By Godfree Matthew Esq.
ABSTRACT
The effects of COVID 19 pandemic on humanity exceeded the bounds of class, creed and status. The low and the high, the mighty and weak are affected. The restrictive measures taken in combating COVID 19 pandemic had affected the rights of Nigerians to access medical treatment abroad.
This becomes worst considering the facts that many of these Nigerians patients or clients might have engaged the services of health institutions and personnel abroad. In the same way, there are other Nigerians who developed serious health challenges which erupted during COVID 19 pandemic that cannot be address within the Nigerian municipal health industry. Thus, even where the patients are intended to seek medical attention abroad, there are prevented by COVID 19 pandemic. Couple with this development, was the challenge of sound scientific means of distant communications between the Nigerian patients and their foreign health care personnel. It was these developments that give birth to this work. Therefore, this work had established that medical tourism was a recognized legal concept under Nigeria’s law. It was also the findings of this work that, in light of the COVID 19 saga, the need for telemedicine was necessary to bolster the efficiency of Nigeria’s health sector. In achieving the aims of this work, the writer relied on the use of statutes, case laws and authoritative textbooks. Journals and periodicals are also resourceful in the cause of this work.
INTRODUCTION
The advent of COVID 19 pandemic into human affairs altered the conventional/conservative ways of doing things. The pandemic has put every aspect of human activities to a standstill. These ultimately affect a lot of endeavours that are connected with human interactions and movements. Due to these developments, the health care industry and medical treatments of Nigerians were greatly affected. As such patients cannot access their foreign doctors for treatment. In some instances even access to municipal doctors in another state for follow up was a challenge due to the restriction of movement. This affects the patients’ rights to access medical treatment of their choice. It is from this angle that this work suggests the need for the deployment of telemedicine in Nigeria’s healthcare sector. Therefore, this paper is divided into four parts.
The first part deals with the conceptual clarifications of medical tourism. Here the definitions and types of medical tourism are discussed. This part of the work also discussed the reasons why people embarked on medical tourism. In the second part, the writer discussed the legal basis for medical tourism under Nigeria’s law. In the third part of the work, the writer examined the concepts of telemedicine and its legal root under Nigerian laws. Here, the focus is on the meaning, functions and the legal roots of telemedicine in Nigeria. The fourth part of this work recommends steps that should be taken to bolster the use of telemedicine in promoting medical tourism. It is the aspiration of the writer to contribute to knowledge and influence policy formulation in medical law and health care industry in Nigeria.
MEDICAL TOURISM DEFINED
There are several attempts to define what constitutes medical tourism among health scholars. Nevertheless, in all these attempts medical tourism is sum up to mean going out for medical treatment by patients outside their country to another state. It is defined as the process of travelling outside the country of residence for the purpose of receiving medical care.[1] It is also defined to mean a situation when people elect to travel across international borders to receive some treatment.[2] To scholars like Pollard, a medical tourist is someone who travels outside his or her own country for surgery or elective treatment of a medical condition.[3] Treatment outside one’s country is called medical tourism because after treatment patients are allowed sometime to embark on sightseeing, visits to historical sites and other acts of familiarization tour.[4]
From these definitions, a common denominator is the desire of the people to seek medical treatments outside their country. It is usually done in search for better health care delivery systems. Some of the medical services rendered to medical tourists include surgery, cosmetics treatment, physiotherapy and other diseases whose panacea/treatment are not adequately available at the municipal state.
CATEGORIES OF MEDICAL TOURISM
There are two types of medical tourisms.[5] These are international medical tourism and domestic medical tourism. International medical tourism refers to a situation where people travel outside their country to receive medical treatment. International medical tourism is further divided into two: (a) outbound medical tourism and (b) inbound medical tourism.[6]
Outbound international medical tourism occurs when a patient travels from his country of origin to a foreign country for treatment. Examples, under this category could include Nigerian patients who travel to India for treatment or Americans leaving Nigeria for treatment in United States. In the inbound medical tourism the patients travel from foreign country to their home country for medical treatment. Examples under this category include instances where Indians, Canadians or Americans living in Nigeria return to their home country for treatment.
