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Iqra Mazhar

Band-aids, such as liquid band-aids, are part of the first aid given to a patient according to the injury. Hydroseal bandaids and blister bandages are also widely used.

Where's The Band-Aid?

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Ismail Munir

A Visa For Health

Introduction

Medical tourism is defined as the practice of traveling abroad to receive medical treatment<a href="#accordion">[1]</a>. This practice dates to the time of Greek pilgrims traveling from the eastern Mediterranean to Epidaurus in search of a sanctuary believed to be of the healing God<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

Even in our modern past, it has been extremely common to find people from less developed areas traveling to more developed countries for the sake of better treatments.&nbsp;

&nbsp;

However, the meaning of medical tourism is not just limited to traveling to more advanced nations. Rather, the opposite is also true. People from developed nations travel to lesser developed areas for cheaper treatment. There can be many other reasons for this. For example, people may choose to get treatment with a drug that is not approved by the authorities in their home country. People with rare diseases or conditions may also travel to places where their condition or treatment is better understood.&nbsp;

&nbsp;

Medical tourism is mostly done for surgeries (both cosmetic and others), or similar procedures and treatments. Medical Tourism is also called &ldquo;health tourism&rdquo; and &ldquo;wellness tourism&rdquo;. All such terms emphasize traveling to avail healthcare services and/or medical treatments.&nbsp;

<div>&nbsp;</div>

Understanding Medical Tourism

<ul>
	<li>Prohibitive Cost</li>
</ul>

Surgical treatments cost a lot in countries like the United States of America where people do not have access to affordable healthcare<a href="#accordion">[3]</a>. On the other hand, they cost a fraction of the amount in other medically rising countries such as India and Pakistan. People travel to get cheaper treatments and save money. 
&nbsp;

<ul>
	<li>Extended Periods Of Waiting</li>
</ul>

There are long wait lists in countries like the UK that provide public health care. Medical tourism is a quick and convenient alternative.&nbsp;

&nbsp;

Public health care systems are frequently associated with prolonged waiting lists for specific procedures. For instance, in 2005, an estimated 782,936 Canadian patients were reportedly put on a waiting list for an average of 9.4 weeks. Canada has an established criteria for nonurgent medical procedure wait times, with hip replacement taking 26 weeks and cataract surgery taking 16 weeks. Such factors convince people to avail timely services abroad instead<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<ul>
	<li>Ease Of International Travel</li>
</ul>

US and UK citizens, for instance, have no problem trotting around the globe. It&rsquo;s accessible and it&rsquo;s affordable for them.&nbsp;

&nbsp;

Moreover, the rising humanitarian concerns have witnessed the emergence of non-profit organizations such as Patients Without Borders that reduce barriers individuals might face while attempting to access international medical support<a href="#accordion">[3]</a>.

&nbsp;

<ul>
	<li>Improved Quality Of Treatment</li>
</ul>

Medical tourism has witnessed exponential popularity in recent decades due to fascinating scientific discoveries and medical breakthroughs. Individuals suffering debilitating pain and discomfort can now rely on advanced technological instruments to treat their sickness. Thailand, for one, has been lauded for its exceptional surgical staff and specialists for gender reassignments&nbsp;and related procedures, whereas Brazilian surgeons, too, have received international accolades for their impressive plastic surgeries<a href="#accordion">[5][6]</a>.&nbsp;

<div>&nbsp;</div>

Medical tourism even in developed countries like the United States has its own risk factors. According to a prediction made by Deloitte Consulting, released in August 2008, the amount of medical tourism coming from the US was to increase by a factor of 10 within the next decade<a href="#accordion">[7]</a>. According to the research, 750,000 Americans traveled abroad for medical treatment in 2007, and 1.5 million more were to do so in 2008. Potential income losses from the rise in medical tourism could amount to billions of dollars for US healthcare providers.&nbsp;

&nbsp;

