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All types of tourism in India have registered phenomenal growth in the last decade ever since the Indian government decided to boost revenues from the tourism sector by projecting India as the ultimate tourist spot. The reason why India has been doing well in all types of tourism in India is that India has always been known for its hospitality, uniqueness, and charm attributes that have been attracting foreign travelers to India in hordes. The Indian government, in order to boost tourism of various kinds in India, has set up the Ministry of Tourism and Culture. This ministry recently launched a campaign called Incredible India! in order to encourage different types of tourism in India. The result was that in 2004, foreign tourists spent around US$ 15.4 billion during their trips to India. Being a country with tremendous diversity, India has a lot to offer in terms of tourism and related activities. The diversity that India is famous for, ensures that there is something to do for all tourists in India, no matter what their interests.


Adventure tourism As a kind of tourism in India, adventure tourism has recently grown in India. This involves exploration of remote areas and exotic locales and engaging in various activities. For adventure tourism in India, tourists prefer to go for trekking to places like Ladakh, Sikkim, and Himalaya. Himachal Pradesh and Jammu and Kashmir are popular for the skiing facilities they offer. Whitewater rafting is also catching on in India and tourists flock to places such as Uttranchal, Assam, and Arunachal Pradesh for this adrenalin-packed activity. Wildlife tourism India has a rich forest cover which has some beautiful and exotic species of wildlife some of which that are even endangered and very rare. This has boosted wildlife tourism in India. The places where a foreign tourist can go for wildlife tourism in India are the Sariska Wildlife Sanctuary, Keoladeo Ghana National Park, and Corbett National Park.

Medical tourism Tourists from all over the world have been thronging India to avail themselves of costeffective but superior quality healthcare in terms of surgical procedures and general medical attention. There are several medical institutes in the country that cater to foreign patients and impart top-quality healthcare at a fraction of what it would have cost in developed nations such as USA and UK. It is expected that medical tourism in India will hold a value around US$ 2 billion by 2012. The city of Chennai attracts around 45% of medical tourists from foreign countries. Pilgrimage tourism India is famous for its temples and that is the reason that among the different kinds of tourism in India, pilgrimage tourism is increasing most rapidly. The various places for tourists to visit in India for pilgrimage are Vaishno Devi, Golden temple, Char Dham, and Mathura Vrindavan. Eco tourism Among the types of tourism in India, ecotourism have grown recently. Ecotourism entails the sustainable preservation of a naturally endowed area or region. This is becoming more and more significant for the ecological development of all regions that have tourist value. For ecotourism in India, tourists can go to places such as Kaziranga National Park, Gir National Park, and Kanha National Park. Cultural tourism India is known for its rich cultural heritage and an element of mysticism, which is why tourists come to India to experience it for themselves. The various fairs and festivals that tourists can visit in India are the Pushkar fair, Taj Mahotsav, and Suraj Kund mela. The types of tourism in India have grown and this has boosted the Indian economy. That it continues to grow efforts must be taken by the Indian government, so that the tourism sector can contribute more substantially to the nations GDP.


India is a perfect destination for medical tourism that combines health treatment with visits to some of the most alluring and awe-inspiring places of the world. A growing number of tourists are flocking in large numbers because of the superlative medical care, equipments and facilities that India offers. India excels in providing quality and cheap health care services to overseas tourists. The field has such lucrative potential that it can become a $2.3 billion business by 2012, states a study by Confederation of Indian Industry (CII). In 2004, some 150,000 foreigners visited India for treatment, and the numbers have been rising by 15 per cent each year. India is in the process of becoming the "Global Health Destination" owing to the following advantages:
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The cost of medical services in India is almost 30% lower to that in Western countries and the cheapest in South-east Asia. Language is a major comfort factor that invites so many foreign tourists to visit India for medical and health tourism. India has a large populace of good English speaking doctors, guides and medical staff. This makes it easier for foreigners to relate well to Indian doctors. Indian hospitals excel in cardiology and cardiothoracic surgery, joint replacements, transplants, cosmetic treatments, dental care, Orthopaedic surgery and more. The medical services in India include full body pathology, comprehensive physical and gynecological examinations, audiometry, spirometry, Chest X-ray, 12 lead ECG, 2D echo Colour Doppler, gold standard DXA bone densitometry, body fat analysis, coronary risk markers, cancer risk markers, high strength MRI etc. All medical treatments and investigations are done using the latest, technologically advanced diagnostic equipments. Indian doctors have got an expertise in performing successful cardiac surgeries, bone marrow transplants, liver transplants, orthopaedic surgeries and other medical treatments. The cost of Infertility treatments in India is almost 1/4th of that in developed nations. The availability of modern assisted reproductive techniques, such as IVF, and a full range of Assisted Reproductive Technology (ART) services have made India the first choice for infertility treatments. Foreign patients can get package deals including flights, transfers, hotels, treatment and post-operative vacation for their medical visits to India. Many foreign patients prefer to combine their leisure and relaxation visits to India with healthcare.

