I weaved my way across the Indian street, dodging traffic that was so random as to be fatalistic. The fumes sent up from the adulterated petrol were fast turning my mucous black and had in fact tarnished the signs on the building opposite. Squinting I could just about make out "Ajay Jain, Dental Surgeon" followed by some indecipherable initial letters as proof of qualification.
Sparks fell from an electricity pole overhead in a tangle of wires that would have made any American electrician faint. I hopped over a stagnant puddle and onto the staircase of the building which looked like it had never been cleaned in living memory. The walls smelled of human urine and by the time I reached the rubble-strewn balcony, I was beginning to wonder if the friend who had recommended I come here for my molar cavity was having a good laugh at my expense.
I knocked timidly on the door bearing a plaque with the name Jain and it swung open to reveal a gleaming white dental surgery. The floor was tiled and kept immaculately clean, air conditioning chilled the sweat on my forehead and there was a little table of magazines to read while waiting for one's appointment.
That was my first experience of seeking medical help abroad back when I was 19. I had the choice between seeing a local specialist or going back home. I tried my luck and found treatment as friendly and professional as in the West and half an hour of dental work cost me a grand total of 400 rupees — $10.
In 2007, 750,000 Americans also concluded that it was cheaper and faster to get medical attention abroad and that number was expected to double for 2008. To get an idea of how much money they hoped to save, check out the numbers from the report by Udaily, a publication of the University of Delaware:
"The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India — and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the U.S. costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa."
And then there's the time factor; while a patient might wait a year for a hip replacement in the U.S., an operation could in theory be scheduled the day after arrival in the Phillipines and many other venues.
It comes as a surprise to many that Americans should need to travel to get medical treatment. The flashing images of wealth and glamour on MTV have convinced the locals in poorer parts of the world that everyone in America is rich.
"Everyone is having at least one swimming pool there," an Indian cigarette seller once told me with great authority. When I told him about the Americans who couldn't even afford health insurance he looked at me as though I was trying to pull the wool over his eyes.
Even for me it was a hard one to swallow when I first came to the U.S. Growing up in Britain, health care was always free and like most Europeans, I pretty much took it for granted. If I ever got seriously ill I always knew that I could just head back home and get diagnosis the next day. I couldn't imagine how Americans would experience any less security or care.
Then I met someone from Oregon who, unable to afford insurance or a trip to the dentist when pain struck, had taken out a rotten tooth with a pair of pliers. The same kind of thing that happens all the time in the Third World.
Barack Obama won early support for his promises to reform health care in the U.S. and time will tell if he manages to deliver. But with American medicine plagued by Big Pharma sales reps, litigation and prohibitively high costs, a medical vacation to Mexico or Panama can save a family a lot of money.
Waiting for my luggage once in Guadalajara airport, I got chatting with an engineer from New York who had flown down with his teenage daughter so that she could get some corrective laser treatment for her eyesight.
"Look," he said, "I could have paid thousands of dollars to get her treated back home but instead we can get it done here for like a third of the cost — and we get to have a vacation together!"
The prospect of our health going wrong is one of the scariest out there. Debilitated by pain, we'd be unable to work and so unable to pay for treatment. Many American travelers that I've known on the road, however, have taken a rather more fatalistic approach.
"I don't even have insurance," one told me, "If I added up all the money that I'd be giving to some greedy company — and who knows if they'll find something in the fine print to avoid paying up — I could just book another flight somewhere warm and get treated there instead."
It sounds good
The thing about medical tourism is that it all looks good on paper. You save a lot of money, you get treated fast and it's an unexpected opportunity to go somewhere exotic. But believe it or not, when something goes wrong with your body, you're unlikely to be in the mood to soak up a foreign culture.
Bangkok is a center for medical tourists who come for plastic surgery, knee replacements and dental work and when I spent a month in the city doing some business, I got to know a few of them. They were easy to spot amid the other backpackers — whereas the other travelers skipped around with bright eyes on their big adventure abroad, planning river trips and island hopping, these poor souls had nothing more to look forward to other than the next appointment.
I took a cold coffee with one woman from Los Angeles who was there to do some cosmetic work on a disfiguring scar that ran down her left cheek, the result of a car accident. Whereas back home no one mentioned her injury, here she was asked a thousand times a day what had happened, a fact that did nothing to calm her nerves as she waited for the day of the operation. She was alone with no moral support, other than long-distance phone calls to a boyfriend back home, and had little in common with the other westerners who had only partying on their minds.