Patients in developed nations discover that their insurance either does not cover orthopedic surgery (for example, knee or hip replacement), or restricts them from choosing the hospital they like, or their preferred surgeon or prosthesis. All this greatly contributes to fueling medical tourism. 
&nbsp;

Canada, Cuba, Costa Rica, Ecuador, India, Israel, Jordan, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, and the United States are popular medical travel destinations globally.&nbsp;

&nbsp;

Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Turkey, Thailand, and Ukraine are popular locations for cosmetic surgery<a href="#accordion">[11]</a>. Other travel destinations include South Africa, Belgium, Poland, and Slovakia.&nbsp;

&nbsp;

Some people travel to receive assisted reproductive techniques, such as in vitro fertilization, surrogacy, or the freezing of embryos for later use. Apart from those, USA and Singapore have been gaining popularity and are held up in admirable regard for their meticulous and effective procedures for diseases and persistent illnesses such as lumbar radiculopathy, chronic obstructive pulmonary disease (COPD), <a href="https://merisehat.pk/disease/alzheimers-disease" target="_blank">Alzheimer&rsquo;s,&nbsp; disease</a> and cancer<a href="#accordion">[4]</a>. 
&nbsp;

Medical travel is not recommended for all cases. Also, wider political issues are likely to have an impact on where medical tourists opt to receive care in some regions of the world.&nbsp;

&nbsp;

Other than that, it&rsquo;s the insurance companies that want to cash out on medical tourism. Insurance policies are formed in a way that allow patients to have expensive surgical and medical treatments and procedures at low-cost in offshore medical facilities.&nbsp;

&nbsp;

Some public opinion also centers around ethical concerns regarding medical tourism. People believe that it increases inequality in society. In Thailand and India, people are concerned that doctors will be so busy treating foreign patients that they will ignore the local masses they are supposed to serve first.&nbsp; 
&nbsp;

Medical tourism, however desirable, is risky compared to the locally offered medical treatment that has no or very low risks.&nbsp;

&nbsp;

The epidemiology of infectious diseases varies greatly across some nations, such as South Africa and Thailand, and Europe and North America. For those who are already vulnerable, exposure to region specific endemic illnesses without first developing a natural immunity can be dangerous. This is especially true in case of gastrointestinal illnesses like hepatitis A, amoebic dysentery, and paratyphoid, which can compromise recovery and further expose the patient to illnesses such as influenza, tuberculosis, and diseases spread by mosquitoes<a href="#accordion">[11]</a>.&nbsp;

&nbsp;

But then there have been instances where patients in the West have been misdiagnosed for years due to the perception that such diseases are rare in the West. In contrast, doctors in poor tropical nations are more open to the notion of considering any infectious condition, including HIV, TB, and typhoid<a href="#accordion">[11]</a>.

&nbsp;

Depending on the institution and the nation, the quality of post-operative care might also range significantly from US or European standards. Long-distance travel is also risky right after surgery because it can lead to problems for example: Long flights and the restricted movement that comes with window seats can put someone at risk for pulmonary embolism and deep vein thrombosis<a href="#accordion">[7]</a>.&nbsp;

&nbsp;

Other vacation activities may also pose a risk; for instance, burnt scars may darken and stand out more as they recover. Additionally, medical tourism clinics may not have a satisfactory complaints process in place to handle patient complaints fairly and appropriately.&nbsp;

&nbsp;

The World Health Organization acknowledged the disparities in healthcare provider standards around the world and established the World Alliance for Patient Safety in 2004<a href="#accordion">[8]</a>. This organization helps hospitals and governments all over the world to establish patient safety policies and procedures, which can be particularly important when offering medical tourism services. Patients may be more vulnerable to issues if they travel to nations with laxer surgical standards. If issues arise, the patient might need to stay in the foreign nation longer than anticipated or, if they have already returned home, they might find it difficult to receive follow-up care.&nbsp;

&nbsp;

Patients occasionally travel abroad to receive medical treatment that their home country&#39;s doctors would not provide because they think its hazards outweigh the benefits. If the expected consequences do materialize, such patients would have trouble obtaining insurance (whether public or private) to pay for subsequent medical bills.

