VZCZCXYZ0035
RR RUEHWEB

DE RUEHTU #0296/01 0651401
ZNR UUUUU ZZH
R 061401Z MAR 07
FM AMEMBASSY TUNIS
TO SECSTATE WASHDC 2820

UNCLAS TUNIS 000296 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR NEA/MAG - HARRIS; HR/EL DIVISION 
 
E.O. 12958: NA 
TAGS: ETRD ECON EINV SOCI TS
SUBJECT: Beywatch: Can Tunisia Cut Its Way Into the Medical Tourism 
Market? 
 
¶1. INTRODUCTION: This report is one of a series drafted by Post's 
entry level officers which have the "Beywatch" caption.  We believe 
the perspectives offered in the following vignette will give the 
reader greater insight into Tunisia.  END INTRODUCTION. 
 
¶2. SUMMARY: From Budapest to Bangkok, Western "medical tourists" are 
swarming to private clinics and large hospitals to receive care for 
a fraction of the cost they would pay back home. Travel agencies woo 
clients with pictures of slim, perky waifs with perfect smiles 
enjoying tour packages that include post-op stays at luxurious 
hotels and the chance to visit cultural sites as soon as the 
anesthesia wears off.  Tunisia is trying to find its footing in this 
relatively new sector of the global marketplace. Though Tunisia only 
attracted about 500 medical tourists last year, local physicians, 
hotels and tour groups are eager to capitalize on a solid medical 
infrastructure and proximity to Europe. END SUMMARY. 
 
-------------------- 
IF THE PRICE IS RIGHT. . . 
-------------------- 
 
¶3.  When comparing costs, it is not difficult to understand why 
someone from a country like the United Kingdom or the United States 
might choose to travel abroad for medical care.  In the United 
States a patient can expect to pay around US $8000 for a facelift, 
but s/he saves almost 70 percent on the same procedure in India or 
Thailand.  Tunisian physicians can match the savings of these major 
players on the international plastic surgery scene: a facelift in 
Tunisia usually runs around 5600 TND (US $4251). 
 
-------------------- 
"SEDUCING CLASSY CUSTOMER CATEGORIES" 
-------------------- 
 
¶4. Tunisian doctors and clinics are starting to form partnerships 
with hotels and airlines to offer patients discounted rates for 
all-inclusive deals.  Dr. Samy Dlimi, a plastic surgeon with a 
private office in Tunis, however, noted one problem: "We don't have 
the hotels other countries do," he admitted.  He is worried he will 
never be able to cater to a more upscale clientele until the 
Tunisian general tourism sector gets a bit of a facelift itself. 
While Tunisia's tourism industry made the country 2.56 billion TND 
(US $1.98 billion) last year, foreigners often note that "five 
stars" here do not equal five stars in much of the rest of the 
world.  The GOT has identified the lack of high-end tourist 
facilities as a challenge, and the Ministry of Tourism website 
insists that "Due importance is given to the quality improvement of 
Tunisian products, which are climbing to the top end of the range 
and are increasingly seducing classy customer categories. [sic]" 
 
¶5. For now, Tunisian plastic surgeons cater primarily to 
middle-to-low income Europeans.  Dr. Dlimi explained that he gets a 
large number of Dutch housewives, French students and Italian retail 
workers.  "It's not the jet set," he sighed.  Dr. Sami Kamoun, the 
director of the private Clinique Avicenne in Tunis, agrees and told 
Conoff that if medical tourism is going to work here it will have to 
be based more on cutthroat pricing than on the extra luxuries 
offered to patients flying to places like Phuket or Rio. 
 
¶6.  Last year, about half a million Americans traveled overseas to 
receive some sort of medical care.  Dr. Dlimi hopes to increase 
their numbers in Tunisia.  "My dream is to build a bridge between 
Tunisia and the United States," he confided dramatically to Conoff. 
But Dr. Mohamed Smida, head of the well known Polyclinique El 
Menzah, scoffs at the idea of trying to attract Americans, pointing 
out that not very many Tunisians speak English and that Americans 
can find better travel deals than flights to Tunis.  (COMMENT: The 
language barrier hasn't stopped British tourists from coming to 
Tunisia for health care, according to doctors and clinics, although 
the British Vice Consul had no knowledge of their presence.  END 
COMMENT.) 
 
