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My Bloody Romania: First stab at medical tourism
Being a homeless, shameless, godless freelance travel writer isn't all glamour, Nike endorsement deals and Friday nights at the Viper Room canoodling with Natalie Portman. There are innumerable indignities associated with this lifestyle, including the startling, nay shocking, confession I am about to make: I have not seen a dentist in over four years.
Now rest assured that during this time I have been brushing and flossing with a ferocity only known to those who have no health insurance and little disposable income, who occasionally suffer the odd nightmare where his teeth crumble into shards while biting into an apple and Natalie Portman abruptly decides that she wants to see other people.
Even so, after four years, punctuated with occasional mysterious aches and an increased sensitivity to ice, I felt compelled to finally see a dentist. Romania may not be the first destination one thinks of when considering medical tourism (or even the 50th) and indeed, generally speaking, one shouldn't. Pretty much all of the competent doctors leave here at the first opportunity for better pay and a lifestyle where a trip to the post office to pick up a package isn't a half day ordeal. Even President B?sescu couldn't find a doctor he trusted to repair a herniated disc last year, choosing to get the work done in Vienna. But dentists are another story. Since it's not nearly as easy for them to find work abroad, even the Jedi Knights of Romanian dentistry are more or less stuck here (though EU membership may change all that).
So with a solid recommendation from friends, I brushed and flossed one last time and walk across town to my appointment.
If one chooses to fixate on aesthetics, they might become a tad nervous upon arrival at their Romanian dentist's office. The 'reception area' did not have the soothing 50 gallon aquarium or three months of People magazine or even lights (there was a ceiling light, but it was turned off – natural light from the windows was sufficient as long as one wasn't trying to read a book or scrutinize their bill). It was simply a tiny, bare storefront space, with two tired plants, four chairs and reading material that consisted of mail catalogues from the local superstore. There was no reception desk and, indeed, no receptionist. Just a frosted door from where the dentist herself occasionally emerged to call in the next patient.
The tiny room was filled with people, some walk-ins cupping their jaws and others with flimsy 'appointments' that were more wishful than abiding – I was invited in 45 minutes after my scheduled time. Inside, the office wasn't much better. Again, no lights apart from the overhead lamp she used to illuminate my mouth. The walls were bare, the only decoration being two tiny, but encouraging pictures of the Resurrection of Jesus clipped to the x-ray light-board.
After truncated pleasantries (which she unexpectedly did in English), she went to work with the iron hook, gouging at my hard-to-reach places. After a quick spit, she fired up the tooth polisher for some nippy work 'only where it was necessary'. Though her spoken chair-side-manner wasn't winning any Florence Nightingale awards, she, like her busty American counterparts, was not shy about cradling my head, squished deep into her left breast. Better than any anesthetic.
Fourteen minutes was all she needed. Never cracking her deadpan disposition, she informed that I have no cavities [punches air] and that it would take about an hour for the underwire mark in my cheek to fade.
Total cost for cursory check-up and hasty teeth cleaning: RON30 (US$12.36). If one is less valiantly hygienic than I am, one might like to know that getting a tooth pulled will run an additional RON25 (US$10.30) and getting a tooth filled should be about the same. I wonder if dental care prices in America would be similar if they cut out the aquarium, People magazine, the team of receptionists and superfluous mood lighting?
So, my fellow budget travelers and destitute freelance writers, probably best to save your LASIK surgery for Thailand, but in the meantime you can get have a professional attend to minor-to-moderate dental issues in Romania with the same confidence you would at home. Like anywhere in the world, dentists' offices ('stomatologie') are on virtually every block, so just shop around until you see a door you like, or if possible, get a local to give you a referral. Be sure to crack a joke while you're at it and take discreet note of their smile.
Leif Pettersen, originally from Minneapolis, Minnesota, co-authored the current edition of Lonely Planet's Romania and Moldova. Visit his personal blog, Killing Batteries, for more amateur medical solutions and reminiscing about his innumerable relationships with movie stars, even if they all deny ever having known him, while deep down still longing for his red hot smokin' body, aren't you Natalie?
Filed under: Romania, My Bloody Romania with Leif Pettersen
Reader Comments (Page 1 of 1)
Ira Mar 4th 2008 7:07AM
Sent: Tuesday, January 29, 2008 1:28 AM
To: newsletter@medicaltraveltoday.com
Subject: Re: This Week in Medical Travel Today Vol2 Issue 9
As a physician, I read the interviews with great interest and came away with a disturbing fact. No where, until you get to Ira Nissel and IMS Global does anyone stress anything but cost savings. Sure the quality of care by a US trained physician in India or Korea might be at the level that can be obtained at home, but aftercare, the possibility of severe complications and need for further intervention are never mentioned. What has been the hallmark of exceptional care for the 50 years I have been a physician has been the continuity of care, a fact that doesn't seem to exist in our "cost savings at any cost" mentality. Knowing your patient, having developed a mutually beneficial relationship over many years immediately provides the treating physician that provides an incalculable benefit to that patient's care.
