Beauty from Afar

We have reached that part of the project where I am finally posting what most people would consider to be the actual book part of the book, by which they would mean: The Introduction. Chapters. Etc.

We’re done with the packaging, the excusing, the thanking, the congratulating, the greeting, the Buy-Me-Take-Me-Home part of the ordeal. We are back where I was in mid 2005. I had signed a contract in January of that year to write a book about traveling abroad for plastic surgery and dentistry and medical care; but I did not really start working on it for a few months, because it took that long for my publisher to actually write me a check for the first half of my advance and I was otherwise sort of broke, or at least broke enough that I couldn’t afford to do the travel I needed to do for research until I saw some money.

I finally sat down to start the actual writing of BFA in June of 2005. I wrote an introduction. Then I wrote another introduction.

I hated them both, and I started panicking. What had ever made me think I could write a book?

Finally, I retraced my steps. I reread the original proposal I had written for the book, which I had liked, and which my agent had liked enough to represent me, and which my publisher had liked enough to give me an advance.

And I found the right tone, and the third try at an introduction was … well, you know. It was fine.

Introduction: How I Got My Smile Back

You have reached my temporary End of File (EOF) Page. If you got here by clicking “Next,” it means that you’ve read as much of Beauty from Afar as I have so far managed to extricate, edit and put online. Please stop back tomorrow or the next day. I do try to add text at least a few times a week and expect that the whole book will be online by sometime in 2010.

If you really want to ready the whole book now — please let me know by leaving a comment somewhere or emailing me (the address is below and also on the “About” page.)  The more that I am conscious that there is a demand for the material, the sooner I am likely to finish the ebook versions. I’d also like to know what people would consider a fair price for an ebook version. I am thinking about $5 but could be persuaded otherwise.

You can still find the physical book through online booksellers, used and new.

If you’ve reached this page through a search engine and have no idea what I’m talking about, please start out at:

www.beautyfromafar.com

and everything should be clear to you within a few minutes.

Thanks,

Jeff Schult
jss at beautyfromafar dot com

Introduction Page 1 | Seeking Beauty from Afar: How I Got My Smile Back

Stumbling upon an open secret

I became a “medical tourist” in the early spring of 2004, when I traveled to Costa Rica for major dental work I could not afford in the United States. I use the term medical tourism, with the benefit of hindsight, as a catch phrase for the unusual business of traveling a long way for health care. It did not gain currency in the media until later the same year. At the time, I considered myself … as what? Not a tourist. More of an exile, perhaps. Though there are certainly terrific dentists in
the United States, I couldn’t afford them. I was on the outside of the health-care system looking in.

My teeth and gums had deteriorated prematurely in my forties to the point where smiling was no longer an instrument of charm. I needed what dentists call full-mouth reconstruction. Insurance companies generally call it unnecessary and would rather wait a few years before contributing to the cost of what by then would be an entirely necessary full set of dentures. In any case, there was not an insurance plan in the world that would cover the $18,000 to $30,000 that a United States dentist would have charged for my full-mouth reconstruction — not unless I’d lost my teeth in a horrible accident, as opposed to simply having them wear away over time. I know. I shopped around.

All this I knew in 2001. By 2004, I had mostly resigned myself to having bad teeth. A quirky grin had become my all-purpose expression of approval. If my misshapen teeth appeared in a photograph, I touched them up with a bit of virtual dentistry. I hoped that what was left of my teeth would last me, functionally, until I was eligible for Medicare. I admit that the molars were still fine for chewing, that the ragged fronts could still tear food. “Let vanity go, you’re 48 years old,” said a voice in my head. I avoided looking at my teeth even when brushing them and tried not to be bitter.

On the evening of February 16, 2004, I was reading the latest messages on the Interesting People (IP) e-mailing list, an influential Internet forum hosted by Professor David Farber, often called, without much exaggeration, the Father of the Internet. The topic was the outsourcing of technology jobs overseas. Jim Warren, a computer professional and long-time online activist, went off on a mild tangent about how it is not just technology jobs that are leaving the country:

“… Many Americans fly to Bangkok to get needed (or simply desired) medical and dental procedures … everything from crucial transplants and sex reassignments to cosmetic surgery and liposuction. The surgery, hospital, and drug costs are almost nothing by comparison to U.S. medical, surgical, and hospital charges.”

