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Oh, my aching back!*

By Inese Timuka . 28.12.2009

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*For all those who have ever experienced terrible back pain at some point in their lives.

Gallery: Orto

Not so long ago, the wealthier citizens of developing countries used to visit the developed world to gain access to advanced medical care. But now it seems that a wave is reversing this trend. With the growing popularity of medical tourism, many people around the world, especially in the UK and the US, are looking for eye-catching treatment bargains in other countries. To find out who the best spinal surgeons in Latvia are and whether they’re ready to offer treatments to foreign patients, we visited "Orto" – the Clinic of Orthopaedics, Sport Traumatology and Spinal Surgery.

More people in pain

Over last 20 or 30 years, the number of patients has grown enormously, said Dr Kaspars Ruks at the beginning of our interview. “The number of those patients whose problems should be treated with surgical procedures has not grown as much as the number of those patients who suffer back pain. These days it’s rare to find someone who hasn't endured pain in the back."

The main reason is a modern urbanized lifestyle and lack of activity. Another trend Ruks mentioned is that thanks to the Internet more and more people share information about pain & treatments – which leads to serious problems as they start "home treatments" themselves. Every case is more-or-less unique.
He continued: "As back pain is so widespread it is good area of business and there are plenty of specialists who are not even doctors as they know only a single discipline such as manual therapy or osteopathy, and unfortunately they know how to solve pain without knowing the core of the problem."
His colleague and founder of the clinic, Dr Andrejs Peredistijs, agreed and said, "Comparing the numbers of patients in 2009 and 2008, there is not much difference. But patients are coming to us with real problems."

Overall, Orto deals with most kinds of bone and joint traumas and diseases.

Prices and long lines

It is known that the leading motive of medical travel to take advantage of First World health care at Third World prices, "patients are demanding help in case the pain in their backs has lasted longer than a couple of months,” said Dr Artis Gulbis, a surgeon at Orto. “We are strongly approved of by foreign patients who have some connection to Latvia, like business or family affairs."

Gulbis finished the Latvian Academy of Medicine and has been practicing in Boston, Anaheim, London and other cities’ clinics and has been working as a lecturer throughout Europe.

He said that the math is simple in giving an overall picture of price differences.

"Just a visit to specialists like us in England costs 300 pounds. But here it’s 10 times cheaper."

Another factor stimulating such a phenomenon is the long waiting lines for treatment in patients’ home countries. Dr Ruks said: "I had a case recently when an Englishman came to me with ruptured disc. In England, this surgery would cost him 30 times more. He was offered two options, either to wait for half a year in line or to pay 30,000 pounds. But here in Riga it costs just 1,000. So it’s obvious where to go to do the surgery."

Dr Peredistijs mentions that at their clinic the price for foreigners is the same as it is for locals.
Asked if they are ready to do just part of the treatment, for example to perform surgery, while the rest is carried out back home, the doctors reply that this doesn't bring great happiness to them as they prefer to be in control of their patients’ health both before and after the surgery as there are plenty of tiny details that depend on the patient. But they don't see other major problems in cooperating with their foreign colleagues.

Latest technologies

The majority of clinics in Latvia, especially private ones, are as equipped with state-of-art and internationally accepted medical devices as any clinic could hope to be, and doctors improve their knowledge on a regular basis. Gulbis said that in Latvia doctors are highly qualified at a young age. “In the UK, doctors in their thirties have just finished their residencies, but at this age our doctors already have around 10 years’ standing in their profession. We are more enthusiastic, more willing to work, and include new techniques in our daily routine. It is important to stress that we are using the most advanced technologies – the same technology is used in New York or Zurich. We use the same implants. Overall spine surgery is developing in two directions, first to simulate the natural structure of the body by using implants, and the second direction is, if surgery is needed, to avoid major damage to body tissue by using the minimally invasive methods."
Gulbis mentioned that historically there has been an in-joke – the bigger the surgeon, the bigger the snip. But nowadays it’s the other way round!

Every surgery is considered to be traumatic for the body. Recently, Dr Ruks started to put into practice spinal vertebrae fixation with a minimally invasive method, which is a considerable achievement as nobody else in the Baltic and Scandinavian region performs these kinds of operations. This type of surgery is mostly performed in case of trauma or for patients with lumbar spine degenerative diseases.
"This method makes the process much more favorable to the patient, as small incisions are made, which guarantees significant reduction of the patient's blood loss as well as significantly reducing the risk of infection. But the most important thing is, we don't seriously damage the natural muscular corset. Using the minimal invasive method, the level of pain during the healing process is much less, and the healing is considerably shorter."
Asked in which cases implantation is used, Dr Gulbis explaines that it differs. "In general, for young people we use implants that guarantee natural movement and stability. But for people over 60, implants are used for backbone stability but without movement possibilities."

We were assured that no matter what the case, only the best available implants are being used. "We work only with the best Swiss implants with the highest level of trust, for all patients in all ages."
We were also told that implants depend on the nature of human life too – how active or quiet it is. For example, for those who might be doing parachute jumping, "stronger" implants can be offered.
Dr Gulbis said that for some implants it is possible that patients could leave the hospital on the very same day surgery is done, but for safety reasons most patients are allowed to leave on the third day after surgery.
When speaking about guarantees, all of the experts came back to the topics of biology, the patient’s general health and his habits. “Instead of giving guarantees in medicine, we talk about forecasts!” said Dr Peredistijs. "It depends on the physical activities the patient does, on other illnesses and other side effects."

Patient-friendly

The recession has already forced several changes in the city’s professional medical scene – in a positive sense. We've noticed that specialists have become better available for their patients, and their schedules are not as tight as they were only a year or two ago.

It is important that in Latvia it is a standard that the doctor is personally involved during the healing process. We hear many references saying that nowhere in Europe is the service as attentive as it is in Riga. Dr Gulbis emphasized: "It is important that patients don't lose contact with their doctor, even after the surgery is complete."
Add to this the affordable prices, doctors communicating in various languages and the attentive service, and you have your perfect medical tourism destination. We believe that because of the relatively low cost and the good quality of medical services, the number of consumers will be growing every year.

Price comparison of procedure costs EUR

Ankle joint replacement

United States 11 304

UK 12 398

Latvia 1024

Hip replacement

United States 32 820

UK 26 141

Latvia 3000

Knee arthroscopy

United States 4813

UK 3466

Latvia 655