The Government of India has declared that treating of foreign patients is legal. It is encouraging medical tourism in the country by offering tax breaks and export incentives to participating hospitals. In addition, the Government has cleared medical visas.


Cost Benefit: The prime advantage is the cost savings with respect to medical consultancy or surgeries. Many of the Indian hospitals, serving international patients, have state-of-the-art infrastructure, highly educated doctors and top-notch services but the figure on that price tag is a fraction of what it would be in developed countries. Even if your insurance does not cover the costs of treatment in India, the final bill in an Indian hospital would most probably be lower than your out-of-pocket expenses. Timeliness: Another advantage is the possibility of getting immediate medical attention. There are no waiting lists or delays to contend with, due to insurance issues or unavailability of doctors etc. Quality Health Care: Indian doctors and paramedics are well trained and are one of the best in the world. Many professionals, at most of the lead hospitals in the country, have been trained abroad prior to working in India. Personalized Care: It is relatively easy to find quality personalized care for critically ill or aged patients. Technological Sophistication: State-of-the-art equipment and infrastructure is the order of the day at most of the top corporate hospitals. Facilitation by Government: The Government of India has recognized the economic potential of medical tourism. It has facilitated travel by introducing a special visa category known as medical visa for patients as well as introduced tax incentives for hospitals. Ease of Travel & Communication: Travel in India has become easier and much faster due to introduction of private airlines. Access to Internet in India is considered to be one of the cheapest in the world and communication facilities are well established. Travel agencies have a great online presence and can offer you package deals that include travel costs, boarding as well as treatment costs. Easy availability of medicine & drugs: Certified drugs and medicines are easily available in India, at comparatively lesser prices.

Modern & Traditional: This is Indias USP. Modern medical aid as well as traditional therapy, such as ayurveda, yoga, naturopathy etc, is available at different locations across the country including Bangalore. Tourism Potential: People who come for relatively simple, but important procedures, can consider packing in some travel too, with their doctors permission! This is an added advantage. Every part of the country is rich in history and diverse in geography.


The chief cities attracting foreign patients to India are Mumbai, Bangalore, Hyderabad, Kolkata and Chennai. Similarly, the speciality hospitals excelling in the medical tourism industry in the country are: 1. Escorts Heart Institute and Research Centre Limited, New Delhi 2. All India Institute of Medical Sciences, Delhi 3. Manipal Heart Foundation, Bangalore 4. B. M. Birla Heart Research Centre, Kolkata 5. Breach Candy Hospital, Mumbai 6. Wockhardt Hospitals 7. Christian Medical College, Vellore 8. Asian Heart Institute, Mumbai 9. PD Hinduja National Hospital and Medical Research Centre, Mumbai 10. Jaslok Hospital, Mumbai 11. Apollo Hospital, Delhi 12. Apollo Cancer Hospital, Chennai

India is uniquely positioned to cater to not merely health (the absence of disease or infirmity) but Wellness too with a rich pool of ancient wisdom, knowledge and traditions to draw upon. From Yoga to Ayurveda, from several schools of meditation to Naturopathy, Indian culture traditionally believes in Wellness as a way of life. And that legacy today makes us one of the major Wellness destinations in the world.

