MEDICAL MANAGEMENT REVIEW
GLOBAL MEDTOUR PRACTICE DURING COVID-19 PANDEMIC
Roadmap for Asia-Pacific oriented clinics & operators
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© Petro Rybalchenko

MEMBER OF UKRAINIAN ASSOCIATION OF SINOLOGISTS
FOUNDER OF ASIA-COACH ACADEMY
MBA (MEDICINE)

Email for cooperation proposals:
medicine@asia-coach.academy

The material below can be used for personal & corporate purposes to implement any of the best ideas and practices indicated in this article. This business cooperation article is not aimed at research, but is expected to give considerable push for posing and solving the existing problems on the crossway of Medicine and Asia oriented Management in Healthcare during the COVID19 outbreak.
INTRODUCTION: FORMULATION TO THE PROBLEM

The issue of planned and so recently "habitual" service of patients from the most vulnerable regions of Asia by epidemic outbreaks by Western clinics and medical tourism operators has become especially acute in 2019-2021. In particular, during the period of aggravation of the COVID19 dynamics and the adoption of urgent measures to save almost all segments of the population by the governments of their countries. There appeared the following phenomena on the way of clinical management (medical personnel and managers of middle and top chains), which provides cyclical service through the programs of international patients:
- weakening of strategies during lockdown;
- patients' fear of entering the program;
- obsessive fear of visiting other countries unfamiliar to the patient in the midst of an epidemic or an enhanced quarantine regime;
- a drop in the quality of staff work against the background of demotivating factors on the way to professional and personal well-being;
- stressful penalties of planned work algorithms due to cancellation of flights, closure of hotels, complication of schemes for covering transnational service costs, especially in countries with closed financial systems and regimes;
- the transition of consumers to domestic, local (often low-quality) healthcare providers.
This series of causes and effects of socio-economic ties in the international environment raises a question along with the main one (about the timing of the end for the pandemic and the return of society to a normal life): how to maintain and continue the development of your business? And in general, how can the administration techniques be developed in such a critical and unprecedented environment for owners and managers? We will try to solve this problem using the example of over 5 years of experience in working in East Asia working with patients from China, Japan, South Korea, Singapore and other countries in various fields of medicine: therapy, traditional Chinese medicine, gynecology and reproduction, as well as regenerative and translational medicine. In the hope of not only illuminating and resolving a number of managerial dilemmas, but also showing new opportunities and prospects for cooperation in a new era, expressing the author's full readiness to provide consulting, training, administrative, marketing and information support to clinics and medical operators in various fields of medicine, we are pleased to present to the world medical and business board updated, innovative programs and approaches that contain the high potential to become catalysts for positive dynamics in optimizing the management of medical tourism services for competent departments, agencies and even large and influential affiliated holdings in the world recognized practice.
1. INDUSTRY CHALLENGES & CASES OVERVIEW

