Health care debate in the USA

One of the flash points in the Democratic party primary battle between Barack Obama and Hillary Clinton is the debate about health care in the United States.

Millions of Americans live without medical insurance, and many of them are not waiting for the government to act.

The following is a transcript from KXAN Austin News' Jim Swift, who has a special report on the experiences of two Austinites who ventured into the world of medical tourism.

Perhaps you are one of those living without medical insurance.

If not, imagine for a moment that you are, and that you face every day hoping nothing goes wrong.

Then it does. What would you do?

Much of what we hear about India is evidently true. There are lots of people, for one thing, leading to lots of traffic and lots of pollution. Monkeys are not limited to the jungle, and cows are not limited to the barn.

We get fresh evidence of all this from Austinite Steve Roach, who arranged a medical tourism trip to India with his friend Frank Murphy.

"You got a good deal here," Roach says."There's a typical tourist," Murphy says.
Last year, Roach, who has only the bare minimum of health insurance, discovered he needed triple-bypass heart surgery.

"Come on now, they were quoting me $48,000 to $85,000, just for the hospital here," Roach says. "That's not the doctor or the anesthesiologist, and you could get 11 days there, all costs, for $12,000. Quite a difference."

"If this alternative had not been available to you, what would you have done?" Swift asks."I would have had to have gotten it here," Roach says."And how would you have paid for that?" Swift asks."Bankruptcy, I imagine," Roach says. "I wouldn't have much choice."

"Based on your experience, watching Steve, is this something you would do if you needed to?" Swift asks.

"If I had to," Murphy says. "Thank God I'm on Medicare, and I don't have to worry about the expenses the way Steve did. But if I were in a similar situation, as far as needing it and not being able to afford it here, yeah, I'd do it."

"People, when they hear you went to Thailand for medical care or a dentist, they kind of have a cultural prejudice, I think," says Leighton Hodges. "People have this stereotype of Thailand of just substandard care, and it's just not the case."

Hodges, another medical tourist from Austin, so thoroughly ground his teeth that his dentist told him he needed major work.

"The dentist said with this dental gum surgery and everything it would be thirty-seven thousand, five hundred and something dollars," Hodges says. "And I took a deep breath, and I said, 'Thank you very much.'"

"This is Tom Cruise and see how he smiles? I think now your smile should be better than this," says a Thai dentist.

Hodges spent more than three months in Thailand and only spent $10,000.

"The lady really knew what she was doing," Hodges says. "So I got a lot of compliments, and people would say, 'You look younger,' or, 'You look better somehow.'"

"In my opinion, you get what you pay for and I really, as a dentist of 20 years, the dentistry I've seen from foreign countries, even with a dentist from America, it is just, it's not good," says Dr. Merrily Sandford.

"There's plaque; this is plaque underneath the crown; this tooth had decay," Sandford says.

As it turns out, the seals leaked on four of Hodge's mouthful of new crowns.

"but even with the four that I'm going to have to, that I'm in the process of replacing, I'm still saving a whole lot of money, and I had a wonderful vacation," Hodges says.

Hodges did his own research and set up his own contacts in Thailand.

Roach, on the other hand, arranged his trip to India through Healthbase, a company that connects patients to more than 200 medical, cosmetic and dental procedures in eight countries around the world.

Weight loss surgery in Thailand

At www.medicaltourisminthailand.com we focus on helping our clients select the best doctors and hospitals at the most competitive price, for their particular procedure. Here is a typical detailed response for a patient requesting details on lap-band surgery:

My recommendation for this particular procedure - lap-band or stomach banding, is Samitivej Hospital in Sriracha, about 40 minutes outside of Pattaya. The Director there, Dr Somchai, is not only a skilled surgeon but also is a graduate from Harvard Business School and he has assembled a fine team of surgeons to work with him. His hospital is widely used by the CEO's and employees and families of the several large Japanese companies in Sriracha, and the hospital is keen on attracting International patients. For this reason you will find that the pricing is very competitive and you will love the friendly approach and welcoming attitude of the doctors, nurses and international staff. Their prices are considerably lower than at Chiangmai Ram, Bangkok Hospital Pattaya, Bangkok Hospital Phuket, Bangkok Medical Center and Bumrungrad Hospital - although I would be happy to refer you to the best doctors at these hospitals if you prefer.