I could relate to her. Only a couple of years before I was living in Brazil when I found myself suddenly alone and ill; one night as I went to sleep I started getting lights flashing behind my eyes and experienced a kind of electric shock in my head. I put it down to the stress of living in Rio de Janeiro and moved to a village along the coast to chill out. The symptoms persisted though and I started to get seriously worried.
I saw a couple of Brazilian neurologists but although I spoke Portuguese and their English wasn't bad, it was miserable to be discussing my health in a second language. Worse, it was terrible balancing up the options available to me without friends or family around to talk it through with. So one day I dropped everything and flew home to see a doctor I knew I could trust. There was no price I could put on that.
Why is it cheaper?
It's also worth asking yourself just why medical treatment is cheaper abroad. It's not that the quality of attention is any less — at least not if you're sensible and make sure your chosen clinic is accredited by an independent body like the Joint Commision International — but other factors come into play.
Other countries may have quite distinct legal and working practices than you would find back in the U.S. Litigation, for instance, may be the bane of professional life in America, but at least it is an option. Suppose for instance, that your operation in India goes wrong — trying to sue a doctor there would be seriously injurious to your health, the case quite probably outliving you.
And whereas the quality and competence of doctors abroad is often every bit as good as in the U.S., you'll occasionally encounter a fairly flexible set of ethics. I remember reading a scandal in the Indian newspapers a couple of years back when doctors had been caught referring their patients for heart bypass operations when there was actually no need. They had simply been getting kickbacks from the surgeons.
Medical tourism is a growing industry and professional attention can be found abroad for just about anything from cardiology to plastic surgery to joint replacements. From Panama to South Africa, Turkey to Thailand, poorer countries welcome visitors in search of treatment with open arms and, while I heard local Thais complain that all their best doctors were busy treating the falangs, no serious harm is done by it.
The other side
There is, however, another side to the story that brings out some of the biggest ethical questions of all.
Despite the best efforts of donor agencies, across the Western world there is a shortage of organs for transplants. In an aging population, by the time donors die their organs are generally in less than top condition. So there you are: you need a liver transplant and the 6-month waiting list might prove fatal; a company in China claims they can perform the operation the day after you arrive — just how many questions would you ask about where the organ comes from?
In countries like China and India, human life is cheap. Street children go missing all the time and are dumped back on the streets minus a kidney. The same can happen in state hospitals where doctors can augment their income by taking advantage of an anethetized patient.
If it's hard to believe that humans could stoop so low, take the case reported by the British newspaper, the Guardian, when they exposed the business in organs from executed political prisoners. The company concerned advertised that, "Viscera providers can be found immediately!" — some poor enemy of the regime executed to supply a fresh heart for a customer from abroad.
Even when people have parted with a kidney voluntarily, it's often for a pittance, many ending up with less than a thousand dollars. They may have been promised more but were then cheated and they may have lacked the education to understand how their health might suffer after such an operation.
We, as patients, are assured that the organ came from a willing, well-paid donor and, as we're unlikely to ever meet the poor sod, we give the clinic the benefit of the doubt. After all, we want the transplant.
Sentiment against so-called "medical tourists" is rising in some countries that have made a business out of providing transplants and other surgeries to wealthy foreigners while, in many cases, their own citizens make do with substandard care.
Even China, which sometimes seems willing to do just about anything, is having second thoughts. It has banned all organ transplants for foreigners while it investigates reports that 17 Japanese tourists received illegal kidney and liver transplants while 1.5 million Chinese languished on waiting lists.
In short, the smart consumer should always look for the hidden costs.
Yes, a vital operation can be arranged abroad cheaply but will it be traumatic to undertake something so important in a foreign setting? Yes, cosmetic surgery is cheap in South America but will we really start following the example of the Argentines and buying breast enhancements as presents for our teenage daughters? And yes, a life-saving organ can be found at short notice in Asia — but can we live with ourselves if we don't know where it came from?
Whatever the ethical and emotional issues surrounding medical tourism, it's clear that it's only going to increase. In a globalized world we'll always head for the cheapest and fastest option. It was director Jim Jarmusch, however, who noted that of the three qualities cheap, fast and good, you could only ever hope for two of them at a time.
Tom Glaister is the author of children's books www.bozoandthestoryteller.com and is also the founder and editor of www.roadjunky.com - The Online Travel Guide for the Free and Funky Traveller.