The destinations of medical tourists are multiple and are not the preserve of a single continent. Normally the destinations are generally grouped according to the care offered. For cardiac and orthopedic surgery or general medical care, the offer of care is mainly concentrated in Asian countries such as Thailand, India, Hong Kong, Singapore, Malaysia, the Philippines, Brunei, the United Arab Emirates and Jordan. These same benefits are also offered by countries such as South Africa, Cuba, Colombia, Switzerland, the USA, Poland, Germany, Lithuania, Ukraine, Israel and New Zealand. For aesthetic treatments, we find many countries in Latin America and Southeast Asia where in some of these countries up to 70% of women from the wealthy social classes would have recourse to cosmetic surgery. These are Colombia, Costa Rica, Bolivia, Argentina, Brazil, Cuba, Thailand and South Korea.
The coronavirus (COVID-19) pandemic has thrown the tourism economy into an unprecedented crisis, under the impact of the brutal and immense shock it has caused for this sector.
The "new crown virus" is currently putting tremendous pressure on the medical system and the world economy, which will change the size and shape of the medical tourism market in an unpredictable way.
In the years before the COVID-19 pandemic, medical tourism was an explosive industry. In just 20 years, globalization and technology have transformed health and medical tourism from almost non-existent to an international medical tourism industry. Governments of dozens of countries believe that this is vital to their economic future.
Now, the specter of COVID-19 has changed everything. We don't know how long this virus will last, or how many waves of new virus outbreaks will threaten the world. Dozens of countries have imposed temporary restrictions on international travel, or even completely but temporarily slowing down the development of medical tourism.
For a long time, the health industry has seen the chain reaction of this pandemic. Alternative surgery has been cancelled, medical supplies have been drastically reduced, disaster planning and emergency preparedness have become central issues, bringing unprecedented burdens to health services. Convention centers, stadiums, cruise ships and hotels have to reconfigure their spaces to meet severe medical needs. No expert or computer model can accurately predict how long our current modern medical operation will be interrupted.
If there is a bright side to all of this, then doing business in uncharted territory will provide an opportunity to innovate and reorganize the systems that determine how health services are delivered. The COVID-19 era has witnessed a fundamental shift to remote and cheaper medical methods, which consume fewer resources . Telemedicine is a center for more effective medical services, allowing non-coronavirus patients to stay at home and freeing up much-needed beds in hospitals. It is almost certain that this will pave the way for a more powerful telemedicine future.
After an international pandemic like the new coronavirus, many people may insist on a more conservative approach to medical services, and the impact of the virus on the entertainment and tourism industries is completely unknown. Even if the virus subsides next week, many people are unlikely to fly or travel to another country without major guarantees of safety and hygiene, which must come from every contact point of the patient’s journey. For various reasons, the medical tourism industry is at the most complex stage in its relatively young life cycle.
For many destinations and hospitals that are still seeking to use medical tourism as the cornerstone of their economy, medical tourism remains important. In terms of the combination of healthcare, hospitality and tourism, no other industry can match it. Medical tourism organizations have no time to consider medical tourism as a new potential economic diversification strategy as they do now. Countries that have responded well to the epidemic may take the lead in medical travel, provide more attractive medical services , and have a higher degree of trust in the destination's ability to care for the people.
COVID-19 has caused huge losses to the tourism and medical tourism industries , but many tourist destinations are actively carrying out brand promotion activities to eliminate the impact of the epidemic. This will undoubtedly open many new doors for medical travelers looking for new opportunities through the healthcare system, which reimagines their services specifically for health travelers. Now is the most prudent time to re-evaluate marketing strategies, improve online image or plan digital marketing campaigns to attract medical travelers. Whether it will ultimately be feasible depends on the extent of the virus's impact on existing medical tourism.
For countries and regions where the new coronavirus prevention and control measures are in place, the medical tourism industry will return to some apparent normality. The rebound may occur in early 2021; it may also occur before that, because organizations and destinations seize the opportunity to focus on medical providers who are currently willing to travel. The development and efficacy of the COVID-19 vaccine will also greatly affect the timetable.
Aspiring medical tourism cities and medical destinations should actively establish relationships with airports, hotels, and health resorts, and use good screening and sanitation procedures. In some cases, the economic recovery brought about by COVID-19 may even provide a rare opportunity to redefine the reputation of medical destinations.
