health tourism in Himachal Pradesh project research report

1. Research Report
31 May 2012
On
Health Tourism in Himachal Pradesh
Submitted To: Submitted By:
Prof. S. P. Bansal Naveen Verma
Director MTA 4th Sam
IVS, MTA, H. P. University Exam No: 1579
Roll No: 443
2012
Institute of Vocational (Tourism) Studies
Masters of Tourism Administration
Himachal Pradesh University
Summer hill, Shimla- 171005

2. ACKNOWLEDGEMENT
First of all I am thankful to almighty God for his divine bless ing
and love.
Its my pleasure to acknowledge indebtedness and heartfelt thanks to
Prof. (Dr.) S .P. BANSAL, Director (M.T.A), Institute Of Vocational
Studies, for his great effort to make us experience and work-on for a
report on :
“HEALTH TOURISM IN HIMACHAL PRADESH”
I would also like to mention the invaluable support of our respectable
teachers:
Dr. Chander Mohan, Dr. Shushma Rewal Chug, for there great guidance
and favorable support.
I would also like to thanks other teachers Dr. Jaswinder
Sharma of the department who helped me during the preparation of this
research.
Date: 31/05/12 Naveen Verma
Place: HPU - Shimla
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3. Contents
S. No. Particulars Page
No.
a Acknowledgement 2
b Contents 3
c Preface 4
Part – I Health Tourism
1 Introduction to Health tourism 6
2 Concept of Healthy Living and Healthy Lifestyle 7
3 What We Can Do for a Healthy Living 7
4 Health Spas and Massage - Health Tourism 23
5 India Health Spas 25
6 Types of Massages for Health Tourism 27
7 Medical Tourism as a part of Health Tourism 42
8 Risks of Medical Tourism 44
9 Benefits of Medical Tourism 45
10 Medical Tourism in India 47
11 Alternative Medicine Treatments 48
12 Alternative Medicine treatments in India 65
13 Health Tourism in India 66
14 Ayurveda & Health Tourism 68
15 Herbal Medicine & Health Tourism 69
16 Yoga & Health Tourism 70
17 Meditation, Meditation Retreats & Health Tourism 71
Part – II Case Study / Research
18 Research Design 73
19 Research Methodology 75
20 Case Study in Health Tourism 81
21 Designing the Health Product 90
22 Developing and Positioning of Health Tourism Product 93
23 Major players in Health Tourism 95
24 Survey 99
Part – III Health Tourism in Himachal Pradesh
25 About Himachal Pradesh 111
26 Health Tourism in Himachal Pradesh 114
27 A Case study on a Health Project in Himachal Pradesh 118
28 Health Tourism in Himachal Pradesh – SWOT Analysis 120
29 Resources available at Himachal Pradesh for Tourism 121
30 Recommendations 122
31 Conclusions 127
32 Questionnaire Format 128
33 References 131
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4. Preface
For centuries health has been one of the main motivations for travel. Travelling for a
change of weather so as to improve or to rebuild ones’ strength/health has always existed.
History traces it long back, though special places or destination for building health
can be positively established since Roman era. The Roman Empire constructed ‘baths’
popularly known as ‘spas’ where various health-related services like massage, sauna, etc.
were provided to visitors. Ordinarily, these spas were believed to be the resting place of
divine nymph and it was believed that when a visitor used to take a dip in the holy water
believed to have developed symbolic relationship with them. Later on, a city ‘Bath’ in
England became very famous as a destination for health tourists. This city boasted of
baths either built by Romans or constructed on the lines of Roman baths. In modern
world, health has become very precious. Feeling and looking healthy seems to be the
mantra for today’s fast moving generation. Consequently, many health related travel
services have come up who looks after both the physical and spiritual well being of the
tour package buyer. The customer/buyer/client/traveller has the choice of picking tours
from various spas, health clubs, ayurvedic, yoga and spiritual centres. These are gaining
popularity among corporate traveller who spends quite a lot of time away from home on
business trips.
This report is divided into three parts, Part I, II & III.
In Part – I, prime focus is upon the concept of health and health tourism. I have tried to
describe various forms/activities of health sector and its link to tourism along with there
current status in India.
In Part – II, with the help of small case study, I have tried to define and describe the
various forms of Health Tourism, design and develop a health tourism product, and
comprehend the future scope and prospect of health tourism.
In Part – III, I have tried to express Himachal as a Health tourism destination, along with
conclusion and recommendations.
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5. Part – I
Introduction to Health Tourism
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6. 1. INTRODUCTION
Definition of Health Tourism
Health tourism or medical tourism is a particular process of traveling different parts of the
world to avail advanced Health & Medical care other treatment by highly experienced as
well as professional surgeons at any of the advanced and state-of-the-art medical
institutes of the world. Health tourism can be described in various ways that are also
known as health travel, medical travel, medical value travel, medical overseas, surgery
overseas, medical outsourcing, health care abroad, offshore medical and many more.
As more people around the world take an active interest in their health, a travel
segment known as health tourism has evolved to fill customer needs. Not to be confused
with medical tourism, which focuses more on surgical procedures, health tourism is a
much broader concept which include medical but primarily centered around resorts
designed to pamper or improve the body and relax the mind.
Hundreds of health resorts and spas exist around the world, offering specialized
beauty and fitness services, and extended programs to improve your health. These resorts
are almost always located in stunning natural environments or in the trendiest city
districts. Spas play a major role in health tourism, but this field also extends into areas
like addiction treatment and weight loss.
Destination spas and health resorts are the most common and popular health travel
venue. They offer a comprehensive range of services, from massage and Ayurvedic
therapy to yoga and outdoor recreation facilities. The goal of these resorts is to send
their guests home feeling happier, healthier, fitter and more relaxed. Everything is
contained within the health spa resort, allowing guests to relax and focus on themselves.
Spa resorts often specialize in a particular health remedies. Mineral baths have
been around for thousands of years, and countries like Bulgaria and New Zealand
capitalize on these natural geothermal properties. Mud baths and other natural health
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7. cures are usually accompanied by a full menu of pampering services like massage and
facials at these facilities. More holistic resorts offer treatments like acupuncture, colonic
cleansing, hypnotherapy and meditation.
There are also specialized health centers for issues such as weight loss. These
resorts place an emphasis on losing weight and improving eating habits. Guests typically
follow a schedule lasting from a few days to a week or more. The meals are specially
tailored to boost health and guests attend workshops to learn more about staying fit,
eating right and keeping their weight down.
Another common specialized health destination is for addicts. Alcohol and drug
addiction are the two most common problems dealt with at these facilities. They are set
up like all-inclusive resort centers, except that there is more emphasis on monitoring the
guests’ behavior and keeping them on their rigid programs. These are not particularly
relaxing resorts, but they can often break a person’s addiction in a healthy manner.
Fitness holidays are gaining popularity with travelers who want to get some well-
needed exercise while on vacation. This is the broadest category of health tourism,
because the location is more important than the venue. Mountain resorts provide skiing
in the winter and hiking and biking in the summer. Beach resorts are also popular for
swimming and water sports. A fitness holiday places the impetus of action entirely on the
traveler, and there are resorts at virtually every popular outdoor destination on the planet.
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8. 2. Concept of Healthy Living and Healthy Lifestyle
Before discussing about Health Tourism, it should be clear to one about the
concept of Health. There are many factors that affect our health. While some cannot be
control (such as genetics and age), there are many other factors that are under your
control.
Not only will leading a healthy lifestyle improve our health, wellbeing and
happiness, studies have also shown that some of the leading causes of death such as heart
disease, stroke, cancer and other serious diseases can be prevented by improving personal
health habits. A healthy lifestyle can also reduce recovery times, make a person look
healthier and younger and provide more energy.
Eating right, staying physically active, reducing stress and avoiding or moderating
harmful addictions such as smoking and drinking are the basis of a healthy life.
3. What We Can Do for a Healthy Living:
Healthy living must take into consideration the needs of the individual since
despite similarities in our physiology, every human being has unique physical
requirements that are dependant on factors such as age, weight, physical and mental
activity and any physiological peculiarities that our bodies develop or are born with.
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9. There are, however, general guidelines that the medical community is in agreement on
and it’s from these guidelines that tip for living a healthy life can be established.
1. Healthy Diet: Eat a balanced diet including a variety of healthy foods
and limit calories and saturated fats.
2. Health Fitness: Be physically active
3. Weight Loss: Maintain a healthy weight
4. Healthy Sleep: All living beings require sleep and regular sleep patterns are
considered essential to a healthy human existence.
5. Checkups: See our doctor for regular visits (not just when our are sick) and
keep our shots up to date.
6. Blood Pressure: Control our blood pressure and cholesterol
7. Manage Stress: Reduce stress in our life
8. Healthy Skin: Protect ourselves from too much sun - don’t sunbathe or use
tanning booths.
9. Stop Smoking: Smoking has no place in a healthy lifestyle.
10. Substance Abuse: Alcohol and stimulants such as caffeine should only be
consumed in moderation and narcotics should be avoided at all costs. If we
have a problem with alcohol or drugs there are retreats and clinics to help us.
11. Sexual Health: Practice safe sex
12. Women’s Health: For women - check your breasts and get regular Pap smears
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10. 3.1 Healthy Living
• Blood Pressure Health:
For many, blood pressure is not a daily concern. Between waking and
sleeping, the strength and speed with which our hearts pump and the resulting
impact on our arteries and overall health goes mostly overlooked. However, for
close to one billion people around the world with high blood pressure, or
hypertension, it is of great importance and something that everyone could stand to
pay more attention to.
Simply put, blood pressure is the force of our pumping blood pushing
against the walls of our arteries. Measuring the blood vessels during a heartbeat
and the moment of relaxation in between provides a dual reading known as
systolic and diastolic pressure. Statistics reveal that people who have normal
blood pressure even into their early 50s still have a 90 percent likelihood of
developing high blood pressure in their lifetimes. Affecting nearly 50 million
Americans at present, the chance of developing high blood pressure is too large to
ignore.
High systolic pressure, especially in people over the age of 50, carries a
number of significant health risks. Heart disease, stroke, heart failure, heart attack,
kidney failure and even death are linked directly to prolonged hypertension. As