Dr. Somchai and his team will spend all of the time necessary with you, finding out exactly what you would like to achieve, and then they will meticulously perform the procedure to your satisfaction. Recently the hospital has had many American patients from Iraq for abdominal surgery - tummy tucks, liposuction, gastric banding and lap-band. The first patient came over and she was so pleased with her surgery, the doctors and the hospital, that within a few weeks several of her friends came over for similar procedures.

Regarding the surgeons' qualifications Dean, all are certified surgeons having completed advanced training, Fellowships or Internships in the United States, Europe or Australia following their medical school training at various Universities in Thailand. All are very experienced in their particular field of surgery (for instance they normally specialize in one particular area of competence; facial surgery say, or abdominal surgery, breast surgery or bariatric or weight loss surgery, and typically, each year they will perform many more surgeries in their particular field than their counterparts in the USA, Europe or Australia.

Samitivej Hospital, Sriracha - near Pattaya:
Lap band surgery including 3 nights in hospital: 320,000 baht (about AUD $10,670, US $9,145) .
Note that these are all inclusive treatment prices with no additional fees added to surprise you later. Initial tests and diagnostics, the procedure and all doctor, nursing and hospital care, medications and follow up visits while in Thailand. There is no waiting time for the surgery and the hospital will schedule the procedure at your convenience Dean

BMC, Bangkok (also highly recommended but more expensive)
Lap band surgery including 3 nights in hospital: 420,000 baht (about AUD $14,000, US $12,000). Expect additional costs for pre op tests and diagnostics and follow up visits with the doctor.

If you can afford the time Dean, I would spend at least 2 weeks first at the Lamphun (near Chiangmai) weight loss program (www.thailand4wellnessprograms.com)

2 week course: US $1,590
3 week course: US $2,260
4 week course: US $2,850

I have seen some amazing results there and it's well worth trying before you go to the expense and trauma of surgery. Even if it did not result in the weight loss you are looking for, this initial weight loss would be a great help in the ease and success of the surgery - the more weight you lose before the procedure, the easier the surgery. I spent a day there recently and cannot imagine a better place to effectively lose weight.

Dental prices also attached Dean, in case you are interested in dental treatment. This is a new clinic that recently opened in Pattaya and many of the expats that live here prefer Dr. Nan and his team at Thai Smile to the much more expensive hospital dental clinics. I'm presently having a complete dental makeover there after seeing the results with two Australian ladies who came over recently. Laser teeth whitening for instance is 6,000 baht or about AUD $200 or US $175.

One especially nice thing about Samitivej - their quote during your initial consultation with your doctor is the exact, all inclusive price with no extra costs added as they do in many hospitals. It includes any pre op tests and diagnostics, the procedure, hospital stay if any with doctor and nursing care and any follow up visits. Compare this with the other hospitals where they charge up to 3,000 baht (about US $85 or AUD $100) for the initial consultation and the same for any follow up visits - plus inflated prices for medications etc.

It costs you nothing extra to book your appointment through Thailand4Healthcare, but it does give you the advantage of an independent assessment of the wide choice of doctors and hospitals. Don't make the mistake of relying on the hospital to select your surgeon from their duty list. We also provide friendly assistance during your complete stay in Thailand, making sure that you have a wonderful experience here and providing any liaison with the doctors, hospitals and hotels. You pay the hospitals and hotels directly at their normal rates (although our company does review the hospital charges to make sure you are not being overcharged).

