Travel with a purpose

Despite the obvious pause caused by Covid-19, travel in general has begun to bounce back to near pre-pandemic levels and the thirst for it shows no sign of slowing down for some time yet. Nowhere is this more evident than the quest for travel with a purpose, this is to say travelling with a specific purpose in mind other than leisure.

Medical travel, and specifically fertility travel are two prime examples of how people are turning to travel with a purpose to address medical needs rather than seek solutions in their home country. The reasons for travel are numerous and include waiting list time, access to specific treatments, cost and success rates. One thing is certain, more people are travelling for medical reasons, and are prepared to travel long distances to access them.

So-called ‘fertility tourism’ is a term which developed shortly after the birth of the first IVF baby in Britain just over forty years ago. As this medical triumph was replicated in other countries, more treatment providers started to open up the doors not only to domestic, but international patients. Over four decades later, you will find at least half a dozen fertility clinics in any developed country offering a dedicated service to patients living outside its borders.

In the U.K., the birthplace of modern day IVF we have witnessed major shifts in the domestic fertility market. A number of medium and large groups have grown their own clinics and invested in others, so much so that, over 60% of all clinics regulated by the Human Fertilisation and Embryology Authority (HFEA) are now owned by such groups. Despite an increase in the number of large clinic groups in the U.K. there is still an apparent gap between demand and supply, particularly when it comes to specific types of treatment.

Those patients seeking treatments involving donor treatments are most likely to look abroad in the first instance. Research carried out by the International Fertility Company (IFC) in 2020 suggested that over half the people that travel from the U.K. do so to access egg, sperm or embryo donor treatments. The reasons for this are numerous but certainly supply is one of the major drivers for travel. Anecdotally across fertility forums and platforms, patients vent their frustrations about donor availability in the U.K. and the waiting lists they face; high costs and the fact that it is no longer possible for individuals to donate sperm, eggs or embryos anonymously in the UK.

It is not surprising therefore that the numbers travelling in search of donor treatment continues to rise. The 2020 research from IFC highlighted access to larger numbers of anonymous donors; cheaper and quicker treatments being key for those patients who travelled.

Donor International has been set up to help patients access competitively priced and quality driven donor treatment. Essentially matching availability with need, its online platform showcases donor treatment options in different countries. Founder and Chief Executive of Donor International Eddie Kuan explains,

“Our ‘One-Stop’ platform gives Individuals and Couples access to over 170 centres worldwide and thousands of donors. With affordability in mind all our Donor International Partner Clinics give preferential treatment pricing and free initial consultations if booked through Donor International”.

In 2005 the U.K. embraced a change in the law relating to egg, sperm and embryo donors. Any baby born as a result of such a donation from 2005 onwards would now, at the age of 18, be legally entitled to find out who their donor was. Whilst this change was welcomed by many, inevitably there are individuals and couples who are dependent upon donor intervention and who wish to keep donor information anonymous. U.K. patients seeking anonymous donors therefore now need to travel to countries in which this remains legally possibly like Spain or Greece.

The Covid-19 pandemic has impacted on the numbers of U.K. patients seeking to travel for treatment in particular by creating an NHS backlog. According to the latest NHS figures over 7 million people were on the waiting list for treatment in England alone with over 400,000 waiting over a year. NHS waiting lists are forcing patients into the private sector in greater numbers than ever before. The Private Healthcare Information Network highlights the number self-paying patients accessing private acute care has gone up by more than a third compared with before the pandemic.

The level of NHS funding for fertility treatment varies considerably across the UK, ranging from 62% of cycles funded by NHS Scotland to less than 20% in some parts of England according to the Human Fertilisation & Embryology Authority. The level of funded treatments is decreasing across the U.K. with only a third of all cycles now being funded. The remainder, and a growing proportion of cycles are undertaken in the private sector.

The combination of a new generation of private sector patients and those seeking to escape long waiting lists, that is, in areas of the U.K. where funded fertility treatment still exists, means that it is likely that the numbers of those seeking treatment abroad will continue to rise. Andrew Coutts, a specialist in cross border reproduction has been working with patients who travel for fertility treatment for over ten years,

“Although we do not have a definitive source of data on outward bound health tourism, it appears it is an option for increasing numbers. One data set produced by the Office for National Statistics has estimated that just under 250,000 UK residents went abroad in 2019 just prior to the pandemic; an increase of 100% from the year before. We are now witnessing a bounce back in travel after the pause for Covid-19 and I can see no reason why this figure will continue to rise year on year. Unfortunately, at the present time we do not have specific figures for those travelling for fertility treatment but anecdotally, we know this figure is significant, and is continuing to grow”.