What happens to a person who has a liver or heart transplant overseas, comes home in stable condition, but suddenly goes into acute rejection. Does he get on a plane back to where the surgery was performed, or does he then see a doctor who has never seen him, might have different thoughts on treatment, and has no real-time opportunity to discuss it with the original surgeon. Add this to the fact that the physician suddenly thrust into the therapeutic mix, might be averse to get involved since he was never able to be the doctor on the case. How would you as a physician feel if you got a call saying that I was in India for my heart transplant, but now that I am home, you need to take care of me because I now have complications. I might just say "sorry, I can't or won't help you. I don't want to be responsible if anything further goes wrong. I will probably get sued."
The fact that primary care physicians at many hospitals are being replaced by "Hospitalists" not because they are better doctors, but because they can provide cost savings, and not necessarily better care as documented by a recent article in the NEJM.
The tragedy confronting my profession is that the mantra of "who can do it cheaper, not who can do it better" reverberates throughout our health care system. Should the delivery of care be an investor owned, bottom line driven and Wall St sensitive industry? Have we forgotten that the best care is the least expensive care in the long run? The only one of the four entities involved in the delivery of care is the insurance industry, as they are the only one guaranteed to make a profit by reducing reimbursement to the physician, reduce services to the patient, and increasing premiums to the employer. It turns my stomach when I hear that Insurance Company A had a 15% increase in profits and that the recently replaced CEO had a separation package of over $200 million dollars.
What has happened to our value system? We have an industry (I cannot call it a profession) now based on fear and greed. What has happened to the value of education, training, knowledge, commitment, sensitivity, experience, honesty, morality and integrity? Caring has been replaced by what is the ROI, positive cash flow and all the other phrases that used to be relegated to the business world.
Ira Nissel's efforts are the only patient sensitive ones in your entire article and interviews. And it is because his work is to provide care for those children who would otherwise not be able to receive it. To put his work in the same category of your other interviewees does him a great disservice.
Can we ever return to the time when doctors follow the following rules: Do the right thing to the right patient for the right reason in the right place at the right time and for the right price?
At a time when the brilliant discoveries and advances in medical science at at their zenith, to have a delivery system that is in such disarray that many physicians are discouraging their own children from pursue a career in medicine. What a shame.
Robert I. Kramer, MD FAAP
Clinical Professor of Pediatrics and Pulmonology (ret)
UT Southwestern Medical Center
Dallas, Texas
Don Mar 4th 2008 11:31AM
Hello Dr. Kramer,
I appreciated your comments very much. I specifically need to comment on one thought. You said, "The tragedy confronting my profession is that the mantra of "who can do it cheaper, not who can do it better" reverberates throughout our health care system."
That is a tragedy, and I agree with you. You will probably also agree with me that socialized medicine has done nothing towards making a better delivery system in American medicine. And it's probably destined to get much worse. It's impossible to talk to most people about it they "know better." This is probably the chief reason medical tourism grew up in India, and it's all over the Internet as to how excellent it is. The next best, but more expensive, is in Thailand.
The private medicine that's going on in India would absolutely astound you. But for starters, there is very little socialized medicine and I hope India can learn from America's mistakes as well as she has learned from our medical schools, hospitals, fellowships and intern programs. In fact, I think she can.
I notice you're retired. I'd love to welcome you to come to India to have a look, not only at our medicine and health care in general, but to see the Taj Mahal and other enchanting areas of our country. I can promise you one thing. You'll no longer be a skeptic after you have seen what we have with your own eyes. There is simply nothing like it in America or in the world. It only starts with a five star room in a hospital. There is much, much more than that.
To be very sincere, most of your concerns, and programs for contingencies were met a long time ago. You probably recollect how many Indian physicians there were before you retired, and it's much greater now in just the last year. Indians aren't stupid nor do they lag behind. They have forged ahead with the best. Many procedures are here, like hip resurfacing, five years before clinical trials were started in America. The good old Food & Drug Administration started out as a better idea than it has become. But the excellence of after care and simple patient care is better here than in America or anywhere else in the world. No Indian physician working with one of our famous private hospitals is going to allow a patient to go home without being very certain the patient is truly ready and able to safely go home. As I've said before, it's possible for American or other world hospitals and clinics to match the quality of medicine, care and service, but none of them will beat India's price. Currently India is light years ahead of all comers in every single area.
Just as an example, we had a patient here for a Roux n Y Gastric Bypass who several days later developed a bowel torsion some days after the surgery. There was no temperature and blood work all appeared good and normal. Only vomiting. Dr. Sanjay wouldn't take the risk. After careful examination, scans which proved negative, etc., he and his team entered laparoscopically one more time and ... there it was! Rare as it was, his expertise met the challenge and he has it on video -- as are all his surgeries. The patient carries a video home with them. The patient has returned home and is doing very well singing the praises of Dr. Sanjay. And you know yourself that with the best care, most problems will be found on the table than afterwards.
Lastly, there is one more thing that makes Indian medicine so much better. She does understand about malpractice and the costs both in terms of policy premiums and the litigious atmosphere and has simply tried harder. To begin with, there was more empathy and interest in the foreigner than should ever have been expected. It translates itself even to the housekeeping staff, and I'm saying that because so many letters of compliments have noticed.