If you decide to go ahead Dean, please book your appointment on line at http://medicaltourisminthailand.com/applicationform.htm . We will take good care of you while you are in Thailand, and Janey (your Concierge, photo attached so you will recognize her) will be there to help with transportation, hotels, appointments etc.

Here's a list of the hospitals and clinics we represent in Thailand :

* Bangkok International Medical Center
* Bumrungrad Hospital
* TRSC Lasik Center, Bangkok
* Bangkok Hospital Pattaya
* Bangkok Hospital Phuket
* Samitivej Hospital, Sriracha
* Chiangmai Ram Hospital
* Thai Smile Dental Clinic
* Ram Hospital, Chiangmai
* Wellness and Weight Loss Centers in Lumphon and Phuket
* Stough Hair Restoration Clinic, Bangkok

Looking forward to welcoming you to Thailand soon Dean - Pattaya (www.squidoo.com/relocatingtopattaya) is a great place to start enjoying yourself while making a real difference in your life. I will spend all of the time you need going over all of the options - but plan on at least a month here if possible. Taking just few weeks out of your life now could benefit you for a lifetime. And if you have never been to Thailand you are in for a wonderful experience. Warm regards - Pete

Dental care in UK is highest in Europe

Dental treatment in England is the most expensive in Europe, according to an unprecedented survey which is likely to fuel the exodus of patients seeking treatment abroad.

The survey of nine European countries found the total cost of a standard filling ranged from €156 (£117) in England to €8 in Hungary. That total included the cost of x-rays, materials, drugs and overheads, as well as the dentist's time.

The findings come amid growing dissatisfaction with dentistry in Britain and shrinking NHS provision. The Government admitted last March that two million patients who wanted NHS treatment were unable to get it, eight years after Tony Blair pledged at the Labour Party conference in 1999 that everyone would have access to an NHS dentist.

Dentists have dramatically increased their private work over the past decade, at the expense of their NHS work, and when a new NHS practice opens, desperate patients queue to register.

Dentists with their own practices earned an average of £105,000 in 2004-05. More than half their total income (52.4 per cent) came from private work, up from 41.8 per cent in 1999-2000. In 1990 it was 6 per cent.

While England topped the table as the most expensive country for dentistry at €156 for a filling, it was closely followed by Italy (€135) and Spain (€125). Costs in the other western European countries were less than half as much, ranging from €67 in Germany to €46 in France.

In all European healthcare systems, the greater the cost of carrying out dental work, the greater the level of government subsidy required to keep the price of dental treatment down for patients.

The cheapest countries for treatment were Poland (€18) and Hungary (€8), the main destinations for dental tourists from Britain. Savings of thousands of pounds are promised by agencies that arrange treatment in these countries, even after paying the cost of flights and hotel bills.

It is the first time that the cost of carrying out a dental filling has been compared across Europe. Siok Swan Tan, of the Institute for Medical Technology Assessment, at Erasmus University Rotterdam, and lead author of the study, said differences in dentists' earnings were the most important reason for the variation in costs. "Without exception, labour costs were the most important cost driver in all countries and practices," she said. "They accounted for 70 per cent of total costs in England. They ranged from €0.09 per minute in Hungary to €2.88 a minute in England."

The figure for England included material costs which "makes straightforward comparisons difficult", she said. The procedure was a filling in a molar tooth in a 12-year-old child.

High costs and the difficulty of finding NHS dentists have combined to make dental tourism the fastest growing category of medical tourism. Of 77,000 travellers from the UK who went abroad in 2006 for medical treatment recorded in the International Passenger Survey, an estimated 43 per cent sought dental care, according to the agency Treatment Abroad.

Keith Pollard, its managing director, said: "Dentistry is the biggest part of the business. The number of providers targeting the UK at the moment is phenomenal. It is driven by the high prices charged in the UK and the difficulty of finding an NHS dentist. When you find a private dentist the prices are shocking."