Warren told of a good friend who had a laparoscopic adrenalectomy — an operation to remove a benign tumor of the adrenal gland — that would have cost $30,000 or more in the United States. In Thailand, she paid 100,000 baht — a little less than $2,600. The quality of care, he said, was outstanding.

Immediately, I was thinking about my teeth again. It had never occurred to me to shop outside of the United States for dental care. Thailand! It sounded a little crazy.

Nevertheless, 3 months later, after a lot of reading, correspondence, and consideration, I was reclining in a dental chair; not in Thailand but in San Jose, Costa Rica. The cost of my full-mouth reconstruction fit inside my credit card limit.  Six root canals, 14 crowns, and 10 days later, I was heading for home with perfect teeth and a dazzling smile for less than half of what it would have cost me at home.

I chronicled my journey for Northeast, the Sunday news magazine of Connecticut’s Hartford Courant. The article over time provoked more gratitude than anything I had written in 20 years of journalism. It also got a chilly reception from dentists in Connecticut. “Hey, maybe the Courant could get a cheaper reporter from Botswana,” was one of the more memorable gibes.

“You were very brave,” a friend told me. She meant, “I wouldn’t have done it. You always were a little crazy.” But I knew that I wasn’t crazy, and I also knew I wasn’t alone. While in Costa Rica, I’d met dozens of people who were in the country for health care — mostly cosmetic surgery and dentistry — and learned that San Jose had, for years, cultivated a reputation as the “Beverly Hills of Central America.” It was an open secret, decades old, spread first solely by word of mouth and later via the Internet.

(Next)

I added Curtis J. Schroeder’s Afterword for Beauty from Afar today, along with fussing with links on the table of contents page and updating the “About” page to reflect the fact that I am available for work and that I am open to the partnership and advertising possibilities inherent in this site.

Curt, as far as I know, is still group CEO at Bumrungrad International in Bangkok, Thailand; and I am still grateful for his kind words, written in 2006.

Yes, putting up the Afterword now is out of order. I thought about putting it up last. But I decided that anything that was really about the book and gives people the reasons why they might want to read it, ought to go up before I started posting actual chapters.

Besides, I love the Afterword and it makes me feel good to read it again.

So … next, I’ll put the jacket copy up, somehow; and then the Introduction … and then, I’ll probably start letting people know about the site and, little by little, post the 12 chapters. I’ll make pretty ebooks, in various formats, once I have pulled all the text out of the Quark file and massaged it sufficiently.

This is another place where links to Chapters 1-12 and the Introduction reside. I am finding it best to provide both the reader and myself with some alternatives as I move along with this project. As it has developed, this page seems to be useful for listing each of the “pages” as I add them.

Introduction | Seeking Beauty from Afar

Introduction (Part 1) Stumbling upon an open secret

Introduction (Part 2) Jurassic Park, it’s not …

Introduction (Part 3) A Nose Job in Iran?

Introduction (Part 4) It’s so … Foreign

Introduction (Part 5) Competition for the United States

Chapter 1 | Medical Tourism: Here, There and Everywhere Part 1

60 Minutes and Medical Tourism … Part 2

Vignettes … Didi, Fabio … Part 3

Patients Going Abroad: A Burgeoning Industry … Part 4

U.S. Healthcare and Spiraling Costs … Part 5

Dear Dr. Rubinstein … Part 6

100,000 Fellow Travelers — or More … Part 7

Tip of the Iceberg — and a Trend … Part 8

Medical Tourism: A Moving Target … Part 9 (End of Chapter 1)

