Sep 17

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.


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Sep 15


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


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.

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