Medical Consultation and Surgery India is the most preferred medical surgery and treatment destination due to major factors favouring it. India has a plethora of Government hospitals and Private Tertiary Care Medical Institutions with International JCI (Joint Commission International) Accreditation. Most of these are among the best in the world. They are well equipped with the latest and most refined technologies. The humane team of internationally trained Consultants and Surgeons in India, supported round-the-clock by specialist clinical teams, ensure total patient care with high success rates. And the cost of Medical consultation and surgeries comes very reasonable. The major surgeries for which foreigners visit India are cited below:
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Heart/Cardio Surgeries Eye Care Cosmetic treatments Dental Care Orthopaedic Surgeries Organ Transplants Infertility Treatment

Alternate System of Medicines

AYURVEDA The term 'Ayurveda' means 'Science of Life'. This probably makes it the earliest medical science having a positive concept of health to be achieved through a blending of physical, mental, social, moral and spiritual welfare. India has moved forwards in advocating the global usefulness of Ayurveda in contemporary scenario of health care through global networks. As a result, many foreign countries have started realising the importance and effectiveness of this science. People from U.S.A., U.K., Russia, Germany, Hungary, South Africa and other parts of the world come to India to get treated by Ayurveda experts here. YOGA Yoga is a science as well an art of living healthy, physically, mentally, morally and spiritually. Its systematic growth from animal level to the normalcy, from there to the divinity, ultimately. Its no way limited by race, age, sex, religion, cast or creed and can

be practiced by those who seek an education on better living and those who want to have a more meaningful life. There are innumerable Yoga centers in India that disseminate information and teach how yoga and medication can bring positive changes to ones life. Although Yoga camps are organised in almost every Indian city, places in India that are popular for their yoga and meditation therapies are: 1. 2. 3. 4. 5. 6. Rishikesh Haridwar Dharamshala Auroville in Pondicherry Puttaparti near Bangalore Mount Abu

In India, Yoga has been developed into a science that is beneficiary in curing several diseases.

NATUROPATHY Naturopathy is a system of healing science that stimulates the bodys inherent power to regain health with the help of five great elements of nature Earth, Water, Air, Fire and Ether. Naturopathy is a call to "Return to Nature" and to resort to simple way of living in harmony with the self, society and environment. Naturopathy provides not only a simple practical approach to the management of diseases, but a firm theoretical basis which is applicable to all the holistic medical care and by giving attention to the foundations of health; also offers a more economical frame work for the medicine of future generation. Naturopathy is also gaining popularity in the Western world because of its natural way of restoring happiness in life. UNANI Unani system of medicine is one of the oldest in the world. It is still popular & practiced in the Indian sub continent & other parts of the world. According to Basic Principals of Unani, the body is made up of the four Basic elements i.e. Earth, Air, Water, Fire which have different Temperaments i.e. Cold, Hot, Wet, Dry. Diseases are mainly diagnosed with the help of Pulse (Nabz), physical examination of the Urine and Stool. Also, patients are examined systematically to make the diagnosis easy as spot diagnosis with the help of simple, modern gadgets.

SIDDHA This principles and doctrines of Siddha system, both fundamental and applied, have a close similarity to Ayurveda, with specialisation in Iatro-chemistry. According to this system, the human body is the replica of the universe and so are the food and drugs irrespective of their origin. This system also deals with the concept of salvation in life. The exponents of this system consider that achievement of this state is possible by medicines and meditation. The Siddha system is capable of treating all types of diseases other than emergency cases. In general, this system is effective in treating all types of skin problems particularly Psoriasis, STD, urinary tract infections, diseases of liver and gastro intestinal tract, general debility, postpartum anaemia, diarrhoea and general fevers in addition to arthritis and allergic disorders. HOMEOPATHY Homoeopathy today is a rapidly growing system and is being practiced almost all over the world. A rough study indicates that about 10% of the Indian population solely depends on Homoeopathy for their Health care needs. It is more than a century and a half now that Homoeopathy is being practiced in India. It has blended so well into the roots and traditions of the country that it has been recognised as one of the National Systems of Medicine and plays an important role in providing health care to a large number of people. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels. And so, people from all over the world reply on Indias mastery in curing diseases through Homeopathy.