Chapter 2 | Comparing Quality, Comparing Costs … Part 1

News Gets Around … Part 2

A Warning Lives on,  Mostly Unheeded … Part 3

Sticks and Stones … Part 4

American Doctors Speak Out … Part 5

Point, Counterpoint … Part 6

The Best of Both Worlds … Part 7

If You Can’t Beat Them … Part 8

Prices in the United States vs. Abroad … Part 9

Chapter 3 | A Brief and Selective History of Medical Tourism Part 1

The Pioneers of Medical Travel … Part 2

Build It and They Will Come … Part 3

Origins of Term Medical Tourism (cont.) … Part 4

The Media Imprimatur … Part 5

Chapter 4 | You’re Going Abroad for…What!? … Part 1

Cosmetic Surgeries and Procedures … Part 2

Eyelids, Foreheads, Noses and Peels … Part 3

Breasts, Arms and Tummies … Part 4

Body Lifts and Butts … Part 5

Hair Implants, Otoplasty, Bariatric, Dental Work … Part 6

What Else is Out There? Non-Cosmetic Procedures; Conclusion … Part 7

Chapter 5 | Research, Research … and More Research … Part 1

Medical Travel and Cosmetic Surgery: Top Resources … Part 2

Patient Support Sites for Medical Tourism … Part 3

(January 2006)

A Bangladeshi, a Brit, an Arab and a New Yorker were sitting in a doctor’s waiting room …

What could be a preamble for an off-color joke is in reality the tangible face of the medical-tourism phenomenon. What brings together such a rich melange of people to a medical facility thousands of miles from the comfort of their homes? In fact, their motivation is as diverse as their cultures, languages, and geography.

The Bangladeshi seeks an alternative to the less-developed medical system in his own country. He comes for quality.

The British woman undergoing radiation therapy for her breast cancer is side-stepping the long queue in England?s socialized health-care scheme. She comes for access.

The affluent Emirati from the United Arab Emirates is seeing four doctors in one morning with a personal interpreter/valet in tow and a steaming cup of Starbuck’s coffee in his hand. He comes for service.

Then there is the New Yorker. What on Earth is he doing here? What has possessed this 55-ear-old upper-middle-class stockbroker from one of the most cosmopolitan cities in the world to leave behind arguably the most sophisticated medical system on the planet to have surgery in Asia? He is one of 40 million uninsured Americans who is self-employed, not rich, not poor, old enough to need his prostate removed but not old enough to qualify for Medicare. And he does not want to pay the high price for private medical insurance. He comes for price.

But the Americans can not be sold on price alone. Our friend from New York is a case in point. Of course, the price was 80 percent less than that of the U.S. quotes he got. But being a day-trader, he knows his research. He knows what he wants — a cutting-edge minimally invasive laser procedure for prostate removal by a surgeon who has done the most of that procedure in the world, in a hospital that is of international standard that could take him right away. His search brought him to Asia.

He came for quality?; and access?; and service; ?and price.

As an American who has lived in Asia for over a decade, I can safely say that we Americans are a demanding bunch. And it is truly a leap of faith to trust your health to a doctor that you have never met at a hospital you have never seen in a country you have to find first on a map.

This is the value then of Jeff Schult’s excellent guide to the world of medical tourism. Jeff has scoured the hot-spots of medical tourism, talked to the patients, Googled the Internet to within an inch of its life, and taken the plunge himself into overseas health care. The result is a balanced, unbiased, and thoughtful guide for the informed consumer. Beauty from Afar is an entertaining and practical handbook that includes important considerations that any prospective medical tourist would? and should? consider before making the “leap”.

I thought I knew a lot about the subject, having lived it for 10 years. Jeff has opened a whole new world of possibilities, and he has made me a student again. I am convinced more than ever that medical tourism is not a fad. It is not about “cheap” health care. It is about smart, well informed people looking for quality service at a reasonable price in a world where distances and lines drawn on a map are not the barriers they once were.

Decisions about your health are important. Read this book. Do your own research. Make smart, informed decisions. Maybe you can narrow the leap of faith to be more of a hop.

Healthy Travels!

Curtis J. Schroeder
Group Chief Executive Officer
Bumrungrad International
Bangkok, Thailand

DEDICATION

For Kellen Michael Schult,
the best son a dad could have
— then,  now and always.