frightening as that may sound, a confirmation of high blood pressure does not
have to be the beginning of the end. Lowering the systolic pressure is necessary
and several methods exist to accomplish this and control high blood pressure.
In most cases, a number of lifestyle changes are required. Dietary
adjustments can be of great benefit in lowering high blood pressure and many
health-care providers encourage their patients to increase their daily intake of
fruits, vegetables and fiber. Decreasing fatty foods, dairy products, salt and red
meats are also counseled. This nutrition program is generally referred to as the
DASH plan, meaning Dietary Approaches to Stop Hypertension.
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11. Other approaches to healthier living go hand in hand with the DASH plan,
such as limiting alcohol consumption and not smoking. Exercise is of obvious
benefit and aerobic activity in the form of swimming, walking, jogging or cycling
for 30 minutes every other day will not only lead to a more appropriate body
weight and lower blood pressure, but will allow any medication required to assist
in controlling high pressure to be that much more efficient.
• Checkups
Also known as health exams, physical examinations or routine physical
examinations, checkups can find problems before they start or before they get a
foothold, and as we all know, prevention is better than cure.
Although many consider the need for having health checkups unnecessary
or only for those with advanced years, having regular annual checkups is a good
idea for people from the age of 30 years. Those into their 50s who don’t go for
regular checkups should have a rethink, as this is the age when diseases may start
to set in more frequently, plus the body generally shows signs of wear and tear at
an increased rate.
The depth of checkups we need will depend on a number of criteria,
including our age, our current state of health and our family history, as well as
whether we smoke, our level of fitness and even what we eat.
Health checkups generally include a weight check, blood pressure check,
regular pulse check, vision tests, and a lookout for breast cancer, testicular cancer,
prostate cancer, and cholesterol levels, for example.
As a preventative measure, doctors will generally advise smokers and
drinkers to cut back on their intake, exercise regularly, and try to reduce stress
levels. In truth, eating properly and exercising are the two biggest factors for
ensuring we give our body the chance of a healthy existence.
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12. General practitioners (GPs) generally do health checkups and are the best
bet to help us feel more at ease, if we are apprehensive about having a checkup.
Family doctors are ideal in this respect. For more thorough checkups, a trip
to the hospital will generally be necessary.
Regarding self checkups, getting into the habit of analyzing our body
whenever in the shower is a good idea for picking up the odd lump or bump. Do
this every other day, or perhaps weekly - women checking for unusual lumps or
bumps on their breasts and men checking for abnormalities in the scrotal area. A
full checkup with our doctor, or at the hospital, should be undertaken at least
every 12 months.
• Health Fitness
Exercise is not only important for our heart, but it is also essential for
maintaining a healthy weight and general well being. Not only can regular
exercise half our chances of developing coronary heart disease and reduce our
chances of having a stroke, but it also helps to lower blood pressure, reduce our
chances of developing diabetes and can assist us to loose or maintain weight.
In addition to the numerous health benefits of exercising, regular activity
can also help to relieve stress, make us feel more energetic, help us to become
more independent and lower our risk of osteoporosis. The great thing about
exercise is that we will benefit from it as soon as we become more active.
If we do not already exercise regularly, we need to start slowly and
consider any health conditions that we have. Starting with a gentle form of
exercise such as walking or swimming is a good way to build up our strength
before taking up a sport or joining an exercise class. Even dancing, cycling to
work, gardening or climbing the stairs is considered exercise.
It is important to increase our activity gradually. Warm up before exercise
and cool down after. If we experience any adverse symptoms when exercising,
such as chest pain, it is important to consult our doctor, who will be able to advise
on a safe level of activity for us.
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13. Aerobic activities such as walking, cycling and swimming are the most
suitable forms of exercise to start with. Avoid intense activities such as press-ups
and weightlifting until one have achieved a reasonable level of fitness. Ideally one
should exercise moderately for 30 minutes five days a week. It is possible to split
one’s exercise into shorter sessions if you easily tire.
An unhealthy lifestyle and physical inactivity can contribute to you
gaining weight and can cause an increase in blood pressure. Regular exercise can
reduce high blood pressure or prevent us from developing high blood pressure.
Build more activity into our daily life and begin to see the benefits of regular
exercise immediately.
• Healthy Diet
Opinions on healthy eating have changed greatly over the last half-century
and in many Western countries what was previously considered a balanced diet is
no longer considered such. Almost on a daily basis, science discovers new foods
and edible substances that are deemed beneficial to health and longevity as well as
the ill effects of foods previously deemed nutritionally sound.
General consensus, however, dictates that a healthy diet should be low in
saturated fats and high in fiber and that the number of calories we consume should
be appropriate to our age, weight and level of daily activity. Beyond this, dietary
specifics depend on the individual in question and any physical conditions or
internal or external factors that might result in increased or decreased
requirements for certain nutrients or compounds.
“You are what you eat” is an old adage, but not one without credible
foundation, with plenty of evidence to suggest that individuals who eat a balanced
diet are far less likely to succumb to illness and disease than those who don’t. The
amount of proteins, fats and carbohydrates we consume is appropriate to our
individual physical requirements.
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14. The above-mentioned compounds are commonly referred to as the three
major food groups and nutritionists advise that for the purpose of good health,
proteins should be a mix of animal and vegetable sources, fats consumed should
be predominantly mono and polyunsaturated, and carbohydrates should be largely
of the non-refined variety.
Balance in diet can also refer to our intake of vitamins and minerals, and
while certain circumstances such as pregnancy, illness or athletic activity can
increase our need for specific nutrients, there are general guidelines for
requirements. These guidelines are commonly known as Recommended Daily
Allowances (RDA) and are devised using the needs of the average child, adult
male and adult female as determining criteria.
There are numerous other issues pertaining to a diet conducive to healthy
living, with many individuals seeking the assistance of dietary supplements to
address specific health requirements. Although some evidence exists to support
the efficacy of certain supplements, nutritionists advise that such products should
only be used in addition to and not as a substitute for a well-balanced diet
• Healthy Skin
While most of us enjoy a holiday at the beach and returning to the office
with a deep, bronze tan as evidence of our dedicated hours in the tropical sun, the
idea of a healthy tan has led us down a dangerous path. Although the sun provides
us with necessary vitamin D, only an occasional 10 minutes of exposure is
required.
Prolonged exposure damages our skin, leading to wrinkles, discoloration
and other blemishes while overexposure (sunburn) has been linked to sun
poisoning, sun stroke, skin cancer and even death. Statistics show that in the
United States, someone dies everyday due to melanoma. The detrimental effects
of the sun are irreversible, so during next vacation to a sunny ski slope or a sandy
beach keep the dangers of the sun in mind and take care of skin.
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15. Fair-skinned people should avoid direct sunlight from 10:00 to 15:00 as a
rule. Sunscreen should be applied at least 20 minutes prior to exposure and
reapplied frequently. Sun block, on the other hand, provides instant protection and
allows for immediate exposure. Either should be reapplied in accordance with the
degree of perspiration or time in the water, regardless of whether or not the
product is labeled as waterproof.
UVA rays are the primary cause of premature aging, so wear a hat with a
brim, loose-fitting clothing and sunglasses during those afternoon walks along the
beach or while relaxing on the ski-lodge patio is recommended. The winter sun is
just as dangerous as the summer sun and often more so due to the amplified
reflection off the snow and ice. Remember too that overcast skies do not mean we
are protected. Diffused rays can cause severe sunburn, even underwater.
If returning from our holiday with milky white skin is a concern, consider
that the medical expenses for the treatment of sun-induced disorders such as cold
sores, eczema, wrinkles, loss of elasticity, sunburn and damage to the immune and
vascular systems are far greater than the cost of a good hat, a pair of sunglass, a
long-sleeved shirt and some sun block.
• Healthy Sleep
“Sleep, those little slices of death, how I loathe them”, wrote celebrated
author of mystery and macabre, Edgar Allan Poe. If only Poe had realised the
importance of sleep, he might have lived past his 40 short years. Indeed, evidence
indicates that good sleeping habits can increase life expectancy.
The science of sleep has been well studied and physicians have determined
that a prerequisite of a healthy lifestyle is sufficient sleep to meet physical and
mental needs. Though requirements vary according to factors such as age and
level of activity, it’s generally accepted that eight hours (with a variance of an
hour more or less) is a healthy period of time to spend at rest.
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16. Though eight hours is considered an optimum period, there are many
factors that can increase an individual’s need for sleep. Heavy exercise, illness,
stress, depression and prolonged mental activity are among the most common
circumstances. In such cases, nine or 10 hours may be considered more
appropriate.
Sleep is important for a variety of reasons and scientists have successfully
broken its functions down into the following categories: restoration, preservation,
memory processing, ontogenesis and anabolism. Though each of these areas can
be explored in depth, in short, they refer to the processes required by all humans
for unhindered mental and physical development and for the repair of any injuries
sustained to either mind or body through disease or daily activity.
Healthy rest depends on good sleeping habits and by this we mean going
to bed and getting up at more or less the same times every day. In doing this, our
internal body clocks become more finely tuned and we are not only able to fall
asleep quicker, but we also benefit from more restful and productive periods of
sleep.
Avoiding stimulants such as caffeine, nicotine and theobromine (from
chocolate) for at least four hours before bedtime is sensible if seeking restful
sleep. Furthermore, drinking alcohol prior to sleep is inadvisable, as its effects
tend to disrupt deep sleep patterns.
Regular exercise can be useful in establishing healthy sleep routines;
however, its best avoided two to three hours before bedtime as it encourages
increased activity of the heart and nervous system, thereby becoming a hindrance
to restful sleep.
• Manage Stress
Everyone feels stressed at one time or another, through work constraints,