International medical tourism is usually resorted to where the patients are likely to be treated with better facilities and sound health care management than what is obtainable in their state of origin or domicile. It is motivated by the quest for better health care personnel and sound health technologies available in the visiting country.
On the other hand, domestic medical tourism refers to a situation where people travelled within their country of origin for treatment.[7] It usually occurs where people travel from one part of the country to another for medical treatment. This is usually due to push and pulls factors associated with the availability of quality health care services. For example, in Nigeria medical tourisms can be seen by the influx of many people coming for medical treatments from one part of the country to Lagos, Abuja, Port Harcourt, Kano, Jos, Enugu and other states’ capital. This is mostly necessitated by poor health infrastructure at the rural and the semi -urban areas.
REASONS FOR MEDICAL TOURISM
There are many reasons why people resort to medical tourism. Some of these reasons include cost, dissatisfaction with medical treatments at home, the rise of advanced medical care in developed countries, access to the latest technology, inadequate health care industry at home and desire to get medical treatment away from home.[8]
Cost is one of the reasons why people go out for medical tourism. In some advanced countries medical bills are expensive. Because of this citizens found it convenient to go for medical tourism abroad in order to reduce cost. For example, most Americans are known to travel for medical tourism despite their technological advancement due to high cost of treatment.[9] This is because United States is one of the places on earth where medical treatment is expensive.[10] Thus, many Americans have cause to travel outside the United States for medical treatment because they will pay less.
There is usually a general assumption that medical tourism is a trend attributed to the citizens of third world countries. However, it is now discovered that even the people in advanced countries sometimes resort to medical tourism in less developed countries. For example, among the top 10 countries which are the global centers of medical tourism, the developed countries of the world like United States, China, Russia and Britain, are not included by some researchers.[11] Therefore, if medical tourism is only a trend patronized by the developing countries, one will not expect citizens of US and other develop countries, to go for medical tourism in countries that are less developed than theirs’.
Moreover, people resort to medical tourism because of their disappointment with the health care system of their country.[12] This is evidenced in the neglect by the government to update and equipped the health facilities of such countries. Aside from this, there are series of industrial dispute among health care professionals.[13] Coupled with these is unprofessional and incompetence of the health care professional. Many cases of surgery are preferred to be done outside than in the host country of the medical tourist.
Again, medical tourism is the access and availability to latest technology and specialized treatment than what is obtainable at the patient’s home state.[14]In some of these destinations of medical tourism, there are highly specialized in specific aspects of medicine. For example, India is becoming a healing haven for patients in need of cardiac and orthopedic surgeries.[15] Medical practice in Singapore developed a sound specialty in hematology, oncology, neurology and stem cell therapy.[16] South Korea is known for specialty in organ transplantation and cosmetic surgery. Their equipments are highly digitalized and they deployed the use of electronic health records.[17]
Bulgaria has one of the lowest prices of treatment. In addition to this fact, Bulgaria has a mineral and thermal springs which are natural remedy for rheumatism.[18] Some of these springs that have therapeutic effects are Korali complex, situated the end of the river Pancherevo Canyon. Researchers posit that it has healing impacts on nervous system.[19] The other spring is Pchelinski Spring which is believed to have healing powers on locomotors apparatus, periphery nervous system, gynecological and infectious diseases.[20]
Another natural site for medical tourist in Bulgaria is the DOLNA Banya mineral complex which treats digestive, respiratory, cardiovascular and reproductive system.[21] The other mineral springs is situated in a village called Chiflik which is believed to heal liver, kidney, digestive and neurological diseases.[22]
A further reason why people travel for medical tourism is the desire for exploration. Many people, who might not have travelled out of their country, might use medical tourism as an opportunity to travel outside. It is believed that this will add to their travelling profiles. To this category of persons, they are not conscious of the cost associated with the travelling. Since developed countries easily granted visa for medical reason, many people prefer to use medical tourism to travel outside.
