October 2013 - latranslation

Medical and Cosmetic Surgery Tourism in South Korea

Medical tourism is now a $40 billion market worldwide and is expanding at the rate of 25% per annum. For Californians, in recent years this has commonly been associated with patients traveling to Thailand, Singapore or India, where a range of treatment such as coronary artery bypass, orthopaedic surgery, rhinoplasty, face-lifts or gender reassignment surgery can be obtained with a saving from 65-90% on the cost of similar surgery back home. Many US patients take this option when they find that their medical insurance does not cover the procedure they require. South Korea has entered this market with the aim of becoming not only one of the major destinations for medical tourism, but to offer a service with government support that complies with internationally accepted standards of practice and care, and which is free from the negative associations often attached to medical tourism.

Rising numbers

According to South Korea’s Ministry of Health and Welfare, numbers of tourists visiting the country for cosmetic surgery has increased by 500% since 2009, with over fifteen thousand patients being treated over the last year; revenue from the entire medical tourism sector in 2012 amounted to $453 million, an increase of 300% over the same five year period. South Korean Plastic surgery trips cost an average of $14,000, which includes air fare, accommodation and airport pick-ups. Clinics provide a range of special services such as multi-lingual websites, email, video consultations and medical interpreters. Most clinics are situated in the affluent Seoul neighborhood of Gangnam, which this year opened a visitor center to help patients choose an accredited hospital. The government has taken measures to crack down on hospitals that work with unregistered tourist agencies, and the state-run Human Resources Development Service of Korea offers an examination for qualification as a specialized medical tour operator. The government is actively promoting the industry abroad with a target of creating 20,000 jobs over the next four years.

The Korean Tourism Organization (KTO) has been designated by the government to handle the majority of the promotional work for Korean medical tourism. From 2009, visitors coming to Korea for medical treatment have been able to take advantage of a special visa for a period of 3 months or a year. The KTO advises that patients obtain a written diagnosis and referral from their family doctor, which will provide invaluable information on all their medical needs to the doctors in Korea. Open communication between the patient, family doctor, medical coordinator and South Korean doctors is routine, and patients’ treatment records and aftercare recommendations are sent back to their family doctor. South Korea’s healthcare system is amongst the best in the world, and the Ministry of Health and Welfare works closely with healthcare providers to enforce public health and safety policies. South Korean hospitals are technically advanced in the use of both state-of-the-art clinical technology and management systems, and cutting edge medical procedures; they also maintain a broad approach to therapy that includes traditional eastern practices such as acupuncture and herbal treatments. Recent research by Ipsos puts South Korea’s healthcare system at the top of the league table in terms of improvement in service over the past five years.

Perfecting cosmetic surgery

In a 2011 poll by Seoul city government, 32% of respondents said they would be willing to undergo plastic surgery to improve their looks – a rise of 21.5% since 2009. According to the International Society of Aesthetic Plastic Surgery, the number of procedures undertaken in 2011 numbered more than 13 for every 1,000 people, which is the highest rate for any country in the world. Hundreds of cosmetic surgery clinics cluster around the Gangnam subway stations in the so-called beauty belt, where Seoul’s reputation as the best place in the world for plastic surgery grows at a pace. Business has never been so good. Kim Byung, who owns BK Plastic Surgery, says that there is a staggering demand for plastic surgery among Koreans, who now flood into the area alongside increasing numbers of patients from around the world. He employs six surgeons and thirty interpreters, who speak – amongst other languages – Japanese, Mandarin, Cantonese, Vietnamese and English. The international nature of the plastic surgery business and the importance of good communication mean that the presence of qualified and accredited specialist medical interpreters is paramount.

Medical interpreters

Patients must make their own decisions about treatment, and these need to be based on informed advice given by the doctor. This is the first principal of good medical practice that can break down when going abroad for procedures and patient and doctor do not properly understand each other. Approximations will not do. In the best of circumstances, doctors can have difficulty understanding a patient who is sick, injured or – in the case of consultations about cosmetic surgery – distressed about their problem or anxious about the surgical procedures. The particulars of a patient’s concerns and the doctor’s medical judgments must be equally clear to both as if they shared the same mother tongue.

Doctors should give advice only; there should be no coercion. The patient should be free to reject whatever he says, even if medically it might not be the best decision. Medical interpreters must reflect this not only in the content of their translations but in the tone of voice and manner with which they pass it on to the patient or doctor, who must both be as comfortable with the interpreter as with each other. The ideal consultation is an open and relaxed discussion of a problem where all participants feel at ease.

Looking to the future

KTO’s Medical Tourism Center’s Deputy Director Hyungtaek Lim said that South Korea’s expertise makes it more than capable of meeting the rising demand. ‘Korea has one of the most specialized industries in the world, with highly advanced technologies. In addition, doctors must undergo a rigorous eleven year training period before they are able to specialize.’ Korean doctors are revered for their skills, which result in shorter surgery and recovery times – ideal for patients who are on short-term visits. The quality of medical services and technology is a major reason why patients choose to come to South Korea.

LA Translation and Interpretation has a subsidiary company Korean Medical Travel Co., Inc. to provide 1-stop service for Medical and Cosmetic Tourism in South Korea. We provide certified Korean medical interpreters and refer you to the top physicians in Korea as well as plan great trips. For more info, call 1-866-327-1004.

