“Not enough chai:” Medical Tourism In India

You must like seeing dead people,” your sister said when you told her you were going to India. “People in India are very poor.”


Indeed, they are poor. But after reading 400 pages on the subject, you have learned a few things about poverty in India: the poor almost alwayshave enough to eat, and they do have access to nutrient dense diets, but do not make use of these opportunities; the poor in India primarily suffer setbacks from missed work and frequently go into debt because of medicalcomplications; and the poor waste highly significant amounts of money on junk food, tobacco, television sets and… chai tea. In principle, this is not so different from poverty anywhere else, but in reality, poverty looks very different, based on what you see while slum-walking.


You have never known poverty. Truthfully, your number one motive for traveling to India was to see the poverty with your own eyes and to get some sense of developing world struggle. Additionally, you wanted a firm reminder to never take what you have for granted because, hey, you were born a rich girl. You’ve never truly known poverty.


Sure, the summers of your youth spent at your mother’s place were characterized by obsessive-compulsive penny pinching, saving, reusing, and deal seeking. She made things work, and despite knowing that your father would have happily contributed cash at any time, she was too proud to ask. You didn’t mind the austerity. It was fun. But that’s the mindset of a child who knows that her life of opulence returns at the end of summer.


You played with the poor neighborhood kids and saw some pretty dire living conditions. Homes with fleas literally jumping out of the carpets. Crumbs, plastics, and foils littering coffee tables—food bank rubbish. Mentally disabled kids, physically disabled parents. Drunk fathers that wouldn’t rise from bed even by 2 o’clock in the afternoon. Lots of screaming, cigarette smoking, and sitting in front of trashy TV with nothing else to do. Your best friend from your mom’s town got pregnant at thirteen, and you came home with a raging case of head lice.


Such is poverty in America, and you’re thankful for your exposure to it. You did love summers with your mother, and practically revered a state of existence in which anything you could ever want was not effortlessly attained.Somehow, it felt more real. Possibly because it appealed to your delight in challenge.


You owe a lot to your mother. She taught you everything you know about value-seeking and making pennies stretch. She also instilled in you a need to maintain your health, particularly through diet, in order to avoid hospitals in the long run.


You also owe a lot to your father. He taught you to be amicable, optimistic, proactive, and eager to work. He demonstrated resourcefulness and do-it-yourselfness. While he was a good negotiator, he taught you that the price of something didn’t matter very much in the long run; whether you put the thing to good use did.


The polarization of your parents’ socio-economic status was less remarkable than their difference in age. Your father was born in 1930, a time when hard work and resourcefulness paid off. Your mother, 1955, came from an era where hard work still paid off, but which led to the cusp of diminishing returns—such that harder work did not yield more, but rather, smarter work did. In her mind, economizing was work, and so she knew not simply how to economize harder by denying herself excess, but how to economize smarter by making good use of opportunities when they came her way.


You’re just another Generations Y-er from an upper-middle-class (father’s) household, who had access and exposure to both the best and the worst education, and who never lacked in opportunities. You were born lucky and you will admit that the majority of your choices have been made freely, without external social or economic pressure.


This is luxury: the ability to choose.


Between your father’s go-get-it attitude and your mother’s lessons in “always check the unit price first, then look at the jar,” you feel you have developed into a well-rounded candidate for a life lacking in wants, and thus feel quite immune to acts of desperation.


That is… until you consider the American health care system and your want for care and treatments.


Blessed be your mother, who taught you the merits of diet and exercise, but she did not prepare you for physical damage. Your father tried: “Jesus! Don’t lift so much! You’re going to wreck your back.” This lesson came from a man who’d broken his. But what did you care? You were eight when he said that to you.


By the age of 20, you’d had three flattened lumbar discs and left nerve deviation that sent fire down your leg. Thankfully, student health insurance saved the day, and you were able to have epidurals, xrays, your MRI, your meds, and your subsequent back surgery paid for—and PT was free! This saved you at least $40,000.


Maybe getting off scott-free (despite your crushed dreams) wasn’t enough of a deterrent. So you played the game of no health insurance, thinking you would avoid the basics like cancer for at least of couple decades, and just as long as you looked both ways before crossing the street, you wouldn’t need emergency care. Enter streptococcus group C, a very common and otherwise benign bacteria group that just so happened to colonize your knee. Two weeks in the hospital, xrays, MRI, emergency surgery, private nurses, and 8 weeks of antibiotics… $50,000. You and your family discussed the option of filing for bankruptcy at the age of 23.


Holy Moses!


But once again, you got lucky. After some expert finagling on the part of your lawyer, and a bit of tearful Ivy League elbow rubbing on your part, the State of Washington’s Labor and Industries insurance program decided that maybe they needn’t reject your claim on principle—that perhaps it was a work-related injury. The truth is… it could have been, but most likely it was because you scratched a mosquito bite with dirty fingernails.


Such is life, totally unpredictable and chaotic.