NHS patient charges are in three bands ranging from £15.90 for a check-up and x-ray to £43.60 for one to six fillings, to a maximum of £194 for crowns or root treatments. Private charges are two to three times higher.

The British Dental Association rejected the research as "deeply flawed". Peter Ward, its chief executive, said it was based on a sample of four practices out of 10,000, and was "riven with problems".

"It is a very small sample, it is not representative and it is not comparing like with like," said Mr Ward. "The dentists selected were community dentists who normally care for patients with special needs who need more staff and take longer to treat. It is impossible to make a sensible comment on a set of flawed data."

The survey is part of a wider study, commissioned by the European Commission, comparing the cost of a range of medical procedures among the nine countries and is published in the journal Health Economics.

Professor Reinhard Busse, of the department of health management at the Berlin University of Technology, who led the research, said: "We wanted to see if we could explain differences in the costs. The aim of the research is to help governments plan what levels of reimbursement may be necessary if, as we expect, cross-border medical tourism increases." The European Commission is due to publish draft plans which would open EU borders to medical tourists, allowing citizens of any of the 27 member states to seek treatment in a neighbouring country with the home country, in certain circumstances, picking up the bill. If the proposals are approved, it will focus attention on the performance of the NHS against other health systems.

The dentistry survey showed that in all cases the total cost of providing a filling exceeded the charge to the patient and in most it exceeded the payment from patient and government combined.

'I had to ask if the treatment was really needed'

Kath Diamond says her daughter Meg, aged 10, has "great teeth". So when she took her for a routine check-up at an NHS dentist in Putney a month ago, she didn't expect to embark on a series of appointments that would end in a bill for several thousand pounds.

But that's what happened after Meg was referred to an orthodontist in West Hampstead, who "immediately" said her teeth were not of the standard to qualify for further NHS treatment. According to the orthodontist, Meg had an "overshot" jaw and "mild crowding" in the lower jaw.

The proposed solution? A night-time head-brace and a removable day-brace for six months, plus 12 to 18 months of "railway track" braces on the upper and lower jaw.

After that she would need another brace every night for a period, followed by a day-brace a couple of times per week for the next decade – until she was 20 years old. After a "long consultation process", a bill was presented for £2,500 on Tuesday.

Mrs Diamond was staggered. "In the end," she says, "I asked, 'Is there a physical need for this treatment?'. They said Meg's teeth would be difficult to clean when older, and I think that is probably not true. It was all to give her the 'perfect' set of teeth."

With understatement, Mrs Diamond adds: "But that would have involved invasive treatment." Reflecting on the episode, she says: "There wasn't a sense of openness about it being what was, essentially, cosmetic surgery".

One in seven Americans lack health insurance

BRONX, N.Y. -- One in seven Americans don't have health insurance -- where do you go for help? Many are headed overseas for surgery. Traveling for health care that's not available, accessible, affordable or acceptable in the United States is a growing trend. Whether you don't have insurance -- or are refused treatment -- more and more people are headed overseas to get their medical needs met. For many, it's a life-saving trip that also saves them money.

"You're going to die because you don't have insurance … that's a scary thought," Kevin Stewart said.

"I was in the beginning stages of congestive heart failure, and so without the surgery, I would have died," Tom Hiland said.

"I can't afford it here. I'm one of those people who's just out of luck," Jeff Schult added.

Stewart, Hiland and Schult -- men left with few options and little time. Stewart's liver was failing -- without a transplant he would die.

Cost of care across the border
One in seven Americans don't have health insurance -- where do you go for help?

"I started feeling really lousy," he recalled.

Stewart is one of 45-million Americans who don't have health insurance. Many will either not get the health care they need -- or will need to look to other countries for more affordable care. In the United States, the out-of-pocket cost for Stewart would be $330,000. In India -- the cost -- $57,000!

"I could afford it. It was like, 'Hey, I can live. I don't have to die,'" Stewart continued.

Hiland also needed a life-saving surgery he couldn't afford. Congestive heart failure was threatening his life.