Medical Interpreters and Obama Care

There is no more vivid illustration of the urgent need for certified medical interpreters than the story of Maria Guevara, whose visit to Los Angeles County General hospital for a pregnancy test in 2008 changed her life forever. She was thrilled to learn that she was three months pregnant. When the doctor asked in English whether she wanted to keep the baby she replied without hesitation, ‘Yes.’ The doctor prescribed medication, which Maria took when she got home. She experienced violent pain and bleeding and returned to hospital where the doctor told her she was having a miscarriage. She said afterwards: ‘My baby was dead. The medication the initial doctor prescribed to me was not prenatal care but medication to induce an abortion. Not speaking any English, I was unable to understand his question to me. He did not speak Spanish and no interpreter was provided. Losing my baby forced me into a deep depression. I could not bear looking at or holding babies because the thought brought back painful emotions.’

Legal obligations

According to the 2010 US census, 20% of California’s 6.6 million residents speak English ‘less than very well’ and have experienced problems in understanding their physician or other health care provider. The number and diversity of US residents with limited English continues to grow, putting pressure on healthcare systems and clinicians to ensure equal treatment by providing interpreters. However, those working within the healthcare system are often unclear about their legal obligations.

California is the most ethnically diverse state in the nation and is one of the most advanced in providing legal rights for patients to have access to an interpreter. The need for certified medical interpreters will increase dramatically when millions of people who do not speak English become eligible for health insurance under the Affordable Care Act (Obama Care). To address the anticipated need for medical interpreters, Assembly Speaker John A Pérez (D-Los Angeles) introduced Bill AB1263, which will significantly expand training. This was passed in Senate on September 11, 2013 and enrolled on September 18, 2013. It will ‘establish the Medi-Cal Patient-Centered Communication program, to be administered by a 3rd party administrator, to, commencingJuly 1, 2014, provide and reimburse for medical interpretation services to Medi-Cal beneficiaries who are limited English proficient.’

An improving situation

Under the Affordable Care Act, the federal government will pay most of the cost of providing interpretation for new patients coming into the system. For an investment of $200,000, California will gain $270 million in federal funds for the creation of 7,000 jobs for Certified Medical Interpreters accredited by the National Board of Certification for Medical Interpreters. Even a relatively fluent interpreter, without specialized training, may have difficulty translating the unfamiliar and complex medical terminology used in consultations. With the increasing use of advanced technology in medical procedures, and the use of medical devices in patients’ homes, this can only make the training of specialized interpreters more urgent, particularly when devices for home use arrive without multilingual instructions. On this subject, the website licensedprescriptions.com says: ‘better communications [are] needed between physicians, hospitals, care givers and patient.’ They go on to say there should be constant dialogue between patients and healthcare providers to make sure the devices are always used correctly, there are no function problems and that the patient has been properly educated on what to do if something goes wrong.

Unfair to children

Despite the legal framework, there is still a shortage of medical interpreters, and hospitals often rely on help enlisted from non-medical hospital staff unfamiliar with medical terminology, or on patients bringing in friends or family to interpret for them. This may be better than nothing, but it is a system open to errors. Unfortunately, particularly in the case of new immigrant families, it is often the children who are more fluent in English and are therefore forced to take responsibility for translation in difficult and harrowing situations that can leave the child permanently scarred.

Poulinna Po was only 15 when she was needed as interpreter for her father, who spoke only Khmer. Her father suffered from diabetes and did not understand how to take his medication. Poulinna Po understood what the doctor was saying, but did not know the Khmyer words needed to convey this to her father. He eventually died from a brain tumor and complications from a stroke for which Poulinna Po blamed herself.

Dr Hector Flores, a director of The California Endowment (whose mission is to expand affordable, quality healthcare for under-served individuals and communities) said: ‘Children do not have the maturity to understand the importance and seriousness of medical discussions. There could be misunderstandings that could lead to serious problems. Imagine a boy interpreting for a mother having menstrual problems. Parents might withhold information and think they are protecting the child, but this would hurt the medical encounter. It’s never appropriate to depend on a child to interpret.’

Looking to the future

Obama Care remains one of the most controversial federal policies of recent years, with many critics seeing it as a clear case of the federal government overstepping the constitutional limits on its power: they point to the 17 powers given to Congress in the Constitution (Section 8 of Article 1), none of which mentions medical care, doctors or insurance. In 1788 James Madison wrote in the Federalist No. 45: ‘The powers delegated to by the proposed Constitution to the federal government are few and defined. Those which are to remain in the state governments are numerous and indefinite.’ In order to protect this state sovereignty, 20 or more states have challenged the constitutionality of the new healthcare law, and several have moved to pass constitutional amendments forbidding any law that makes it mandatory for citizens to participate in a health-care system; but surely this is overlooking the enormous need of millions of people for medical care that these measures are designed to address.

With regard to the provision of interpreters, the ad hoc arrangements that for decades have been at least inadequate and at worst dangerous to patients, had to be addressed. Uniform standards, qualifications and quality measures are all provided for under the new act, as well as the setting up of the Community Advisory Committee that ‘shall include interested stakeholders that reflect the diversity of the state in terms of race, ethnicity, gender, sexual orientation, immigration status and geography,’ to create and administer a training program for medical interpreters.

In his speech to Congress in 2009 President Obama said: ‘Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and countercharges, confusion has reigned. Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on healthcare.’

– Clare Heel –

LA Translation and Interpretation provides Certificate in 40-hour Training in Medical Interpreting in Korean, Mandarin and Spanish, among others. Call 1-866-327-1004 for more information

Medical and Cosmetic Surgery Tourism in South Korea

Medical interpreters and Obama Care