-------------------- 
QUALITY CONTROL 
-------------------- 
 
¶7. "Label Esthetique," a large Tunisian agency offering packaged 
medical tours, brags in its advertising that its doctors have all 
received diplomas from France, and the Clinique el Menzah, a large 
center for plastic surgery in downtown Tunis, details its 
physicians' work experiences at hospitals in Milwaukee and St. 
Louis. Doctors admitted to Conoff that although Tunisia's medical 
education system has solid infrastructure Western clients simply 
feel more comfortable working with experts trained in the very 
countries in which they cannot afford healthcare. 
 
¶8.  But while Tunisia may boast of a highly skilled set of medical 
professionals with international accreditations, there seems to be a 
lack of regulations in the aesthetic surgery field.  Dr. Dlimi 
estimated that only half of all plastic surgeons practicing in the 
country are government qualified in that field. Dlimi shook his head 
 
sadly when describing dermatologists performing eyelid surgery, 
trauma surgeons doing nose jobs, and general practitioners trying 
their hand at liposuction.  As plastic surgery is not a formal 
specialty in the Tunisian medical education system, doctors wishing 
to perform the procedures must either study abroad, or do so without 
technical training or GOT sanction. 
 
¶9. Dr. Kamoun has recently gone into partnership with two French 
travel agents who want to set up an office in Tunis to handle the 
logistics of bringing European clients to his clinic, but despite 
his hopes to expand his client pool, he worries that if medical 
tourism in Tunisia grows too rapidly, it could lead to shoddy care, 
which in turn could result in the bottom dropping out of the market. 
 "If doctors aren't careful," Dr. Kamoun noted, "they will destroy 
Tunisia's reputation by pushing commercialism over medicine."  On 
the other hand, many Tunisian medical students go abroad and stay 
abroad to practice, because there are more of them than there are 
patients.  Kamoun noted that medical tourism, and the new clinics 
and offices it would bring, could provide a reason for Tunisian 
doctors to stay in Tunisia. 
 
-------------------- 
LATE IN THE GAME, CAN TUNISIA STILL PLAY? 
-------------------- 
 
¶10.  Since tourism accounts for 7 percent of the Tunisian GDP, and 1 
in every 6 jobs in the country is somehow related to travel and 
tourism, it is not surprising that GOT representatives have been 
pushing the country's hope of increasing its stake in the medical 
tourism economy.  Tunisia has already gotten its feet wet in many 
ways; it has been treating Libyan patients for years, even during 
the embargo.  But Tunisia is about a decade behind its competitors, 
and will probably have to work all that much harder to make itself a 
household name for worldwide patient care. 
 
¶11.  There are also some marketing hurdles that Tunisia may be 
facing as it competes in the global medical tourism marketplace. 
Tunisia, like France, has laws forbidding doctors from advertising, 
which is why you will only find their initials (Dr. F, Dr. P, etc.) 
on websites.  This may be acceptable for larger clinics posting the 
resumes of a long list of physicians, but for individual doQrs 
trying to get their name out to potential clients, this represents 
an impediment.  Also, perhaps due to the low 8 percent internet 
penetration rate here, the websites of Tunisian clinics and tour 
agencies tend to be a little less attractive or technically sound 
than those of their competitors.  In a commercial arena driven by 
the World Wide Web, tech savvy may be as important as surgical 
skill, and Tunisia has some catching up to do. 
 
-------------------- 
COMMENT 
-------------------- 
 
¶12. There are many obstacles to Tunisia becoming a formidable 
competitor for medical tourists.  The doubts about the quality of 
hotels and the tourism industry in general, language barriers, and 
concern about sustaining professional medical standards, all call 
into question whether Tunisia could be successful in such an effort. 
 It is doubtful that large numbers of American patients will ever 
travel the distance to a country most of them have probably never 
heard of for medical care, since they do not come in large numbers 
for general tourism, and Westerners' apparent preference for 
European-trained doctors may not bode well for the sustainability of 
the sector.  While some doctors and the Ministry of Tourism would 
prefer to attract high-end travelers, a renovation of the tourism 
sector aimed at charming the wealthy might make it difficult to 
maintain, much less expand, the Tunisian client base of travelers 
seeking affordable package deals and, in some cases, doctors.   But 
if the government begins to better regulate the practice of 
aesthetic medicine, and investors refrain from a sudden glut of 
discounted clinics, there may be hope that medical tourism may 
continue to grow here, particularly in terms of market share among 
middle income patients from Europe. 
GODEC