Donor International is seeking to offer those that are considering travel for donor treatment a transparent directory of options. As it grows it will provide the most comprehensive resource for patients and treatment providers wherever they reside.

Fenomatch: Unique, ground-breaking, and trusted

improving donor selection using objective criteria

It is estimated that 15 to 20% of couples worldwide will need to rely on assisted reproduction treatments to achieve a pregnancy. The reasons for this are numerous and sometimes complex but there is an undeniable fact: infertility is on the rise.

In most countries there is one treatment which appears to be requested by more and more patients. This treatment involves donor eggs, sperm, or both. In Spain where Fenomatch is based, donor treatment now accounts for 40% of all assisted reproduction procedures.

This is where Fenomatch’s journey began 4 years ago, in January 2019. The Founder of Fenomatch, Luis Arenaz, identified a number of gaps in patient care during the assisted reproduction journey and this was particularly apparent when it came to the donor selection. Based on personal experience, Luis knew first hand that according to Spanish law Spain donor selection had to be undertaken by the medical teams within each IVF clinic; with no input from the patient. Then, as now, Spain offers donors anonymity which means that any recipient will not be allowed to learn about any of the personal characteristics of the donor apart from those which relate to their phenotype; for instance, eye or hair colour. Any donor was traditionally offered and, accepted without any identifying information such as a photograph.

This process was far from ideal for the patient so Luis and his team set about identifying a process which would address this gap in donor selection as well as remaining within Spanish law. At that time, Luis was running a software development company with more than 18 years of experience in the field and he decided to use its experience and know-how to help patients. This was the beginning of what would become Fenomatch. The main goal of the company was established; to improve the donor selection process, both for the patient and the clinic.

Within a short period of time Fenomatch began to attract interest from patients and professionals; it revolutionised the way that recipients participated in the donor selection process. Whilst they were still not able to learn personal characteristics of any donor they were able to participate in choosing a donor that was physically similar to them through Fenomatch’s unique facial matching technology.

So, what is facial matching and how does it work?

Well, Fenomatch developed something called a Software as a Service (SaaS) which allows assisted reproduction centres, clinics and banks the ability to base donor selection on objective criteria. This criteria was founded on two principles. One which matched the facial characteristics of the patient to available donors and another which used an AI-based facial matching process between the patient and any pool of donors previously selected.

The facial matching AI algorithm developed by Fenomatch allows the user to visualize through a numerical score the level of facial resemblance between the patient and each donor of the pool of donors. The software does not choose the donor but provides the fertility professional with enhanced information which makes the matching process that much more efficient.

In four short years the tool that was inspired by Luis and his team has improved the donor selection process by decreasing the time it takes to match donor and recipient and has reduced the possibility of human error. Additionally, it has helped establish an internal protocol which aids the work of the professional charged with matching and offers a level of reassurance and confidence to the patient which in turn, improves their experience.

The Fenomatch brand and associated technology has become synonymous with facial matching and donor selection in assisted reproduction and is regarded worldwide, as a leader in the field. Fenomatch now represents a unique tool which has helped thousands of patients who rely on donor led treatments.

TOP TIPS FOR AN IVF CYCLE

By Rachel Sherriff, Founder of The Fertility Suite

Are you about to embark on an IVF cycle, or maybe you had your first child via fertility treatment and are about to embark on a frozen embryo transfer to try for baby number two? There are lots of things you can do to help optimise your chances of success and having had my own son via IVF I know how hard it can be. Here are my top tips for optimising your chance of IVF success and surviving the two week wait!

Optimising Egg Quality

The three 3 months before your eggs are collected is a vital time, this is how long it takes them to be recruited and matured so what you do in that time will affect your hormones, general inflammation and overall egg health. If you are having a fresh treatment cycle then optimising egg quality really should be at the top of your priority list and there are lots if simple changes you can make to help.

Good nutrition is key

Clinical evidence is starting to show us that nutrition really can make a big difference to egg & sperm quality and therefore overall embryo quality. It is worth spending the time before a cycle to make sure your nutrition is on point.