ACKNOWLEDGMENTS

I’d like to simply ask anyone who’d like to be acknowledged to bop over for dinner some night as soon as I’m settled in again somewhere, assuming that you don’t mind eating take-out. We can sit around and talk and I can thank you properly and fulsomely. But it would be a pretty empty gesture unless I left some directions or at least an address, neither of which I can anticipate right now. The only thing I know for sure is that we will do this again some time. That?s fair warning for those who found that me writing a book turned out to be more entertaining than they would have thought.

I started writing acknowledgments when the book was only half done, which seems pretty presumptuous, but it was about at that point that I realized that there really would be a Beauty from Afar and that there would be people to thank for that. First, thanks to everyone who always believed that I would write a book — Mom and dad, my brothers, assorted girlfriends over the years. That was a lot of damned pressure, you know? No wonder it took me until I was 49! But it’s okay, I forgive you enough to thank you lots, for everything, all along the way. In particular, I owe Frances Kuffel for saying that I would be good at this in such a way that I believed her, and for her encouragement, faith, and support as a friend. I have called this faith a curse, on occasion, but thank her for it regardless.

More graciously, perhaps, I’d like to thank Susan Campbell, who gave me the idea that going to Costa Rica for dental work might be a fine magazine story, which it was, and Stephanie Summers, the best managing editor that the Hartford Courant Northeast magazine could hope to have had, for publishing that really long story. Whoever heard of a 10,000-word piece about dental work?

Next, chronologically, I want to thank Beth Bruno for introducing me to my agent, Linda Konner, and Linda for persevering on my behalf through the perhaps inevitable 20 or so rejections, until finding an editor who agreed with us that this book was a good idea. That editor, Debora Yost at Stewart, Tabori & Chang, later told me that there are a lot of books about cosmetic surgery and that they say all the same things (which explains, somewhat, the rejections). But she was the only acquisitions editor who read my proposal and realized that my book was not about cosmetic surgery, but was much more about traveling abroad for medical care, a topic about which she knew almost nothing. She warmed to it, and I am grateful. Many thanks also to Lisa Andruscavage, whose questions and assiduous copy editing both sharpened and smoothed my best early efforts.

I am humbly grateful to all the surgeons, doctors, and medical professionals around the world who contributed to this project by sharing their knowledge and experience, and hope that they find the result did them justice individually and collectively. I have a heightened appreciation, in particular, for the deep, shared commitment to well-being that they hold universally, wherever they may practice, under whatever conditions.

Finally, I’d like to thank the patients, too many to count, who shared with me their experiences in traveling abroad for medical care and cosmetic surgery; and I hope, as I know they do, that the publication of Beauty from Afar will illuminate the path along which they traveled and show the way for others to come.

(9-15-09) added original Table of Contents

(9-14-09) Since it is increasingly apparent that physical copies of Beauty from Afar are becoming more scarce, I’m commencing to put the text online. Like, starting now, really.

I do not yet have pretty e-books made up. I’m working from an ugly Acrobat document I managed to make out of the original Quark document of the book that I wheedled away from my publisher in 2006. I don’t even know how I managed to get that far, since neither version of Quark I have will open the publisher’s file now. InDesign won’t do it either. If someone with a Mac and Quark 6 or so wants to see if they can help me out with a conversion … well, I’d be grateful.

Meantime, I’m pulling the text out and pasting it to a text file that will eventually work great as a flat format e-book. And, as I go, I’ll post pages. Today, we have the original author’s note and the foreword.

That’s the cover of the book, at right. I didn’t pick it. And, in fact, I’m still a little embarrassed by it, for obvious reasons. I’ve been told by a lot of people I shouldn’t be and they’re probably right. “Sex sells.” What’s to be embarrassed by?

Still …

Here is the never-before-published cover sheet I did for the original book proposal. You can tell I had a different notion of what the book was about.

(February 2006)

Throughout the research and writing of Beauty from Afar, I communicated with and consulted many surgeons, doctors, nurses, and other health care professionals. I talked to and consulted many more people than those mentioned or quoted in this book, having had to pick and choose each step of the way. Readers should not assume that any particular doctor or medical facility has my particular endorsement just by fact of their appearance in these pages. That which serves the general narrative of this book should not be taken as more than that. In no way do I mean to suggest, for example, that the surgeons to whose work I refer are better at what they do than many others who are unmentioned. They are offered as illustrative examples and are among those who have the most experience in medical tourism. From their collective individual experiences, from the published news reports about medical tourism of the last decade, from extensive research online, and from collateral reading of what few books touch upon the subject, I was able to assemble a more general picture of what individual prospective medical
tourists should seek out, and what they can expect to find.

