arrived, and in the first trimester of 2016, there have been 305.

“In Nicaragua we do not compete with anyone else as we are the only hospital with JCI accreditation”, says the Medical Tourism Department executive.

The best market strategy that HMVP has is to ensure that its patients are satisfied with the service they are provided.  “The best recommendation we can get is by word of mouth because a satisfied client will recommend us to friends and family.  But we also have managed to ensure that patients leave with a positive image of the country.  Many have told us that our installations are much better than those of hospitals in their countries and that the wait time is very short”.

Besides the Medical Tourism marketing team, the hospital also uses new information technologies to promote its services.  The team participates in international fairs as well to talk about what the hospital offers.

STEM CELLS

HMVP is at the forefront of important medical research such as treatments using stem cells, which are extracted from the patient’s own fat to treat a number of diseases, especially osteoarthritis of the knees as well as the lumbar area.

“There is intense pain in the knees because of wear on the cartilage. Stem cells have been shown to regenerate this cartilage by up to 85 percent when injected into the knee”, says Dr. Arturo Gómez, plastic surgery specialist and stem cell researcher at  HMVP.

Gómez explains that stem cells are extracted from the patient by means of a simple and rapid procedure. “Fat is extracted through a liposuction procedure.  It is then put through a biotechnological process using centrifugation in order to obtain stem cells which are then applied by a specialist to the knee or lumbar areas.  This method has had many benefits for patients who suffer from diabetes and who are amputation candidates because of gangrene.

Through magnetic resonance imaging we have seen abundant generation of arteries and veins after the application of stem cells around the ulcers.  This procedure has saved patients’ limbs.  We also treat burn patients and do breast reconstruction using fatty tissues enriched with stem cells”.

According to Dr. Gómez, “HMVP is a medical center that all Nicaraguans should be proud of.  Lately, many Central Americans have been coming because they have realized that we have excellent professionals, quality service, and they can also save a lot of money, especially for plastic surgery where we charge up to 50 percent less than what other countries in the area charge.  For example, a tummy tuck costs seven thousand dollars in Costa Rica and Honduras, while it only costs between 3,000 and 3,500 dollars in Nicaragua”.

The stem cell treatment is a proprietary treatment, which is not done very often in Central America and which can avoid amputations.  “Panama has stem cell treatment;  Costa Rica is only just beginning, and it is being extracted from bone marrow there, a procedure which only obtains between 35 and 40 thousand cells per CC (cubic centimeters). We, on the other hand, extract up to 60 thousand through the patient’s fat. The procedure lasts at the most three hours. We base our work on scientific research; we know which stem cells to remove and how many live cells, and with this information we can guarantee the safety of our treatment”, says Dr. Gómez.

Besides the doctors at HMVP, there are independent physicians who treat less demanding foreign patients. “In Managua and León there are doctors who see foreign tourists”, adds Dr. Gómez.

“If a patient wishes, he or she can call a doctor directly.  What is important to do though is to verify that the doctor in question is a member of the corresponding specialist association. If the doctor is not a member of an association, there is a risk because it is not the same to see a doctor who is certified by an association as one who is not. At least with plastic surgery, treatments can be carried out according to international standards.  Other specialties have developed in the country like, for example, ophthalmology, bariatric surgery and dentistry”, says Dr. Gómez.

According to Dr. Gómez, it would be good if there were a company, acting countrywide, to handle medical tourism, “because doctors cannot do this on their own. The Colombians, Costa Ricans and even the Cubans have support and logistics in place to attract patients to foreign countries, and they pick them up at the airport, give them tours, and provide post operatory support”.

He says that “In León, a beautiful city, there is much to see, and it is only an hour from Managua; patients can save up to 500 dollars there for their surgery compared to Managua, and they can take a religious tour, see the colonial architecture of the city or climb volcanoes”.

To date, only HMVP offers certified medical tourism. This hospital has also become a reference for foreigners residing in Nicaragua, members of diplomatic missions and international executives.

RESEARCH INTO THE APPLICATION OF STEM CELLS TO KIDNEYS

Dr. Arturo Gómez, researcher at the Cellular Medicine Center at HMVP, said that in their search to offer new treatments to the world, they are looking at the functioning of stem cells in patients with kidney failure, which would have an impact worldwide were it to be successful.

“Research is being carried out on patients from the pacific region of  Nicaragua to observe the behavior of stem cells in the renal arteries to see if the kidneys recover their function. This study is being carried out in León, and to date there are two cases; however, it is hoped that 12 cases will be quantified.  There are studies proving that it works in animals, and if it works in humans, it would be fantastic.  We are searching for a cure for patients suffering from kidney problems”.

Gómez says that this research is being led by American scientist, Dr. Michael Carstens and has the support of the Ministry of Health, the Oscar Danilo Rosales Hospital School (HEODRA), the OPS and Carlos Pellas. The patients were selected by nephrologists, and the work is supported through donations.  The main donor is Carlos Pellas, who provided the equipment, and the Ministry of Health supports the project logistically by putting the hospitals and the university at their disposal.

“This is the meeting of the wills of different actors that could bring something very positive to humanity”.