After COVID-19, with the rise in economic conditions and unemployment, consumers' price awareness will rise as a more important factor in the decision-making process of medical services. Medical destinations should consider a more proactive approach when establishing relationships with insurance companies and other healthcare purchasers and recommenders. Global buyers will look for safe, high-quality destinations to provide complete patient care services for their insureds and customers. In this era of increasing economic pressure, savings and economic incentives will be attractive to corporate recommenders and individual medical travelers.
Still there are cases where countries try to revive the situation with minimum losses for the industry.
CASE 1
For example, earlier in October 2020 it was reported that Thailand’s New Crown Epidemic Management Center previously had pointed out that Thailand’s medical tourism plan had resumed, and the government would adopt strict disease control measures and welcome foreign medical tourists to Thailand for medical treatment. According to the regulations of the Epidemic Management Center, medical passengers must arrive in Thailand by plane at this stage to ensure effective disease control. In response, the Thai Medical Center Committee had stated earlier that it would request instructions from the Epidemic Management Center to further open four airports, including Koh Samui, Phuket, Chiang Mai and U-Tapao, so that medical tourists can fly directly to resorts in the above-mentioned areas. isolation.
It was reported in mass media that as of now, Thailand had received 1,123 foreign medical tourists, and there were still 2,220 medical tourists waiting for visas. It is expected that in the next few months, the number of medical tourists will exceed 3,000.
Branagh, senior vice president of Dusit Medical Group, said that since the first wave of the epidemic, all hospitals under the group have been prepared to deal with it. Even if the second wave of epidemic occurs, the hospital can calmly face it.
The new coronavirus epidemic has opened up the physical distance between people, and it has also changed the way people live and work, and has accelerated the development of the medical system in the direction of remote services under the new normal. Long before the outbreak, many medical institutions in Thailand took the lead in trying virtual hospitals and remote diagnosis and treatment services to provide professional medical advice to patients who cannot go to the hospital in person in a more cost-effective and efficient way.
The COVID-19 outbreak has all but brought global medical tourism to a halt as institutions cut back on non-essential services and patients stay at home due to travel restrictions and social distancing models. However, with the lifting of flight bans and the temporary reopening of many countries, there are several examples of how the medical tourism segment could position itself for a rebound.
Comprehensive testing, for both foreigners and nationals, will be key to restoring patient confidence in medical tourism destinations, as will strong hospital hygiene regimes. This involves frequent cleaning and disinfection, as well as increased ventilation and air filtration.
New technologies also have a critical role to play for institutions seeking to capture market share : for example, doors that open and close through a smartphone app can reduce the physical contact that occurs during patient visits, while advanced medical technologies, such as robot-assisted surgery, may reduce the risk of transmission.
On a related note, the pandemic could accelerate the current trend for medical complexes to operate with high-end accommodation . This allows them to derive greater income from patient visits and, perhaps more important in the context of the pandemic, allows patients to remain in a controlled medical environment to sleep, eat and relax.
CASE 2
In August 2020, Christian Schumacher, executive director of King's College Hospital in Dubai, told local media that the number of consultations the hospital received from medical tourists had returned to around 60% of levels seen in January. In particular, he noted an increase in the number of visitors from countries with less developed health systems, such as Nigeria, as well as other countries.
An important underlying factor in this upturn in demand is the UAE's broader commitment to testing.
According to the Dubai Health Authority (DHA), since the start of the pandemic, more than 4 million PCR tests have been performed in the UAE - including 950,000 in Dubai alone - making the UAE the fifth largest country in the world in terms of the number of tests per capita at the beginning of August.
Dubai's long- standing focus on developing the medical tourism sector has also allowed it to recover on a solid footing.
Before the pandemic, the Dubai Health Tourism Council was on track to meet its goal of 500,000 medical visitors per year by 2021 : some 337,000 visitors in 2018, the most recent year for which data is available. available. Among them, 33% were from Arabic speaking countries, mainly Kuwait, Saudi Arabia and Oman. Asia represents 30% and Europe 16%
While it is true that COVID-19 reduced visitor streams in the first half of 2020, the combination of digitization and government support mechanisms points to better prospects for the second half of the year and beyond. In addition to this, you need to know more about it.
For example, the Ministry of Health's Dubai Health Experience is the region's premier medical tourism portal , allowing tourists to book their entire visit online; Jordan recently launched its own comparable registration platform.
Meanwhile, Dubai Health City, believed to be the world's largest healthcare free economic zone, received financial assistance in May that includes both benefits and regulatory fee exemptions . Operations resumed there on July 21.