LEGAL BASIS OF MEDICAL TOURISM IN NIGERIA
It is factual that majority of Nigerians detest the term medical tourism because of two things.[23] In the first place, medical tourism is deemed as the elitist approach of accessing quality health care system. By doing so, they have neglected the development of their municipal health care industry which is resorted to by the majority of the poor. Secondly, Nigerians detest the term because it is affiliated with capital flight and corruption.[24] However, while social critics may abhor medical tourism because it is a privilege of the few to the detriment of many, the law is balanced in its regulations of medical tourism. This is seen in the manner Nigerian laws regulates and supports medical tourism. By doing so, the Nigeria law has accorded medical tourism the status of legal right accrued to any Nigerian who can afford it.
Medical tourism is legally recognized under Nigeria law from two sources of law; case law and legislation. The case law that recognizes the rights to medical tourism is the case of Shehu V Afere.[25] In this case, the court upheld the rights of any citizens to seek for medical treatment anywhere in the world provided he can afford it. On the unfettered right of a person to choose the hospital he likes, the court held that a person is entitled to seek the best medical treatment to save his life provided he can afford to pay for it. This position is stated in the dictum of Opene J.C.A (as he then was) when he held that:
The appellants had argued that it was absolutely unnecessary for the 2nd Respondent to proceed to Belgium and U.S.A for treatment while there are medical facilities for his treatment in Nigerian hospitals and that the alleged medical expenses abroad are unreasonable. I must observe that if there is anything that is unnecessarily that is the appellants’ argument that is completely unreasonable. ……..I am of the view that 2nd respondent or any other person is entitled to seek the best medical treatment to save his life anywhere provided he can afford it. [26]
From the above dictum of His Lordship, Opene JCA (as he then was), it is a settled law that a patient can seek medical treatment abroad provided that he can legitimately afford it. This further means that patients in Nigeria are at liberty to go to any part of the world for treatment once they can pay for their trips and medical bills. It is from this judicial authority that medical tourism is said to be a legally recognized right under Nigeria medical law.
About 16 years after the decision of Court of Appeal (Kaduna Division) in Shehu V Afere (Supra), the Nigerian legislators enacted a law legalizing right to medical tourism. The law that provides for right to medical treatment abroad is the National Health Act, 2014. This position is provided under section 46 of the National Health Act, 2014 which provides that:
Without prejudice to the rights of any Nigerian to seek medical check-up, investigation or treatment anywhere within and outside Nigeria , no public officer the of the government of the federation or any part thereof shall be sponsored for medical check-up , investigation or treatment abroad at public expense except in exceptional cases on the recommendation and referral by the medical board and which recommendation or referral shall be dully approved by the minister or the Commissioner as the case may be.
From the above provisions it is clear that an ordinary citizen of Nigeria has unfettered rights to seek medical treatment abroad or to seek for medical treatment from one state to another. However, by the above provisions, medical treatment shall not be used as perquisite of office. As such public officers are prohibited from using public funds to embark on medical tourism. They can only be permitted to embark on medical tourism in exceptional circumstances which is approved by the Commissioner or Minister of health or other medical authorities by giving referrals or recommendations for treatment abroad.
Flowing from the expositions above, it is settled that medical tourism is a right recognized and protected by law. This is because both case law and legislation provides for the rights to medical tourism. However, despite the legal provisions for the right to medical tourism, Nigerians were drastically affected by the COVID 19 pandemic. The ways in which COVID 19 affects medical tourism will be examined in the next part of this work.