Nourish your body with good foods and hydrate. Following a low sugar, high protein and fat diet is best as sugar is a key hormone disruptor and creates inflammation within the body. Naturally by increasing your protein you will be fully for longer and crave less sugar. Increase your intake of fibrous vegetables as keeling your bowels regulate is also key for hormone balance as this is one of the main ways that the body is able to detox excess hormones.

Key Supplements

Its often not possible to get all of the vitamins and minerals we need from food especially if we want to supercharge egg quality. As a minimum taking a pre-natal supplement, omega 3 and vitamin D which are the 3 key supplements for fertility & early pregnancy, plus any medications you have been prescribed to support your pregnancy. We would also recommending working alongside a good nutritionist who will likely recommend some high dose antioxidants such as CoQ10 or Resveratrol and tailor make a supplement programme according to your clinical picture.

Reducing Toxins

An essential step in ensuring a healthy pregnancy and delivering a healthy baby is to reduce your exposure to specific toxins that can harm fertility. Elimination of toxins is not a fad but a lifestyle approach for your fertility health and beyond.

One toxin that has been shown to compromise egg quality is Bisphenol A (BPA). Research shows that women with high levels of BPA during IVF treatment had fewer embryos to transfer and a reduced chance of pregnancy. High levels of BPA also increase egg abnormalities, interfere with reproductive hormones and appear to increase the risk of miscarriage.

The aim is to reduce your exposure not to avoid it entirely. The good news is that there is a lot that you can do to reduce your exposure. By taking a few simple steps, you can reduce the amount of BPA in your system quickly. It’s never too late or early to start, but ideally, you will reduce BPA exposure for 3-4 months before conceiving.

Phthalates are another example of endocrine disruptors which may impair the quality of eggs and fertility. They are often used in plastic, vinyl, cleaning products, nail varnish and fragrances.

Early human studies show the impact on sperm quality by altering hormones and causing oxidative stress. The latest research points to them effecting egg health in the same way.

Phthalates have also shown, at high levels, to affect the developing foetus negatively. Exposure to these chemicals is also linked to an increased risk of endometriosis and miscarriage.

Some ideas to reduce toxins include:

• Replace synthetic and fragranced products with natural, plastic-free versions. Include moisturisers, perfume, shampoo, conditioner and body wash.
• Choose a natural deodorant that is free from toxic metals.
• Replace pads or tampons with organic pure cotton ones or use silicone menstrual cups. Also, try washable and reusable period pants and pads.
• Choose Epsom bath salts which are natural, rather than synthetic fragranced bubble baths, and enjoy the benefits of a nice long soak, along with the magnesium, that relieves muscle tension and stress, which is important when looking to conceive.
• Avoid nail varnish and instead buff and file your nails.
• Avoid perfumes and use essential oils (check they are pregnancy safe).

Complimentary therapies

Consider acupuncture in the three months prior to IVF as this can be excellent for regulating hormones, menstrual cycles and modulating your immune system which is key for fertility.

I would also recommend a session of acupuncture within the 24 hour window after your embryo/s have been transferred. Studies have concluded that acupuncture given with embryo transfer improves the rates of pregnancy and live birth among women undergoing IVF. Find an acupuncturist that specialises in fertility though as not all general practitioners will be familiar with the protocol used in the studies.

It can also be beneficial to have another session a few days after transfer as the implantation window for a 5 day blastocyst starts a few days after transfer and last for around 4/5 days.

Post Transfer

Continue on your existing exercise program or routine, there is no evidence to show that running, swimming, cycling or anything similar can cause implantation to fail. Your embryo is well protected within the uterus and exercise can actually help keep the healthy blood flow to the pelvic cavity, which supports implantation.

Exercise which should be avoided is basically anything new or too extreme – i.e.: don’t start couch to 5k if you’ve never run before, or any competitive sports such as training for a marathon or competitive CrossFit. These intense sports tend to raise cortisol levels which is not ideal after an embryo transfer.

Continue to nourish your body with good foods, you have probably done this prior to egg collection as you have been keen to create the healthiest eggs possible however it’s important to continue looking after yourself as the same principles apply to early pregnancy.