2. REESTABLISHING BROKEN SERVICE AND MANAGEMENT PARADIGMS

This may be an appropriate time to question or even change the paradigm of the medical tourism industry, and to evaluate the industry views, business development practices and management methods. Why is it regarded as a way to escape, relax and socialize; to establish a new identity and status; as a reward; as a breakthrough from the routine in a meaningless or unsatisfied life? Why do people decide to leave home thousands of miles to get (or restore) the feeling of "happiness" overseas? Why does culture commercialize medical tourism and make it as an "attraction" to attract patients, thereby driving economic growth?
Patients should not be seen as primary sources of business assets like some of medtour agency owners may seem like to approach, nor should it be seen as frivolous and often artificial. Tourism is a mindful business investment that should focus on the development of sustainable resources, with environmental protection and sustainability as the goal, rather than development as the goal.
In other words all efforts of a managers should be thrown upon sustainability of the service environment during the planned program for the patient.
Some travel industry partners have begun to accept their role in causing the pandemic and fulfilling their responsibilities, although the focus is on finding short-term solutions to the current crisis, rather than long-term improvements.
These companies are redesigning environmentally friendly adventurous activities, from wineries to outdoor activities, focusing on private individuals, individuals or small groups that require social distancing and covering their faces. Some travel partners have adopted new standards and upgraded cleaning procedures based on recommendations from medical/hospital consultants. Some companies even invest money in places where they can help, for example, using antibacterial fabrics and surfaces into the abyss and upgrading their HVAC systems.
Restaurants, hotels, airports and public places are redesigning their environments to make them contactless and/or introduce robots. Mobile applications are used for booking, check-in/check-out, room access, digital payment and purchase of services, entertainment and event reservations. The new Covid-19 technology can ensure crowd size and management in public events, airports, shopping malls, museums and hotels.
In Asia, the community relocated to a highway to reduce the time from the airport to the downtown hotel. In other parts of the world, children paraded in front of tourists, demanding pencils, paper and books because the local economy cannot support elementary education.
The epidemic caused by the virus has prompted the Asian governments and the markets to re-examine the original medical management system, and reforms to it will be very necessary. Building the administration system that can not only satisfy the huge population of chronic diseases but also combat sudden emergencies at critical moments will be the main focus of future institutional reconstruction.
With the innovation of drugs, traditional infectious diseases have gradually weakened under the popularization of vaccines, and can no longer cause huge damage. Chronic diseases formed under changes in the dietary structure pose a major challenge to disease control and medical expenses. Therefore, the focus is shifting from dealing with traditional severe infectious diseases to how to effectively control patients with chronic diseases. However, the emergent event of the new epidemic has given a warning that public health management should re-evaluate the emergent new infectious diseases, and building a health management system that can simultaneously deal with acute and chronic diseases will be a top priority.
From the perspective of the development of the epidemic, front-end health education and prevention, screening, coordination and connection, treatment and post-cure tracking require a complete chain of services, and none of them are indispensable. In the past few decades, although a relatively complete multi-level prevention and control system has been established, the real service capabilities of the grass-roots and intermediate levels have never been established, especially the technical capabilities of doctors have never been as developed as in developed countries. Uniformity among all levels. Moreover, because the grassroots can only ask for consultations and the overall service capabilities are weak, it is difficult to obtain high returns in the current product and surgery-oriented medical market, which further weakens the willingness of high-level doctors to join. This has caused the multi-level medical system to become more of a form. Not only is it unable to establish a response to the crisis of acute and severe illness, but even the usual minor and chronic diseases cannot attract patients.
On the other hand, because the entire medical system has only focused on treatment for a long time, and the service at the front and back ends has been underestimated. This has led to a break in the Chinese medical service chain itself. Once an emergency event occurs, the multi-level prevention and control system cannot function in fact.
The so-called fragmentation of the medical service chain means that every link of medical service is broken and there is no effective connection. The treatment of patients is also focused on treating headaches and feet, and lacks a holistic service thinking. On the surface, there are many reasons for the fragmentation of the medical service chain, such as competition between hospitals, competition between doctors, doctors' inability to practice freely. But in fact, the fragmentation of the service chain is due to the fact that the payer has never been able to carry out effective checks and balances on the medical system, and thus cannot straighten out the service chain, which ultimately leads to the complete decentralization of the entire medical service chain and separate governance.
Whether it is online or offline services, whether it is a hospital or a clinic, each service subject has its own interests. In order to ensure its own development, it is normal to continuously expand and increase revenue. For doctors, obtaining a decent and sufficient income is also their basic professional guarantee.
Everything is developed according to the needs of the service provider. The service provider promotes the most profitable part of the current medical system to develop on a large scale and cannot make money.And ghen gradually weakened. For example, doctors’ income mainly comes from products. Diagnosis of illnesses is increasingly relying on instrumental examinations, treatment plans are also mainly dependent on medicines and surgery, and there is growing interest in services other than products such as follow-up visits and disease management. Small, because the same benefits cannot be obtained from these services. This has slowly distorted the entire medical service, making the break in the service chain more and more obvious.
Therefore, when the multi-level prevention and control system is facing greater pressure, a large number of primary and intermediate medical institutions cannot play a valuable role, and all the pressure lies in the tertiary hospital system. However, if a new management system is to be comprehensively constructed, a long time investment is required. This is not only financial investment, but more importantly, how to promote the uniformity of doctors' technical capabilities, which requires reforming the doctor's and the manager's training system. At this stage, it is obviously unrealistic to do it overnight. In the case that the ability of primary doctors cannot be improved quickly, it is more effective and possible to first establish a whole set of health management system from screening to treatment to ensure protection against sudden diseases and chronic disease coverage.
At present, although there is a screening mechanism at the grassroots level, it is concentrated in the field of chronic diseases and the assessment is too lax. Strengthening the training of basic-level doctors on infectious diseases and basic screening skills will be the first step. While training and improving basic abilities, strengthening assessment is the key to ensure that basic-level doctors can master basic skills.
Second, while strengthening training, improving the inspection capabilities of the grassroots is the key. Now the inspections at the grassroots level are mainly submitted to higher-level hospitals or third-party inspection agencies, but the actual cycle is longer, and it usually takes 3-7 days to submit the inspection results. . Speeding up the inspection efficiency and time period at the grassroots level will be a new development challenge and opportunity.
Third, the establishment of a coordinator has three main responsibilities:
Provide patients with educational materials for screening; provide guidance to patients with positive screening results and instruct them on how to conduct further medical treatment and examination.
Ensure patient coordination and connection between basic medical doctors and specialists during screening and follow-up treatment.
In specialist treatment, coordinate patients to obtain treatment and guide patients to obtain special government subsidies for patients.
Fourth, establish strict clinical pathways and inspection and review mechanisms to guide the implementation of primary and lower-level medical institutions. What kind of people need to be screened, and what is the frequency of screening, all these require the establishment of a strict clinical pathway review mechanism.
Fifth, medical insurance and financial investment in screening needs to be strengthened urgently. The shortcomings of medical insurance are urban and rural residents. Due to the low payment ratio, it is difficult to support investment in screening. In this part, financial investment is urgently needed.
In short, the institutional reform of public health management is systematized and takes a long time. However, building a service chain from screening to treatment will be realized faster and will also help to control all-round acute and chronic diseases.