Similarly, that I mention companies that cater to patients who wish to travel abroad for surgery should in no way be construed as endorsing the quality of their services. Again, they are examples, a few chosen from many fledgling enterprises. It is my personal judgment, based on lengthy experience as a journalist and virtually none with startup companies, that those I selected have a stronger chance than most of succeeding in the long run; but I have no way of knowing for sure.

In the interests of full disclosure, readers should also know I have accepted no remuneration, fee, or discounted services from any business or individual mentioned in this book. I owe meals to a couple of people, perhaps, but owe favorable or preferential treatment to no one and made no bargains regarding treatment in return for interviews or access to facilities. Many of those I did interview were allowed to review draft text of Beauty from Afar to check the accuracy of my reporting, and I thank them all for their time and diligence. The end product is solely my responsibility.

Many people have asked me why I chose to write about the specific countries that I did. Fine low-cost medical services and talented, highly qualified surgeons exist in many others. All along, however, I was determined to provide information about countries that are currently the most accessible and inviting to medical tourists, the ones where the U.S. and European markets are targeted and courted. Certainly, one can find excellent plastic surgeons and medical facilities in many countries that are unmentioned in this book. If you prefer going to one of them, don’t take my neglect as a sign of my disapproval. Do your homework, choose wisely, and have a great trip.

Jeff Schult
Author, Beauty from Afar

(February, 2006)

At first blush, it may seem a bit odd that a board-certified plastic surgeon living and practicing in the United States is writing a foreword for a book detailing the ins and outs of getting cosmetic treatments outside of this country. What’s next? Major airlines offering insight into bus travel? At the risk of being called a heretic, however, there are several reasons why I think education about cosmetic medicine abroad is useful and why this book, Beauty from Afar, can be helpful for people considering surgery outside the United States.

First, let me say that I support the cautious position of the American Society of Plastic Surgeons (ASPS), detailed in this book, on travel abroad for cosmetic surgery. It is sound advice that I feel is inarguable. At the same time, the ASPS has been very good about including and cultivating the input and instruction of very talented surgeons from around the world. Their techniques are frequently included in ASPS journals and educational meetings.

On a personal note, I have been extremely fortunate to have spent time training with very gifted physicians practicing outside the United States, among them Dr. Ivo Pitanguy in Brazil. The techniques that I acquired while observing these doctors are an integral part of my practice today and are used on an almost daily basis. I have personally seen quality surgical skills outside of our borders.

When we talk about travel abroad for medical services, we are almost always involving an aspect of medical economics. We Americans know that we have an extremely competent medical system. But we also know that in relation to the rest of the world, we have the most expensive. Health care in America can come at a very high cost. This means that, at times, many Americans are unable to afford the highest level of health care services that they feel they may want or deserve. This is true of the aesthetic medical field as well. While my advice would always be to have your surgery done domestically if you can afford it, there are many people who simply would not be able to have a procedure done if they had to pay U.S. prices. In today’s global market where multiple companies and individuals are outsourcing to save on costs, it comes as no surprise that this phenomenon has surfaced in the medical industry.

Ultimately, however, quality and safety must be the top priority, whether you are seeking medical attention here or abroad. Unfortunately, in the United States as well as in other countries, there seems to be no shortage of unscrupulous practitioners who portray themselves as experts in their field, but who have never completed a recognized training or credentialing process. The medical experience for a patient is daunting enough, even in a qualified and legitimate familiar environment. Stepping over the border for equally qualified and legitimate care requires guidance. That’s why Beauty from Afar is so essential. This book provides individuals the necessary tools to make an informed decision when seeking out individual health-care options. Its solid principles apply to anyone searching out quality health care, whether across town, a border or the ocean …

John J. Corey, M.D.
Aesthetic Surgeon in private practice
Scottsdale, Arizona
U.S.A.
www.doctorcorey.com