So we finally have new dates to go to India. We will fly out January 14, 2013 and return January 28, 2013. The following is useful information provided by the Clinic. Sorry the formatting when I pasted isn't great.

What you need to know

Make a checklist of every item you plan to take on your trip

Clothing, shoes, toiletries, maps, guidebooks, reading material, etc.

Hosting

You will be met at the airport to be conducted to the hospital via transportation that we have arranged. You will also be in constant contact with our Overseas Manager from the time you arrive until the time you leave to go home. He will be able to direct you to anything you need or to answer any questions. You will also be conducted on some tours of the area when the time is appropriate.

Immunizations and Medications

You should have already received the appropriate vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination. No doubt your doctor has determined what you will need, depending on factors such as your health, immunization history, and planned activities. Regarding the prescription medicines you take every day, make sure you have enough to last during your trip and keep them in their original prescription bottles in your carry-on luggage. You will be staying at the hospital which will be convenient for any medicine or physician consultation should the need arise.

Passport and Visa

Make a photocopy of your passport and store it separately from the original. If you lose your real passport, having a copy will speed the replacement process.

Clothes

Avoid over-packing and review your checklist to determine whether there are any items you can remove to lighten your load. Noble Hospital will be doing your laundry regularly and this will cut down considerably on the clothes you need to bring. With this in mind, ask yourself what you will really need for the trip considering the weather and where you are going. Begin packing your luggage, checking off each item on your list as you go. Pack clothing using the "roll" technique. Lay two or three items on top of one another, smooth to flatten, and roll them up like you would a sleeping bag to save space and prevent wrinkles. For summer travel, consider replacing your jeans with light-weight travel pants which take less space and dry quickly. Many people prefer to shop for clothes in India as they like to adopt a more local way of dressing and clothes can be purchased very cheaply. However, cities such as Pune are fast becoming very westernized and you'll see people wearing jeans and t-shirts. In smaller cities and villages, people still dress conservatively. The most important rule for both women and men is to keep your legs and shoulders covered. Wearing shorts should be avoided. Females will also often find it beneficial to wear a shawl or scarf that covers their upper body. For men, short-sleeved shirts are more respectful than wearing t-shirts.

Money, Credit Cards and Currency Exchange

Cards are widely accepted in major cities. ATM machines can also be found in most places, including in small towns. You must change your PIN to a 4-digit number before leaving Canada for an EMV chip card to work in many locations. The entrance fee at many tourist sites can be paid in US dollars if you have the exact change, so do carry some US currency with you in small denominations. Indian currency is highly regulated & can't be purchased outside India, so it's also a good idea to carry some currency that you can exchange for Indian rupees when you arrive. Our Overseas Manager will be able to direct you to the best exchange rates, so you don't have to worry about where to exchange your money.

Personal Care Items

Buy travel-size containers for your toiletries, regardless of the length of your trip. Enclose toiletry containers in airtight plastic bags to prevent contents from spilling into your suitcase in the event of a leak. Wrap socks or pajamas around breakable items to cushion them. If you run out, shampoo, conditioner, moisturizers, razors, deodorant, and sanitary napkins are all readily available and you can always drop into a local shop to restock your supply of soap and toothpaste. Bring mosquito repellent with you, as western brands tend to be stronger and more effective than the Indian ones. It's also a good idea to pack your favorite hair products as the range of gels and hair sprays is limited, and hair wax is virtually non-existent.

Medicine

Medicines for specific ailments, with similar active ingredients to what are found overseas, are available in India. The problem is figuring out the brand names and making the pharmacist understand what you're after. Therefore, you should bring an adequate supply of whatever medicines you usually need. If there are any questions about a prescription you might need, your physician at Noble Hospital will take care of it. Common items such as Vitamin C and aspirin are not difficult to purchase from a pharmacy. However, even a common drug such as acetaminophen (aspirin) is known as paracetamol in India.

Shoes and Suits

Shoes and suits are other clothing items that can be bought very cheaply in India. Markets abound with them in all different colors and designs. You get what you pay for though, so make sure you bring a sturdy and comfortable pair of walking shoes, sneakers or sandals. If you intend to go out in the evenings, bring a pair of dress shoes as well.

Sarees

Silk Sarees are available in a wide variety of styles and colours. Most female tourists want to buy a few that they can take home for casual or dress wear at Indian weddings or other occasions. Your host will take you to the local clothing district for the best deals. It's a good idea to let him do most of the negotiating for anything you want to purchase.