3. BUSINESS STRATEGY & MANAGEMENT TACTICS
To protect patients and personnel some clinics in institutions in East Asia implement the system of management that considerably help carrying out a daily work of their personnel during the pandemic outbreak. We may classify it in the next functional split:
A. Infection control
1) Thorough standard precautions (standard precautions)
2) Predict and prepare for risks
3) Measures to prevent the spread of new coronavirus infection
4) First aid when there is a shortage of infection protection equipment
5) Response to visitors
6) Points to keep in mind when visiting a patient's home

B . Dealing with infected patients
1) Preparing to accept moderately to severely infected patients
2) What to do if an inpatient is found to be infected
3) When staff are infected or suspected of being infected

C. Staff protection
1. Labor management
1) Relieve anxiety about working in a ward that accepts new coronavirus infections
2) Ensuring sufficient breaks and naps
3) Consideration for nursing staff who are raising children
4) Consideration for pregnant nursing staff
5) Nursing that requires consideration when arranging in the ward for new coronavirus infection

Staff requirements
6) Examination of treatment for nursing staff who deal with the new coronavirus infection
7) Personnel adjustment and securing / working plan
2. Improvement of working environment
1) Securing and providing accommodation
2) Environmental improvement of the place used by nursing staff
3) Precautions when commuting and leaving work
3. Education and training
1) Adjustment of annual education / training plan (including nursing research)
2) Change of education / training method
3) Business consideration by changing the education / training plan
4) Consider the current practice itself as learning about infection control

D. Correspondence to nursing students
1. Securing newly hired staff in 2021
2. On-site training

E. Medical fee schedule for new coronavirus infection

1. Calculation of medical fees at medical institutions
2. Temporary response at home-visit nursing station
Though at the top management level for the head departments for marketing and international patient care units or divisions, it is important to understand that any challenge to humanity, first of all, is nothing more but the opportunity to qualitatively change something and carry out a series of adaptive reforms, which can be expressed both in the development of the direction of service and measures for safe for the medical services running to comply with its algorithms in critical and previously unheard, unknown, unfaced conditions for a manager.
Similarly to how an auditor performs the assessment of assets and liabilities, securities, payables and receivables etc., so the management also daily and non-stop implements the progressive change mindset to optimize the administration of programs during the COVID19 outbreak within the patients environment.