HOW COVID 19 PANDEMIC AFFECTS RIGHT TO MEDICAL TOURISM IN NIGERIA
COVID 19 pandemic affected medical tourism in Nigeria through the restriction of movements and lack of effective telemedicine. Restriction of movement during COVID 19 affects the rights of many Nigerians in diverse ways. There are those who might have been on referral to visit certain hospitals abroad for treatments. These classes of persons are left at home to continue with their plights and some ended up dying. [27]
Again, there are those who might have booked for medical tourism but are affected by COVID 19. To such persons, their contractual obligations with the foreign hospitals subsist, even though; they have not travelled to the destination of their contract. Their contract is still executory. As the prospects for the enforcement of such contract is optimistic. It is only frustrated by COVID 19.[28]
Also, the other classes of persons who were affected by COVID 19 pandemic are those seeking for medical tourism within Nigeria. The restrictions on inter-state movement really affected patients in rural areas or semi-urban areas. Some of these patients have appointment with doctors in the big cities like Lagos, Abuja, Kano, Jos, Enugu and others. Thus, the rights for medical treatment to attend to the patients are stultified. The rights for medical follows up is also affected as patients are also affected by the COVID 19 pandemic.
The other categories of persons affected are those whose treatments are interrupted by the breakout of the pandemic. These categories of persons are those who are hard hit because COVID 19 interfere with their course of treatment. They may be having returned date but cannot be able to go back for medical tourism because of restriction.
Again, when doctors treat patients and they returned to their native country, there is a problem of follow up- whenever the patient develops later infections associated with the surgery.[29] In a situation where a patient who undergoes surgery but later developed infection resulting from the operation conducted from medical tourism, he definitely needs follow-ups from the doctor abroad.[30] In the same vein, patients who are undergoing treatment with foreign doctors outside Nigeria are entitled to follow-up treatment. But due to COVID 19 pandemic, this became impossible. Thus, there is a disconnection with the chain of treatment between the patients and their doctors.
The above challenge of follow up should have been better addressed if Nigeria has robust telemedicine infrastructure. It is from this ground that the concept of telemedicine became a desideratum in the lights of the COVID 19 pandemic.
Other challenges relating to medical tourism include barrier in communications, the risk of the patients travelling via plane and the ubiquity of anti-biotic resistance.[31] Language that is not properly understood may lead to misinformation which may affect the treatments. Also after treatment the patients are likely to fly back to their home countries. Experts opined that the situations associated with flight can increased the risk of blood clot.[32] The fact that resistant bacteria may be prevalent in one country than another is another challenge of medical tourism. For example the bacterial resistance in US may be different from the resistant level in Nigeria.
It is important to note that there are patients who lost their lives due to the restriction on international movements. They died because the health care system in Nigeria cannot address their health needs. They became circumstantial victims of COVID 19 pandemic in Nigeria. It is believe that if Nigeria’s health care system is adequately attended to, this menace might not have been that monumental. It is from this background that sound modern health facilities needed to be the priority of Nigerian government. This in turn placed the need for telemedicine in promotion of medical tourism. It is from this prism that the next part of this work discusses the necessity of telemedicine.
THE NECESSITY OF TELEMEDICINE IN PROMOTING MEDICAL TOURISM IN NIGERIA
The word telemedicine is defined in several ways to mean the same thing. The Advance Oxford Concise Medical dictionary defines telemedicine to mean the use of information technology in the diagnosis and treatment of patients.[33]By this definition, telemedicine includes the use of telephone between doctors and patients during clerking as well as the use of telecommunication between doctors when engaging in particular treatment.[34]
Also, telemedicine is defined as a process that requires the management and practice of distant medical treatment of patients by general practitioner and specialist.[35] It is meant to ensure effective distant support and assistance a medical practitioner can render to a patient who is far away from him.[36] It is from this point that it is termed as distant healing.
