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Analysis

ON THE HIP REPLACEMENT TRAIL: Medical tourism in India

by Madelaine Healey, La Trobe University M.Healey@latrobe.edu.au

As well as Goan sunshine, Rajasthani palaces and the Taj Mahal, tourists to India can now take advantage of budget priced heart bypasses or hip replacements. India is swiftly catching up with countries like Thailand and Argentina in the growing international medical marketplace.

India is well-positioned to capitalise on medical tourism. A joint McKinsey and Confederation of Indian Industry (CII) report found it could attract some US$ 1-2 billion annually by 2012. Around 150,000 medical tourists visited India in 2003, a number reported to be growing by 15 per cent annually. At present, most come from other developing countries, especially the Gulf states, but a large push into the developed world has begun.

The medical services offered to tourists are of a high standard, and are certainly cost-effective, typically between 10 and 35 per cent of Western prices. A heart bypass in Britain normally costs about £15,000; in India it is £4,300.

The dominant Apollo Group has a network of hospitals across India and in the Gulf. Its Chairman, Dr Prathap Reddy, established the group in 1980, and has since become a role model for a new generation of dynamic healthcare entrepreneurs. Reddy and others frequently present the benefits of their businesses in patriotic terms: medical tourism creates jobs and brings in valuable foreign exchange. The growth of elite medicine in India, they suggest, entices non-resident Indian doctors to return home, where in addition to elite medical practice, they put their skills to use tending Indian patients and teaching Indian students.

It is certainly true that some of the most talented and highly trained doctors are being lured home. Moreover, these elite institutions are pioneering new procedures, such as telemedicine, which those in the business suggest could be applied to some of India's most critical public health problems.

The growth in medical tourism and elite private healthcare forms part of India's much vaunted 'service-led growth', which helped the country achieve a growth rate of 8.2 per cent in 2003-04. It is essential, however, to question frequent rosy appraisals of this kind of growth.

First, there must be scepticism as to the extent of the proclaimed trickle down effect from elite medical businesses. A more apt metaphor might be a siphon, since more lucrative private medicine is unarguably drawing doctors and desperately needed nurses away from the struggling public sector.

Furthermore, national prowess in triple bypasses, knee reconstructions and artificial hips is not going to attack India's most serious health issues, such as the resurgence in malaria, the continuing severity of tuberculosis, and alarmingly high maternal mortality rates.

Lobbyists for a more equitable health system lament the granting of tax breaks and financial incentives to healthcare businesses while public health spending remains extremely low. According to the United Nations Development Program the Indian government spends only 0.9 per cent of GDP on public healthcare, the fifth lowest rate in the world.

While the IT industry may have infused massive wealth and ratcheted up the scale of visible inequality in India, at least the poor were not desperately in need of computers, nor were they dying in large numbers due to lack of software engineers. Healthcare driven by profit can pose problems on numerous levels, and certainly demands a careful policy response within a setting of dramatic local and global inequality.

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INDONESIAN FOREIGN POLICY: Rowing between two reefs

by Daniel Novotny, danielnovotny@hotmail.com, Departments of Indonesian Studies and International Relations, UNSW, Sydney.

The far-reaching shifts in international relations in the post-Cold War period are causing much debate about the future direction of foreign policy in Southeast Asia. Of particular interest is Indonesia's ambiguous approach to its relations with the United States and China.

Some suggest the anti-American sentiments that have swept many parts of Asia are evidence of a gradual decline in Washington's influence in the region. This view, it is argued, is supported by the fact that the US has not been invited to participate in the embryonic East Asian Community. Others question whether Southeast Asia's seeming failure to balance the rapidly rising power of China indicates it has chosen to embrace Asia's past hierarchical order centred on the 'Middle Kingdom'.

The author recently spent six months in Indonesia, conducting 45 in-depth interviews with prominent members of the nation's foreign policy elite about their perceptions of external threats facing Indonesia in the post-Cold War period. The data collected reveal a more nuanced view than the anti-American rallies or even some official proclamations might suggest.

Indonesian leaders generally believe the nation will increasingly have to manoeuvre between the United States and China who will vigorously compete for influence in the region. And they have an overwhelming preference for a US military presence, as opposed to a Chinese or any other state's military presence in Southeast Asia, even if, as one person noted, 'the US should be on tap, not on top'. The elite believes the Indonesian public's current sensitivity toward the US is superficial and issues-based. Underneath, today's superpower is generally considered a benevolent and friendly power without any territorial designs.

By contrast, the perceptions of China are influenced by a long history of interaction and by geographic proximity. The Indonesian elite is concerned about the prospect of facing a giant with hegemonic intentions at its doorstep. As one leader emphasised, 'for Indonesia the most important thing now is to anticipate'.