demanding relationships, health, and so on, and how we manage that stress is
important for our overall wellbeing.
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17. Stress can affect us in lots of ways, including: emotionally, through
anxiety or tension; behaviorally, through excessive smoking and drinking, being
overweight, nervousness; and how we think, causing apathy, forgetfulness, and
indecisiveness.
If stress is not nipped in the bud fast, it can lead to all sorts of mental and
even physical illnesses. Immense pressure is placed on the body through how we
think, leading to an increase in heartbeat, breathing rate and blood pressure, and
the longer this goes on, the greater are the demands we place on our bodies.
Common side effects from continued stress include cardiovascular disease
(affecting heart and blood vessels), high blood pressure, and an acute proneness to
infection. Chronic fatigue is also common and can last for years if complete rest is
not initiated. As we can see, the way we think can have profound effects on our
whole system.
Luckily there are methods for managing stress and offices set up to help. It
is important to visit our doctor or community health center if we often feel
stressed, anxious or depressed, and if we think we cannot deal with our reactions
to stress. Psychologists and counselors are specialists trained to deal with stress in
individuals.
There are also basic things we can for our self to help cope with and
manage stress. One of the most important aspects for starters is to make sure we
are well nourished and drink plenty of water, as lack of one or both can bring on
or exacerbate stress in itself. Maintaining a certain level of fitness is also
fundamental in dealing with stress for similar reasons to being undernourished.
In addition, we should also try to understand situations that make us feel
stressed and try to avoid them; be it people, events or places. Also understand
what situations are within our control, prepare ourselves for stressful events by
thinking about the future and do things that make us happy.
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18. • Stop Smoking
There is no question that smoking is bad for us, as well as for those around
us. Smoking is addictive primarily through the nicotine content (an alkaloid
poison) in the tobacco, but also through the appeal of cigarette in-hand for many
users.
And it’s not all nicotine either; there are numerous other chemicals being
inhaled which have profound affects on the body. In short, dozens of cancer-
causing chemicals come with tobacco smoke, harming almost all organs in the
body that ultimately leads to disease and lack of health in general.
Common side affects from smoking include: coughing and wheezing;
irritation of the windpipe and voice box; breathlessness; lung irritation and
damage. Common diseases caused by long-term smoking include: lung cancer;
lung diseases like chronic bronchitis; heart attack and stroke; gangrene through
bad blood circulation.
Specific negative attributes from smoking in the male body may include
impotency and sperm complications, while females may experience reduced
fertility, early menopause and increased risk of cancer of the cervix.
The good news is that the earlier we quit the better chance we have of
reducing our risk of major health complications, such as heart disease, stroke, and
cancer. Those who manage to quit by the age of 30 gain a considerable number of
years of life expectancy by avoiding many smoking-related diseases.
Even those who quit at advanced years can improve their life expectancy.
The affects on our health will not be immediate, but after a few months of quitting
our heart and lungs will function better.
Quitting smoking can be extremely difficult for many smokers who are
addicted to nicotine and many people may need extra support when trying to go
‘cold turkey’. Telephone support and quitting smoking courses can help smokers
kick the habit, while nicotine replacement therapy is available from pharmacies.
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19. These include nicotine skin patches and nicotine impregnated lozenges, chewing
gum, tablets and inhalers.
Tips for quitting smoking: set a stop date and go cold turkey; discard all
cigarettes, lighters and ashtrays; ask our smoking partner to also give it up, or at
least be away from us when they want to smoke; ask for support from friends and
family; take up regular exercise; eat more fruit, vegetables and less fatty foods if
we gain weight; and treat ourselves with the money we save on cigarettes.
• Substance Abuse
There are different definitions of the term substance abuse, but for the
layman it is best defined as the use of substances with psychoactive or stimulating
properties in manners likely to cause harm to the physical or the mental health of
the individual concerned. Substance abuse can lead to serious long-term problems
and even death, depending on the circumstances and factors involved.
The most obvious example of substance abuse is the abuse of alcohol, a
phenomenon common to all societies where alcohol is legally available for
consumption. Abuse to the point of addiction is termed ‘alcoholism’ and the most
common long-term effect is cirrhosis of the liver, a condition frequently resulting
in death. Alcoholism invariably impacts significantly on the families of sufferers.
Since the effects to the health of long-term users are well-documented,
tobacco smoking can also be considered substance abuse. Smokers experience
withdrawal if deprived of nicotine in the short-term and risk complications such as
emphysema, lung cancer, respiratory complaints and arterial disease if the habit is
pursued over extended periods.
The use of illegal drugs such as marijuana, amphetamines, cocaine and
heroine may all be considered substance abuse since none are without side effects
or the potential for damaging health. Though the dangers involved are specific to
each drug and some carry considerably more serious risks than others, the
common factor between all is that of dependency. Users can develop physical or
mental addictions to these illegal substances.
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20. Common household substances such as solvents and adhesives, gas and
aerosols, paint and lighter fluid can also be addictive. Inhaling these substances
brings the risk of damage to the heart, kidneys, brain, liver and other organs, as
well as the possibility of Sudden Sniffing Death Syndrome.
Many countries offer help for substance abusers; this can come in the form
of government-funded projects or private assistance such as is available at
rehabilitation centers and retreats at popular medical tourism destinations. Many
hospitals have programs dedicated to assisting abusers, not only in their
withdrawal from substances but also in the treatment of maladies brought on by
them.
• Weight Loss
If we’re overweight, there are many reasons to lose some of the excess.
Healthy weight loss can result in better general health, looking better, feeling
better and increased levels of energy. Many people can lose weight but often
struggle to keep the weight off once they’ve lost it. When we decide that we want
to lose weight, it’s important to start the process with clear intentions and long-
term goals.
It’s good to start the weight loss process by having a clear idea of how
much weight we need or want to lose. To help guide us with this we can ask our
health-care provider to conduct a Body Mass Index (BMI) assessment. The
assessment will give us a reliable measure of our total body fat by comparing our
height and our weight. We can also make this assessment ourselves by using an
online BMI calculator. The results of the BMI will place us in one of five
categories, from underweight to extreme obesity.
Once we’ve established our current weight category, we have to set ourself
achievable and realistic goals. It’s better to spread your weight loss goals over a
significant period of time rather than going for a quick weight loss program where
we will be more prone to regaining weight after we have achieved our initial goal.
Start by setting ourselves the goal of losing just a few pounds, then once we’ve
achieved that goal, apply a second goal of keeping it off for one or two weeks.
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21. Diet is one of the most important aspects of losing weight and keeping it
off. Try not to be taken in by fast track diets; while these types of diet may work
in the short term, keeping the weight off can be difficult once we get bored of the
imposed restrictions of the diet. Instead, start from working with our current diet
and eating patterns.
For one or two weeks, keep a record of what we eat and drink each day. Be
honest and note quantity and portion sizes. Once we have a clear record of what
we are eating and what our eating patterns are, then make realistic goals based on
our records. If we see that we are eating a chocolate bar once every second day,
make a goal to reduce this to a frequency that is achievable.
Finally, keep active! Exercise and general activity is vital in the process of
losing weight healthily and keeping it off. Again, set achievable goals that we can
increase as time goes on. We may want to start with something simple like
walking to pick the kids up from school rather than driving.
Women Health
For women to stay healthy there are a number of special issues they should
consider to avoid female-related illness and disease. With the increase in breast
and cervical cancer cases, it’s particularly important for women to ensure that they
conduct regular self-examination of breasts and have regular cervical Pap tests
Breast cancer is one of the most common forms of cancer in women. When breast
cancer is discovered early and treated quickly, the possibility of curing the disease
is much higher. It’s therefore essential for women’s health that all women conduct
monthly self-examination in order to detect any early signs of the disease. If you
should discover anything unusual, pay a visit to your women’s health-care
provider who will advise you in undergoing further tests if necessary.
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22. Cervical cancer is also a common form of cancer in women and like breast cancer,
early detection of the disease can increase the possibility of cure. To check for
cervical cancer, cells that may result in cervical cancer or other cervical related
infections, women should have their health-care provider conduct regular Pap
tests.
How often these tests should be conducted depends of your age and whether you
suffer from any other medical conditions. Your doctor will advise you how often
you need to be tested and of any other necessary precautions women should take
to stay healthy.
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23. 4. Health Spas and Massage - Health Tourism
Massage has been used for centuries to relieve stress and treat a variety of health
conditions. Ancient civilizations from Rome and Japan to India incorporated massage
techniques into their medical treatment regimens. Today, most people are familiar with
massage as a luxury spa treatment, and many new techniques have been developed to
appeal to an ever widening taste for exotic and effective wellness experiences.
The term ‘massage’ is generally used to describe treatments that use pressure to
manipulate the body’s soft tissues. Target areas can include skin, muscles, ligaments,
tendons, joints, and other connective tissue. In addition, some massage therapies target
lymph vessels and various organs of the body. The goal is to promote healing, support
wellness, relieve stress, and clear the mind of clutter.
The massage practitioner may use hands, feet, fingers, elbows, forearms, or
massage aids during a treatment. Scented or unscented oil is often used while heated
stones are now used in one of today’s popular massages. Depending on the type of
massage, clients are clothed or unclothed. If unclothed, towels or sheets are draped for
privacy and only the area being worked on is uncovered. Clients may be seated on a
massage chair or lie on a massage table or a mat on the floor.
23