Telemedicine is a broader branch of e-health that relies on the use of Information Communication Technology for exchange of information between doctors and patients, sharing of knowledge, prescriptions of treatment and other related healthcare services.[37] It can be conducted via live proceedings by the use of video conferencing among members of a patient’s health-care team. This is known as synchronous method.[38] Video-conferencing may be complimented by use of diagnostic devices such as electronic stethoscopes, otoscopes, dermatoscopes etc,.[39] It can also be conducted via telepathology- a process where digital pictures of micro slides can be sent by the internet to a pathologist for a further opinion or input. This procedure is known as asynchronous method.[40] It is also from this perspective that telemedicine is also known as e-medicine.[41]
REFLECTIONS OF TELEMEDICINE UNDER NIGERIAN LAWS
Nigeria laws recognize the use of telemedicine in the course of treatments of patients. Some of these laws include the National Health Act, 2014, Code of Medical Ethics, 2008, and the World Medical Association (WMA) Statements on Ethics of Telemedicine, 2018.
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The National Health Act provides for the uses and classifications of health technologies in hospitals. It also provides for the use of such technologies based on the demographic, geographical and special needs of the people within that locality.[42] It is meant to address the health needs of the people when circumstances arise. However, before any health establishment should be used it must obtain a qualifying certificate known as Certificate of Standards.[43] It is this certificate that validates the states of the technologies that will be deployed in treatment of patients. Failure to obtain certificate of standard is an offence punishable with the fine or conviction or both.[44]
Telemedicine is also reflected in the provision of sections 27, 28 and 29 which deals with access to health records of patients. In that process, the law also enjoined all health recorder officers to ensure that access to the information of patients are protected from interference with third parties, either as hackers or interlopers. It is for this reason that the law prohibits any person to connect any part of computer or any electronic device in which information are store- whether through hard or soft ware, from within or from distance.[45]
Another law that validates the use of telemedicine in Nigeria is the Code of Medical Ethics, 2008. The Code in section 22 provides for the necessity of telemedicine in the following words:
Telemedicine, a professional opportunity outcome of modern advances in computer and telecommunications technology is steadily creeping into professional practice in Nigeria.
It is medicine requested and practiced at distance, and it is particularly useful for patients’ care and management by general practitioners and specialists in accessing tele-support in their daily practices on the basis of requirements for specialists’ consultation in various specialties of medicine and dentistry.
The import of the above provision is that telemedicine is an integral part of medical law and practice in Nigeria. As such it applies on doctors in the treatment of their patients and clients’ counseling. It is a clear confirmation that the use of information and communication technology (ICT) is a legal and medical fact in Nigeria. As such doctors are enjoined to follow the laws as prescribed by the Code of Medical Ethics, 2008.
Another aspect of the law that governs telemedicine in Nigeria is the World Medical Association on the Ethics of Telemedicine, 2018. This soft law mandates the use of telemedicine as an international practice. It stipulates ethical guidelines to be respected by physicians while using telemedicine. Some of these ethical issues are respect for the autonomy of the patients, protecting and securing the privacy of the patients as well as duty of care and diligence in the treatment of their patients. [46] This international instruments directs that all medical practitioners to apply and abide by the ethics of telemedicine at their home countries.
From the above expositions it is glaring that the use of telemedicine is statutorily justified. It is also a fact that in line of the COVID 19 pandemic, there is the need to utilize these available provisions of the law in promoting medical tourism both abroad and at home. Doing so will be an apt remedy to the plights of patients on medical tourism whose treatment was interrupted by COVID 19. It is from this viewpoint that one should look at why the use of telemedicine should be strengthened in Nigeria health sector.
WHY TELEMEDICNE IS A NECESSITY IN NIGERIA
From the previous aspects of this work the needs for telemedicine has been raised in one way or the other. Therefore, in this session of the work, the writer will examine the reasons why telemedicine is necessary in Nigeria’s health sector in the light of COVID 19 pandemic.
