Beauty from Afar

Chapter 1 Page 4 | Patients Going Abroad: A Burgeoning Industry

The story of modern medical tourism is, at one level, also part of the story of the changing global economy, of giant and accelerating shifts in the production of goods and services to nations that have lower costs than the United States and Western Europe. The catch-all phrase for this is  “globalization,”  and it represents, depending on whom one listens to, anything from the end of civilization as we know it to the last, best hope of mankind. The truth, as always, is more complicated, though that is of little solace to workers in the United States whose jobs have been outsourced, whose factories have been off-shored, who are still trying to figure out just exactly how  “free trade”  is helping them.

For the estimated 42 million people (1) in the United States who lack adequate medical insurance, however,  the globalization of quality medical care and services actually is one of the benefits of free trade. And the availability overseas of comparatively inexpensive elective procedures, including plastic and cosmetic surgery,  gives
Americans who are willing to travel outside the country options to which they are turning in increasing numbers.

Medical care, however, is not like manufacturing textiles or CDs or writing computer programs or providing technical support via telephone.  In the United States, and everywhere else, the first requirement of a medical-care system is that care be available locally, and the second is that it is available swiftly in an emergency. No one is going to go abroad for a simple check-up, for a flu shot, to have a cavity filled, to set a broken bone  —  not unless they live near a border and it is convenient to do so.  Increasing numbers of Americans willing to travel overseas for certain kinds of treatments and surgeries will not have a radical impact on the general delivery of health-care services in the United States anytime soon. In some areas, the effect is ambiguous; medical tourism is a back-up system, a safety valve for the American health-care system.

That an uninsured North Carolina man would have heart valve surgery in a state-of-the-art hospital in India with top-flight surgeons and eight registered nurses tending to his needs for $10,000 instead of in a hospital near his home for $200,000, as reported by CNN in January 2005,   does not deprive the hospital in the United States of $200,000 in revenue. The man didn’t have insurance and he didn’t have the money. Having surgery in India was a way to save or extend his life in a way that he could afford. His only choice in the United States was to wait until he had a heart attack so that he could be treated on an emergency basis. Assuming he survived, sticky financial negotiations that might have led to his bankruptcy would be left until later.

Medical tourism, in the short run,  provides a similar safety valve for the public health-care systems of Canada and Western Europe where the problem is not so much cost as it is accessibility. People needing or wanting non-emergency medical treatment can wait months to see a doctor. Canadians may even venture to the United States for care, despite the cost, to avoid average waits that were as high as 17.9 weeks in 2004. (2)

In June 2005, the Deccan Herald News Service of India reported that the largest holiday tour operator in Great Britain, Thomas Cook,  and the Apollo Group of India were in advanced negotiations over all-inclusive medical tourism packages. Those close to the deal speculated that the number of Britons who might travel to India for health care could rise from 400 or so annually into the tens of thousands,  should the trip become sufficiently routine.

(1) National Center for Health Statistics, 2004 National Health Interview Survey. Early Release of Selected Estimates. (Author’s Note, 2009: This has been a much-debated number for some years. But most sane people agree that the number of uninsured and underinsured people in the United States is “a lot.”)

(2) Fraser Institute (Vancouver, B.C.) 14th annual edition of  “Waiting Your Turn: Hospital Waiting Lists in Canada” (2004).

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… and I am quite sure I am the only one who noticed.

Here is what should have been yesterday’s update:

60 Minutes and Medical Tourism Part 2

And yesterday’s update, of course, should have come today:

Vignettes … Didi, Fabio … Part 3

I fixed the internal navigation of the site. And if I haven’t mentioned it before — I will be wildly grateful to anyone who points out any technical or factual errors I might make in the course of publishing the text of Beauty from Afar.

The 60 Minutes show in 2005 that featured Bumrungrad International hospital in Thailand did much to legitimize medical tourism in the United States.  It spurred more serious journalistic coverage of the subject and, thereafter, people who went abroad for medical care were treated with a little more respect.

It also got the attention of my publisher, which asked me if I could write Beauty from Afar faster than I had agreed. By contract, I owed them the book in January 2006. After some hemming and hawing and looking at the calendar, I said I could turn it in by October 2005.