24. The types of massage most familiar in western cultures include Swedish, deep
tissue and sports massage. Asian massage techniques include Ayurvedic, Thai, Shiatsu
and reflexology. Beyond these traditional methods, there are many types of massage that
combine techniques, incorporate stretches, or target specific trigger points.
Medical massage is used increasingly for conditions such as breast cancer, sinus
relief, and temporarily reducing blood pressure. Other types of medical massage are used
to relieve pain.
Massage therapists and practitioners are usually regulated by a governing agency
of the country where they practice. Because there is no single entity regulating massage, it
is best to ask your practitioner about their qualifications and training, or ask to see a
license or certificate verifying their compliance with local regulations.
Countries with Health Spas: Czech Republic, Estonia, France, Germany, Hungary,
Italy, Japan, Mexico, New Zealand,
Philippines, Poland, Romania, Singapore,
Slovakia, Slovenia, Thailand, Vietnam, USA.
India is also emerging as a new health tourism
destination. Kerala is world famous for its
Ayurveda and Massage therapies. We will
later discuss scope of Health Tourism in
Himachal Pradesh.
24

25. 5. India Health Spas
While not as popular a spa destination as Asian counterpart Thailand, India is an
up-and-coming spa destination that attracts thousands of spa-goers each year with its
unique treatments not found elsewhere.
Specializing in yoga, ayurvedic therapies and massage, Indian spas offer exotic
wellness treatments suited to treating a range of ailments as well as generally rejuvenating
the body as a whole. The growing spa industry in India is centered in Kerala, but there are
quality spa resorts in most major tourist destinations.
Better known for their specialist treatments than for their luxuriousness, Indian
spas are among the most affordable spas in the world and offer a range of services. Some
spas are part of resort complexes that offer accommodation and introductions into age-old
practices such as yoga, meditation and ayurveda.
Popular health spa treatments in India include: ayurvedic massage, rejuvenation
therapy and water therapies as well as standard spa treatments found elsewhere, such as
facials, body wraps and exfoliation. Many patients come for the alleviation of health
conditions through the use of ayurvedic medicines and therapies by qualified physicians.
Unlike spas in many other parts of the world, spas in India typically offer insight
on how to achieve a healthy lifestyle that maintains balance and harmony through
centuries-old traditional methods. Ayurveda, yoga and meditation are all useful tools that
Indian spa therapists use to assist patients in making healthy lifestyle changes.
25

26. The modernity of spas in India is variable, but most health spas catering to
foreigners are well equipped with contemporary facilities and trained professionals. Many
people complement their spa treatments in India with sightseeing or a break by the beach
at a luxury resort.
Not all spas in India are regulated, making it essential you research the spa you
wish to visit before seeking treatment. Make sure you choose a therapist that has
significant experience in their field before undergoing any major spa treatment or therapy
in India.
26

27. 6. Types of Massages for Health Tourism
• Acupressure massage
A traditional Chinese medical practice, acupressure is a technique based
on the belief that stimulation of certain points of the body can bring relief of
medical symptoms and their root causes. The practice is similar to acupuncture,
making use of meridians (channels along which the body’s life energy, or qi,
flows) to encourage the body to heal itself without need of drugs or surgery.
Acupressurists will diagnose a patient’s problem based on the description
of their symptoms and with little in the way of a physical examination aside from
checking the patient’s pulse.
The patient’s condition is, in Chinese medical terms, related to interference
in the natural flow of qi (pronounced chi) in a specific area of the body. An
Acupressurist will attempt to address this interference by applying pressure to
specific points along the meridians with the hands, elbows or tools. The points
chosen may or may not be focused in the area where the patient’s symptoms are
located.
Acupressure can be used to relieve a wide selection of ailments and is
commonly reported to be successful in aiding those wanting to lose weight or quit
smoking. Many pharmacies sell acupressure wristbands designed to alleviate the
symptoms of pregnancy nausea or travel sickness, suggesting that there is some
mainstream acceptance of acupressure theory.
There is no scientific evidence to show correlations between acupressure
and health benefits. However, there is some acknowledgement within the medical
community of its benefits, with local GPs and medical specialists often referring
patients for acupressure treatment when conventional approaches have proved
ineffective.
27

28. • Aromatherapy massage
Popular among followers of alternative and complimentary medical
approaches, the principles of aromatherapy are several millennia old. Historians
believe that it was probably the Chinese who first developed the belief that
ingesting the vapors of oils derived from certain plants and their fruit can be
beneficial to both physical and mental health.
Although often under scrutiny from the conventional medical community,
aromatherapy is regularly practiced. The most common means of ingesting
essential oils is by inhalation. Oils are diluted with water and placed in an oil
burner, with a candle producing enough heat to cause the oil to evaporate. As the
vapors permeate the air, their effects may be felt by anyone in close proximity.
The alternative to this method is to add a small volume of essential oil to
base oil such as sweet almond and then apply to the body through massage. This
technique allows external ailments to be treated directly, as opposed to inhalation
which is intended to have a more general and systemic effect.
Oils can be used to treat a variety of complaints with inhalation said to aid
headaches, symptoms of common colds, stress, anxiety, insomnia and digestive
complaints. Topical application is allegedly efficacious in treating arthritis and
rheumatism, skin rashes and infections, warts, insect bites and minor wounds.
Some elements of aromatherapy have worked their way into mainstream
culture and consumerism. Nowadays it’s not uncommon to see essential oils such
as tea tree added to popular skin and hair care products. Lavender is widely
acknowledged for its calming effects and is commonly added to bath oils, pillows
and inhalers (aroma sticks).
28

29. • Cranio sacral massage
Cranio sacral therapy, known as CST, is a type of gentle bodywork or
therapy that targets the membranes and cerebrospinal fluids that surround and
cushion the brain and spinal cord. CST therapists believe that when this fluid is
blocked, an imbalance occurs and illness and injury can result.
CST concentrates on the cranio-sacral system, which is made up of the soft
tissue and bones of the cranium (head), the pelvis, and the spine. Spinal fluid that
travels through this system can be restricted by trauma to the body such as a fall or
an accident, or through tension brought on by stress or nervousness. A blockage in
this system can cause muscle and joint strain, emotional disturbances, and
impeded operation of the body’s organs and central nervous system.
A variety of healthcare providers practice CST in the course of their
treatments. Dentists, massage therapists, chiropractors, osteopaths, occupational
therapists, and nurses may all use CST to establish harmony in the central nervous
system and assist in healing.
During a full CST session with a specialist in this therapy, the movement
of the cerebrospinal fluid is assessed. While lying face up on a massage table, the
therapist gently manipulates the bones of the skull, spine and pelvis as well as the
soft tissues of these areas to release blockages. Depending on the severity of the
condition, more than one treatment session may be scheduled over a period of
time.
CST is commonly used to treat migraine headaches, sinus problems, TMJ
syndrome, fibromyalgia, mental stress, and neck and back pain to name just a few
conditions. CST takes advantage of the body’s natural healing capabilities and is
often used along with traditional massage to help the body regain balance.
29