One of the reasons for the need of telemedicine is to ensure the scientific advancement of Nigeria in the health care sector. Having sound and updated health technologist will ensure and promote the development of domestic health care system by Nigeria government. This is because in this modern age the development and civilization of any country is gauged by the degree of its technological advancement.
The use of telemedicine will be necessary considering the restrictions of movements both international and inter-state. Therefore, patients who have made arrangements to go outside Nigeria for treatment, but were restricted can resort to telemedicine. This can be done by collaboration between a foreign hospital through the use of virtual treatment by using media like zoom, Skype, video conferencing and other means. Those who are affected within Nigeria can resort to use of virtual treatments too. However, it is important to note that while telemedicine is statutorily recognized, it is faintly reflected in Nigeria health care system.
Closely related to the above is the fact that deployment of telemedicine will reduced the tendency of doctors’ physical contacts with patient. This will in turn reduced the tendency of human to human transmission of COVID 19. This is because through either audio or video tele-conferencing doctors can prescribe drugs, instruct patients and direct other incidental health tips. Therefore, it is only through the use of telemedicine that the social distancing can truly be observed between doctors and patients. Thus, the use of telemedicine will reduced the proliferation of the COVID 19 index in Nigeria.[47]
Telemedicine will be of help to the rural populace. In the first place, it will help in reducing the influx of people from rural to urban areas. It will also extend and take treatment to the people at the grassroots. This became of further importance because there are some parts of Nigeria that are too remote to be accessible. In relation to COVID 19 pandemic, telemedicine is resourceful in enlightenment programmes. Instead of health personnel travelling from one end of the state by the use of telemedicine, health talks and awareness can be created to the large number of persons without reaching out to them in their physical setting.
In country like Nigeria, where computer literacy level is low,[48] it will be nice to strongly advocate on the practice of telemedicine. This will increase the frontiers of knowledge of information and communication technology to doctors, patients and the society at large. This will in turn bolster virtual literacy in Nigeria.
Globalization is another reason why Nigeria should strengthen its telemedicine architecture. The world is in digital era now. Less emphasis is given to human efforts in state of affairs. Humanity is joined together by the rules of complex web called internet- thus, the phrase ‘global village’. In the same way, by practicing telemedicine Nigeria can easily collaborate with other jurisdiction that have rich practice in telemedicine. Through this, medium Nigeria will be able to exchange mutual benefits with other countries. If Nigeria’s telemedicine industry is sound, the so –called 15 Chinese doctors might not have visited Nigeria for treatment and enlightenment. All that would have happened is for the countries to maximize the digitalization of their telemedicine.
THE WAYS FORWARD
It is factual that COVID 19 pandemic has wreak a lot of havoc on Nigerians. Pertinent among these negative impacts is the restriction on the right to medical tourisms both at national and international life. Despite the restriction caused by the COVID 19 pandemic there is still hope for the living. Thus, in order to be equipped with antidote against further pandemics or any health hazards of similar effects like COVID 19, this work suggested some measures that need to be taken. These measures are discussed in the subsequent paragraphs.
The first thing to do is to reduce the tendency of Nigerian going for medical tourism. This can be done by developing sound and updated health care industry with well trained and remunerated staff. The health equipments needed include advanced equipments needed in telemedicine service that are legally permissible in Nigeria.
In line with the above, the use of telemedicine now requires diplomatic engagements. Diplomacy here is through collaborations and cooperation among member states. It could be done through regional or sub- regional cooperation. A typical continental paradigm on telemedicine that is worthy of note is the Europeans Brussels Treaty (2020).[49]
The Brussels treaty is a Convention that allows European countries to adopt the practice of interstate telemedicine among member state.[50] Thus, once a doctor who is qualified and registered in UK (then) can practice telemedicine to his patient in France.