Once again, Dr. Kramer, do take me up on a visit to India. I'd enjoy showing you around. You would love the trip, and go away with an appreciation that only a first hand experience would provide. By the way, that's why I live here permanently. :) Much as I love my motherland, and I'm a red-blooded American, I've fallen in love with India and will remain until my very last days.
Best regards,
Don Wood, Director
America's Medical Solutions, Pvt. Ltd.
www.americasmedicalsolutions.com
Don Mar 4th 2008 12:16PM
Hello Ira:
Apparently someone should teach you the logical fallacy of *unsupported* ad hominem remarks. If you're going to bad mouth India, you're surely not going to be doing anything good for medtoursforyou. Are you? So, go ahead, and just be sure you spell "India" correctly. :)
Don Wood, Director
America's Medical Solutions, Pvt. Ltd.
www.americasmedicalsolutions.com
Ira Mar 5th 2008 2:27AM
Don,
I forgot one more important point I neglected to mention… what about the levels of contamination in the surgical wards in Indian private and public hospitals??? This is a little known fact and a question most patients won’t even think of asking… even if the private medical center does not have an emergency room…the level of contaminants and pollution in the air are high.
Fact Air Pollution in India
Industrialization and urbanization have resulted in a profound deterioration of India's air quality. Of the 3 million premature deaths in the world that occur each year due to outdoor and indoor air pollution, the highest number are assessed to occur in India. According to the World Health Organization, the capital city of New Delhi is one of the top ten most polluted cities in the world. Surveys indicate that in New Delhi the incidence of respiratory diseases due to air pollution is about 12 times the national average.
According to another study, while India's gross domestic product has increased 2.5 times over the past two decades; vehicular pollution has increased eight times, while pollution from industries has quadrupled. Sources of air pollution, India's most severe environmental problem, come in several forms, including vehicular emissions and untreated industrial smoke. Apart from rapid industrialization, urbanization has resulted in the emergence of industrial centers without a corresponding growth in civic amenities and pollution control mechanisms.
The results of the study, done by a team of scientists headed by Dr N Palaniswamy, Deputy Director, State Corrosion Protection Committee
So what you are saying is if the building in India says “Private Hospital” the air is also of better quality???
Cheers
Ira
elfin Sep 20th 2007 12:12PM
Yes, but the dentists with the mostest are in Chisinau! my guy was good looking (always a plus if you're going to stare at his face for hours on end!) and gave me a Hollywood grin, assuring me I'd get married the minute I left the office(hotel Cosmos), all for 100 Euros.Plus he capped 80 % of Gemma's teeth for 400 euros.on the downside I got to hear "go west" by the pet shop boys everytime i was in the Chair...
Sheila Scarborough Sep 20th 2007 2:52PM
You know, this doesn't sound a whole lot different than when I go to my local rather spartan "Castle Dental" chain office here in Texas, and it's a quarter of the cost.
Leif Sep 21st 2007 2:41AM
Guy dentists. Not as nice to have them gyrating against you...
Sheila - I'm hoping there's a version of Castle Dental in Minneapolis. You never know when you're gonna get that bad apple.
Don Sep 24th 2007 4:13AM
Leif,
Allow me to take exception to your statement "So, my fellow budget travelers and destitute freelance writers, probably best to save your LASIK surgery for Thailand, but in the meantime you can get have a professional attend to minor-to-moderate dental issues in Romania with the same confidence you would at home."
I'm Don Wood, one of three Directors of America's Medical Solutions (www.americasmedicalsolutions.com). We would recommend India rather than Thailand for your mentioned needs for many reasons. First, we three Americans live right here in Mumbai, India where we take a very proactive part in every case we refer to Indian hospitals. The point being that every kind of medicine and technology one needs or wants is available here. Recently someone posted elsewhere her thirteen reasons for coming to India for medical, dental, eye, IVF, etc., care. There are some in the world who may match Indian care, but no one beats it. Especially when it comes to human care and price. Now with us Americans here, there is no better place in the world to go. We have people saying they would crawl back to India if they needed additional health care. So, bring your dental and LASIK (etc.), needs here.
By the way, there are no fees for our services. We're paid directly by the hospitals for our referrals, and they value getting them.
Ira Mar 4th 2008 7:04AM
Dear Don,
"There are no fees for our services. We're paid directly by the hospitals for our referrals" because the hospitals add your fee to their costs.... at least be honest, there is nothing wrong with making money when providing a service to someone... India? a medical destination not so sure...true the Ministry of tourism does a lot of advertising but... we have heard too many stories/testimonials from people who went to India and came back with other medical problems...India is a very beautiful...but it stops there...What happens when a person leaves India and then has complications? Private medical centers and clinics tend to disappear into the night...over night...then what??? For all those of you reading this look at Israel as a destination...for more see www.medicaltourismforyou.com or email me and I will give you more than 10 reasons to come to Israel for any type of medical treatment or procedure.
PS. I was under the impression that American doctors don't believe in medical tourism...they say its unsafe and not as good as US health care??? I'm confused.
Ira