30. • Endermologie
The unsightly dimpling of the skin on thighs and stomachs, called cellulite,
is an endless source of frustration for many adults. Even very fit people may have
cellulite, and weight loss and liposuction do not always affect the appearance of
cellulite. Endermologie, a non-surgical and non-invasive technique that reduces
the appearance of cellulite, is one approach to combating cellulite.
Endermologie was developed by French plastic surgeons and the technique
is now patented in the United States and approved by the Food and Drug
Administration (FDA). The technique uses rollers and suction to redistribute the
top layer of skin and reduce the dimpling effect of cellulite. It does not remove the
fat under the skin, as liposuction does, but rather treats the skin’s appearance.
During an endermologie session, a small, motorized device with two
adjustable rollers and suction is applied to the problem area. The skin is gently
folded and unfolded under the continuous action of the rollers, creating movement
in the deep tissues. As the subcutaneous fat layer thins, blood and lymphatic flows
increase, which causes the excess fluid to be released.
Endermologie is most effective on fit persons between the ages of 30 and
45. People who do not exercise regularly may see only temporary results, and
people more than 30 pounds overweight will most likely see no results from the
treatment. Typically, 14 to 28 sessions are required, with monthly treatments
thereafter. For maximum benefit, drinking eight glasses of water every day is
recommended and regular exercise will also extend the benefits of the treatments.
In addition to treating the appearance of cellulite, endermologie has some
significant health benefits. It improves circulation, stimulates collagen production,
causes deep lymphatic drainage and can improve symptoms of fibromyalgia and
chronic fatigue. This technique can also be used to soften burn scars and
connective tissue.
30

31. • Hot stone massage
This highly relaxing form of massage is known for its stress-reducing
properties. The hardness of the heated stones means the therapist can apply deep
pressure, making this a good form of therapy if you want to address a specific
area.
Although this form of massage has been around for centuries, it only
recently became internationally popular when US massage therapist Mary Nelson
introduced its current form in 1993.
The water-heated basalt stones used in hot stone massage vary in size and
weight with some as small as a walnut while others come in at over one kilogram.
The heat level of the stones is closely monitored before they are used. Stones
below 118°F can fail to relax the muscles while stones over 129°F can cause
discomfort to the client.
Heated stones are typically placed under the client with a sheet of fabric in
between. Other heated stones are then used for massaging the client along their
leg, torso and arm muscles with the help of oil. The process is repeated on both
the front and back of the body. Cold stones are occasionally used towards the end
of the session.
As the stones can target specific areas with ease, with the added benefit of
the relaxing effects of heat, hot stone massage is considered to be very mentally
relaxing. The benefits may also include improved circulation and calming of the
nervous system. It is necessary to choose a therapist who has been properly
trained in this type of massage.
31

32. • Lymph drainage massage
Manual lymphatic drainage (MLD) is a gentle massage technique that
improves circulation of the lymph through the lymphatic system. The human
body’s lymphatic system drains fluids, detoxifies and regenerates tissues and
helps maintain a healthy immune system. A lymphatic system that functions at its
best is critical to the body's health and wellbeing.
In the 1930s, Dr Emil Vodder and his wife Estrid began using MLD to
treat chronic sinusitis and other disorders of the immune system. They developed
a technique of gentle hand movements to cause lymph movement and introduced
their method in Paris in 1936. This technique is now one of the primary tools used
to manage lymph-edema, a condition where the lymphatic system is obstructed.
When the lymphatic system is obstructed, toxins accumulate and physical
ailments can result.
Lymphatic drainage massage therapy stimulates and moves excess fluid
away from swollen areas so that it can drain away. It combines slow, gentle
pressure with soft pumping movements in the direction of the body’s lymph
nodes.
The massage therapist usually starts with the lymph nodes in the neck and
moves down the body, then out to the limbs. This massage technique uses the pads
of the fingers and thumbs and the palms of the hands. The increase and decrease
of pressure creates a suction and pumping effect that mimics the body’s natural
action.
Cancer treatments such as radiation and surgery can cause the lymph
system to become blocked. With breast cancer, this often occurs in the armpit.
Nodes in the groin area or the pelvis can occur if cancer affects these areas. MLD
is very helpful in relieving swelling and helping the immune system to recover. In
addition to these serious situations, MLD can also improve the appearance and
health of skin.
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33. • Microdermabrasion
Microdermabrasion is a recently developed skin care technique used as an
alternative to face lifts, plastic surgery, chemical peels and Botox. It is effective in
reducing fine lines, sun damage, age spots, wrinkles and acne scars. Even better, it
stimulates the production of skin cells and collagen for healthier skin overall.
In microdermabrasion, tiny grains are used to gently buff away the top
layer of skin, or stratum corneum. The stratum corneum is composed of dead skin
cells that protect new skin cells growing beneath it. This layer is also where
wrinkle lines and blemishes reside, so removing this layer also removes these
imperfections in the skin. When the stratum corneum is removed, the theory is
that the body rushes to replace the lost skin cells with new, healthy ones.
Microdermabrasion is performed in salons and clinics by trained
technicians or dermatologists. At a clinic or salon, the technician or dermatologist
uses a tool that sends out a stream of tiny crystals (aluminum oxide, sodium
chloride or sodium bicarbonate) and collects the leftover dead skin cells and used
crystals in the tool’s vacuum. Some newer tools use a diamond-tipped wand
instead of a stream of particles.
In the first hour after treatment, the skin may show mild redness and
swelling that can last from an hour to several days.
For men and women, microdermabrasion is most often used to improve
skin on the face, chest, neck, arms and hands. This technique has virtually no side
effects and gives the skin a fresh, healthy glow. It is effective on all skin colors
and types and can be used for skin that is sensitive to chemical procedures. A
milder version of microdermabrasion can also be performed at home with over the
counter creams and lotions.
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34. • Myofascial release
Myofascial release therapy is a massage technique that reduces or
eliminates pain and tensions in the connecting tissue (fascia) of the human body.
Stress, injuries, overuse and poor posture can cause restrictions to fascia.
Myofascial release therapy is directed at freeing these constrictions or blockages.
Fascia is tightly woven tissue that covers and interweaves every part of the
body including nerves, veins, muscles, and internal organs. This fascia is one
continuous system that ties the entire body together without interruption. It
provides support and structure, but is also flexible so that we can move and bend
with ease. Damage or injury to fascia affects more than just the area directly
affected, making healing damaged fascia important for the body’s overall health
and wellbeing.
The developers of myofascial release therapy have backgrounds in
physical therapy, rolfing, and other types of neuromuscular therapies. During a
session, the therapist gently stretches tissues along muscle fibers. The stretch is
held until the tension is released and the tissue softens. Stretches may be held for
up to several minutes. A single session may last up to an hour and several sessions
may be held over a week or more, depending on the severity of the condition.
Myofascial release therapy is also commonly used to treat back pain,
shoulder pain, headaches, fibromyalgia, chronic fatigue syndrome, menstrual
problems, incontinence, tennis or golfer's elbow, shin splints, sprains, rheumatoid
arthritis, muscle spasms, whiplash injuries and carpal tunnel syndrome. In
addition, myofascial release can be used to treat children suffering from birth
trauma, head injuries, cerebral palsy, and scoliosis.
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35. • Prenatal/postnatal massage
For thousands of years and across many cultures, massage has been and
continues to be an integral part of easing a woman’s pregnancy, labor, delivery
and recovery after birth. In western society, pregnancy massage is becoming one
of the fastest growing massage therapies.
Expectant mothers experience unique physical and emotional changes due
to increased weight, shifting posture, and changing hormone levels. Physical
discomfort ranges from muscular tension and headaches to pressure on knees.
These changes can create both physical and mental stress.
Too much stress can negatively affect the health of both the mother and
the baby, resulting in a higher incidence of miscarriage, premature labor and other
complications. Massage can help a woman before and after birth by reducing both
anxiety and physical pain.
Prenatal massage takes traditional massage techniques such as Swedish or
a deep tissue massage and tailors them to address the issues and conditions that a
pregnant woman faces. For example, more time is spent on easing low back and
hip pain, swelling, nausea, constipation and heartburn. During the massage, a
pregnant woman is nestled in pillows or specially designed cushions and lies on
her side or in a semi-reclining position.
During labor, massage strokes on the backs and legs have been shown to
speed labor and reduce the instances of complications in labor. After the baby's
birth, massage therapy can help the body return to its pre-pregnancy state,
alleviate pain, promote a renewed sense of body and self, and help maintain
flexibility despite the physical stresses of infant care. For post-caesarean mothers,
postnatal massage techniques can also reduce scar tissue and aid the healing of the
incision and related soft tissue areas.
Expectant mothers should check with their doctors before getting a
massage. Prenatal massage may not be recommended if the mother has diabetes or
high blood pressure. Information about medical condition and personal
preferences should be shared with the massage therapist so the massage can be
tailored to meet specific needs.
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36. • Reflexology
If the way to a man’s heart is through his stomach, then it should come as
no surprise that the road to health and wellness may lie in the soles of the feet.
Reflexology, also called ‘zone therapy,’ is based on the belief that the bottom of
the foot is covered with points that correspond to the body’s systems and parts.
Massaging these points can bring healing and wellness to the body and rebalance
its energy flow.
Practices relating to reflexology date back to the ancient civilizations of
China, India and Egypt. However, the technique was first introduced to the West
in the early 1900s by Dr William Fitzgerald, who called the technique ‘zone
therapy.’ Eunice Ingham developed Fitzgerald’s theory further and in the 1930s,
reflexology was born.
Today, reflexology has been shown to be effective for back pain, sports
injuries, digestive and stress-related disorders, migraines, infertility, arthritis,
sleep disorders and hormonal imbalances.
A trained reflexologist first questions a patient about their medical history
and current health issues to better direct treatment. Feet are then soaked in water
and herbs, and then the therapist locates specific points on the soles of the feet or
sometimes palms of the hands. Fingers are used to stroke and apply pressure to
these points and to crush small ‘crystals’ that are deposits of lactic acid that build
up in the feet. These crystals are then reabsorbed into the body and eliminated by
the lymphatic system.
Sessions generally last one hour, but a course of sessions may be
prescribed depending on the specific needs of the patient. Every person’s
experience is unique to them, and the therapist relies on information from the
patient about how they feel and what they experience during the treatment.
Because reflexology stimulates the body’s own self-healing, patients may feel
nauseous, lethargic or tearful as the body begins to heal itself.
36