<div>&nbsp;</div>

In Pakistan, medical tourism is unfortunately an unexplored sector with enormous potential<a href="#accordion">[9]</a>. Pakistan can easily become a center for regional medical tourism, on par with many other nations in its neighborhood, according to Pakistani medical specialists.&nbsp;

&nbsp;

Major cities like Islamabad, Karachi, and Lahore are home to a plethora of contemporary medical facilities that are equipped with the latest technological advancements. Internationally qualified and trained physicians and surgeons are frequently employed at hospitals in Pakistan. However, several issues such as security concerns, political instability, and generally subpar health infrastructure have hindered the industry&#39;s expansion in country<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

Many people have flown to Pakistan to seek medical treatment. Many international patients, mostly of Pakistani descent, travel to Pakistan to receive a variety of treatments that they would not otherwise be able to access in their residing countries because of the cost or lack of insurance coverage. The most common treatments that these patients seek are cardiac surgery, infertility treatments, and cosmetic surgery<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

<ul>
	<li>Organ Transplant</li>
</ul>

The initial spread of medical tourism in Pakistan can largely be accredited to an untapped market for affordable organ transplant<a href="#accordion">[9]</a>. In the past, a considerable number of patients from throughout the world traveled to Pakistan for kidney transplants. However, after laws were passed to curb illegal trade in selling kidneys, these incidents decreased. Pakistani medical professionals believe that by establishing proper regulations, this untapped market of medical tourism might grow significantly.

&nbsp;

<ul>
	<li>Fertility Treatment</li>
</ul>

Pakistan has served as a less expensive alternative for fertility tourism. This includes in-vitro fertilization (IVF) and infertility treatments<a href="#accordion">[9]</a>. To put it in perspective, IVF costs a third of what doctors would charge in Dubai. America and the UK have considerably high prices as well. The boost in medical tourism in Pakistan can also be assessed from the fact that there were just 3 IVF clinics in 1998 and today, there are more than 15 clinics. IVF can cost anywhere from Rs. 200,000 (USD 1,950) to Rs. 450,000 in Pakistan, compared to an average cost of up to $12,000 in the United States.&nbsp; 
&nbsp;

The growth in medical tourism has largely been impacted by restrictions on international travel due to the global COVID-19 pandemic. Apart from mobility and falling global economy, the political and capacity related multidimensional problems generated due to the pandemic have hindered accessibility of medical tourism. All developments have come to halt.&nbsp;

&nbsp;

However, this recent pandemic might have opened a new doorway to medical tourism. It gave people a new reason to travel for the sake of getting vaccinated. It has been reported that rich people from Canada and Europe have been traveling to the UAE to avail prompt access to the COVID-19 vaccine. These people pay large sums of money to become eligible to receive vaccines. Meanwhile, they also get to enjoy a luxurious holiday. UAE is itself promoting Dubai as a vacation spot for this cause.

<div>&nbsp;</div>

Medical tourism highlights a larger problem in society that both physicians and leaders must address. The problem of access to affordable healthcare is the right of every living citizen in the country. This industry of medical tourism is run by patients who feel disenfranchised by the healthcare system of their homeland<a href="#accordion">[10]</a>.&nbsp;

&nbsp;

According to Princeton university healthcare Economist Uwe Reinhardt, &ldquo;[Medical tourism] has the potential of doing to the US healthcare system what the Japanese auto industry did to American carmakers<a href="#accordion">[10]</a>&quot;. 
&nbsp;

Conclusion

Medical tourism is not a sudden innovative creation like the nuclear bomb. It is a simple result of supply and demand. When a consumer has access to a thing that is cheaper and of acceptable quality, they will go for it. But where do we draw the line? That is the question. It starts as a simple solution to the problem of convenience but the minute it starts to raise questions over medical ethics, the point where people start to travel with the intention of exploitation, then that is where the authorities need to draw the line.

[1] Medical Tourism: Travel to Another Country for Medical Care. Centers for Disease Control and Prevention.