"I would probably not be here today if I had not had the surgery," Hiland said.

Denied insurance again and again. Surgery in the United States would set him back $200,000. In India, the 23 night hospital stay cost him $15000. The operation … done by an American-trained surgeon.

"I said is this possible that there could be such affordable treatment and high quality care compared to what we're brainwashed into believing in the U.S. … that we have the best medical system in the world?" Hiland asked.

Doctors in the United States are divided on the issue.

"Price is not the main mediator of service anywhere, but especially in health care," said Mark Solomon, M.D., a member of the American Society of Plastic Surgeons.

"It may be a reasonable decision if something that you need and you just cannot afford it here to take the risk," explained Arnold Berlin, M.D., associate professor of surgery at Albert Einstein College of Medicine in Bronx, N.Y.

But is care being comprimised? United States based Johns Hopkins now works with hospitals in Panama City, Panama and in Singapore, China. The Cleveland clinic owns facilities in Canada and Austria. Harvard is affiliated with facilities in India, and a new report by the National Center for Policy Analysis shows the 20-day mortality rate for patients undergoing heart bypass surgery is 0.8 percent -- the United States' national average is 2.9 percent. More and more Americans are deciding to go abroad -- using medical tourism companies to guide them.

No one can guarantee a good outcome, and many countries have no recourse for anything that goes wrong. But for many people desperate for affordable care, it's their only option. Schult is author of Beauty From Afar -- a book about his experience going overseas -- a divorced dad, with no extra cash and a mouth-full of rotting teeth.

"I stopped smiling. I had lost my smile," Schult added.

He did have insurance -- it would cover the cost of dentures -- but only if he waited for his teeth to fall out.

"I joke now, but I was kinda bitter about it," Schult continued.

He saved 70 percent to 80 percent by going to Costa Rica.

"I had a smile again. I had really given up on that and they gave it to me. I was very grateful," Schult said.

A feeling Hiland and Stewart share.

"It's a great thing to be feeling better every day and better than I have in well over a year," Stewart added.

"I like to say, two and a half years after having mitral valve surgery in India, that I'm still kicking, and my heart is still ticking," Hiland said.

Overseas surgery -- a big decision for anyone, but for these three men … it paid off.

The medical tourism industry has caught the eye of congress. Last year, the Senate held a hearing on the globalization of health care to determine what is at the root of the growing trend. It found the ease of international travel and the growth of quality care facilities in developing countries plays a role, as well as soaring costs of medical care in the United States.

Handshake saves British man's life

A man's life was saved by a chance handshake with a doctor, who diagnosed him with a life-threatening tumour.

Mark Gurrieri, 36, was working at a restaurant when a friend there for lunch introduced him to his dining partner, GP Chris Britt, 46, of Woodford Green, Essex.

The two men shook hands and Dr Britt noticed Mr Gurrieri's huge, spongy-feeling hand and his large facial features as symptoms of acromegaly - a tumour at the base of the brain, which can be deadly if untreated.

Mr Gurrieri had the 2cm tumour diagnosed last month after doctors confirmed the rare condition.

"My mum thinks Chris is my guardian angel," he joked.

"I could have lost my sight, or I could have had a number of other ailments, so I think I owe my life to Chris - and a few meals at the restaurant."

Dr Britt said he hadn't seen a case of acromegaly since he was a medical student. "It's the sort of diagnosis you might make once in a career if you're lucky. It's so rare most GPs wouldn't have seen patients with it."

Laser Hair Removal at BMC, Thailand

Bangkok Medical Center has a well equipped International Dermatology Center with expert dermatologists having a great deal of experience with Laser hair removal.

The Dermatologist can provide an accurate quotation based upon an initial evaluation with the patient, but here are some typical prices. The number of sessions will be determined by the area and density of the hair to be removed.