It was another close medical call, one which taught you, fundamentally, that the human body is at once strong and fragile. It has unbelievable healing powers, but can also be snuffed out of existence in a moment—by a truck, a bacterium, a virus, a natural disaster! If your life is not snuffed out in a merciful moment, then the alternative is a slow, agonizing decline.


Because of your history of hospital visits, you eat and drink and sleep and exercise in an effort to forestall injury, disease, and death. And yet you are reminded year by year that your body is losing the war of attrition. Damage incurred as a youth who never grew out of her eight-year-old-I-can-lift-this! mentality catches up with you later in life.


For these reasons, you decided to make excellent use of an opportunity: MEDICAL TOURISM IN INDIA. Just as the poor in India are set back by medical problems, so are Americans. Hopefully you can sort yourself out early, for a fraction of the cost.


* * *


So tell me, what kind of pain do you get?” Dr. Serana asks you, after guiding your knee through a series of bends. “Does that hurt?”




He pokes and prods. “Any of this?”


No. It’s fine now. But it gets swollen and inflamed when I use it. I haven’t been using it.”


Your damn knee. That victim of chaos. Achey, slippy, crunchy, grindy. Losing more of its function every year.


How long can you walk, for example, before the pain becomes an issue?” he asks.


I recently did an 800 kilometer walk. Walking sually isn’t a problem. It’s trying to bend the knee after a walk that’s the problem.”


You don’t care for Dr. Serana. He doesn’t seem to understand your concern. There you are, young, fit, healthy, complaining about a knee that still permits you to walk such great distances, and just outside the door are half-a-dozen aging, middle-class Indians, some moaning with crippling pains.


So… basically I came here because I was advised by an osteopath to consider getting my knee cleaned out—to remove some of the debris so that this friction from the crepitus stops occurring. You know, like a preventative measure. But what you’re telling me is that I should just continue to use it until the pain is unbearable and then get surgery?”


Dr. Serana looks startled and almost offended. “No, that’s not what I mean…” he begins.


But what does he mean? He repeats himself, and the message sounds no different. You grimace at the prospect of a future of diminishing functional returns. You prod him for more information, ask him about the tendonosis, the snapping and grinding, the bone spurs, the soft tissue. The future that is in store for you. No progress.


The inflammation does not cause the arthritis. It is the arthritis that is causing the inflammation. What causes the arthritis is weight on the joint. You simply must not bend the knee anymore,” he insists. He is sorry, there is nothing you can do. Machinery wears down.


But! But… no…


Further discussion about the knee is useless, so you decide to tackle the issue of your low back: the muscle spasms, nerve irritation, inflamed S.I. joint, the pain that had only visited once in a while which is now an ever-present annoyance. One of those things that creep up so slowly and deliberately that you forget what life is like without it.


He sends you for an MRI, so you return down the hall, past radiology, where you’ve just been X-rayed 20 minutes earlier. You have to run to an ATM to withdraw enough cash: 6,500 rupees, about a hundred bucks. You stand at the counter and watch as your name, Maria Mae Stevens, which had been reduced to Aria Mae Stevens, gets further butchered to Aria Steven. To your right, a miniature, sun-dried woman runs of a mop over white tiles, clearing away your muddy shoe-prints.


This same creased, stooped woman leads you down a hall, gives you a cubby in which you must deposit all of your valuables, and takes you into a storage room that happens to house the MRI machine. You strip in the corner, standing on a slab of concrete, and shove your clothes—cubby key buried deep within—on the corner of a high shelf. The woman speaks no English, but she taps and gesticulates clearly enough, and you stuff cotton-balls in your ears as the technician arrives on scene.


You climb into the machine and feel very glad to be there. It has been eight years, and you’ve been dying to know what in God’s name has been going on in your back since surgery. Before they slide you inside, you stall to unscrew your navel piercing. You hand it apologetically to the technician who, unsure what to do with it, turns the pieces in his hand over onto one of the dusty storage shelves.


Whaaaap! Whaaap! Whaaap! Tap! Bam! Tick tick tick tick tick…. vrraarooom! Goes the machine.


In 24 hours, you will have your results.


While annoyed by the bleak outlook for your knee, you can’t help but feel immense satisfaction that you have just received a minimum of $1,350 worth of medical care (consultation, knee X-rays, another consultation, an MRI of your lumbar spine) in the short span of two hours, for the low, low cost of $109.


It is a truly budget-blowing day, but also a day of enormous savings. Medical tourism! The images will eliminate bullshit guesswork in the future and hopefully help you identify a correct course of action.


* * *

You have patellar femoral syndrome,” the physical therapist says.

You sit in his office, just 8 hours after your MRI follow-up at the hospital across town. You want a second opinion in your knee, since Dr. Serana’s diagnosis of “you have arthritis and must never bend your knee again” plus “the disc compression is causing inflammation in your back, which is causing the nerve irritation. I will prescribe you muscle relaxers, vitamin D, and vitamin B12” just didn’t cut it. You want someone with expertise in soft tissue.