[2] Meštrović T. Medical Tourism History. News Medical Life Sciences.

[3] Jennifer W. Why Patients Are Turning to Medical Tourism. verywellhealth.

[4] Lancaster K. Medical Tourism: What is it, what are its Benefits & is it Worth It?. Hive Life.

[5] Chokrungvaranont P, Selvaggi G, Jindarak S et al. The development of sex reassignment surgery in Thailand: a social perspective. The Scientific World Journal. 2014;(182981).

[6] Batista B. State of Plastic Surgery in Brazil. Plastic and reconstructive surgery. Global Open. 2017;5(12).

[7] Keckley P, Underwood H. Medical Tourism Consumers in Search of Value. Washington DC: Deloitte Center for Health Solutions; 2008:30.

[8] Donaldson S, Fletcher M. The WHO World Alliance for Patient Safety: towards the years of living less dangerously. Medical Journal of Australia. 2006;184(S10). doi:10.5694/j.1326-5377. 2006.tb00367.x

[9] Salim Y. Medical Tourism: The beckoning of healing hands | The Express Tribune.

[10] Milstein A, Smith M. America's New Refugees — Seeking Affordable Surgery Offshore. N Engl J Med. 2006; 355:1637-1640.

[11] Puri S, Singh A, Yashik. Medical tourism-A New Arena. Iran J Public Health. 2010;39(3):16-19.

Zarlish Kazmi

As children, we&#39;ve all had moments where the slightest scratch and, at times, a bad mosquito bite, sent us running to get a band-aid from the medicine drawer. And we would end up finishing a whole packet of bandages and looking like an Egyptian mummy wrapped in colorful band-aids. Of course, a grown-up probably ended up locking the medicine drawer to save the supplies for an actual emergency. Or just changing the location of the bandages.&nbsp; 
&nbsp;

While the bandage haul is likely a result of your younger self&#39;s mischievous mind, it&#39;s easier to blame it on the easy access to supplies, thanks to most families keeping medicines and first aid supplies just lying around the house in various cabinets and drawers. Since kids will be kids, it&#39;s best to keep all basic medical supplies in a small first-aid kit. Not only does it protect children from accidentally ingesting medicines or finishing packets of bandages, but also keeps you prepared for dealing with common injuries and emergencies<a href="#accordion">[1]</a>. The common injuries that a first aid kit can treat include minor cuts and abrasions, burns, sprains and strains, nosebleeds, insect stings, and <a href="https://merisehat.pk/disease/allergies">allergic reactions</a> to poisonous plants. 
&nbsp;

So, what do we put in a first aid kit?&nbsp; 
&nbsp;

Understanding How To Make A First Aid Kit For Home

A first aid kit should be customized according to a family&#39;s needs. This means the supplies should be chosen based on the number of members in the family, their specific needs (e.g., allergies, chronic conditions), and the climate of your location (chances of severe weather). 
&nbsp;

The American Red Cross recommends that a first aid kit include any personal items, such as medications and emergency contacts, along with any items suggested by a healthcare provider<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

