TMCís Complex Array of Services Are as Big as Texas by Larry Luxner Texas Medical Center, an enormous complex of hospitals and related institutions just outside downtown Houston, is rolling out the welcome mat for overseas patients. From Baylor College of Medicine to Methodist Hospital to the Texas Heart Institute, the 42 medical institutions that make up the Texas Medical Center (TMC) are eager to recover business lost in the aftermath of the Sept. 11 terrorist attacksómostly in the form of wealthy Arabs, Latin Americans and other foreigners who generally pay up front in cash for surgery and routine checkups. When viewed as a single entity, TMC ranks as the largest concentration of medical facilities in the world, covering 740 acres of land south of Hermann Park and east of Rice University. In 2001, TMC recorded 5.1 million patient visitsónearly 14,000 a day. Other statistics are equally impressive: The enormous complex includes more than 100 permanent buildings, 22 million square feet, 20 miles of streets and roads, and more than 42,000 parking spaces. ìThereís no place like it in the world, although we have had many delegationsókings and queens, sheiks and shahs óall coming here to look at Texas Medical Center, or to be a patient at one of our institutions,î said TMCís senior vice president, Kathryn Stream. TMCís 42 institutions have a combined 6,176 licensed beds, a shared operating budget of $5.4 billion and a total of $7 billion in capital investments. At last count, 19,332 students attended regular classes at the seven educational institutions under the TMC umbrella. The complex also employs more than 61,000 people and indirectly pumps an estimated $13.5 billion into the Houston economy. TMC is so big that it even boasts its own newspaper, the Texas Medical Center News, published twice a month for nearly 100,000 readers. TMC says its mission is to ìhelp its member institutions, and those they serve, achieve the individual and collective goals of meeting the highest possible standards of education, research and humane care.î Last year, TMCís University of Texas M.D. Anderson Cancer Center ranked No. 1 in U.S. News & World Reportís annual listing of the nationís best cancer research centersóahead of New Yorkís Memorial Sloan-Kettering Cancer Center, Baltimoreís Johns Hopkins Hospital and Minnesotaís Mayo Clinic. In the same survey, the Texas Heart Institute ranked seventh in heart surgery, while The Institute for Rehabilitation and Research (TIRR) scored secondóafter the Rehabilitation Institute of Chicagoóin the field of rehabilitation. Likewise, Methodist Hospital placed 32nd in the treatment of kidney diseases and 10th in neurology and neurosurgery. TMCís roots go back to Monroe Dunaway Anderson, a wealthy cotton broker who left nearly $20 millionóthe equivalent of $141 million in todayís dollarsóto his private foundation when he died in 1939. The foundationís trustees purchased 134 acres of land near Hermann Hospital to house the new M.D. Anderson Hospital for Cancer Research. They then used land and cash as incentives to attract other institutions. In 1943, Baylor University College of Medicine relocated from Dallas to Houston to become the educational cornerstone of TMC. Kareem Botani is the manager of international affairs at Memorial Hermann Hospital, which in 1968 became the primary teaching hospital for the University of Texas. ìI believe we have the best medicine here in the United States, the best physicians and the best technology. The whole system is set up around the patient and the family,î he said. Memorial Hermann Hospital, which offers marketing and promotional materials in Arabic and other languages, is especially known for liver and kidney transplants. Today, the four-pavilion complex covers 1.8 million square feet. ìOur institutions have several things in common: They are all nonprofit,î said Stream. ìTheir mission is either education, research or patient care, or a combination of those things.î Today, TMC is affiliated with seven systems of higher education; altogether, TMC encompasses two medical schools, four nursing schools, two schools of pharmacy and one school of public health. ìAs you can imagine,î said Stream, ìthe graduates of these institutions are pretty heavily sought after, and they donít have any problems finding jobs.î Because of Houstonís proximity to Mexico and the cityís long association with the oil industry, it has strong ties to both Latin America and the Middle East. As such, these two regions account for most of the international patients who visit TMC each year for surgical procedures and routine checkups. Ruthy Khawaja is director of international services at Methodist Hospital, one of TMCís largest institutions. In 2002, the hospital reported $975 million in net patient revenues, up from $732 million the year before. Khawaja said that before Sept. 11, 2001, Methodist Hospital was receiving 5,000 patients a year from abroad. After the attacks, the number of Arab patientsóparticularly citizens of Saudi Arabia and the Gulf statesódropped dramatically, although arrivals from Latin America increased (see related sidebar). ìOverall, we had a much smaller drop than anticipated because our mix was more diversified,î she said, ìand because our share of the Latin American market has picked up, which offset some of the loss from the Middle East.