Problem 1 "Brake of the Original Strategy for Business"
The world is different and we do not know how to instantly change it, how to influence certain processes in the environment of our management, whose name is alive but ill people. We did not have time to prepare and work out a package of alternative strategies along the way of our business in advance and now we are forced to rescue it depressingly. But we, like yesterday, always have a problem today, and it must be solved by building a constructive path, overcoming all barriers to the health and well-being of the population in their countries and the world community as a whole. At the level of the strategy for managing medical institutions and programs of tour operators that ensure the flows and streams of patients from critical geopoints covered by the virus (especially East Asia), the necessary force majeure adjustments must be made, taking into account the data obtained by factor analysis. In this industry, we now have all the opportunities and prerequisites to conduct full-scale consulting work and debug management functions covered amidst the panic caused by epidemic.

Problem 2 "Negative Financial Forecasts"
With the decline in the flow of patients to treatment programs and the profitability of private medical institutions, there is an urgent need to reshape budgets, recalculate salaries, up to the cut of key positions of management and client support. The Head of the finance department comes to the CEO's office and says: "That's all. We are now in red minus, and for a very long time." Wait colleagues, let's not rush to premature apocalyptic conclusions, but we will conduct an operational audit of personnel for compliance with their positions, compliance with internal instructions and compliance with protocols for interaction with medical personnel. You need to understand the workforce that finalizes the outcome of the battle for the survival and profitability of an enterprise in a pandemic period. How highly efficient is the mid-level management prepared and oriented in the company? How high is the credit for its innovative operational interaction with the outside world and its reputation in affiliated professional and international circles? Do you really believe that the lack of high ethical principles of external cooperation of your staff can immediately lead your clinic to victories in overcoming a crisis of an epic proportion? What does the CFO have to do with it? All these issues will be addressed in our cooperation programs to optimize administration in the private healthcare system. It will be the author's great pleasure to invite the entire finance department to another course on "Drowning Rescue Combat".

Problem 3 "Fear to Keep Going"
Fear of developing further business only because of the accumulated critical factors and acute lack of resources does not mean theie complete absence in the economic system of levers of effectively influence on the situation along with a niche of new and already proven methods. Yes, the staff of the clinic must be kept, the equipment should be operated properly and amortized, often lacking expendable materials for operative sections and manipulation rooms, including those that support biological environments for laboratories. However, we should not forget that, among other things, actively gain popularity both domestic and international business support programs, a whole bouquet of new barter opportunities for mutually beneficial cooperations between clinics, and such a concept as an exchange of specialists. How big is the desire of your team to achieve the result by common efforts, and how much instead of blocking and not admitting to its key employees, the company is ready to challenge the time in which it lives, taking responsibility for today, and maybe tomorrow? And why should it be scary to go further if you sit in one place as if do not, not at work? Merely exacerbating your own stagnation is not even scary, even on the contrary, so much is "more comfortable"? The inner world of the head and the top management team, their values and a visual, the involvement of the clinic integrating the world is very important for the victorious result of the clinic, if this is not, then "karma" comes, and only rebooting can break it mechanically. Nevertheless, even today we can fundamentally turn out the seeming irreversibility of this situation by introducing to the internal corporate environment package the executive programs, which is also a positive prospect and the result of fruitful joint cooperation. The deep understanding of the organizational psychology of clinics and medical projects can perform an unprecedented miracle: the clinic or agency simply recover.