<ul>
	<li>Antiseptics: Cleaning the wound is the first step in treating any kind of minor cuts or scrapes. Antiseptic solutions such as pyodine, hydrogen peroxide, alcohol swabs, Dettol, and saline water should be kept in a first aid kit for cleaning wounds. Sanitizers should also be kept so you can take care of wounds with clean hands. 
	&nbsp;</li>
	<li>Bandages:&nbsp;Various types of bandages need to be added to a first aid kit. The classic band-aids can help cover small cuts and abrasions. Sterile gauze dressings of different sizes can be used for large wounds. For burns, sterile gauze with a paraffin layer is often kept. And ACE bandages are used to wrap sprained or strained ankles or wrists. Moreover, an adhesive tape should also be kept to secure gauze pads used for dressing large wounds. 
	&nbsp;</li>
	<li>Over-The-Counter Medications:&nbsp;Over-the-counter medications can help provide pain relief, reduce fever, treat allergic reactions, calm down inflammation, and even save lives. Acetaminophen, ibuprofen, antihistamines, antacids, laxatives, cough syrups, and throat lozenges can help manage these symptoms. Moreover, including aspirin can be lifesaving, especially when someone is seen suffering from unexplained chest pain or symptoms of a heart attack. However, aspirin should not be given to people who are either allergic to the drug, have bleeding abnormalities, or are taking other blood thinners.&nbsp; 
	&nbsp;</li>
	<li>Thermometer:&nbsp;A thermometer helps check for fever, which is an indication of an illness or infection.&nbsp; 
	&nbsp;</li>
	<li>Prescription Medications:&nbsp;If any family member takes prescription medication for any chronic condition or illness, it is important to keep a small stock of their medicines in the first aid kit. This can be beneficial in severe weather situations, such as storms or other disasters. Moreover, if someone is prone to allergic reactions or suffers from anaphylactic allergies, a spare epinephrine auto-injector (e.g., EpiPen) should be kept in the first-aid kit. However, when placing medications in a first aid kit, ensure they can be kept at room temperature and do not require refrigeration.&nbsp; 
	&nbsp;</li>
	<li>Tweezers:&nbsp;Tweezers can help remove splinters or glass stuck in the skin. 
	&nbsp;</li>
	<li>Ointments and Balms:&nbsp;Calamine lotion and hydrocortisone creams can help calm down inflammation and treat skin rashes. For simple wounds and cuts, antibiotic creams can be used. Moreover, balms should also be included in first-aid kits as they can help relieve pain in the case of sprains and strains. 
	&nbsp;</li>
	<li>Disposable Gloves:&nbsp;Gloves can help people take care of cuts and wounds in a hygienic manner. Moreover, they can also be filled with water and used as a cold pack.&nbsp; 
	&nbsp;</li>
	<li>Emergency Contacts List:&nbsp;A list of emergency contact should always be present in a first aid kit. This can include emergency phone numbers, the contact information of family physicians, and the numbers of local police, ambulance, and fire rescue departments.&nbsp; 
	&nbsp;</li>
	<li>Non-Perishable Food Items:&nbsp;To prepare for emergency situations such as power outages in case of heavy rains or storms, bottled water and non-perishable food items can be kept in the first aid kit.&nbsp; 
	&nbsp;</li>
	<li>Other Items:&nbsp;These include flashlights, chargers, radio, instant cold packs, face masks, scissors, sunscreen, and petroleum jelly.&nbsp;</li>
</ul>

&nbsp;

The list of basic supplies for a first aid kit can be quite long and gathering these items can be quite a daunting task. Moreover, depending on your location, not all the supplies might be accessible to you. Therefore, we&#39;ve compiled a list of household items that can instead be used for a first aid kit. These include: 
&nbsp;

