To The Max


June 22, 2011
Afghans are making the long trek to India for medical treatment, providing healthy results for both patients and providers.

It is a long way from Sayed Obaidullah’s home in Afghanistan to this modern health clinic in India’s capital. A taxi drove him, his wife and his 10-year-old sister four hours from the city of Polikhomri on a dusty road to Kabul, where they caught a two-hour flight to Delhi.


Traveling from Afghanistan to India to see a doctor seems a long way to go. But Obaidullah is matter-of-fact about the journey. “Treatment has a good result for people from Afghanistan,” says the clean-shaven, 27-year-old construction firm manager. He sits in the air-conditioned waiting room of Max Medcenter, a clinic in Delhi, next to his sister, who is waiting to see an ophthalmologist for an undiagnosed eye condition. The girl wears a yellow dress, matching leggings and pigtails; she looks like an ordinary fresh-faced child except for a milky cloud over her left eye. In Afghanistan doctors “don’t know how to treat diseases. Some machines and technology they haven’t there,” explains the young man in English.

Obaidullah’s sister is just one of thousands of Afghans who are flocking to Delhi for medical treatment ranging from routine checkups to heart surgery to cancer treatment and even Lasik eye procedures.

In the past three years Indian hospitals have seen a sharp increase in patients from Afghanistan because of rising disposable income for middle-class Afghans and the lack of quality health care in much of the country.

For Delhi’s Max Healthcare, a chain of eight hospitals and clinics backed by U.S. private equity firm Warburg Pincus, Afghans are by far the largest group of international patients. Max treated 2,400 Afghan inpatients in the financial year ended in March, a 30% jump over the previous year; they make up nearly half of its foreign inpatients.

Afghan outpatients numbered about 10,000 last year, again about half of the international total, said Hari Boolchandani, head of international patient services at Max. Iraq and Oman, Max’s second- and third-largest sources, last year contributed fewer than 1,000 inpatients combined.

Afghanistan, a country typically equated with poverty and war, has become a surprisingly robust market for Max. Afghans pay in full and in cash, just like regular domestic patients. It’s a trend that Analjit Singh, Max Healthcare’s founder and chairman, could hardly have anticipated, although he envisioned a global health care provider when Max opened its first clinic in 2001. Max Healthcare’s total revenue reached $150 million in financial year 2011, representing a 28% rise, while Ebitda (basically operating profit) jumped 121% to $11.3 million. Max Healthcare is part of parent Max India, which is publicly listed.

Max isn’t the only health care group treating more Afghan patients. Apollo Hospitals, another major nonstate Indian chain, took in a good 2,000 Afghan patients this past financial year. Afghanistan is also Apollo’s largest international base.

Fortis Healthcare, which has 29 health centers across India, expects the past year’s 600 Afghan patient total to rise 30% this year.

Afghanistan’s GDP per capita is $1,000, yet disposable income for some has risen in recent years. International aid contracts create employment, and sectors such as construction, telecom and banking are growing. There is also the impact of Afghanistan’s largest agricultural product: the opium poppy. Gross opium revenue of farmers reached an estimated $1.2 billion in 2002, according to the UN Office on Drugs & Crime.

India has good reasons to court Afghanistan and cultivate economic and strategic ties. Afghanistan is strategically important in relations with rival Pakistan and is also a potential passage for natural gas reserves from central Asia. Indian infrastructure companies have also won lucrative international contracts to rebuild Afghanistan. And India itself has pledged $2 billion in aid to Afghanistan’s reconstruction.

However, because of volatile security conditions in Afghanistan, marked by incidents such as the 2009 bombing of the Indian Embassy in Kabul, nearly all Indian doctors working there have left. Thus, affluent Afghans tend to come to India, particularly for complicated procedures, for which Afghan doctors lack expertise, equipment and operating rooms.

Afghan inpatients seek neurosurgical and orthopedic procedures, as well as treatment for cardiac conditions and cancer. By Western standards medical care in India is inexpensive, but it’s still beyond the budget of an average Afghan—or Indian, for that matter. For example, at Max cardiac surgery costs about $3,780, while a comprehensive one-day physical exam costs $245.

Afghan patients are always accompanied by other family members, notes Max’s Boolchandani, so travel expenses to Delhi, especially for a stay lasting several weeks, can quickly add up. One return flight from Kabul to Delhi alone costs from $400 to $700.

Yet clearly there are Afghans with money to spend. Patient Obaidullah, for example, has a beefy build and wears a trendy outfit of distressed jeans, a striped purple shirt and pointy leather shoes. His sister is not the only one getting treated: His wife, a 24-year-old university graduate, is getting Lasik eye surgery to correct her nearsightedness, which costs up to $900 at Max.

To make travel easier India has streamlined the visa process for Afghan medical tourists; getting a visa usually takes a day.

Indian hospitals are also assertively marketing to Afghan patients. Max and Apollo both hold free training sessions for Afghan doctors in Delhi to forge referral links. Both host periodic free health care camps in Kabul where patients consult with doctors willing to be flown in from India. Max advertises the camps on television during popular Hindi soap operas.

Max, Apollo and Fortis all have interpreters who speak Farsi or Dari, though many Afghans speak Hindi or Urdu, languages spoken in Delhi. All three hospitals have information centers in Kabul. This year Max plans to open information centers in other major Afghan cities such as Herat, Mazar-i-Sharif, Kandahar and Jalalabad.

However, Afghanistan is still a tricky market for Indian health care groups. Business is subject to the vagaries of the region. For instance, in the run-up to Delhi’s Commonwealth Games last year, India clamped down on Afghan visas.

In spite of targeted marketing, many Afghans show up at hospitals in Delhi based on word of mouth from relatives and friends. That is the case with 62-year-old Burhanuddin from Kabul. The gray-bearded clothing shop owner, who goes by one name, suffered a stroke 20 days before but looks alert as he sits up in his Max hospital bed.

After his stroke Burhanuddin had stayed in a hospital in Kabul for just one day before flying to Delhi with his 46-year-old son. He’s regained some movement on his left side, he says through a Farsi translator. So far his medical bill is $534. Was that too expensive? Burhanuddin doesn’t hesitate. “We don’t care about the cost,” he replies.

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