37. • Salt glow
One of the most popular spa treatments today is salt glow. Incorporating
scented oils and therapeutic salts, this treatment stimulates the skin and exfoliates
it, leaving the recipient of this luxurious treatment with a healthy glow.
Salt glows are also known as ‘salt scrubs’ and ‘sea salt scrubs,’ but they
are essentially all the same. Because the salt is combined with oil and some type
of aromatic such as lavender or lemon, it also hydrates the skin. Treatments can
vary slightly at different spas, and most spas combine a salt glow with other
treatments such as body wraps, steam showers and massages. The salt glow
treatment itself takes between 40 minutes to an hour.
During this relaxing and invigorating treatment, clients lie unclothed on a
massage table or special wet table with a sheet or towel draped for modesty. The
therapist rubs a mixture of sea salt and oil over the skin, covering both front and
back sides of the body. Because salt is somewhat abrasive and therapists may use
different amounts of pressure, it is important to speak up if the pressure applied is
too much, or to request more pressure if desired.
Afterward, the salt mixture is rinsed off. If a wet table is used, the therapist
may use a hand-held showerhead or moist towels to remove the mixture. Some
wet tables incorporate an array of showerheads that spray over the body. Other
spas may provide a convenient shower enclosure for rinsing off.
Once all traces of salt are removed, other treatments follow, most often a
body wraps or massage. If no other treatments follow, the therapist applies body
lotion with massaging strokes, leaving the skin feeling soft and radiant.
37

38. • Shiatsu
Shiatsu is a Japanese style of acupressure developed over 5,000 years ago.
Shiatsu combines the principles of traditional Chinese medicine with those of
acupuncture, but it is performed with finger pressure instead of needles. There are
a number of acupressure techniques, and Shiatsu is the most well known of these.
Shiatsu practitioners believe that our vital life force, ‘chi’, flows in
connected channels, or meridians, throughout the body. An organ's chi can be
accessed at certain points along the meridian. Shiatsu systematically stimulates the
body by pressing on specific points along these meridians. Finger pressure
stimulates the nerves and tissues, influencing the flow of chi.
Poor or blocked chi circulation causes disharmony in the body that may
show up as pain, emotional stress, depression, fatigue and disease. Proper chi
circulation along the meridians creates harmonious movement and balance
throughout the body.
Shiatsu stimulates the circulation and the flow of lymphatic fluid and the
hormonal and immune systems, releases toxins and tensions from muscles, and
acts on the autonomic nervous system, allowing deep relaxation and promoting
the body’s natural healing power.
During a Shiatsu treatment session, loose clothing is worn and no massage
oil is used. Shiatsu uses a combination of pressure and assisted-stretching
techniques, some of which are common to other therapies. Shiatsu is not
recommended for people with heart disorders, multiple sclerosis or cancer.
Shiatsu can promote a sense of well being, but it also has a number of
temporary side effects resulting from the blockages being released. Patients may
feel tired or emotional, or experience coughing, excess mucus or headaches, or
other pains and aches after treatment. In general, any such effects are considered
positive signs that the body is making an attempt to correct its own condition in a
natural way.
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39. • Sports massage / deep tissue massage
Increasingly, athletes and trainers are embracing massage as an integral
part of their athletic regimens. Massage can treat sore muscles, promote healing,
maintain health, and perhaps give an edge to competitive athletes by increasing
their range of motion and flexibility. Weekend warriors, gardeners, parents of
small children, and others who use their bodies in strenuous activities are also
discovering the benefits of sports massage.
Muscles, tendons and soft tissues can become stiff and sore for a variety of
reasons. These include over exercise, damage to tissue, a build up of waste
products and muscle spasms caused by reduced blood flow. Trigger points, or
stress points, are specific spots on a muscle or tendon that are painful when
pressed. Trigger points may be caused by falling or being hit, or they can develop
over time from stress and strain.
Sports massage often incorporates deep tissue techniques to work a
specific joint, muscle or muscle group. Deep tissue massage does just what its
name suggests: it reaches the deeper layers of the soft tissue. The practitioner uses
fingers, knuckles, elbows, opposing thumbs, the heel of a hand or foot, and the
forearm to reach these tissues. Pressure is applied gently at first and then becomes
stronger as the deeper tissues are reached. Very little lubricant is used since this
type of massage doesn’t travel generally over the skin, but is more focused on
specific points.
Regular sports massage can reduce the chances of injury by preparing the
body for exercise. It can also reduce the amount of recovery time between
workouts, improve flexibility in muscles and joints, and make the body more
efficient in processing nutrients and oxygen.
39

40. • Swedish massage
Swedish massage is one of the most well known and popular massage
techniques today. This full body treatment helps the body to cleanse itself of
toxins, relieves muscle tension, reduces stress, improves circulation and promotes
relaxation. It is often used for patients with stiff joints and is helpful in relieving
pain for arthritis sufferers.
Swedish massage was developed in the 1800s by Dutchman Georg Mezger
and later popularized by Per Henrik Ling, a Swedish fencing master and
gymnastics teacher. Different types of long, flowing strokes are used in Swedish
massage, usually in the direction of the heart. The patient is undressed and draped
for modesty and oil, cream or lotion is used to reduce friction against the skin.
Swedish massage often begins with effleurage. These are long, gliding
strokes meant to calm and relax the muscles. Petrissage are kneading strokes
applied using the palm or finger tips to roll and compress muscle tissue.
Tapotement is a rhythmic stroke applied with the heel of the hand or edge of the
palm that stimulates muscles and helps relieve cramped muscles.
Vibration, compression and friction strokes are also used to release tension
and reach deep tendons and ligaments. Friction can also help to reduce the
formation of scar tissue.
Because the skin is the largest organ of the body, massaging it with these
specific strokes can set up a chain reaction that affects all the body’s systems in a
positive way. It affects the muscles, nerves, glands and circulation systems to
promote wellbeing and good health.
40

41. • Thai massage
During a Thai massage, the whole body is treated to kneading,
manipulation, stretching, and very active involvement with the masseuse. The
masseuse uses elbows, knees, hands and feet to apply the massage, providing both
stimulation and relaxation.
Thai massage shares with other Asian healing practices the concept of
energy lines that run throughout the body. These are called ‘meridians’ in Chinese
medicine, ‘nadis’ in Indian medicine, and ‘sen’ in Thai. Traditional Thai massage
focuses on 10 points along the sen lines that contain important energy points. In
the northern style of Thai massage there are a lot of stretching movements, while
the southern style emphasizes acupressure.
In Thai massage, the recipient wears loose clothing and lies on a mat on
the floor. The massage practitioner leans on the recipient's body using hands and
usually straight forearms locked at the elbow to apply firm, rhythmic pressure.
The practitioner sometimes uses legs and feet as well. Oil is not used in traditional
Thai massage.
A full Thai massage session typically lasts two hours and includes
rhythmic pressing and stretching of the entire body. This may include pulling
fingers, toes and ears; cracking knuckles; walking on the recipient's back; and
manipulating the recipient into yoga stretching poses. There is a standard
procedure followed in Thai massage that is adjusted according to the length of
time requested.
Traditional Thai massage has been used for centuries to treat muscle and
joint pain, cramps, numbness, loss of strength and function, allergies and
emotional stress and tension. It is used now to help treat a wide variety of ailments
that include headaches, insomnia, high blood pressure, sciatica, low back pain,
diabetes, menstrual pain and more.
41