Problem 4 "No response from specific groups of prospective patients at the international stage"
Various culture groups require various service approaches and adaptation of clinic promotion strategy. What is good for Chinese patients maybe completely unacceptable for Japanese ones. What relates to Christian ethics on the West may completely be unknown to Muslim civilization circle in the Middle East. Doctors who cherish working in international surrounding often don't have time to adapt positioning considering this specifics and all that is left is to simply translate the materials conveying direct senses in different languages. That often becomes a barrier for marketologists to deliver the clear product and service message for the customers. When in 2013 the author served as the head of marketing department in Chinese medical centre combining the Western and Traditional medicine in Guangzhou the department had to split the team into regional subdivisions where for example the Bangladesh assistant dealt with Hindustan, Japanese did outreach to Korea, Algerian manager covered France and Benelux and the head operated for the Central Asia region. Later when establishing and managing East Asia Department for Reproductive Medical Center we were assisted by well filtered and trained team of young and promising orientalists provided and recommended to assist me by the leading national universities in Ukraine from the circles afiliated to sinology and East Asian studies. Nowadays this generation successfully operates and specializes on this field in different clinics due to their firm life choice to keep going. While managing the Asia Pacific Division in regenerative and translational medicine for EU hub the author used the principle of training and certifying the regional outer operators who already had been living in the regions we mostly needed to concentrate on, so the countries that just perfectly fit to conduct detoxication via stem cells did not necessarily go under the burn treatment cell transplantation. Basically with every single larger or minor project we made up a collegial decision what exactly would fit best to reach out for patients of different cultural background. In overall assessment of the path went through so far the author came to a conclusion: clinics should learn the languages of medicine in their patients countries.
After completing my training with the center of Iranian Studies in Kyiv and entering the program of Egypt Arabic training for the next 2 years I do realize that even here we may not include all peculiarities and aspects of service positioning with future partners at the international stage: be it esthetic surgery, oncology, preventive medicine, orthopedics, ophthalmgology or neurosurgery. What is very much clear now: the COVID19 pandemic period should also crystalize the vision on how the patient groups of our focus from different nations accept , interpret and react to this global challenge domestically only then we can open the doors to their hearts. Hence I invite the medicine involved readers for round table discussions, workshops and program development be it the clinics or international healthcare organizations. Ukrainian medicine also will consider it as an honor to contribute to taking away all possible barriers sharing its experience and borrowing new advanced technologies from our partnership states on the West and the East.

Problem 5 "Losing faith in what you do and are called to be. Dissonance of mission in the world"
A healthy society is, first of all, the total commitment of society to its health. As the owners of a clinic, medical center or agency, we sometimes fear that the mission that we have chosen to carry to this world is still true, even from the time when we laid the foundation of our business and created the project. The mission determines the strategy. Did something change at a critical moment? If, yes, and our attitude towards society and its event space has changed a lot, then this also suggests that we will certainly overestimate our attitude towards the business in which we work and which we do. The worldview of a healthy society affects all levels of the clinic's management, from the founders to the receptionist. It is important to always display this mission in both a solemn and a daily setting. Its correct presentation to employees and equally to the outside world will determine not only the reputation of the clinic, but will also serve as an indicator of whether all team members share this mission. In practice, this is called brand management. After all, it is not only its external habitual presentation that is important, but also the internal quality component, which will be shared by all personnel and all consumer groups. Even a pandemic cannot kill a mission, this must be remembered and worked upon. Therefore, I invite medical institutions to collective coach of their staff on the programs they currently design and implement.

CONCLUSION: PERSPECTIVES & COOPERATION AT THE GLOBAL STAGE

Professional, certified and integrated management is entering the arena of strengthening operational and coordinating strategic processes in the private healthcare sector. The doors to the world of supporting the dynamics of the development of international practice of doctors with patients in the countries from the Asia-Pacific Region should be open to everyone in the West with the aim of deepening the understanding of a high-quality service culture in the localized and refreshing innovative visions through the import of technologies and effective management solutions. In the recent period, the Ukrainian school of medical management is going through many challenges together with the world community, integrated into cooperation and daily overcoming obstacles to the recovery of business and the improvement of a highly competitive business environment. The collegium of Ukrainian specialists in oriental studies, as well as doctors in the advanced fields of medicine, are always ready to get involved in the work towards achieving high rates of trans-regional cooperation with the countries of the Far and Middle East. I am glad to invite doctors and key operators in the international medical tourism market to colaborate in the development and implementation of vector-oriented solutions in the pandemic period , critical for medical centers and clinics. Any approaches and ideas for specific tasks can be tested not only in the form of specific programs on the basis of clinics, but also approbated in scientific and business conferences, as well as in the framework of narrow-profile dialogues connecting the achievements of the practice of modern management and medicine.
For more detailed information and proposals for the formation of a mutually beneficial paradigm of cooperation, please contact the author directly.

December 20, 2020,
Durres, Albania