The long road to treatment : Understanding Manipur’s medical migration

Dr Raj Singh
Not long ago, I received a phone call that should worry every doctor, hospital administrator, health policymaker, and political leader in Manipur.
A relative was preparing to travel to Guwahati for treatment. For three weeks, he had consulted three different ENT specialists in Imphal for a swallowing problem. Since the symptoms persisted, he decided to go to Guwahati. He visited an astrologer to fix the travel date.
The astrologer suggested an auspicious date for travel. He also reportedly told my relative that the problem was not in his throat. It was in his heart. He advised him to see a heart specialist.
And he also suggested another ENT Specialist in Guwahati in case.
My relative believed him and met the same ENT Specialist the astrologer suggested. The doctor in Guwahati prescribed a medicine and advised his patient to try it for 3 days and see a Thyroid specialist if the problem persists. The problem started to disappear within two days, and the Thyroid investigation on the fourth day showed no problem. He came back much relieved and has now resumed normal work.
Think about that for a moment.
Three trained medical specialists could not earn a patient’s confidence enough to keep him within the State’s healthcare system. An astrologer could.
This is not a story about superstition.
It is a story about trust. And it is a true story that prompted me to write this article.
Trust may be the most valuable medicine that Manipur’s healthcare system is currently lacking.
The Silent Exodus
Every year, thousands of Manipuris travel to Guwahati, Kolkata, Delhi, Chennai, Vellore, Bengaluru, Hyderabad and other cities for medical treatment.
Many of these journeys are medically justified. Complex cardiac surgery, organ transplantation, advanced cancer treatment, highly specialized neurosurgery, and rare disorders naturally require referral to larger tertiary-care centres.
But that is not what we are witnessing.
Patients are travelling outside even for conditions that local hospitals are technically capable of treating.
Kidney stones, Gallbladder surgery, Orthopedic procedures, ENT problems;
Routine investigations.
Follow-up consultations.
Second opinions.
The question is obvious.
If Manipur today has numerous specialists, super-specialists, private hospitals, modern diagnostic equipment, intensive care facilities and advanced surgical units, why are patients still voting with their feet?
The answer lies beyond infrastructure.
The answer lies in confidence.
My Own Lesson on an Operating Table
A few months ago, I experienced this problem personally.
A kidney stone had blocked my ureter. It was an emergency.
I was wheeled into the operating room for a stone-removal procedure.
What happened next had little to do with medicine and everything to do with professionalism.
After waiting in distress, I was asked to change into the operating gown in a hallway leading to the Operating Theatre, which turned out to be literally a “Theatre.”
Inside the operating room, several men and women were engaged in animated conversations that seemed completely unrelated to the patient lying on the table.
That patient was me.
As preparations began, I found myself exposed, anxious, and inadequately reassured.
Attempts were made to insert instruments into my body while casual conversations were on.
The procedure had to be repeated because the staff assisting the doctor were not properly holding the equipment.
The discomfort was mine.
The anxiety was mine.
Then came a conversation that no patient should hear while lying on an operating table. ‘Where is your stone crusher ?’ The doctor meant the lithotripter machine.
The search began.
One staff member did not know where the machine was.
Another staff member thought another doctor had used it.
They found the machine, but the nozzle was missing.
For several minutes, the operating theatre resembled a workshop searching for a misplaced tool.
Meanwhile, I lay there, imagining that the operation might not proceed because someone had misplaced an essential component.
Fortunately, the missing piece was found.
The procedure succeeded.
The doctor later advised me to return for another procedure to remove a few more stones still lurking in the kidney.
I knew the doctor could do it. But I never went back.
Instead, I travelled to Guwahati because everyone advised me to.
The same treatment that might have cost around Rs 20,000 locally ended up costing me nearly Rs 2.5 lakh. And the treatment facility and the service at the Guwahati hospital were not extraordinary.
The difference was not medical.
It was psychological.
I had lost confidence.
The Economics of Distrust
Economists speak about ‘capital flight.’
Manipur suffers from something equally damaging - “medical capital flight.”
When patients leave the State, they do not travel alone.
They carry money.
A patient travelling to Guwahati or Delhi typically spends on:
* Hospital charges
* Airfare or transportation
* Accommodation
* Food
* Local travel
* Companion expenses
* Lost wages
Obviously, the cost of treatment becomes five to ten times higher outside the State.
Multiply this by thousands of patients every year.
The result is a massive transfer of wealth from Manipur’s economy to healthcare markets elsewhere.
This is perhaps one of the least discussed economic leakages in the State.
We debate border trade.
We debate tourism.
We debate industrial investment.
But we rarely discuss the enormous amount of money leaving the State through medical migration.
The Second-Opinion Syndrome
A friend of mine once faced a medical condition for which a doctor in Imphal advised major surgery.
Naturally worried, he travelled to Delhi for a “second opinion.”
There, another doctor prescribed medication without the need for a major surgery.