î Khawaja said her hospitalówith information centers in Guatemala City and Mexico City and affiliations with 24 other hospitals worldwideóhas gone out of its way to make Arab patients and their visitors feel more welcome. ìFor example, Middle Eastern patients, particularly during the month of Ramadan, miss being able to gather every night, whether they fast or not,î Khawaja said. ìWe try to give them that by having gatherings for patients once a week. They enjoy it so much that they bring others who have nothing to do with being in the medical center, just people they met in Houston who happen to be outpatients.î When TMC patients arrive in Houstonís George Bush Intercontinental Airport from overseas, theyíre usually met at the gate by one of 16 official greeters who among them speak more than 30 languages. ìThey meet our international patient arrivals, take them through customs here in Houston, and find appropriate transportation for them,î said Khawaja. ìWeíve found that many patients, particularly from Latin America, were just arriving and asking the airport assistance people to help with making appointments and getting to the medical center.î In January 2005, TMC will open a resource center and lounge at the airport. The project is being jointly financed by all of TMCís institutions and will cost several hundred thousand dollars. The lounge will include private bathrooms and will serve as a place to get some coffee and have a little peace before being taken to the medical complex. The University of Texas M.D. Anderson Cancer Center is the largest teaching hospital within TMC. The center focuses on pediatric care and treats many children coming from Mexico, Venezuela, Turkey, Spain and the Middle East. When a child comes to M.D. Anderson, he or she is assigned a primary pediatric oncologist. Types of cancers treated include acute lymphoblastic leukemias, lymphomas, Hodgkinís disease, all brain tumors, osteosarcoma, bone marrow failure and pediatric blood diseases. Services include pediatric blood and marrow transplants, radiotherapy, innovative surgical approaches, interventional radiology, clinical trial participation, long-term cancer care, and psychological and psychiatric care. ìOne of the things that differentiates us from other oncology hospitals is that none of our physicians are in private practice,î said Wendeline Jongenburger, director of international programs at M.D. Anderson. ìAll of our physicians are facility members, state employees, and they get paid a salary for their services. This has allowed us to develop multidisciplinary care. There is no financial incentive for one of our physicians to not refer a patient to an oncologist if it is more appropriate.î Another thing that distinguishes the hospital is ìthe emphasis we place on interpretation services, which we provide free of charge,î Jongenburger said, noting that both the international patient representatives and the 24 interpretersówho between them speak 14 languagesógo through ìa very intensive training program where they are trained in medical terminology specifically for oncology.î The TMC family also includes Texas Childrenís Hospital, the nationís largest pediatric hospital with more than 1,580 board-certified, primary-care physicians, pediatric sub-specialists, surgeons, dentists and others. Child magazine named Texas Childrenís the No. 4 childrenís hospital in the nation, and U.S. News & World Report ranked it No. 8. In addition, Texas Childrenís participates with Baylor in some 400 research projects annually and receives more research money than any other pediatric hospital in the United States. ìHere at Texas Childrenís, we have a great working relationship with thousands of physicians in Latin America,î said Nagib Mustafa, the hospitalís international attachÈ. ìMany of them have done their fellowships and residences not only here at TCH but at St. Lukeís Methodist, M.D. Anderson and other hospitals here. Those relationships donít go away once they go back home. We try to nurture them and continue referral patterns.î At the moment, Texas Childrenís is engaged in a $345 million, five-year expansion that will nearly double the hospitalís structural space. That will help accommodate the thousands of children who are treated there each yearóincluding more than 1,000 overseas patients from 80 countries, such as Guatemala, Mexico and Saudi Arabia. Houston has 78 foreign consulates, and each new one is invited to lunch at TMC. To boost its international involvement, said Mustafa, ìWe invite embassy attachÈs from Washington to come here and spend three or four days touring the hospital and medical facilities. We reach out to foreign governments and institutions, and we also provide tours to consul-generals whenever people from their countries come to Houston.î As for the patients themselves, ìthese are kids, so sometimes they have a different perception when they come here,î said Mustafa. ìItís Texas, so they expect to see cowboys and horses.î What they often end up seeing instead is the inside of a shopping mall. ìShopping is a main attraction for overseas patients and their families, and the Houston Galleria is only three or four miles away,î Mustafa said. ìI have a family here right now, and it was the first place they stopped.î Larry Luxner is a contributing writer for The Washington Diplomat.