Sushrut Hospital & Research Centre in Nagpur is a specialty Orthopedic Hospital specializing in Knee and Hip Replacement surgeries. It is situated right in the heart of the city in an area named Ramdaspeth, in Nagpur city, India. Dr. Sushrut Babhulkar, a world renowned orthopedic surgeon is the man behind the more than 2000 successful orthopaedic surgeries performed in the institute. Dr. Sushrut Sudhir Babhulkar, is a graduate and Post-Graduate (MS Orthopaedics) from Indira Gandhi Medical College, Nagpur. He then did his Masters Degree from Liverpool University, England M Ch (Orthopaedics) in 1994 and during the same time worked at various centers of Excellence in UK like Royal Liverpool University Hospital, Fazakarley Hospital etc. in 1995. Dr. Sushrut is actively involved in joint replacement surgeries of Hips, Knees, Shoulders and elbows employing all varieties of implants like cemented and non-cemented options. The institute is a small but efficient hospital of 105 beds having five specialist doctors and about 50 support staff in various categories. Of late with the concept of medical tourism gaining popularity, there has been a definite increase in the number of overseas enquiry that Sushrut Hospital is receiving and so far has successfully treated 8 European patients. Presented below is a brief summary of the procedures followed by Dr. Sushrut beginning with the arrival of the foreign patient in India right up to his departure to his native country. Dr. Sushrut has opened a coordinating office in Mumbai that has a Medical Coordinator as well as a Travel Coordinator. The medical coordinator is a qualified medical practitioner who receives all the medical queries as well as is responsible for monitoring of the basic health parameter of the patient upon arrival in India, Mumbai being the first touch down destination for many foreigner travelers. Thus right from his arrival in India, Dr. Sushrut has ensured that the patient is in safe hands and feels assured of being under medical supervision. This motive behind this move is to encourage patients to come to Nagpur. An interesting fact presented by Dr. Sushrut Babhulkar is that it takes a patient 2 hours to reach any hospital in Mumbai from the airport whereas it takes only one and a half hours to reach Nagpur from Mumbai. Thus, other than the traffic congestion the patient is also spared the pollution of Mumbai. Moreover it has far less problems that a place like Mumbai has, important being traffic congestion and for a doctor, time is the most precious thing that can make a difference between wellness and pain. The hospital has tie up with Tuli International for arranging the recuperation vacation to Kanha Tiger Resort. Regarding tie-ups for the stay of the patients, Dr. Sushrut is having discussions with top hotels in Mumbai like Grand Hyatt to put up Level 1patients and Hyatt Regency for accommodating Level 2patients as these hotels are situated close to the airport from where it shall be convenient for them to take a flight to Nagpur The foreign patients undergo the surgery after completion of the preliminary tests usually on the 3rd day after his arrival in the hospital. On the 6th day, the patient has the option of either recuperating in the hospital or a package trip to Kanha Tiger Resort which is about 250 Kms from Nagpur and a very famous tourist destination. During his travel to Kanha, the patient is accompanied by an expert orthopedic surgeon, a physiotherapist and a nurse. On reaching Kanha, the doctors come back but the nurse stays on and returns along with the patient after 5-6 days of rest and relaxation in the lap of nature. The stitches are then removed on the 12th day and the patient then goes back to his native country, hale and hearty on the 13th or 14th day of his tour. Thus, within 15 days the patient fully recovers and is made pain free and mobile!