42. 7. Medical Tourism as a part of Health Tourism
Medical tourism or ‘global healthcare’ as it’s increasingly called, involves
travelling to a foreign country for a medical procedure. This industry has been growing
rapidly over recent years as more and more people seek faster or cheaper alternatives to
the healthcare offered in their own countries. Occasionally the medical procedure needed
is urgent, but more often it is an elective treatment such as cosmetic surgery or dental
care.
The number of people seeking healthcare in foreign countries now runs in the
millions each year. Most patients are Westerners attracted to the concept of quality
surgical treatment for a fraction of the cost they would pay in their own countries. After
receiving the medical treatment, the patients take a relaxing recovery vacation in the same
country. Often patients can pay for their surgery, flight and a week or two at a resort for
as little as a quarter of what they would have paid back at home.
Leading the medical tourism industry is India, with Thailand and Malaysia close
behind. India’s medical tourism industry grows around 30 per cent annually, thanks to an
aggressive marketing plan that focuses on all-inclusive package tours.
Thailand’s main institute is Bangkok’s renowned Bumrungrad Hospital, which
combines luxurious accommodations with world-class treatment. Bumrungrad Hospital
claims to treat more patients per year than any other facility in the world. Meanwhile
Malaysia promotes its many neighboring tourist destinations to match competitive rates,
internationally-trained doctors and excellent facilities.
The medical tourism industry has emerged in response to the incredibly huge costs
of having most surgical procedures performed in countries like the United States, Britain
42

43. and Japan. Without medical insurance, most Westerners have no chance of being able to
afford treatment, and sometimes even with insurance the costs are much higher than those
offered by Asia’s medical centers. Medical tourism has become big business for these
countries by offering realistic costs for patients.
Besides the obvious economic benefits of having your knee replacement surgery
done in a place like India or Thailand, one can enjoy a well-deserved vacation afterwards.
Depending on the nature of the medical procedure, patients can lounge on the beach or
visit the major tourist attractions of the country. If the treatment is more severe, medical
tourism hospitals such as Bumrungrad have accommodations that seem more like a 5-star
hotel than a hospital ward.
Popular elective medical services include knee or hip joint replacements, cardiac
surgery, cosmetic surgery and dental surgery. Patients in need of emergency procedures
are also attracted to this concept as the wait period for certain operations can take up to a
year or more in their own countries. Often they can have the procedure done immediately
in another country.
Medical tourism fills a valuable niche that is desperately needed in countries with
bureaucratically flawed or unaffordable healthcare. This industry looks set to expand at a
blistering pace over the next decade as more and more people begin to trust the quality
and see the advantages of having their surgery performed in developing countries.
43