By Brussels treaty all medical practitioners who are from member states can practice anywhere in Europe.[51] It is for this reason that articles 3(1) of the Brussels treaty clearly provides that once a doctor is assessed and accredited by the country of his origin he is qualify to treat a patient anywhere within the EU member states.[52] By doing so it is assumed that the said medical practitioner has complied with the rules governing EU on telemedicine. As such, it is right to say that membership of the states parties to the Brussels Treaty confers on doctors the unlimited jurisdiction to practice anywhere in Europe.
The European Union model with respect to telemedicine, as provided by the Brussels Treaty, is commendable. As such Africa and other regional blocs should emulate this model of telemedicine. This could be done at continental, regional and sub-regional levels. Such treaty could be done in the level of diplomatic engagement between two or three countries whereby citizens of such countries can benefit from telemedicine.
Also foreign health care centers should liaise with renowned hospitals in the host country of their patients. There should be referral by foreign hospitals for follow-ups at the residents of the patients seeking medical tourisms. This will address the challenges of the risks posed by COVID 19 pandemic. Since patients cannot travel out, they can be treated in hospitals referred to, by doctors from their states of origin.
CONCLUSION
This work addressed the plights of patients who are on medical tourism and those intending to do same. It is structured into four parts. In the first part the work deals with the basic concepts of the subject matter of the topics life definitions, classifications and reasons for medical tourism. The second part discussed the legal justification of medical tourism under Nigeria’s law. In the third part of this work, the writer discussed the necessity of telemedicine in promoting medical tourism in Nigeria. The work also discussed the legal basis of telemedicine and examined why it is necessary to combat COVID 19 pandemic in Nigeria. The fourth part of this work, deals with the suggested ways on how to promote medical tourism through the use of telemedicine.
1.Tomislav Mestrovic, “What is Medical Tourism?”,News Medical Life [email protected]/amp/health<accessed on 1stJuly,2020 >
2.Medical Tourism,-Definition, History, Types, Importance, Issues and Challenges@https://tourismnotes.com>medical-t..<accessedon1st July, 2020>
[4]. Tomislav Mestrovic, Loc Cit
5.MedicalTourism: Types and Options-Medical Tourism Articles|myMEDholiday ,October,[email protected]>medical…<accessed on July,18th, 2020>
8.See”TopTen Reasons for Medical Tourism| Employee Benefit News@https://www.benefitsnews.com>top-…<accessed on July 17th,2020>
9.DalenJ.E, ”Medical Tourists: Ingoing and Outgoing “,American Journal Of Medicine,@P.1@https://www.amjmed.com>pdf..<accessed on July 17th ,2020>
- .According to the Report of the year 2019,the Top Ten Countries that are centers of global medical tourism are (1)Thailand(2) India (3) Brazil( 4) Malaysia (5) Turkey (6) Mexico (7) Costa Rica (8) Taiwan(9) South Korea and (10) Singapore. See”10 Best Countries For Medical Tourism(Updated 2019)@https://wotmed.com.blog<accessed on 2ndJuly,2020> Also, the top 5 countries with high medical tourism includes only one European Country .See Scot t Louise, “Top Countries Best Known For Medical Tourisms”. https://www.oceanairtravels.com<accessed on 2nd July,2020> However, there are other statistics that include Germany, Spain, Israel, Switzerland, Ukraine and Italy as one of the tourist haven of the world. See Fahad Mawlood,”10 Best countries for Medical Tourism- Top destinations for Treatment”,Updated26/11/2019. All these countries listed are not reckoned with as the highly advanced countries compare to US, China, Japan, France etc.
