The Dominican Republic aims to become an international health destination, particularly for people from Caribbean countries. Rescue RD group offers medical services in Puerto Plata, La Romana, Bavaro and Sosua-Cabarete.It has seen a gradual increase in cases referred to the Dominican Republic from other Caribbean islands in the last four years. But these are mostly travellers who become ill or injured during their holiday and need to be airlifted from islands that have inadequate medical care, and are mostly covered by travel insurance, Developing medical tourism is a priority for the country; say the Tourism Ministry, the Exports and Investment Center (CEI-RD), Congress, Free Zones Council for Export and Public Health. These government organisations claim that the growth of public and private healthcare nationwide, including in tourist resorts, would be a good base for targeting medical tourists from the Caribbean and USA. These arguments are often boosted by numbers claimed for existing medical tourists. RDD Rescue points out that the numbers are actually of international patients and in 2013 alone, this included 36,000 tourists assisted with emergencies. There are four types of hospital in the Dominican Republic. The first is the public hospital. There is one in every reasonable sized town and the medical treatment is free, but all medicines and x-rays, stitches etc have to be paid for. The standard of care is average at best and they should only be used in dire emergencies. The in patient has to provide their own sheets, pillows, toilet paper, food etc, and they are basically looked after by members of their family. It is very unlikely that English will be spoken here. The second type of hospital is the major international hospitals only in the capital, Santo Domingo and Santiago. These hospitals have the latest equipment and top medical professionals. They have private facilities, but even the public facilities will be two bedded rooms with a bathroom. The health care is not free and payment is needed for the room and medical help. These hospitals carry out everything including organ transplants and some, although not all of the staff will speak English. The third type of hospital is the high quality hospitals and clinics in the tourist areas. Whilst not as large as the major hospitals in Santo Domingo or Santiago, these are high quality clinics with a high standard of in-patient care and all will speak English. The fourth type is local clinics for local people. There are usually 3 to 5 in each town. They will be of a higher standard than the public hospital, but not as high as those in tourist areas. There are single in-patient rooms with bathrooms and televisions, and are fine for basic operations or broken bones, but anything more complex will need to be referred to a larger hospital. Costs are significantly lower than the tourist clinics or the major hospitals and they are unlikely to speak English. In practical terms, the only places capable of handling medical tourism are the handful of international hospitals and the small private clinics in tourist areas. The public hospitals are places that medical tourists should avoid, and the local clinics do not have facilities. In DR there are two worlds, the haves and those of the have-nots. It is a land of extremes and stark contrasts. There is extreme poverty side by side with extreme wealth. While public bodies claim to want medical tourism, none are yet prepared to spent time or money in promoting the concept. This is left to individual hospitals and a small medical tourism association with three members.