<ul>
	<li>Cling film - While this may commonly be used around the house to keep food fresh, it can also be used in place of a bandage, especially in case of burns. Since it doesn&#39;t stick to the burnt area, it can be used to loosely wrap the skin after covering the area with a burn ointment. Moreover, the transparency of the wrap allows direct observation of the burn&#39;s healing process.&nbsp; 
	&nbsp;</li>
	<li>Honey - For thousands of years, honey has been a part of wound dressing due to its antibacterial and anti-inflammatory properties<a href="#accordion">[3]</a>. The natural substance can be used for wounds and burns to accelerate the healing process. Instead of burn ointments, a thin layer of honey can be applied to the area. 
	&nbsp;</li>
	<li>Baking Soda - A teaspoon of baking soda dissolved in a cup of water can help reduce pain and swelling associated with bee, wasp, and hornet stings 
	.&nbsp;</li>
	<li>Hajmola - The tablet contains a blend of different spices such as ginger, black pepper, cumin seeds, and black salt that help aid digestion and control dyspepsia. 
	&nbsp;</li>
	<li>Aloe vera - If you have an aloe vera plant at home, its gel can be stored in an airtight container and be used for minor cuts, burns, and even sunburns. The plant has anti-bacterial, anti-inflammatory, anti-viral, and anti-septic properties that help treat wounds<a href="#accordion">[4]&nbsp;</a>and can be used in case of skin burns to provide a soothing effect. 
	&nbsp;</li>
	<li>Oatmeal - An oatmeal bath helps ease the itchiness and rash associated with allergic reactions to poison ivy and even sunburn and eczema.&nbsp; 
	&nbsp;</li>
	<li>Tea bags - The anti-inflammatory property of tea leaves makes teabags an excellent treatment for sunburns, insect stings, and boils. 
	&nbsp;</li>
	<li>Ispaghol - Also called psyllium husk, the soluble fibre is excellent for controlling diarrhoea, controlling cholesterol, maintaining blood glucose levels, and treating constipation. 
	&nbsp;</li>
	<li>Tampons - While having extra tampons in the first aid kit can help prepare you for unexpected visits from Aunt Flo, they are also extremely beneficial for nose bleeds. The tampon&rsquo;s absorbent property helps soak up a large amount of blood and stop the bleeding. 
	&nbsp;</li>
	<li>Carom Seeds (Ajwain) - A common cooking herb in the Indian subcontinent, carom seeds are also known for their therapeutic effects on digestive issues<a href="#reference">5</a>. These include abdominal pain, indigestion, bloating, and diarrhoea.&nbsp;&nbsp;</li>
</ul>

&nbsp;

Just having a first-aid kit lying around the house is not enough. It is important that at least one family member is aware of the supplies in the first aid kit and know how to administer them in case of injury or emergency. However, a first aid kit is not a replacement for a physician. If there&#39;s ever an emergency, the first step is to call the ambulance or emergency number. The supplies in the kit can be used to provide immediate care to the person while you wait for help to arrive.&nbsp; 
&nbsp;

When making a first-aid kit, it is important to keep it in a place that&rsquo;s not easily accessible to children. The kitchen is often preferred for the placement of the kit. Moreover, the kit should be regularly refreshed. This means the medicines and supplies should be checked for expiry dates and replaced in case of expiry. Any electronic devices such as flashlights and radios should be checked for rust and the replacement of batteries. 
&nbsp;

Key Points

<ul>
	<li>A first-aid kit is essential to help people stay prepared both for minor injuries and for major disasters such as storms and power outages. Some of the common injuries and illnesses that these kits can treat include minor cuts, burns, sprains, strains, nosebleeds, pain relief, insect stings, and poison plant exposure.</li>
	<li>Bandages, antibiotics, ointments, pain relievers, antiseptics, and emergency contact numbers are a common part of at-home first aid kits.</li>
	<li>However, common household items can also be added to these first aid kits. These include teabags, oatmeal, honey, aloe vera, cling film, and carom seeds.&nbsp;</li>
	<li>A first-aid kit should be routinely checked for the expiry of medications and supplies. Moreover, at least one family member should be aware of the supplies in the kit and know how to use them in case of an emergency.</li>
</ul>

&nbsp;

[1].Seiden, H., Cantarutti, P. & Thayer, S., 1985. A Customized First Aid Kit For Home and Vacation. Canadian family physician, Volume 31, pp. 2316-2318

[2].American Red Cross, 2022. Make a First Aid Kit.

[2].Scepankova, H., Combarros-Fuertes, P. & Estevinho, L. M., 2021. Role of Honey in Advanced Wound Care. Molecules, 26(16).

[4].Hekmatpou, D., Mehrabi, F. & Aminiyan, A., 2019. The Effect of Aloe Vera Clinical Trials on Prevention and Healing of Skin Wound: A Systematic Review. Iranian Journal of Medical Sciences, 44(1), pp. 1-9.

[5].Boskabady, M. H., Alitaneh, S. & Alavinezhad, A., 2014. Carum copticum L.: A Herbal Medicine with Various Pharmacological Effects. BioMed Research International.