It was April 2005 at this point. I was saying, “Sure, I can write this in six months.” And I did.

When it come to writing about places to which I have traveled, I have almost always chosen to write about the people I encounter and what it is like to be *me* when I travel. This is perhaps remarkably egocentric, yet I don’t see an honest way out of it. People can have wildly different experiences from a trip that is supposed to be more or less the same for anyone. I imagine that most people have very similar trips to DisneyWorld, for example. Yet my first visit there was on a belated honeymoon, nearly a quarter of a century ago; and my strongest recollection of the trip is a fabulously nonsensical fight I had with my then-wife over a game of miniature golf. This is not Disney’s fault; for all that they try to homogenize the American Vacation Experience, not everyone leaves with the intended memories.

Anyway —  I tried to make Beauty from Afar as much a book about compelling personal stories as it is a general guide to traveling overseas for cosmetic surgery, dentistry and medical care. So Chapter 1 starts out at a breakfast table at Las Cumbres Inn in Costa Rica, with patients sharing experiences, before I head in to Prisma Dental for a long second day with my mouth open.

Chapter 1 | Medical Tourism: Here, There and Everywhere

We’re up to Page 23 of the actual book, out of 220.

So the introduction to Beauty from Afar is now completely online. The concluding segment is Competition for the United States.

The intro seems short to me, maybe because I vaguely remember agonizing over writing it a few short years ago. There are only five segments; in the physical book, the introduction is only nine pages. Online, it is just five.

But it says what it needed to say. The difficulty in writing it, originally, was in deciding what to leave out; what to save for later. That was where having written a book proposal came in really handy. I trusted my outline.

Beauty from Afar was primarily aimed at readers in the United States, though I tried to make it clear that consumers of hospital care, cosmetic surgery and dental services in other countries could also learn a thing or two and might want to consider traveling for medical procedures. But by reasons of history, geography and national psychology, it seems that it is Americans who had the biggest leap of faith to make, to trust doctors in countries other than their own.

I touch on this in the brief “It’s so … Foreign” segment of the Introduction.

One more intro section to go and I can move on to Chapter 1 …

Introduction Page 4 | Seeking Beauty from Afar: How I Got My Smile Back

It’s so … Foreign …

The mainstream media in the United States didn?t really know what to do with the story. It was so … foreign … and always seemed tainted with desperation and a little craziness. No one seemed to know how many people were getting on airplanes and traveling abroad for inexpensive plastic surgery. Doctors in the United States, when asked, uniformly warned against the practice.

If you paid attention only to newspaper, magazine, and television reports emanating from the United States in 2004 regarding traveling outside the country for cosmetic or plastic surgery, you would reasonably conclude, in fact, that anyone who did so successfully was simply lucky. First-person stories such as my own were few and far between. The bulk of the reporting fell into two broad categories:

1. Horror stories. If someone went overseas for plastic or cosmetic surgery and came back dissatisfied, disfigured, or, very occasionally, in a box, it was news. As a journalist, I fully empathize with why this was so. Such cautionary tales of … “This could happen to you!” … are a staple of journalism everywhere.
2. Novelty stories. I would call them success stories, but they were rarely offered as such. As opposed to the this-could-happen-to-you tales, these were stories that portrayed traveling abroad for surgery as though the patient (and the reporter) had stumbled upon something exotic, something cutting edge, not quite ready for prime time. Again, as a journalist, I empathized. As my editor at Northeast said, “It’s new to our readers.”

I was reminded of the last phenomenon on which I’d done significant research and reporting, the rise of the Internet in the mid-1990s. Reading and watching the mainstream media at that time, one could be forgiven for thinking that the new medium was notable only for spreading pornography (horror) and creating instant millionaires (novelty.) Eventually — and it took several years — the media found context, understood what was happening, and started explaining it better.

The same sort of comprehension regarding medical tourism started to evolve in 2004. As I continued the routine of research, reading dozens of e-mails a day, plowing through message-board postings, checking for the latest news, home and abroad, I watched the story change. It would not have happened so fast without the Internet. In fact, it wouldn’t have happened at all without the Internet. But change it did, rapidly.

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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

(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.