Noble Hospital

What to Expect upon Arrival

Noble Hospital is a modern international private hospital similar to any such facility you would find in Europe or the United States. Similar medical facilities do not exist in Canada, but you will find it cleaner than hospitals of similar size here. You will not have to take any precautions against hospital acquired infections (HAIs) as Noble has a well developed hospital-based program of surveillance, prevention and control of healthcare-associated infections. After arrival, each patient will be interviewed by the physicians and triaged for their procedure after resting from their journey. Aspects of the minimally invasive procedure along with follow-up for the rest of your stay will be explained at that time by your surgeon.

Lifestyle in Residence

There is a special CCSVI Ward that has been designated for International MS patients. There will be a nurse and a physician on the ward on a 24/7 basis. The staff is friendly and all speak English. Security is always present and visible. During your entire stay, North American cuisine will be served for each meal and patients will generally find themselves eating together in the common room. You and your travel companion will be staying together in a private hospital suite equipped with flat screen TV (with English language programming) and a laptop should you not want to bring your own. You may wish to bring your own ground coffee with you. There is a "Bodum-style" coffee maker, but Indians do not generally perk or drip their coffee, opting instead for instant coffee which seems to be the only type of coffee available on the market and not generally to the North American taste. Our overseas manager will be available for the 10-day duration and will organize a few shopping, restaurant, and sight-seeing trips when the time is appropriate. You should follow his advice closely as to your personal activities outside the hospital area.

Other Useful Tips

· Check your luggage prior to packing to ensure it is empty.

(especially if the luggage is not yours) as you are responsible for its contents when you pass through customs. It is better to be safe than sorry. Once you have packed, consider using tamper evident products to seal your case, so you can check if your luggage arrives without being breached before you go on to clear customs.

Plan to bring a snack on the plane in case you get hungry. Bring a snack like a bag of pretzels or something (avoid peanuts as these can cause allergic reactions in other passengers). Pack it in your small carry-on.

· Plan activities while travelling.

To avoid being bored on the flight, be sure to include things like books, games, Sudoku, or Crosswords to keep you occupied. Inside the suitcase with the diary and pen, pack one travel size game if you're traveling with someone else.

· In the other big suitcases pack a diary and a pen you can write in during your trip.

When you come back you will want to see what you did on your trip. Keep in touch with your friends with stationery.

· Bring a Camera.

India is one giant photo opportunity. Remember to bring your camera and take as many pictures as you can.

· Anti-bacterial hand wipes are extremely useful for many situations.

· Electronic appliances.

The rooms where you are staying in the hospital will be fitted with a voltage converter and plug adaptor.

Cultural Faux Pas… The Do's and Don'ts of Indian Etiquette

Fortunately, Indians are very forgiving toward foreigners who aren't always aware of the etiquette of Indian culture. However, to help you avoid embarrassing mistakes, here are five things not to do in India.

· Don't wear tight or revealing clothing. Indians adopt a very conservative standard of dress, particularly in rural areas. Western dress standards, including jeans on women, are becoming quite prevalent in cities. However, it's still necessary to keep your legs covered. Sometimes you'll see an Indian man wearing shorts, or an Indian woman wearing a skirt above the ankles but covering your legs and shoulders is especially important when visiting or walking around temples in India (and they are everywhere!).

· Don't wear your shoes inside. It's good manners to take your shoes off before entering someone's home, and it's a prerequisite before entering a temple. Indians will often wear shoes inside their homes, such as when going to the bathroom. However, these shoes are kept for domestic use and never worn outdoors. Shoes are sometimes also removed before entering a shop. If you see shoes at an entrance, it's a good idea to take yours off as well.

· Don't point your feet at people. Feet are considered to be unclean and therefore it's important to avoid pointing your feet at people, or touching people or objects (particularly books) with your feet or shoes. If you accidentally do so, you should apologize straight away. Also, note that Indians will often touch their head or eyes as a show of apology.

· Don't eat food or pass objects with your left hand. The left hand is considered to be unclean in India as it's used to perform matters associated with going to the bathroom. Therefore, you should avoid your left hand coming into contact with food or any objects that you pass to people.

· Don't be offended by intrusive questions. Indians are really naturally inquisitive people and their culture is one where people do anything but mind their own business, often due to the lack of personal space and privacy. As a result, don't be surprised or offended if an Indian asks you how much you earn for a living and a host of other personal questions, all in the first meeting.

Common Annoyances for North Americans Travelling to India

These facts may only apply if you travel outside of Pune and are in the category of "good-to-know"

Sanitation and Hygiene

Sanitation and hygiene is severely lacking in some places in India. India and can be the cause of many problems and illness for visitors. Some adjustment is required while traveling in India, and you have already had your shots as a precaution. With a bit of care you should be able to avoid getting sick. You will be staying in an extremely clean private hospital and it's unlikely that you will encounter the same challenges that a regular traveler would in the course of your 10 days.