Surviving the two week wait

Avoid the tendency to google individual symptoms or spend hours on fertility forums, you can go down a rabbit warren which leads to anxiety and undue worry. If you do read forums remember that you only have a snippet of those individuals histories and their fertility picture may be completely different to yours, therefore just because they took XYZ or did certain things and it was the ’key’ to getting pregnant….it doesn’t mean that you need to do it or that it’s right for you, follow your medical professional or complimentary health providers advice!

Do the things you enjoy. Let’s start with the obvious one. Watching the clock only makes time go slower. So arrange a date night or two, go to the cinema, go shopping, go out for dinner or binge watch Netflix. Time will pass anyway so why not fill it doing the things you love. This might be seen as distraction, which is an ok coping mechanism to use sometimes, as long as it’s not the only method you have of dealing with difficult emotions. Watching or listening to something which makes you laugh is a great way to distract and lift your mood. What’s your favourite funny film?

Which TV show or podcast makes you howl with laughter? Put them on and see what happens.

Use relaxation techniques. No, not “just relax”. But taking time out to focus on breathing deeply is a natural and easy way of relaxing and will force you to stay calm. Maybe listening to a guided relaxation to avoid your mind from wondering. Maybe yoga, visualisations or meditation.

Find support from people who get it. Your partner, a friend, someone in your family, a colleague, the online TTC community or support from a specialist. The two week wait is a particularly stressful time, emotions are heightened. Things you can normally handle without any problem, can tip you over the edge during this time. Avoid keeping your pain to yourself. Suppressing difficult emotions will only cause them to fester and lead you to feel worse. Who is that person for you?

Rachel Sherriff is a fertility acupuncturist who runs The Fertility Suite in Surrey and online platform and podcast The Fertility Method. She support’s couples who are struggling to conceive using acupuncture, reflexology, nutrition and online courses. She will help you achieve a happy, healthy pregnancy whether naturally or through fertility treatment. Having been through fertility struggle and treatment herself she wants you to feel empowered, educated and confident to take back control of your fertility.

Courses Link:

https://course.thefertilitymethod.co.uk/collections

Web address

www.thefertilitysuite.co.uk

Email:

hello@thefertilitysuite.co.uk

PCOS: Tackled by Acupuncture and herbal medicine

Mike Berkley,

The health implications of Polycystic Ovary Syndrome (PCOS) stretch far beyond fertility and conception. Indeed, the third ESHRE/ASRM consensus, following agreements on diagnosis in 2004 and treatment in 2008, considered the wide-ranging ‘health aspects’ of PCOS, notably insulin resistance and other metabolic disorders, type 2 diabetes, cardiovascular diseases and cancers. Among the ‘pregnancy complications’ were gestational diabetes, pre-eclampsia and the birth of small-for-gestational age babies.

Just last year the largest study in the literature to date in assessing PCOS as a risk factor for the metabolic complications of pregnancy confirmed that women with PCOS are indeed at a two-fold higher risk of developing gestational diabetes than women without PCOS, at a 50% increased risk of developing gestational hypertension, and a 30% increased risk of pre-eclampsia.

Acupuncture and herbal medicine, via their regulatory functions on the endocrine and metabolic pathways may be helpful in reducing the possibility or the severity of gestational diabetes, pre-eclampsia and gestational diabetes.

The results come from an analysis of the largest inpatient cohort in the USA (the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database) in which deliveries to women with diagnosed PCOS between 2004 and 2014 (14,882 patients) were compared with a non-PCOS reference group of more than 9 million deliveries. While the results appear to echo those of earlier, and smaller studies, the authors state that this study avoids much of the formers’ heterogeneity and confounding from inadequate statistical power. Thus, in their opinion these earlier studies (even a large meta-analysis from 2019) were unable to isolate PCOS as an independent risk factor for all metabolic complications of pregnancy.

First, in terms of metabolic characteristics, the study showed that pregnant women with PCOS were at baseline more obese than controls (22.3% vs. 3.5%), had greater prevalence of chronic hypertension (8.4% vs. 1.8%) and had more pregestational diabetes (4.1% vs. 0.9%). All these differences were statistically significant. There was also a higher rate if IVF conception in the PCOS women (2.4% vs. 0.1%) and more multiple pregnancies (5.9% vs. 1.5%), which seemed largely explained by IVF.

Acupuncture and herbal medicine, via their regulatory functions on the endocrine and metabolic pathways are often helpful in assisting in weight-loss.