This is why Indonesian foreign policy follows a two-pronged approach. While seeking a closer engagement with Beijing, Jakarta concurrently balances China's growing clout by tacitly backing the US military presence in the region, endorsing the ASEAN Regional Forum security framework and encouraging other powers, namely Japan and India, to greater involvement in regional affairs. Indonesia is also anxious to prevent China from dominating the emerging East Asian Community. This was manifested recently in its determined push for the inclusion of India and Australia into the emerging structures of the community.

In the future, Indonesia, like other states in the region, is very unlikely to accept a predominance of either China or the United States. Instead, we can expect Southeast Asian states to keep manoeuvring between the two powers to maintain a desirable and delicate US-Sino regional balance.

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Profile

This month we profile the treasurer of the ASAA and scholar of India, Dr Peter Mayer, Associate Professor, School of History and Politics, University of Adelaide
http://www.arts.adelaide.edu.au/historypolitics/people/politics/pmayer.html

Q.  When did you become interested in studying Asia and why?

A. My interest in Asia, particularly my interest in India, began in my second year of university in the United States. That more general interest was sharpened utterly by meeting a fellow student, a young Indian woman, at the end of that same year. We fell in love and were married two years later. I decided at that point to undertake a postgraduate degree and immerse myself in the study of India and Indian languages. India seemed the most complex, bewildering and enthralling society one could seek to understand. After studying it for about forty years, I've had no reason to alter that opinion; I think a lifetime is a bit on the short side if one wants to fully comprehend India.

Q. What are your current preoccupations? How do these fit into the contemporary scene?

A. I'm currently finishing a book on the sociology of suicide in India. India has the doubtful distinction of having the second highest number of suicides in the world, about 110,000 per year. In some parts of India, especially in the south, youth suicide rates are exceptionally high, more than three to five times the rates in Australia. My book is the first major systematic study of Indian suicides. What I'm trying to clarify is how the patterns of suicide I've found are related to major social changes in India, such as rising mass literacy, especially female literacy, falling family size, changing expectations about marriage, economic restructuring and high levels of unemployment. As is so often the case, India's immense regional diversity makes this a complex issue but, paradoxically, the very extremity of those differences provides clues necessary to begin to discern an answer. Although suicide is a very rare event, vulnerability to suicide seems to provide a dark but revealing window on aspects of change and dislocation which are affecting society.

Q. What are your hopes for Asian studies in Australia?

A. I'm inclined, against my general nature, to be pessimistic in the short term. We achieved remarkable things in Asian studies in Australia in the 1970s and 80s: we created some of the world's leading centres for the study of Asia, especially Indonesia; we appointed able scholars and fostered remarkable expertise, especially in the light of Australia's relatively small population; we saw the numbers of students studying Japanese, Chinese and Indonesian rival and in some cases surpass those studying French and German. That's now slipping from our grasp. In the next five years we will lose, through retirement, many world-class scholars. In most cases they will not be replaced by younger scholars with Asian specialisations because the numbers of undergraduate students wanting to study these subjects is insufficient to warrant it. Our ability to sustain language programs is perhaps the most visible area at risk, but across the board, my feeling is, that by 2010 we will be back almost where we were in 1965, before our push to make Australia 'Asia literate'.

Researcher of the month

Lynette Ong is writing her doctoral dissertation on the politics of credit in rural China at the Australian National University in Canberra. Originally from Malaysia, Lynette has had wide international experience: from receiving primary education in the Malaysian state of Sarawak, studying in a boarding school in Melbourne when she was a teenager, to undertaking her tertiary education in New Zealand, England - and now Australia. Her nomadic lifestyle has helped her to blend into, and appreciate, different cultures. This is a real advantage in her current work in rural China.

Lynette's Masters in Development Economics, undertaken at the University of Sussex, took her well beyond Asia to Poland, where she constructed an econometric model to study the effects of changes in education, gender, and industries on wages of Polish workers during economic transition. That work helped her to design and conduct a credit survey in rural Sichuan in 2004. She interviewed more than 300 rural households and half a dozen Rural Credit Cooperatives to understand the uses of credit, households' perceptions of how the credit cooperatives work, and how loans are allocated. In the hinterland where the development of financial institutions is still embryonic, it is often the political and social factors that allocate economic resources. This makes things more interesting because the realities are far from what are described in economic textbooks.

Lynette has worked as lecturer in Contemporary Chinese Economy & Society at the ANU, an economic intelligence analyst at Michelin's Asia-Pacific headquarters in Singapore and at the Economic Development Board of Singapore.

During her free time, she does what she enjoys most - writing. She ventured into freelance journalism many years ago and has not looked back. She is a commentator on China and Asian politics, economics and business in various offline and online publications. You can reach her at onglynette@yahoo.com.au.