Begging

India, despite its rapid economic growth in recent years, still remains a developing country with a lot of poverty and begging. It's common anywhere that there are tourists. This includes important monuments, railway stations, religious and spiritual sites, and shopping districts.

Concept of Time

Indian Standard Time is more than just the official name for the local standard time. It's also jokingly referred to as the loose concept of time that the country runs on. Traffic and unforeseen circumstances often result in it taking longer to get to places and get things done than planned. Not only that, Indian people have an infuriating habit (by western standards) of saying "5 minutes" when in reality the actual time is likely to be half an hour or more. People will also arrive unexpectedly, or on the contrary, not turn up when expected.

Crowds and Lining-Up

India's population has now grown to around 1 billion people. Many of these people have migrated from rural areas to the major cities in search of work. These cities are teeming with life and the sheer amount of people can take quite a bit of getting used to. It doesn't help that lining up in an orderly manner is quite unheard of in India. Simply because there are so many people, everyone strives to get in front of everyone else to avoid missing out. Pushing-in and shoving other people out of the way are common practices. Therefore it's important that you to stand your ground. Don't be afraid to push back or tell someone off.

Staring and Unwanted Attention

If you've ever wanted to know what it's like to be famous, India is the place to come. Foreigners, with their white skin, height and different clothes, stand out and attract attention. This is particularly a problem for women travelers, and even more so for those that are fair with blonde hair. Indian men will openly stare and make unwanted advances, often including groping and photographing. Be aware that in many cases a photograph is not a harmless photograph, they will show it to their friends and make up a story to go with it. Ladies will feel much more comfortable traveling around India with a male companion. Although staring will still be prevalent, Indian men will be much less likely to approach you.

Theft

India is not a violent country when it comes to robberies. Most Indians know that just because they can afford to travel, tourists are not rich people. However, as just about anywhere in the world, there are some thieves waiting for the right opportunities to take advantage of people's carelessness with their possessions. The majority of thefts in India happen to hapless visitors who have failed to take adequate precautions. Pick pocketing is extremely common, as is the stealing of purses out of ladies' handbags that are left open. Make sure you carry them safely in a fastened bag, preferably one that is worn across your shoulder. You should also take care not to leave valuables lying around in your hotel room, and make sure your luggage isn't left unattended anywhere. Small padlocks are useful for securing your bags.

After Landing in Mumbai

Our Mission is to make this tour one of your most memorable journeys and we pray that this treatment serves as the turning point in your life.

Upon arrival at the Mumbai International Airport, known locally as the Chhatrapati Shivaji International Airport, you will be welcomed by CCSVI Clinic Representatives who will convey you in air conditioned vans to our Noble Hospital in the city of Pune, approximately 100 miles away. The route indicated on the map below will be covered on the scenic Expressway.

Your suites have been prepared at the Noble Hospital venue where you will be staying throughout this tour. Again, your suites are equipped with Wireless Network and Laptops for you to stay connected with your family and friends via the Internet. The average Indian temperature stays at around 30C in the summer but may be more humid than you are used to. For your comfort, your suites have central air conditioning.

The electrical supply is 220 Volts in India, unlike the usual 110 Volts in North America. Therefore please make sure you use the converters supplied by the hospital before you connect any of your electrical or electronic appliances.

Everything you will need is available in the hospital and nearby stores. Please feel free to contact me in case you require any assistance. We are available on a 24/7 basis to help you or take care of your needs.

You may call me directly at: +91 (992) 149-6595

Or send an email to me at: [email protected]

We are here to serve you and make all aspects of your treatment a success!

Surjo Banerjee,

Overseas Manager

CCSVI Clinic

Supplemental on Medical Tourism

Regarding Patient Safety

The Canadian Medical Association has identified nine risks of travelling abroad to seek medical intervention, or "Medical Tourism". Medical Tourism usually happens in cases where Canadians either cannot access the procedure in Canada (as in the case with Liberation and Stem Cell Therapies) or where the wait times for surgeries are unacceptable and action must be taken before the risks of waiting any longer imperil the health outcome for the patient. Medical Tourism is generally disapproved of by the Canadian Medical Establishment (as directed by the CMA), but the 'establishment' is not the group whose health is at risk. Patients like you do not take their health lightly, and are generally making the decision to travel for a medical procedure because the risk of waiting significantly outweighs the risk of accessing medicine within a foreign medical system.

