The medical tourist.

Health and medicine explained.
Dec. 6 2005 6:53 AM

The Medical Tourist

How my shoulder sent me to China.

This article is the first in a two-part series. Read Part 2 here.

My sleek arm sling. Click image to expand.
My sleek arm sling

Always lift from your knees, and never sprint a mile through the Atlanta airport with 75 pounds of luggage heaped on your right shoulder. That's the lesson I learned after making that run last October to avoid missing a connecting flight. Ever since, I have lived in constant pain, a pain that radiates from my right shoulder and surges down the length of my spine. In hopes of obliterating this pain, I have exhausted the bulk of my resources, both financial and imaginative. I have given up typing, eating out, sitting through movies, and thinking for any prolonged period about any topic other than my body. And still the pain only intensifies.

It seems my only recourse is fantasy, and most nights I lull myself to sleep with fairy tales of resurrection and escape. I fantasize about sprouting robot limbs, or visiting an authentic, fin-de-siècle sanitarium. Not just visiting one, actually, but taking up residency there, like Hans Castorp in Thomas Mann's The Magic Mountain, who extends his three-week trip to the Berghof International Sanitarium to seven years. Regularly served meals, toilets disinfected daily, existential small talk with mink-wrapped contessas—really, I see no flaw in the tapestry.

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In the late 19th century, with the growth of both commercial travel and tuberculosis, the sanitarium emerged as a ubiquitous cultural institution. Today, it is once again common to journey abroad in search of a cure. But while Hans Castorp's retreat was populated by obscure aristocrats and overfed dowagers, the new breed of medical self-exiles is by definition middle-class. For almost 10 years, millions of people have traveled great distances for health care, primarily because they cannot afford the same treatment at home. As the ranks of the uninsured in this country continue to swell, more and more Americans are becoming medical tourists, buying tickets to East Asia, the Middle East, Latin America, Eastern Europe, and South Africa. They go for procedures both urgent and elective, from liposuction to heart surgery, lid lifts to total knee replacements.

Last year, the medical-tourism business grossed around $40 billion, and the numbers are getting bigger every day. A recent McKinsey study predicts that medical tourism in India, worth $333 million last year, will bring in $2.3 billion by 2012. Compare price tags and you'll understand why. A bone-marrow transplant costs $2.5 million in the United States. Doctors in India can do it for $26,000. Heart-bypass surgery runs $60,000 to $150,000 in this country. In Asia, the average cost is $10,000. Other less-serious procedures—tummy tucks, face lifts, breast implants, LASIK eye surgery, even MRIs and dental work—can also be had at a fraction of they cost here.

The hospitals abroad offering these bargains insist that the savings come at no sacrifice to quality. They lure potential patients with airport pick-ups, private nurses, frequent-flier miles, and all-inclusive post-op resort stays. Why go to the hospital in Boston if you can stay in a five-star hotel in Thailand? A record 1 million tourists traveled to that country last year for health care. Using Thailand's success as a model, countries like India, Malaysia, Singapore, and the Philippines have established governmental committees to promote medical tourism.

All I can say is: Sign me up. I am not among the 45.8 million Americans with no health insurance, but I do fall into another broad category, the inadequately insured. My shabby health-care plan is one of the many drawbacks of freelancing. It didn't cause me much anxiety, not even when I injured my shoulder in the Atlanta airport that afternoon. The flight that followed was excruciating. Still, I never doubted that a boiling-hot bath, some Advil Liqui-Gels, and a few yoga classes would fix my shoulder right up. I am excessively tall, with bad posture, bad typing habits, and a weak lower back. I've gotten used to inflicting prosaic injuries on my body and adept at repairing the damage.