However, in all pregnancies the women with PCOS were more likely to develop gestational diabetes, pregnancy-associated hypertension, and pre-eclampsia than controls. The adjustments controlled for age, income level, obesity, smoking and chronic disease. The study also controlled for ‘insurance type’, which was significantly different between the two groups and may explain a possibility of underdiagnosis in women belonging to lower socioeconomic groups and receiving their care through Medicaid.

Acupuncture and herbal medicine, via their regulatory functions on the endocrine and metabolic pathways are often helpful in reducing the possibility, or the severity of gestational diabetes, pre-eclampsia and pregnancy-associated hypertension.

The adjustments proved important in the findings, indicating, for example, that the two-fold added risk of gestational diabetes was independently associated with PCOS and not confounded by obesity (or other confounding factors). The author’s conclude,

“Most studies and meta-analyses suggest between a 2.5- to 4-fold increased risk of GDM in the PCOS population, with significant uncertainty about whether or not the attributable risk is from PCOS alone, or if it is related to obesity.’

Acupuncture and herbal medicine are valuable interventions when trying to reduce what is in excess and support that which is deficient.

For example, excess may be viewed as gestational diabetes, pre-eclampsia and gestational diabetes, whereas deficiency may be seen as having reduced or stunted-activity of estrogen in the follicles due to excess androgens. By increasing that which is deficient (estrogen, or estrogen activity), this will then create a more balanced ratio between estrogen and follicular androgen. This can translate into better egg quality in the PCOS patient.

Mike Berkley, is Founder and Director at The Berkley Center for Reproductive Wellness in New York.

Berkleycenter.com

Fertially: Not just another fertility platform

Andrew Coutts

With so much information already available online you might ask whether there is room for one more platform.

The first conversation I have with anyone looking for answers to their fertility issues online is not about their ‘problem’ or about solutions to it. It is about how frustrating it is trying to find an answer at all, or at least an answer they can confidently assume is honest, transparent and correct.

There are growing numbers of forums, patient support platforms, and influencers offering general and bespoke advice on every aspect of fertility you can think of. But, who should we believe, who should we trust?

I am sure that most of us involved with providing patient care, support, and signposting do so from a deep conviction of wanting to help others. This might be based on our own personal experience, a professional interest or simply because we are paid to provide the best possible advice. In areas of life which have been addressed online (which is basically all areas of life) there will always be those trying to exploit the vulnerable and the fertility world is no different. In my experience however, the fertility community although not immune to this, is, on the whole, a trustworthy one. BUT, whilst we can say with some confidence the majority of information from trustworthy sources is accurate to a point it can sometimes be misleading or open to interpretation.

Any searches we perform online, any articles we read, and any forums we join therefore need to be viewed and considered with a certain degree of care. Whether we are comparing success rates, reading patient reviews or choosing treatment providers we have to be mindful that the information provided by a particular source might be open to interpretation and we should always, always, seek to compare, or confirm with others, before we decide on a particular course of action.

I was recently approached to consider the merits of a new initiative called FertiAlly.com, a simple (aren’t all the best ideas based on a simple proposition?) platform which provides straightforward answers offered by experts to straightforward questions posed by patients. I liked the idea so much I got involved in spreading the word. I like the simplicity of the concept where fertility experts are asked the questions that are really important to patients and their responses are captured on video and posted online for all to access freely. And, with a nod to honesty, transparency and an acknowledgement that we are dealing with complicated issues there are sometimes different answers given by different experts to the same question! Doesn’t this add to the confusion, I hear you ask. No, I don’t think it does, it is reassuring in many respects that questions posed by patients prompt reaction, differences of opinion and generate discussion. In many respects this is how we all learn, and I firmly believe that anyone who has questions about their fertility health or are considering treatment options should participate and listen to debates and answers created by fellow patients.

This is where the unique nature of the FertiAlly platform sits. It simply allows patients to drive the conversation rather than being directed or led by professionals.

By driving the dialogue, it is the patient that will ultimately benefit by getting the answers that are important to them and which will enable them to make fully informed decisions about the direction their fertility treatment, care and support should take.

Although still in its infancy, FertiAlly has quickly built up a bank of almost 70 worldwide fertility experts spanning different specialisms.

Patients can also contribute to the development of the newly launched European Fertility Society (EFS), an independent, not for profit organisation set up to safeguard and promote the interests of both patients and treatment providers. For each answer published on the fertially website a donation of 5 Euros will be made to the EFS.