12.Abubakar Mohammed, Bairu Salawu, Oluyemi Joseph, Abdullateef Raji Atolagbe Emmanuel and Kadiri Kehinde, “ Medical Tourism in Nigeria :Challenges and Remedies To Health Care System Development”IJODEMAR,VOL..13.NO.1 JUNE,2018,Pp226-227
[14] Scott Louise, Loc Cit
[15] Ibid
17.Ibid.Also See”10 Best Countries For Medical Tourism(Updated 2019)Loc Cit
18.Darina Grogorova, “Bulgaria’s Most Famous Springs Now Open In Winter”Tourism.@http://www.bnr.bg.>post.>bulgaria… ..<accessed on July 17th ,2020>
19.Ibid.See also, ”Kalina Varbanova and Terry Boyd, “Bulgaria is sitting on a gold mine of spas, mineral springs and holistic health centers”,by dispatcheseuro,21,October,2016@https://dispatcheseuro.com>spa-…<accessed on July 23,2020>
[23] Abubakar Mohammed, Bairu Salawu, Oluyemi Joseph, Abdullateef Raji Atolagbe Emmanuel and Kadiri Kehinde, Loc Cit
26.Ibid@Pp145-156 Paras. HC
- This author knows of a prospective patients whose arrangement for medical tourism to India for Kidney Transplant was truncated by the COVID 19 pandemic. The patient later died.
- The position of law in most common law jurisdiction is that where a contract is frustrated by the force Majeure, parties who might paid money had the right to recover the money. This is the judicial remedy. However, the parties can resort to non judicial remedies , by extending the scope of the timing of the contract. On the alternative, parties can cancelled the previous contract and substitute with a new contract. this is known as novation. See Grover V International Textile Ind.(Nig.) ltd (1976) LPELR -1342 (SC). See also Wigwe & Partners, “The Effects of COVID 19 Pandemic on Contractual Obligations”, April 2nd, 2020@https://wigweandpartners.com>news<accesssed on July 21,2020>
- ScieceBeta,“10 Hidden Dangers of Medical Tourism”@https://sciencebeta..com>medical-to..<accessed on July 21st,2020>
31.Traveller’s Health,” Medical Tourism : Getting Medical Care in Another Country”, CDC@htpps://wwwnc..cdc.gov.travel>page<accessed on the July,21,2020>
33.Oxford Concise Medical Dictionary, 8th Edn (Oxford University,Press,2010) P. 720
[35] R.K.Gorea,”Legal Aspect Telemedicine: Telemedical Jurisprudence: Editorial”,JPAFMT,2005:5.ISSN [email protected]
[36]. Peter Obute, “ICT Laws In Nigeria: Planning and Regulating A Societal Journey into the Future”, PER, 2014, Vol. 17 @ Pp.420-426.
37.C .Jack, “Informed Consent for Telemedicine in South Africa: A survey of Consent Practices among health care professionals in Durban, KwaZulu-Natal” SAfr J BL 2013;6-2,P.55
[41] Global Observatory on eHealth series-Volume 2” Telemedicine Opportunities and Developments in Member States” 2010p.8@ www.researchgate.net /publicationPdf. ..<accessed on July 17th ,2020>
42..Section 12 of the National Health Act, 2014.
43.Section 13 of the National Health Act, 2014.
44..Section 14 of the National Health Act, 2014.
[45] Section 29(2) (i) of the National Health Act ,2014.
46.See Principles 1 to 10 of the WMA on the Ethics of Telemedicine, 2018.
- X Song,” The Role of Telemedicine During the COVID-19 Epidemic in China-experience from…@http://ccforum ..biomedcentral.com<accessed on July 20, 2020>
48.Joseph Olayanju Akinwale, ”Assessment of ICT Literacy Needs And Competency Level of Pre-Service Teachers in University of Lagos”, Vol. 1 No.1 Pp. 12 and 13 (2017) International Journal of Innovative Technology Integration in Education,pdf@https://ijitie..aitie.org.ng>ijitie>view<accessed on July 20, 2020>
- It is also known as” Commission Staff Working Document: on the Applicability of the existing EU Legal Framework to Telemedicine Services”
[50].William Ferreira, Adilene Rosales and Hogan Lovells, ” Deciphering International Telemedicine Regulations”, April 14,[email protected]|legal news<accessed on May 25, 2020>.
[51] . William Ferreira, Adilene Rosales and Hogan Lovells, Ibid