What is causing this tendonosis in my knee?” you ask. “My orthopeadic doctor says its’ from bone spurs. But I have those in both knees, and it is only the right one that is a problem”

The PT shakes his head. “It is not bone spurs. You’re knee cap does not track properly. But it’s okay. We can fix it. And your back. And your shoulder. In ten days you will be 100% cured.”

Your eyebrows rise. “Is that so? Wow! And do you have some kind of money back guarantee if I am not?”

The physical therapist smiles at his assistant, then back at you. “Well, of course, the human body is complicated, and that all depends on you. What you do outside of this office, how much activity you engage in… it may not be 100 percent.”

You smile back. “Of course. I just think that sounds like a very tall order.” A very strong sales pitch. “Tell me more about my maltracking kneecap. I have suspected this much, but I have been unable to confirm it.”

The physical therapist indicates that you sit on the examination table with your legs hanging off the edge. He begins to draw lines over your knee caps, and you feel giddy with anticipation, for there is little you enjoy more than having your body analyzed.

See here… that is your knee cap on the left leg and it tracks…” he draws a line laterally “over here. And your right knee cap….” he draws a line pointing in the same direction as the one one on the left “tracks over here. Go ahead and straighten and bend your legs for me. See?”

You do not see.

If you did this in front of the mirror, you would see. The right kneecap should be tracking in this direction.” He points to the curvy line he drew in a medial direction.

Don’t you mean the other way?”

Oh yes! Of course!” he draws the same line laterally. Your knee is covered in lines, and you still do not see, and express as much. “Okay, well all I have to do is stabilize this muscle,” he grabs hold of your vastus lateralis and pulls it medially “and now bend your knee” you feel it crunching “and see? It tracks properly.” You try many times, and he struggles to hold your muscle in place.

…but it still crunches. You are dubious. The physical therapist is now rushing. You are reminded of the fruit cart salesman who performs “magic tricks” with his scale to confuse you into paying too much.

So your knee, your back, and your shoulder. My assistant will explain the rest.” All smiles, all relaxed and confident posture. You like this man (you did not like Dr. Serana). Most of his diagnoses make sense. Most of them.

The PT package is about $600. “It will be 30 hours of therapy,” the assistant explains. “45 minutes per day for each part of your body, a mediation session, counseling session, and dietary consultation. Plus blood work. We must check your vitamin D levels, your B12 levels, and uric acid levels.”

That’s interesting. I’ve heard about uric acid and low back pain. Can you tell me more about how uric acid has an influence? And specific dietary sources?”

The assistant smiles, “I cannot. I am afraid I don’t know. But you will have a dietary consultation after we get the test results.”

Why not just tell me the diet I should follow, and we can skip the tests all together?”

I’m afraid I cannot advise you. That is up to the doctors.”

You shrug. This whole consultation has cost you four dollars. But a $600 mouth-watering therapy program hangs in the balance of his ability to answer your questions.

Suppose I don’t want to address the shoulder problem,” oh but you did! “and just want to work on the knee and the back. What kind of drop-down pricing am I looking at?” You do, after all, sell packages for a living.

Of course, it will cost less. But not very much. It would be more worthwhile to do all three body parts.

Thank you for your time,” you say, “I must discuss this with my hosts. It sounds like a very good deal.” Thirty hours of therapy! Stim, ultrasound, manual manipulation, heat and cold treatments, and some complimentary Ayurvedic and herbal therapy as well. All under direct guidance. Sounded perfect.

But at home you are unable to confirm your maltracking kneecap (as you have been unable to confirm it for months). You sit on the tile floor in the bathroom and bend and flex the night away. You draw more lines, you use your computer’s webcam to record your squats. You stand in front of the mirror. Nothing.

* * *

The next night, your yoga instructor rocks your world. You explain to him your “diagnosis” of “patellar maltracking” and he devotes the entire class to your low back and to your knee.

For $2.70, you bicycle and pedal, bend and straighten, contract, lift and lower. You twist side to side, belly breathe, and gather your energy.

You melt. You feel high. Your low back pain releases slightly. This is good news.

And you learn, not surprisingly, that your kneecap tracks like a boss.

Fuck both those doctors.

* * *



Eight days later, you are in Udaipur. Knee and back are stiff and swollen from one week of inactivity. Much of your post-yoga progress has been lost.


A tiny little man teaches evening yoga to you and your buddies for $1.35. For one hour, you are shamed by several dozen poses which exploit your weakest link—hip mobility. Too many years of sagittal plane exercise has made you move like a Lego man. The yogi is amused by your awkwardness. But you smile and fall over and appreciate the learning opportunity.


At the end of the course, you thank the little man and then ask him to place his hand on your knee and to feel the racket when you bend it.


What causes…” the tendonosis? You are certain that this expert in human movement can pinpoint your problem. You can feel it. He’s spent an entire hour studying your sub-optimal movement. He must know!


He makes you squat up and down a few more times. Crruuuuunch, crackle, snap, pop! “What causes?” you repeat.


Not enough chai,” he says,


Face palm.


Categories: India | Tags: , , , , , | 1 Comment

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One thought on ““Not enough chai:” Medical Tourism In India

  1. I enjoyed the article.

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