I began this article by talking about the multitude of platforms that you can access for information and help on every aspect of (in)fertility and this number appears to be growing on daily basis. The FertiAlly platform should not however be simply disregarded as the next in a very long line, it is far more than that.

Check out the FertiaAlly YouTube channel for yourself.

Malaysia’s role in health tourism: What can the patient expect?

Andrew Coutts takes a look at what awaits the healthcare traveller in Malaysia.

The Malaysian Government identified the growth potential of medical tourism in the late 1990’s and took the strategic decision to pool the collective strengths of the private and public sectors to harness the country’s medical tourism industry. It was a decision which proved to be extremely productive.

 The unique private/public collaboration which saw health tourism promoted by the Government and fuelled by the corporate sector provided tourists with the stamp of regulatory approval in terms of quality, safety standards and medical related legislation. This endorsement combined with significant investment powered the development of the sector until it was so rudely disrupted in early 2020 by the Coronavirus pandemic. Up until March 2020 health tourism in Malaysia had seen monumental year on year increases in terms of both the numbers of patients travelling for medical treatment and income generated by the activity. Between 2011 and 2018 the number of healthcare travellers’ who visited Malaysia more than doubled from 643,000 to nearly 1.3 million.

Central to the exponential growth of medical tourism has been the considerable influence and work of the Malaysia Healthcare Travel Council (MHTC), the Malaysian government’s medical tourism arm. MHTC grasped the notion early on that branding is the key to effective marketing and with this in mind, it has developed a unique brand which has become synonymous with a portfolio of services designed to promote and support the ‘whole’ patient experience. Recognising that the medical procedure only forms part of this experience MHTC facilitates the overall patient journey in aspects of accessing information, the most appropriate treatment options for the patient, whilst collaborating with the country’s hotel, travel and leisure sectors to create a memorable truly Malaysian experience. A package of care which has ticked a number of boxes: facilitating the most appropriate treatment options for the patient whilst stimulating the country’s hotel, travel and leisure sectors.

MHTC’s work has also benefitted from the resources it has had at its disposal. The country is blessed with a wealth of available and skilled medical and technical expertise, political and economic stability, excellent infrastructure and transport links and a tourism sector with an exceptional track record in attracting visitors in their millions from all over the world.

What Can Patient’s Expect?

 The country offers healthcare, accommodation, entertainment and travel at very competitive prices. Tourist resorts sit in a tropical climate, ideal for rest and recuperation and there is no need for visitors to obtain a visa for stays less than 90 days in general. The vast majority of care providers speak English and there are no waiting lists for whichever medical treatment you require.

Many of the country’s 200 private hospitals provide excellent rehabilitation and wellness facilities to ensure travellers can access help and support for recovery purposes and each is recognised by internationally accredited bodies including the Joint Commission International (JCI) and the International Society for Quality in Health Care (ISQua) reflecting their commitment to high-quality care.

 This commitment to upholding the highest standards of care and service has consistently attracted external recognition in the form of both travel and healthcare awards. The country has been awarded the “Best Healthcare In The World” category in the International Living Annual Global Retirement Index in four out of the previous five years. At the most recent ‘International Medical Travel Journal Awards’ the country’s total belief in patient-centred philosophy was acknowledged by the awarding of 9 out of the total of 15 honours announced; a feat not matched by any other country in the world.

The Future of Health Tourism in Malaysia

 MHTC recently staged the fifth annual, ‘insigHT’, the region’s medical travel market intelligence conference. This virtual event staged during the Coronavirus pandemic brought together leaders from worldwide medical tourism hubs to discuss the future of the sector.

 As borders begin to open and patients prepare to travel once more in 2021 flexibility, innovation and collaboration were identified as the key drivers for renewal and growth. Malaysia hopes that the blueprint for private and public sector collaboration it initiated in the late 1990’s to promote good health will now enable it to achieve a far quicker recovery than in countries less prepared. The conference acknowledged that the pandemic has also accelerated the need for healthcare to embrace Innovation and digitalisation and harness available technology to assist communication between patient and provider.

The future may not be as certain as it was at the beginning of 2020 but you can be assured that Malaysia with a track record stretching over twenty years is very well placed to harness existing technology and ensure that patients remain at the very centre of the medical and tourism service it provides.