‘The bloke can be a bit hazy about what’s going on’: men and cross-border reproductive treatment

While social science research has begun to demonstrate the significant impact of infertility and involuntary childlessness for men, far fewer studies have specifically explored the male experience of, or men’s involvement in, infertility treatment-seeking and there are few published studies which specifically describe men’s experiences with cross-border reproduction. This paper presents data from the first UK study of transnational treatment-seeking and specifically explores men’s involvement in this process. Data from interviews with 10 men and 34 women who were seeking treatment abroad are organized according to three themes: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. The paper argues that gender is an important aspect of the cross-border treatment experience and that both traditional and emergent gender identities are expressed in the process of treatment-seeking. Healthcare providers need to actively explore men’s perspectives of the treatment process in all locations, to improve quality of care by reducing men’s feelings of marginalization and enhancing their experience of treatment, especially but not exclusively, around the issue of semen collection.There has been little research which has tried to understand more about men’s experiences and involvement in seeking medical help for infertility. There are no published studies which explore the experience of travelling abroad for infertility treatment from the male perspective. In this paper, we present findings from the first UK study of cross-border treatment-seeking and specifically explore men’s involvement in this process. We present findings from interviews with 10 men and 34 women who were seeking treatment in countries outside the UK. These findings are organised according to three themes drawn from the interviews with the men and women: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. This research shows that, as is often the case with treatment-seeking in their home country, men are less likely to get involved in the planning and organization of treatment, but take responsibility for supporting their female partner. Men found some aspects of the treatment process, especially giving a semen sample, particularly difficult. Infertility practitioners in the UK and in other countries need to take account of gender differences and include a consideration of men’s experiences in a more sensitive and proactive way.     

Medical tourism: Assessing the evidence on treatment abroad

The review focuses on one growing dimension of health care globalisation – medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The review sought to identify the medical tourist literature for out-of-pocket payments, focusing wherever possible on evidence and experience pertaining to patients in mid-life and beyond.     

湖南中医药旅游的研究现状及意义

旅游业是一种新兴产业,中医药旅游业的发展,是对中医药文化的弘扬和发展,也是对旅游业的促进。湖南具有丰富的中医药旅游资源,研究和开发湖南的中医药旅游资源,对湖南旅游业的发展具有很好的促进作用。     

Sending NHS Patients for Operations Abroad: Is the Holiday Over?

INTRODUCTION

The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems.

PATIENTS AND METHODS

This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems.

RESULTS

OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05.

CONCLUSIONS

The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients.     

Dental implant tourism

Access and affordability of dental care can be problematic for some in the Australian community. Therefore, dental tourism is increasingly becoming more attractive to some patients due to decreased expense, increased convenience and immediacy of treatment. However, there are significant issues for both clinician and patient in regards to dental tourism. Lack of accountability and regulation are the main issues and this is particularly evident when complications occur. This paper presents five cases where complications have arisen in the setting of dental tourism.     

Trends in unrelated-donor kidney transplantation in the developing world

Living unrelated donors (LUDs) constitute an incremental source of kidneys for transplantation at a global level. Excellent outcomes are reported, superior to those of deceased-donor transplantation and comparable to related donor transplantation. LUD include six categories: spouses, distant relatives, paired-exchange, living-deceased exchange, and non-directed and directed donors. Although a financial reward may be involved in any of these categories, it is in the declared selling of organs that ethical concerns have intensified. There are three patterns of paid LUDs in the developing world: organized, erratic and commercial. The only model of organized LUDs is in Iran, where a central agency assigns and compensates the donors. Erratic LUD transplantation has been experienced, and subsequently banned, in the development of transplant programmes in most developing countries. However, the tightness and enforcement of the official ban are geographically different, providing variable room for uncontrolled trafficking. Commercial transplantation has, thus, become phenomenal in a few countries, gradually evolving into an organized business that follows market dynamics, including advertisement, brokerage, commissions, auctions and tourism. While most international organizations and activist groups condemn commercial transplantation, it is often perceived, in certain cultures and under particular socioeconomic standards, as a human right that meets the demands of all stakeholders, and should be organized rather than declined just for the purpose of meeting the values of a third party.     

Transplant Tourism or International Transplant Medicine? A Case for Making the Distinction

Transplant tourism is routinely denounced by influential voices such as the World Health Organization, the Declaration of Istanbul and the Madrid Resolution as an unethical solution to worldwide organ shortages. Instead, it is suggested that national deceased donor schemes and multinational organ‐sharing programs are the only acceptable avenues for addressing the organ shortage crisis. The present demand for self‐sufficiency in organ supply responds to risks such as poor clinical outcomes, and exploitation of the poor through the various commercial practices of transplant tourism. However, opponents of transplant tourism say little about what governments should do to ensure that their citizens have real and comprehensive access to all forms of transplantation. To address this complex question, we describe a current practice of international transplant medicine in Singapore. It addresses salient concerns with transplant tourism and supports the principle of national self‐sufficiency in organ supply, even as its health care system thrives and expands comprehensive transplant services to its citizens by catering to international patients. We offer a critical appraisal of the Singaporean system, and some suggestions to minimize the risk of abuse by international patients or operatives of illegal organ markets.     

Surge of Dengue Virus Infection and Chikungunya Fever in Bali in 2010: The Burden of Mosquito-Borne Infectious Diseases in a Tourist Destination

Labor flow and travelers are important factors contributing to the spread of Dengue virus infection and chikungunya fever. Bali Province of Indonesia, a popular resort and tourist destination, has these factors and suffers from mosquito-borne infectious diseases. Using area study approach, a series of fieldwork was conducted in Bali to obtain up-to-date primary disease data, to learn more about public health measures, and to interview health officers, hotel personnel, and other resource persons. The national data including information on two other provinces were obtained for comparison. The health ministry reported 5,810 and 11,697 cases of dengue hemorrhagic fever in Bali in 2009 and 2010, respectively. Moreover, two densely populated tourist areas and one district have shown a particularly high incidence and sharp increases in 2010. Cases of chikungunya fever reported in Bali more than doubled in 2010 from the previous year. Our findings suggest that Bali can benefit from a significant reduction in vector populations and dissemination of disease preventive knowledge among both local residents and foreign visitors. This will require a concerted and trans-border approach, which may prove difficult in the province.     

长三角都市带北缘古镇群旅游资源的开发

长三角都市带北缘扬州、南通、泰州等地区拥有旅游资源品位、区域条件和区位特性俱佳的苏中古镇群。目前中短途古镇观光、休闲度假产品供不应求。苏中古镇群利用介入机会开发替代性古镇旅游地，发展古镇休闲度假．农业观光等旅游项目，不但可以选择优于单一工业化的可持续发展模式，也必然对旅游环境容量超载的江南古镇产生空间分流效应。建议重点开发综合评价值较高的狼山、如城、邵伯和溱潼古镇群的休闲度假旅游。