My ergonomic back wedge, memory-foam pillow, and heating pad (plus cat). Click image to expand.
My ergonomic back wedge, memory-foam pillow, and heating pad (plus cat)

Not this time. This time I tried everything, and nothing worked. Days passed, then weeks; I was still waking several times a night, overwhelmed by pain. Still, I remained optimistic and inventive. When told that my insurance didn't cover physical therapy, I decided to pioneer my own wellness regimen. I attended geriatric yoga classes and repeated the relevant exercises with the sash of my bathrobe at home. I bought a wet-dry heating pad and strapped it over my shoulder like an assault rifle while I typed, read, watched TV, or slept. I clocked long hours in the steam room of my gym, subjecting strangers to a shoulder-roll and side-stretch show. I slathered myself in icy-hot ointment until the top floor of my apartment building reeked of my grandmother's medicine cabinet. I took Alexander Technique lessons. I forced myself to sleep on my back, with a bolster under my knees. I popped Aleve and Motrin and vitamin B-6 by the handful, as well as a potent painkiller cocktail my doctor called the "truckers' secret." I cut my workload in half. I trained myself first to pilot the mouse with my left hand. Then, like Ernest Hemingway, Philip Roth, and Donald Rumsfeld, I learned to type standing up, and finally, disastrously, to dictate. Whenever a paycheck arrived, I supplemented this rigorous routine with massage, acupuncture, and cortisone injections.

But even after I qualified for fancier medical insurance and began physical therapy twice a week, the pain persisted, as ineradicable as cockroaches. It didn't help that my neurologist showed up four hours late to our biweekly appointments and spent our 10 minutes together either talking on the phone to his wife or spewing jargon about "irregular modalities" and "compressed neuromuscular pathways." While quick to prescribe me the nerve-numbing medications, he refused to address the most basic questions about my condition: What in God's name was the matter with me, and why wouldn't it go away?

By late summer, the pain ran the whole show. I was too depressed and painkiller-addled to return phone calls, too palsied for even the most casual e-mail correspondence. Important friendships fell away as I passed night after night in my orthopedic office chair, watching the same old episodes of Law & Order. Between self-pity cycles, I took to daydreaming about shoulder surgery with a fervor some of my contemporaries devote to weddings. Instead of a rock glittering on my left hand, I pictured a diamante X-acto knife slicing into my scapula and scraping out the toxic little lump lodged there. The glorious recovery period would find me in a cloud of scented mist, enthroned on my brand-new, state-of-the-art Zero-Gravity Back Lounger. When at last I re-entered the world, I would be symmetrical, bionic, unrecognizable.

The results of my MRI, however—the MRI I spent two months hassling my insurance company to approve—disrupted this dream sequence. The film revealed a chain of bulging disks in my neck. To my dismay, my doctor warned they would be tricky to correct surgically, at least not without considerable risk to my spinal column. This unexpected conclusion echoed a much earlier diagnosis, delivered in halting English by an acupuncturist in Brooklyn's Chinatown. "No, no, not shoulder," the man had said as he jabbed needles into my medulla, "your pain is from the neck." He recommended acupuncture three times a week for the next two months—then, he snapped, no more pain.

Sound seductive? Obviously. But there was a problem, the same as always: price. Acupuncture cost $75 a session, so three a week came to $225; after three months, I'd be out a total of $2,700. Having quit my job to maximize my hours in the steam room, I couldn't possibly spare $2,700 on an experimental treatment, not when I was already spending $300 a month on insurance and another $60 a week in physical-therapy co-pays. Acupuncture was an extravagance I simply couldn't afford.

But soon after my MRI results came back, an acquaintance of mine, a med-school student who had studied the effects of Traditional Chinese Medicine on cancer patients, mentioned that acupuncture treatments cost about $1.50 in China. A dollar fifty? I made her repeat the number. It seemed unbelievable. Could I really relieve this horrible pain for less than a slice of pizza?

Though I lacked any concrete knowledge on the subject, I'd always believed in Traditional Chinese Medicine, the same way that I believed in essential oils, echinacea, and colloidal oatmeal baths. And I knew that in any 12-step program, belief is half the battle.

Without more thought, I made a decision. I was bored, desperate, impulsive by nature. So what if I had no cash? I always had frequent-flier miles to burn. I logged on to continental.com and discovered that I could fly round-trip to Beijing for $30.62 in airport taxes. I bought a ticket.

Click hereto read Part 2.