44. 8. Risks of Medical Tourism
Looking at medical tourism from an economic perspective makes it easy to see
why this option is so appealing. Receiving quality, affordable healthcare from
internationally-trained doctors and surgeons in a relaxing resort atmosphere is a great
option. But patients considering medical travel should be aware that it does carry a few
serious risks.
The most common issue related to medical tourism is the quality of the medical
institution itself. It can be difficult to check the qualifications of the doctors,
anesthesiologists and other specialized staff at medical facilities which are privately-
owned and operated. This is particularly true with cosmetic surgeons, who almost always
have their own privately-run clinics.
It is absolutely essential that any medical tourist thoroughly researches the
hospital, clinic or institution where they are planning to have their procedure done. This is
best accomplished by scouring the internet, especially blog sites that provide firsthand
experiences and advice from others who have already completed the procedure. With a bit
of research reputable hospitals and clinics are globally well-known and easy to
distinguish from shady unqualified doctors.
The protection laws in a country are rarely enforceable in other nations. Patients
who receive poor or damaging medical treatment usually have no legal recourse.
Malpractice and negligence by either the individual doctor or the institution are very
rarely covered, leaving medical tourists left to fend for themselves. On other hand, it’s the
lack of expensive malpractice insurance prevalent in the West that helps keep costs so
low in these countries.
The issue of follow-up care is another thing to carefully research and consider
before choosing an institution for your medical care. Most medical tourism packages
provide very little, if any, follow-up care after your operation. Once you return to your
home country, any complications that arise will be more difficult to deal with. Again, this
is a particular concern with cosmetic surgery.
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45. The recovery vacation period so heavily promoted by medical tourism packages
can also carry certain risks. Depending on the extent of the surgery, travelling soon after
an operation greatly increases the potential for complications. Long air flights increase
the chance of swelling, blood clots and infection. Even sunbathing on the beach will
darken the scars.
The best solution here is to allow for plenty of time to recover in the country
where the medical procedure is done. Don’t assume you can really get out and about too
much during this vacation period. Rest is what your body will need, so choose calm,
relaxing destination for this vacation recovery period.
The bottom line is that medical tourism isn’t a perfect, guaranteed option.
Travelers will be out of their element both during and after the procedure, potentially
adding stress to the situation. Post-care varies widely between facilities, so do a thorough
check and carefully weigh the advantages of cost versus safety when making this
important decision.
Chances are, if you pick a reputable hospital or clinic you will have no problems
whatsoever. But as the medical tourism industry continues to grow at such a fast pace, the
inevitable quacks will become more prevalent.
9. Benefits of Medical Tourism
As the technology, doctor training and standards of healthcare in developing
countries has vastly improved in recent years, more and more people are looking at
medical tourism as an attractive solution to their health problems. The popularity of
medical tourism can be directly traced to the incredibly high costs of healthcare and long
wait periods for some procedures in many countries.
Medical tourism is not a new idea. Ancient Greek pilgrims used to travel to a
small town called Epidauria for treatment. This area was considered the sanctuary of
Asklepios, the god of healing, and probably the first medical tourism destination. Spa
towns were also considered medical travel destinations, especially in 18th century
England, where patients believed the healing waters of some areas could treat gout,
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46. bronchitis and other conditions. Today, Asian countries such as India, Thailand and
Malaysia are leading the way in the medical tourism industry.
Medical tourists come from all over the world, but most are citizens of Western
nations such as the United States, Britain, Europe, the Middle East and Japan. The most
obvious benefit for medical tourists is the dramatic savings in cost. A coronary artery
bypass at Thailand’s Bumrungrad Hospital costs around one-tenth of what it does in the
United States. Even more mundane procedures such as extreme dental work can be a
fraction of the cost in countries such as Thailand.
Another major benefit is the speed at which some surgical procedures can be
completed. The waiting period for a hip replacement in Britain, for example, can be up to
a year or more. A patient can fly to India, Thailand, Malaysia or the Philippines and have
the procedure done almost immediately. Since most of the doctors and surgeons in
medical tourism destinations have been well-trained internationally, patients can expect
quality healthcare at the reputable institutions.
Insurance is another factor in the decision to choose a foreign country for a
medical procedure. Some orthopedic operations, especially knee and hip replacements,
are often not covered by health insurance. As a result, orthopedic surgery has emerged as
one of the main treatments performed overseas due to the low cost and freedom to choose
where to have the surgery performed.
People who cannot afford health insurance simply have no choice but to travel
abroad for an expensive medical procedure. With an estimated 45 million Americans
currently uninsured, this creates a huge market for people needing affordable healthcare.
A final benefit is the pleasure of adding some travel and adventure to your
medical needs. For many medical tourists, a trip to Thailand or India will be a first. A big
component of the medical tourism industry is the relaxing vacation period following the
medical procedure. Medical tourism destinations promote this aspect just as much as the
quality and cost of their healthcare. In Thailand, patients can lounge on one of the
country’s many beautiful beaches during their recovery, while India offers some amazing
spa resorts where luxury and pampering is the focus. Up-and-coming South Africa even
promotes wildlife safaris as part of its medical tourism packages.
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47. 10. Medical Tourism in India
Popular For: Alternative Medicine, bone-marrow
transplant, cardiac bypass, eye surgery, hip
replacement
Visa Requirements: A valid passport and visa are
required.
India is a global leader in medical tourism, and one of the world’s least expensive choices
among medical tourism destinations. Focusing on heart surgery, India also attracts
patients with high quality dental care, Ayurvedic spa treatments and other medical and
alternative treatments.
Medical facilities at India’s leading private hospitals are excellent and state-of-the-art.
Despite the country’s reputation for poverty and poor hygiene, the value for money
offered here draws thousands of patients each year. Many visitors complement treatments
with a stay at an ashram where they can learn how to meditate or practice yoga from
experts in these ancient traditions.
Pros: The medical cost savings of having operations and treatments in India are among
the best in the world, with fees between a third and 10 percent of the equivalent procedure
in the US. Many doctors are trained abroad and hospitals attracting international patients
are on a par with those in the west with all staff being proficient in English. In addition,
India has many appealing options for recovery with costs for accommodation typically
low. The Indian health and medical industry is large and boasts some well developed
infrastructure, particularly in big cities such as Chennai, which support the wealthy
classes.
Cons: Although India has a rich legacy of cultural sites that attract tourists, it is not
practical to enjoy some of these sites while recovering. If anyone do venture out of a
sterile hospital environment expect to be exposed to bacteria that may cause a stomach
upset or worse. India gets extremely hot in the summer months, with temperatures
reaching 40°C at times. During the monsoons, water-borne diseases become a problem
too, so choosing a good time to visit is essential.
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48. 11. Alternative Medicine Treatments
• Acupressure
A traditional Chinese medical practice, acupressure is a technique based
on the belief that stimulation of certain points of the body can bring relief of
medical symptoms and their root causes. The practice is similar to acupuncture,
making use of meridians (channels along which the body’s life energy, or qi,
flows) to encourage the body to heal itself without need of drugs or surgery.
Acupressurists will diagnose a patient’s problem based on the description
of their symptoms and with little in the way of a physical examination aside from
checking the patient’s pulse.
The patient’s condition is, in Chinese medical terms, related to interference
in the natural flow of qi (pronounced chi) in a specific area of the body. An
acupressurist will attempt to address this interference by applying pressure to
specific points along the meridians with the hands, elbows or tools. The points
chosen may or may not be focused in the area where the patient’s symptoms are
located.
Acupressure can be used to relieve a wide selection of ailments and is
commonly reported to be successful in aiding those wanting to lose weight or quit
smoking. Many pharmacies sell acupressure wristbands designed to alleviate the
symptoms of pregnancy nausea or travel sickness, suggesting that there is some
mainstream acceptance of acupressure theory.
There is no scientific evidence to show correlations between acupressure
and health benefits. However, there is some acknowledgement within the medical
community of its benefits, with local GPs and medical specialists often referring
patients for acupressure treatment when conventional approaches have proved
ineffective.
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49. • Acupuncture
Acupuncture is a Chinese practice based on the principles of Chinese
medicine. The basis of the practice is the premise that the insertion of needles into
specific points in the body can bring relief and even the cure the patient of
physical ailments or disease.
While there is no scientific evidence to back up the benefits of
acupuncture, many doctors acknowledge that the practice may be capable of
aiding patients who have not experienced any success with the use of conventional
drugs or medical techniques.
Acupuncturists believe that a person’s medical condition and their
consequent symptoms are the result of a disturbance in the flow of qi (pronounced
chi and meaning ‘life energy’) in some area of the body. In order to address the
disturbance, practitioners insert needles into key point along meridians, which are
the channels that Chinese medicine believes are responsible for moving qi around
the body.
A patient may have pain or symptoms in a specific area of the body.
However, the acupuncturist may diagnose the root cause of the problem as being
located elsewhere and consequently needles are often inserted into areas other
than those where pain or visible maladies are present. The technique involves little
in the way of pain or discomfort although it can be time consuming, sometimes
requiring patients to endure lengthy periods with needles in their body.
Acupuncture can be used as a single approach to a medical condition but is
often combined with other elements of Chinese medicine for maximum effect. In
western countries, the practice has gained popularity among patients wishing to
lose weight or stop smoking. Irrespective of the treatment’s efficacy, it’s widely
accepted that acupuncture is safe and presents few side effects for those
undergoing treatment.
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50. • Aromatherapy
Popular among followers of alternative and complimentary medical
approaches, the principles of aromatherapy are several millennia old. Historians
believe that it was probably the Chinese who first developed the belief that
ingesting the vapors of oils derived from certain plants and their fruit can be
beneficial to both physical and mental health.
Although often under scrutiny from the conventional medical community,
aromatherapy is regularly practiced. The most common means of ingesting
essential oils is by inhalation. Oils are diluted with water and placed in an oil
burner, with a candle producing enough heat to cause the oil to evaporate. As the
vapors permeate the air, their effects may be felt by anyone in close proximity.
The alternative to this method is to add a small volume of essential oil to
base oil such as sweet almond and then apply to the body through massage. This
technique allows external ailments to be treated directly, as opposed to inhalation
which is intended to have a more general and systemic effect.
Oils can be used to treat a variety of complaints with inhalation said to aid
headaches, symptoms of common colds, stress, anxiety, insomnia and digestive
complaints. Topical application is allegedly efficacious in treating arthritis and
rheumatism, skin rashes and infections, warts, insect bites and minor wounds.
Some elements of aromatherapy have worked their way into mainstream
culture and consumerism. Nowadays it’s not uncommon to see essential oils such
as tea tree added to popular skin and hair care products. Lavender is widely
acknowledged for its calming effects and is commonly added to bath oils, pillows
and inhalers (aroma sticks).
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51. • Ayurveda
Also referred to as Ayurvedic medicine, Ayurveda (meaning ‘knowledge
of life’) is an alternative medical approach that originated in India. It’s uncertain
what period of history the philosophy was conceived, but historians speculate that
it’s probably several thousand years old in its simplest form.
Ayurveda is a holistic medical approach that considers both body and
mind and their relationship to each other when diagnosing and treating a patient.
The philosophy holds that we are all comprised of three essential abstract
elements or properties, which Ayurveda refers to as doshas. The three doshas are:
vata, pitta and kapha, and the degree to which each presides in us may determine
our physical and mental characteristics.
Ayurveda views disease and physical ailments as imbalances in the three
doshas, or the tridosha system as it is otherwise known. Treatment is therefore a
means of rebalancing the system and reestablishing harmony in the body. The
philosophy holds that this can be achieved through various techniques which
include the consumption of Ayurvedic herbs, the administration of special forms
of massage, the adaptation of a specific diet, the practice of yoga and regular
exposure to certain elements of nature.
Having long been popular in Asia, Ayurveda is becoming increasingly
popular in the west. Ayurvedic practitioners can assist with specialized treatments,
but patients need to be aware of the specifics of their own tridosha system and the
elements of their lifestyle that can aggravate it, in order to ensure that further
imbalances are not created.
The philosophies of Ayurvedic medicine have no scientific basis however
many Ayurvedic treatments are unquestionably profoundly soothing and relaxing.
The methods of purifying the body known as panchakarma are widely
acknowledged as having obvious therapeutic properties including improved
circulation; relief from pain, stress and insomnia; increased flexibility and
improved athletic performance.
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52. • Balneotherapy
Balneotherapy is an approach to the treatment of disease or physical
ailment involving bathing and stimulation of the body by water. The philosophy
takes into account the chemical properties of specific sources of water as well as
the effects of hot, cold and moving water. The name of the treatment is derived
from the Latin word ‘balneum’ meaning ‘bath.’
Balneotherapy can be administered at a variety of locations. However, it’s
often pushed commercially by spas which are strategically constructed at natural
sources of water that are rich enough in therapeutic elements such as silica, sulfur,
selenium, radium, arsenic, lithium, potassium, manganese, bromine and iodine to
be beneficial to those who bathe in them.
Due to a surge in popularity of spas, balneotherapy has come to mean
almost any treatment that involves water including the consumption of water and
the inhalation of vapors from waters rich in constituents deemed beneficial to
health. The application of mud and sand to the skin is also often classified as
balneotherapy.
Ingredients used to good effect in balneotherapy are not necessarily found
naturally in the water, with herbs such as chamomile, thyme, oak bark and walnut
leaves commonly added to warm waters to address specific medical conditions.
Balneotherapy is considered an alternative medical practice with little
specific scientific evidence to substantiate its benefits. However, there are few
conventional doctors that deny the physical and mental health benefits of bathing.
As far back as Roman times bathing was recognized for its healing properties and
this reputation has ensured that the practice has survived until modern times.
Today the affluent enjoy balneotherapy as a spa treatment while those with
circulatory, muscular and skeletal complaints among other ailments benefit from
the symptomatic relief it provides.
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53. • Chiropractic
Chiropractic is an alternative medical approach that was founded in the
USA in 1895 by DD Palmer. It focuses primarily on the body’s nervous, muscular
and skeletal systems, seeking to address mechanical dysfunctions through various
manual therapeutic techniques. While based on philosophies beyond the
boundaries of conventional medicine, chiropractic is practiced in more than 100
countries around the world.
Chiropractic treatment typically involves the practitioner manipulating
muscles, joints and soft tissues of the patient. Some emphasis is placed on the
spine and the belief that disorders associated with it can have a dramatic effect on
the nervous system and bring about a variety of complaints in different parts of the
body. More modern theories have concentrated on the relationship between
structure and function and its subsequent effect on the body’s neurological
mechanisms.
As one of the better-established disciplines of alternative medicine,
chiropractic is also one of the better regulated, with recognized certificates and
qualifications available in a number of countries. In the US, chiropractic is the
largest alternative medical profession with some 70,000 practitioners in operation.
Numbers are also significant in the UK and Australia with approximately 2,381
and 2,500 chiropractors operating in these countries respectively.
The most common therapy in chiropractic is spinal manipulation; however,
there are a variety of other treatments frequently used including: ice
pack/cryotherapy, trigger point therapy, corrective or therapeutic exercise and
extremity adjusting.
Practitioners in the chiropractic industry remain divided over certain
chiropractic philosophies. Traditionalist chiropractors adhere rigidly to the
principles established by the founder of the original movement while other
practitioners offer treatment based on a combination of chiropractic, conventional
medical, osteopathic and naturopathic principles.
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