Westerners Seek Cheap Medical Care in Asia

By Ramola Talwar Badam, Associated Press Writer

September 24, 2005

Bradley Thayer, a retired apple farmer from Okanogan, Wash., traveled 7,500 miles to get his torn knee ligament fixed, and says he paid a third of what it would have cost him in a U.S. hospital. And that included air fare to Bombay.

Thayer, 60, had no health insurance when he fell and injured himself while summering in British Columbia. He says his U.S. doctors told him he would have to wait six months for surgery and pay bills totaling $35,000. So he joined a rising tide of American and European patients heading to India, Thailand and Singapore for top-class orthopedic surgery, plastic surgery, infertility treatment and cardiology that come much cheaper than in the West.

It's the latest in outsourcing — Asian doctors study in the United States or Britain, acquire their skills and reputations in hospitals there, then take them back to their home countries and wait for the business to come to them.

"Flying halfway around the world is cheaper," said Thayer, beaming from his Bombay hospital bed. "I came straight to India. It's a long way to come without tests, but I feel great."

He had never been to India, and he first he had to overcome the stereotypes at home.

"My friends and relatives said I was crazy. They said, 'they'll cremate you along the Ganges.'"

But he already felt familiar with Asian doctors. "In Canada and America when you read the names of doctors in hospitals, every third or fourth doctor is Indian," he said.

Hospitals in Bombay, Delhi and Bangalore have been taking these so-called "medical tourists" since the mid-1970s, initially from the Middle East and South Asia, later from Africa, and now from the West.

So far, news has spread largely by word of mouth, or on Web sites set up by patients to extol their Indian experiences and become vocal proponents. Now the Indian government is getting behind it, offering one-year medical visas extendable for an additional year, and organizing exhibitions abroad to advertise Indian hospitals.

It is also planning to create a list of recommended hospitals. That's important because while India has top-notch doctors, it is still notorious for its filth and poverty. Even at some top hospitals, nursing care can be poor and hygiene standards dramatically lower than in the West. So it's important to shop around.

"Many foreigners are still not completely convinced about India. They worry about safety standards," said Vinod Tenguria, founder of Vedic India, a company that arranges hotels for patients.

Cosmetic surgeon Dr. Mohan Thomas, a member of the government's council for medical tourism, says foreign patients need to choose carefully.

"Check the doctor's credentials, the hospitals he is attached to and, most important, see some work he has done," advises Thomas. "Check how much effort the hospital takes with cleanliness starting with the bathroom."

He says 25 percent of his patients are from overseas, primarily Britain, the United States and Africa.

Invariably they go to the best private hospitals and stay in high-end private rooms, which are on usually on different floors from the cheaper general wards.

India is a diverse country accustomed to huge disparities, and although public health standards have risen as the economy has boomed, many poor people can't afford basic medicine, let alone private hospitals. There is no national health system, and government hospitals are overcrowded and underequipped. A recent outbreak of encephalitis killed more than 700 people in small towns and villages of north India.

"It's always the poor who suffer whether in India or America," said Sushant Mishra, a health worker in a northern Bombay shantytown. "We saw the poor blacks suffering during the Katrina hurricane. They didn't have access to food, water or even regular medical facilities in the richest country in the world. Life's the same everywhere."

India is still a relative newcomer to the international medical market, attracting 150,000 foreign patients last year, compared with Singapore's 200,000 and Thailand's 600,000.

But India's numbers are increasing. In Jaslok, one of Bombay's top private hospitals, three Americans were recovering from orthopedic surgery in June alone.

Texas-born businessman Robert Carson, 46, says he pulled out of hip replacement surgery the evening before it was scheduled in a Bangkok hospital.

A TV program about a new treatment — hip resurfacing — convinced him the procedure was less invasive and promised more mobility since the bone was shaved and not cut as in a traditional hip replacement. The procedure is not offered in Thailand. Three days later he was in Bombay and being operated on by Dr. Ameet Pispati, a British-trained pioneer of the procedure.

"I'd come back in a minute even if costs were equal to the U.S.," he said. "I would come because of the personal care."

He had found his American doctors stingy with information, whereas "the doctor here was very communicative. He told me what could go wrong and what he's done before," said Carson. "And it's not because I'm a foreigner; other Indians also received equal personal care."

Many doctors give their patients their home and cell-phone numbers and encourage them to call with questions.

The absence of long waiting lists also draws patients.

"I could have had total hip replacement done in the States for nothing because I have a health plan. But I found it worth it to come here. I didn't want to stand in line," said Gordon Deboo, a retired NASA research scientist.

Deboo, 73, from Walnut Creek, Calif., was thrilled that his wife could stay in the hospital room at no extra cost.

In some cases, entire families travel with the patient.

"My daughter and son-in-law came with us. They didn't trust us," said Edna Harsha, a 59-year-old school bus driver from Lakeville, Minn., recuperating from hip surgery with her husband by her side.

She lay in a hospital room with a commanding view of the Arabian Sea, looking at photographs of Bombay's sights taken by her family.

Couples from the United States, Ireland and Southeast Asia also head to India for infertility treatment — with some women bringing frozen sperm in liquid nitrogen containers.

Dr. Firuza Parikh, a leading infertility specialist, said she generally asks women to plan to stay for two IVF cycles, or two months. They stay in hotels or rent apartments.

"The husbands usually come for a shorter period and we freeze the sperm," she said.

In vitro fertilization can cost $20,000 in the United States and $15,000 in Europe. In India it costs about $2,500.

Thayer, the retired farmer, has a suggestion for India: to anchor a cruise ship in international waters off Los Angeles — "One deck for orthopedic surgery, one deck for cardiology. We need a change in America, we need cheaper medical treatment. We need a big hospital ship from India."

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