Book of the month

Culture, Identity, Commodity, Diasporic Chinese Literatures in English, edited by Tseen Khoo and Kam Louie, Hong Kong University Press is a pioneering work focused on diasporic Chinese literature in English. The innovative research in this collection draws on a broad range of texts including novels, autobiographies, plays and Chinese cooking shows. In so doing, the authors examine issues of cultural and racial identity, the politics of Chinese-ness and notions of belonging in contemporary Western society. See http://www.chinabooks.com.au/newbooks/diaspora.htm.

Recent article of interest

Japan Focus recently ran an article analysing the Japan's snap election, to be held in September. Ronald Dore, author of Stock Market Capitalism, Welfare Capitalism: Japan and Germany vs. the Anglo- Saxons, argues that the election is likely to focus as much on the dire state of Japan's relations with China and Korea as on privatisation of the country's post office and its vast savings pool. See http://www.japanfocus.org/.

Did you know?

Applications are open until Friday 2 September for the 2006 round of Asialink's Arts Residency Program. These residencies provide an opportunity for Australian arts practitioners to spend up to four months living and working in an Asian country. They aim to expand the experiences available to Australians in Asia, to develop projects related to the host country and to encourage on-going involvement between Australian and Asian writers, artists and organisations. A grant is available of up to $12,000 towards travel, living and project expenses. Up to 40 residencies are offered in: Arts Management, Literature, Performing Arts and Visual Arts/Craft. See http://www.asialink.unimelb.edu.au/arts/residencies or phone (03) 8344 4800.

Diary dates

WORLD EXPO: March to September 2005 in Aichi, Japan. See http://www.expo2005.com.au/ for more information about the Australian pavilion.

SONS OF KINGS, Exhibition of Paintings, 8 June - 4 September 2005, Sydney. Created in the Rajput courts of Rajasthan, north-west India, these paintings and drawings encapsulates the vitality and sensuality of life at the courts from the 17th to the 19th century. At the Art Gallery of NSW. See http://www.artgallery.nsw.gov.au/artmail/general/June_05. For enquiries phone (02) 9225 1744 or email: artmail@ag.nsw.gov.au.

IMPROVING POLICING FOR WOMEN IN THE ASIA PACIFIC REGION CONFERENCE, 20-23 August 2005, Darwin. Delegates from Australia, New Zealand, the Pacific Islands and Asia will explore how policing can better protect women's human rights and strategies to improve the number of women in key decision making positions within policing. For more information go to the Australasian Council of Women and Policing website at http://www.auspol-women.asn.au/.

AN EVENING WITH TASH AW, 1 September 2005, Canberra. Tash Aw was born in Taipei and brought up in Malaysia. He moved to England in his teens and now lives in London. His first novel 'The Harmony Silk Factory' has just been published and has received really excellent reviews: 'A fine, strong, confident novel - and what a storyteller Tash Aw is. Unputdownable' (Doris Lessing). The Asia Bookroom is hosting this event between 6 and 8pm. Weedon Close, Belconnen. RSVP: (02) 6251 5191 or books@AsiaBookroom.com. For other events see http://www.AsiaBookroom.com/.

ASIA ESSENTIALS, Annual Studies of Asia Conference for Primary and Secondary Teachers, 2 September 2005 Melbourne. The conference will focus on making connections between the Victorian Essential Learning Standards (VELS) and studies of Asia. 8.45am - 4.00pm at the Melbourne Zoo, Elliot Ave, Parkville. For more details and a registration brochure, contact Jill Wilson (Ph: (03) 8344 4800 or email j.wilson@asialink.unimelb.edu.au).

KEY STRATEGIC ISSUES FOR THE COMING DECADE: Australian Strategic Policy Institute's International Conference, 14-15 September 2005, Canberra. Topics will include security, terrorism and international relations. Two day conference including dinner: non-members: $1,650; members: $1,485. See http://www.aspi.org.au/pdf/Flyer_29Jul.pdf or contact (02) 6270 5109, lynnegrimsey@aspi.org.au.

INDONESIA UPDATE 2005, 'Indonesia, Australia and the Region', 23-24 September, Canberra. This year's update will provide an opportunity to review the state of the often contentious bilateral relationship in the context of wider regional concerns and cooperation. It will be held at the Australian National University and is free of charge. Conference convenor: John Monfries, john.monfries@anu.edu.au. See http://rspas.anu.edu.au/economics/ip/IU05/ and follow the links for the program and registration.

INDONESIA COUNCIL: OPEN CONFERENCE, Flinders University, Adelaide, 26-27 September 2005. This multi-disciplinary conference will provide a forum for innovative work on Indonesia, with particular emphasis on bringing established scholars and newer students of Indonesia together. Registration is free. To register, please send an email with your name, institutional affiliation and email address to icoc2005@yahoo.com.au.