Notwithstanding the concerns voiced by the CMA, CCSVI Clinic recognizes the issues with Medical Tourism and has taken every precaution in arranging for your treatment at Noble Hospital. For these reasons we have addressed each one of the CMA's issues with regard to our particular service:

1) Inadequate regulation within the industry.The medical tourism industry is indeed global and involves many parties beyond patients and health service providers. Although international regulation within the industry is lacking, Noble Hospital operates under the most rigorous of patient regulatory standards to ensure the safety of Canadians and indeed all of our International patients.

2) Lack of systematic reporting of clinical outcomes.The CCSVI interventional program at Noble Hospital has been approved by an Internal Review Board (IRB) after months of review of the application. Subsequent to your medical procedure, clinical outcomes are systematically gathered and verified through the hospital system. Prior to departure back home, all patients will receive their complete hospital record including a CD of the actual procedure itself. This will allow you and/or your physician to be able to review your personal health record and make important future decisions based on the clinical data should the need arise. Furthermore, your medical file will stay on permanent record at Noble.

3) Replacement of clinical decisions with financial ones.The CMA is greatly concerned that patients going abroad might substitute clinical factors with financial factors when engaging in decision-making about their healthcare. For example, foreign clinics may shorten the recommended recovery period in order to lessen the cost of the patient's stay abroad. Though this may happen with other medical facilities in other venues, financial considerations are not of importance for the physicians at Noble when making decisions about the care of their patients. In fact, your stay at Noble has already been subsidized by our foundation and costs of treatment already significantly exceed what you are paying. In addition, we have already sent some MS patients who re-stenosed early, back to Noble for re-treatment at absolutely no cost to the patient.

Exposure to new health and safety risks.While there are always risks related to medical interventions, and also to traveling abroad, medical tourism potentially exposes patients to new risks. The CMA is concerned that traveling on long flights soon after surgery could bring about deep vein thrombosis due to compromised mobility. The CCSVI Clinic has designed a

10-day recovery period for this reason and furthermore the rigorous monitoring of the patient post-procedure is the subject of our approved study.

4) Threats to informational continuity of care.The CMA is concerned that there are currently no adequate systems in place to enable the transfer of health records between medical tourists and their physicians at home and destination countries. This can result in Canadian patients who have chosen to go abroad as medical tourists having discontinuous medical records. However this is a failing of the Canadian healthcare system, and we believe that we supply superb and robust personal medical records for you to share with your physician or specialist on return. Your surgeon at Noble is also available for a telephone conference at any time post-procedure, should you or your physician wish to follow-up with consultation.

5) Provision of follow-up care and monitoring happens at home. Although patients might choose to go abroad for procedures, follow-up care and long-term monitoring will need to happen in their home countries. This includes providing the necessary care and expertise for complications that could arise. An implication of this need for care in countries with public healthcare systems, such as Canada, is that patients' home systems become responsible for bearing some of the costs of medical tourism. It is indeed unfortunate that the Canadian healthcare system has decided to withhold the ability to receive Doppler Ultrasound follow up but CCSVI Clinic does provide an inexpensive provision for a follow-up screening at a facility in the US. Furthermore, MS patients need to continue to make their voices heard by politicians and the healthcare establishment where the liberation procedure has been proven safe and effective.

6) Procedures might be illegal or untested.Some patients are motivated to go abroad by their desire to access procedures that are unavailable in their home countries, while they are categorized as experimental or there are ethical objections to them. While that may be true for rules made in Canada, the particular procedures that you are accessing, namely venous angioplasty for CCSVI and Hematopoietic Stem Cell Transplantation (HSCT), have been approved and ethically practiced at Noble Hospital for at least several years and in hundreds of such procedures are seen as well-tolerated and safe for the patient.

7) Absence of patient monitoring.CCSVI Clinic ensures that patients are monitored around the clock for the entire duration of your stay. Furthermore, multiple Doppler Ultrasound screenings are performed post-procedure to check for re-stenosis. Should there be any indication of reversal, you will immediately be taken back to the cathlab for a follow-up procedure. All tests and procedures become part of your permanent patient record.

8) Health inequities could be exacerbated.Some have suggested that by allowing patients to bypass system limitations, medical tourism is a practical way to shorten waiting lists and address other health system challenges. However, the CMA feels that medical tourism could exacerbate inequities in access to care among Canadians. In fact, this point is not valid where medical procedures such as Liberation and Stem Cell Therapies are not offered in Canada.

Our main concern is for your personal safety and health outcome. Our program is built around the principles of best medical practices, ethics, respect of the patient's needs, and making a positive contribution to medical science through study.