He recovered completely.
Stories like this spread rapidly.
They become legends.
Each story may contain nuances that the public never hears.
Perhaps both doctors had reasonable arguments.
Perhaps the case evolved.
Perhaps diagnostic interpretations differed.
But perception matters more than technical explanations.
Once people hear ten such stories, they develop a mental shortcut: ‘If doctors here advise surgery, better go outside first.’
That single sentence can destroy years of investment in local healthcare.
The Missing Ingredient: Professionalism
The uncomfortable truth is that many patients do not complain primarily about competence.
They complain about behaviour.
The average patient rarely has the expertise to evaluate surgical skills.
What patients can evaluate is professionalism.
Did the doctor listen ?
Did the staff show empathy ?
Was privacy respected ?
Was the procedure explained ?
Was the equipment ready ?
Did the hospital function like a coordinated system ?
Did anyone make the patient feel safe ?
In service industries, perception is reality.
A five-star hotel may have ordinary furniture but extraordinary service.
A hospital may have extraordinary equipment but ordinary service.
Guess which institution earns loyalty.
This Is Not a Manipur Problem Alone
Many regions have faced similar crises.
In the 1980s and 1990s, patients from several Gulf countries routinely travelled to Europe and North Ame-rica because they lacked confidence in local health- care.
The Governments invested not merely in buildings but in quality systems, accreditation, patient experience, and international standards.
Today, countries such as the United Arab Emirates attract medical tourists rather than exporting patients.
Similarly, cities in Thailand transformed themselves into healthcare destinations not simply because of medical expertise but because patients trusted the overall experience.
Even within India, hospitals such as Christian Medical College Vellore built their reputations as much through patient-centred culture as through clinical excellence.
Patients travel long distances because they trust the system.
Trust is their product.
Medicine is only part of the package.
Why Trust Matters More Than Technology
Healthcare is unique.
A customer entering a restaurant can judge the food after eating it.
A person buying a mobile phone can test it immediately.
Patients cannot accurately judge the quality of medical care.
They therefore rely on signals: Professional conduct, Orderliness, Cleanli- ness, Communication, Compassion, Transparency, and so on.
The moment these signals disappear, trust collapses.
And once trust collapses, people start consulting astrologers, relatives, WhatsApp groups,
neighbours, taxi drivers, and strangers before consulting doctors.
That is not because society has become irrational.
It is because institutions have become unconvincing.
The Culture Question
The deeper issue may be cultural.
In many professions in Manipur, technical qualifications are often mistaken for professionalism.
The two are not the same.
A brilliant surgeon can still create a terrible patient experience.
A highly qualified doctor can still destroy confidence through indifference.
Professionalism means respecting systems.
It means preparing equipment beforehand.
It means maintaining patient dignity.
It means minimizing patient anxiety.
It means understanding that every patient arrives carrying fear.
In healthcare, patients are not customers buying a product.
They are vulnerable human beings temporarily surrendering control of their lives to strangers.
That trust must be earned.
How to Reverse the Exodus
The encouraging news is that this problem is largely correctable.
First, hospitals must measure patient experience as rigorously as clinical outcomes. Every hospital should conduct anonymous patient-satisfaction audits.
Second, operating theatres must adopt strict professional protocols. Equipment searches should never happen during procedures. Pre-operation check- lists must become mandatory.
Third, communication training should be compulsory for doctors, nurses and support staff.
Empathy is not a soft skill in healthcare. It is a clinical skill.
Fourth, hospitals should establish independent grievance mechanisms. Patients who feel mistreated need channels for feedback without fear.
Fifth, medical associations must openly discuss professionalism rather than treating criticism as an attack on the profession.
Sixth, the Government should publish quality indicators for hospitals : patient satisfaction, infection rates, response times, accreditation status, and outcomes. Transparency builds confidence.
Finally, hospitals must understand a simple reality. Patients compare experiences-Not qualifications, not degrees, not equipment lists.
But experiences.
Beyond the Obvious
The healthcare crisis in Manipur may not be a shortage of specialists.
It may not even be a shortage of technology.
The deeper crisis is a shortage of trust.
When a patient believes an astrologer more than three doctors, something fundamental has broken.
When patients spend 10 times as much travelling out of State for treatment available locally, something fun- damental has broken.
When hospitals possess modern equipment but cannot inspire confidence, something fundamental has broken.
The tragedy is that trust takes years to build and only minutes to destroy.
The hope is that professionalism can rebuild it.
The day Manipuris begin choosing hospitals in Imphal not because they have no alternative but because they genuinely trust them, the State will witness not only a healthcare transformation but also an economic one.
Until then, one of Manipur’s largest exports will continue to be its patients and the money they carry.
This column, “Beyond the Obvious,” seeks to examine public controversies not through emotional binaries but through deeper historical memory, constitutional logic, and comparative political thought - in the belief that durable peace lies not in louder demands, but in wiser design.