EIGHTH WOMEN IN ASIA CONFERENCE, University of Technology Sydney, 26-28 September 2005. The theme of this year's conference is 'Shadow Lines', which has to do with movement across both geographical borders as well as those of the mind. Guest speakers invited include Dr Valentine Moghadam from the University of Illinois, Dr Ananya Jahanara Kabir from the UK, Dr Ruri Ito from Japan, Carla Bianpoen and Ms Samsidar who are both working with displaced women in Aceh. See http://www.wia2005.net/. For enquiries, please email catherine.walczak@uts.edu.au.

LAWASIA CONFERENCE ON INTERNATIONAL TRADE LAW, 7-8 October 2005, Ho Chi Minh City. http://www.lawasia2005vietnam.com.vn/conference_program.html or contact: lawasia2005vietnam@viettel.com.vn.

INTELLECTUAL PROPERTY LAW AND THE PROTECTION OF INDIGENOUS TRADITIONAL KNOWLEDGE IN BIO-RESOURCES, 14 October 2005, Perth. Gary Meyers, Law and Research Fellow, will present this seminar at the Asia Research Centre 12.30pm in the Senate Room at Murdoch University. See http://wwwarc.murdoch.edu.au/seminars.html.

Call for papers SOUTHEAST ASIA, A GLOBAL CROSSROADS CONFERENCE, Chiang Mai, Thailand, 8-9 December 2005. This conference will have several panels, including the New Media, Pop Cultures, In(ter) Asia Panel. Papers are invited that deal especially with new media technology (including radio, television, film, and internet), as important sites of production and consumption of popular cultures (not only the aesthetic genres like pop music or soap operas, but also sports, fashion, travels, shopping) within contemporary Southeast Asian societies. See http://conference.seasrepfoundation.org/index.htm.

Call for papers MEDIA AND IDENTITY IN ASIA CONFERENCE, 15-16 February 2006, Curtin University of Technology, Sarawak Malaysia. This is an interdisciplinary conference jointly organised by the Media-Asia Research Group at Curtin University of Technology in Western Australia and Curtin University of Technology, Sarawak Malaysia. For more information visit http://mediaandidentity.curtin.edu.my/.

Call for papers AUSTRALIANS AND NEW ZEALANDERS IN CHINA, 1800-1950, 14-16 April 2006, Canberra. This conference will have a special focus on the contribution of women to ANZ-China relations. Abstracts of approximately 300 words are invited. Contributions by ANZ citizens/residents of Chinese ethnic origins are particularly welcome. Contact the convenor, Dr Ian Welch, ian.welch@anu.edu.au.

Call for papers THE NEXT ASAA CONFERENCE! 26-29 June 2006, University of Wollongong. Invitations are open to panel organisers and individual presenters to submit abstracts at asaa@uow.edu.au, especially on the theme of 'Asia Reconstructed', a title that is intended to invite submissions from fields as diverse as development studies and post-colonial literatures. Contact Professor Adrian Vickers, conference convenor, at avickers@uow.edu.au.

ASIA-PACIFIC MISSIONARIES: AT HOME AND ABROAD, 2nd Biennial conference, 25-27 August 2006, Canberra. The conference will be held at the Coombs Lecture Theatre, Australian National University, Contact: Dr Ian Welch, ian.welch@anu.edu.au.

You are welcome to advertise Asia-related events in this space. Send details to: fbeddie@ozemail.com.au.

Feedback

What would be useful for you? Human interest stories, profiles of successful graduates of Asian studies, more news about what's on, moderated discussions on topical issues? Send your ideas to fbeddie@ozemail.com.au.

About the ASAA

The Asian Studies Association of Australia (ASAA) promotes the study of Asian languages, societies, cultures, and politics in Australia; supports teaching and research in Asian studies; and works towards an understanding of Asia in the community at large. It publishes the Asia Studies Review journal and holds a biennial conference.

The ASAA believes there is an urgent need to develop a strategy to preserve, renew and extend Australian expertise about Asia. It has called on the government to show national leadership in the promotion of Australia's Asia knowledge and skills. See Maximizing Australia's Asia Knowledge Repositioning and Renewal of a National Asset http://coombs.anu.edu.au/SpecialProj/ASAA/asia-knowledge-book-v70.pdf.

Asian Currents is published by the Asian Studies Association of Australia (ASAA) http://coombs.anu.edu.au/ASAA/, thanks to a grant from the Myer Foundation made to assist the ASAA promote the study of Asia in Australia. It is edited by the ASAA's promotions agents, Francesca Beddie and Peter Rodgers.