Dr. Sushrut uses the most advanced technologies in performing these surgeries, many of which are proprietary. The surgeries performed are computer assisted and he uses a special laminar air flow space suit to perform the complicated surgeries which assure zero infection. This technology even helps a doctor sitting thousands of miles away to watch the surgery being conducted on his patient, whom he sends to India becoaude of lack of expertise in his country. The amazing thing about the surgeries performed by Dr. Sushrut is that it allows the patient a very high degree of mobility compared to the surgeries performed in foreign countries. For example a patient operated upon by Dr. Babhulkar is able to squat while the foreign surgeries allow the patient limited mobility of being able to sit on a chair. Thus the comfort and mobility offered by Dr. Babhulkar is unmatched in the world as of today. As accreditation is an issue with the foreign patients who seek medical intervention, Sushrut Hospital has an ISO 9001-2000 certification and is pursuing the other essential accreditation required for a super specialty hospital promoting medical tourism. The patients who have availed the services at Sushrut hospital are all praises and extremely excited about the experience they had in Nagpur. The wellness and comfort that they experience after having undergone the surgery is beyond description. The word of mouth publicity by the foreign patients is also helping in bringing new patients to seek medical assistance in Sushrut Hospital. Moreover, Dr. Sushrut Babhulkar also has an associate in Europe who recommends patients in need of knee, joint and total hip replacement, hip resurfacing surgeries to Sushrut Hospital. Incidentally, since all the foreign tourists who have been treated by Dr. Sushrut were old, none took the recuperating trip to Kanha as they did not want to undertake an additional journey and preferred to return back to their home country as soon as possible. But the facilities provided by Hotel Tuli International at the Kanha tiger resort matches the best in the world. Kanha tiger resort is a private initiative of Hotel Tuli International. The hotel on its part adheres to the rules that apply to the other resorts functioning in the state of Madhya Pradesh (MP) as the Kanha reserve is under the jurisdiction of the MP government. Most of the visitors going to Kanha are foreigners, but it is also very popular among the local Nagpurians and visitors from other places in Maharashtra. Some people are also exploring the possibilities of having marriages organized in the resort The resort employs substantial local people for the odd jobs that are required to be done at the resort. Therefore in terms of employment generation, the resort has contributed substantially in the social upliftment of the local population. In addition, many small service providers have sprung up on the roads leading up to Kanha, thereby creating secondary employment in the micro-region. Kanha tiger resort being in the wilderness, there is an absence of a vibrant local market. But the tourist who comes to Nagpur helps himself in the huge shopping malls that have come up in Nagpur in the past couple of years. Moreover, Nagpur is also famous for its oranges and hence it is also known as the Orange City of India. The city also offers some exotic sweets that are a specialty of this region. The other players of the medical tourism network who do not play a very active role in the present case study are the following: Local tour operators Local insurance agencies Local market and the Local guides Though this case study does not have the involvement of all the probable network members that normally constitute a medical tourism service sector network, it has the potential of becoming an immensely popular and preferred destination, particularly for the people seeking

knee and total hip replacement interventions. The identified gaps/weaknesses and recommendations emerging out of this case study are presented in details below:

Weaknesses and Recommendations:

1. Preference for the metro cities by the foreign tourists Many foreigners still prefer to get themselves treated in the metro cities of India rather than opting for the mini-metros or A class cities. The most important reason for this is the good flight connectivity offered by the metros. But this advantage is not without associated problems of: _Traffic congestion (which is negligible in the A class cities) _High levels of pollution (The A class cities fare very well as the levels of pollution are very low) _Possibility of not being operated upon by the top doctor of a super specialty hospital (Smaller super specialty hospitals in the A class cities offer the surety that the operation will be performed by the most expert doctor of the hospital with the assistance of other specialist doctors, if needed. Recommendations: The powers that be of the A class cities should argue their case before the Ministry of Civil Aviation for increase flight connectivity. With the entry of the private players into the field of aviation, the chances of getting a favorable response to this demand are brighter than ever before. 2 Perceived poor infrastructure in A class cities The A class cities are perceived as having poor infrastructure development. On the contrary, it is the infrastructure of the metro cities that is under heavy stress as there is virtually no scope for horizontal infrastructure development in these cities, which mandates the development of tall sky-scraper buildings. The A class cities on the other hand, offer ample space for people willing to invest and develop the infrastructure and the cost of land is also comparatively much cheaper than in the metro cities. Recommendations: The municipal corporation of the A class cities should realize the potential benefits of developing world class infrastructure and strive to strike collaboration with builders of their city in developing infrastructure that shall be in great demand in the years to come. Private builders too can try and tap the potential that the real estate market has to offer today. 3. Disinterest/Lack of awareness of the Maharashtra Tourism Development Corporation (MTDC) When contacted, the MTDC officials of Nagpur were totally unaware of the concept of medical tourism. This lack of awareness is also reflected in their lackadaisical approach towards development of tourist locations in and around Nagpur, which has numerous wild life reserves like the Tadoba Andhari National Park, Totladoh Wild life reserve and Karmazari wild life park, besides famous pilgrimage locations like the famous temple at Ramtek, where lord Rama is believed to have rested during his 14 years of exile and the Dragon temple near Kamptee, which depicts the rich Buddhist heritage. Recommendations: An in house awareness programme should be conducted for the MTDC officials to make them realize the tourist potential of Nagpur and its adjoining areas. The MTDC has ample funds to develop the tourists hot spots under its jurisdiction. What is lacking

is the will to put in hard work to develop new world class tourism facilities and maintain the existing ones. The State Ministry of Tourism also needs to be made aware of the increasing popularity of medical tourism so that state of Maharashtra does not lose out to other states in attracting foreign tourists. 4. Lack of vigorous marketing by healthcare institutes Dr. Sushrut Babhulkar strongly brought out the point that the healthcare institutes in Nagpur offering specialty medical interventions like Sushrut Hospital and Research Centre as well as other institutes run by individual expert doctors have not been able to market themselves well in the rapidly expanding market of medical healthcare providers. The primary reason attributed to this was the lack of time on the part of the doctor to look at this aspect. Recommendations: There was a suggestion that there should be service providers who can help individual healthcare institutes in bringing their expertise before the world. The mutual benefits of this will be huge and shall go a long way in diverting medical tourists to the A class cities. 5.Lack of coordination between the hotels and healthcare institutes At the moment, the healthcare institutes and the hotels are operating independently of each other in Nagpur. The hotel has its own clientele and is not aware of the potential clients in terms of the medical tourists who come to Nagpur to avail medical interventions. Nagpur has two five star hotels, one situated at a stones throw from the airport and the other right in the heart of the city. Recommendations: These hotels and the health care institutes should work in collaboration which will prove to be mutually beneficial for both the parties and the hotels will also do better if they can extend their services from merely providing accommodation to providing for the tourists journey to the nearby tourist hotspot and also a full time general practitioner to attend to medial emergencies, if any. 6. Proactive role by the insurance companies Nagpur boasts of a healthy presence of both government and private insurance companies. But these insurance companies as of today are only targeting the consumers in terms of the myriad healthcare policies that they have to offer. The medical cover by such insurance companies to a foreign tourist is virtually non-existent. Recommendations: The insurance companies should set in place some kind of policy that will help in cutting down the window/waiting period of three months and they should be able to provide medical cover to the foreign patients seeking a major medical intervention. At the moment, it is felt that a major intervention in the insurance sector is needed with respect to providing insurance facilities to medial tourists. Summarizing the above discussions, the general recommendations that will give a major boost to Indian medical tourism include the following: Working towards internationally recognized accreditation Regulatory bodies with teeth Better coordination between the ministries Co-operation between the different stakeholders of this service sector network Medical insurance reforms Vigorous marketing & information dissemination Sustainable development

Conclusion of the Study:

This case study is an excellent example of an individual trying to promote medical tourism in his own special way. This has inspired many medical specialists of the region to come together and form a group and tap the tremendous potential that medical tourism holds of cities like Nagpur which is developing by leaps and bounds, the proof of which is that major companies are setting up their base here.


1. To provide for brighter prospects for the industry, the hospitals can also acquire international accreditation, integrate traditional and clinical treatments and offer end-to-end value added services by tying up with tour operators, airline carriers and hotel companies. 2. Hospitals can also allow foreign patients to pay through credit and ensure proper support services to foreign patients after they return to their native countries. 3. The Government of India can also reinforce its support through quick visa processing, improved flight connectivity and infrastructure development.


There is no doubt that in the last 20 years, India's healthcare sector has made tremendous progress, not only in the science of medicine but also in the quality of service that out private hospitals are able to provide. Thousands of people in the UK, Europe and North America, who have come to some of the top hospitals in India to avail of a variety of medical services in the past decade, have gone back delighted with the experience. Even the Joint Commission International (JCI) the global wing of the American JCAHO (Joint Commission for Accreditation of Health Organisations), has recognised that the quality of hospitals in this country matched US standards in every way. Leaders of the global healthcare community have also heaped fulsome praise on the leading Indian hospitals during personal visits from time to time. This does not means to say that there aren't very specific situations where it may be essential for someone to go overseas for medical treatment, particularly if the disease is a very rare form or if very expensive equipment is needed. Having said that, the leaders of the country have been the best brand ambassador to

our medical tourism. The last two Prime Ministers of the country have treated themselves in Indian hospitals. Atal Bihari Vajpayee for his knee replacement surgery and Manmohan Singh for his by-pass surgery. This legacy and brand building for the last 2 decades has been put under an opposite impression by the ruling party leader Sonia Gandhi. By getting herself treated abroad recently, she has raised eyebrows of many on the ability of Indian physicians. Is it not the promoters responsibility to use its own product? A question unanswered..