Area	1 session	2 sessions	4 sessions
	Price in baht	Price in baht	Price in baht
Face	7,500	13,500	25,000
Bikini	6,000	11,000	20,000
Under arms	5,000	9,000	17,000
Chest or back	10,000	18,000	34,000
Whole legs	20,000	36,000	68,000
Shin	10,000	18,000	34,000

Estimate 33 baht to US $1.

Please book your appointment on line at www.medicaltourisminthailand.com/applicationform.htm

6 Simple Steps forWomen to look Younger

Six simple steps for women to look younger without surgery.

There's no way around it: by the time you finish reading this column, you will be older. You can't stop time. But perhaps you can cheat it a little. We're not talking about surgery here. That's a topic for another column. Instead, here are six relatively simple steps to looking younger in the new year that don't require a scalpel.

1. Get an eye exam
If you're 40 or older, you may have noticed that it's getting harder and harder to read fine print or to see close objects. That's because the lens of your eye becomes less flexible as you get older, leading to a condition called presbyopia or farsightedness. We know, it's hard enough to find time for regular physical and gynecological checkups. You've probably put a visit to the eye doctor on the back burner. But the National Institute on Aging recommends that after age 40 you should have your eyes checked every one to two years by an ophthalmologist or optometrist. That's not just good for your sight but for your appearance. Squinting a lot to see not only makes you look older but it will give you new wrinkles in the eye area, which you definitely don't want. So instead of straining your eyes or pointing to menu items and ending up with mystery meat, get an exam and invest in some reading glasses. Don't worry: that doesn't mean donning granny glasses. There are plenty of trendy pairs from which to choose. Who knows? Wearing a cool pair of specs might even make you look younger (or hipper, at least).

2. Get fitted for a new bra
Next time you're out shopping, take a look at the women around you. Chances are you'll see a lot of saggy boobs, which are instantly aging. Industry experts estimate that four out of five women are wearing the wrong size. Even five pounds lost or gained can affect your bra size. Your size may also change when you start or stop exercising and when you're pregnant or nursing. Because of these shifts, the average adult woman can go through six bra sizes in her lifetime. We suggest going to a specialist at a department store or a lingerie store for a fitting. She'll take two measurements. The band size is determined by the width of your chest at the smallest part of your back (and is usually measured under your breasts). If the number is even, you add 4; if it's odd, you add 5. To get the cup size, you put the tape around your breasts at the fullest point. The difference between that number and your band size tells you your cup size. For example, between a half inch and one inch is an A cup, two inches is a B, and three inches is a C. A new bra should be snug at the loosest setting. That way it will still fit on tighter settings after repeated wear and washing. The bra band should be parallel to the floor. Straps should not cut into your shoulders; if they do, it means they are carrying too much of the weight of your breasts. It's really the band that's supposed to do most of the supporting. Your breasts should fill the cups and not fall out of the sides or top. If the cop is puckered, that means it's too big. Even after you find the correct size, you may have to try on different styles to find one that works for you. Bras from different manufacturers may fit differently. Also, consider investing in a sports bra for exercising.

3. Use moisturizer
As you age, your skin becomes less taut. In your mid-30s you may begin to see fine lines around your eyes and mouth. These generally get more pronounced as you get older. The speed of skin aging depends on a combination of heredity and environment. Some people are born with skin that looks young forever; others appear to be 50 when they're only 35. But your skin will age faster if you smoke or have been out in the sun a lot without sunscreen. Women whose weight has fluctuated a lot also often have skin that's less firm. Using moisturizers won't provide a permanent fix, but it can provide a temporary lift. Look for a product that includes sunscreen, which you should also be using. We especially like tinted moisturizers with sunscreen: one-stop face care. And you don't have to spend a week's salary on face care products. Dermatologists tell us that drugstore brands (Oil of Olay or Neutrogena, for example) are every bit as effective as the fancy stuff sold in department stores.

4. Lift weights
Women are often afraid to lift weights because they think it will make them look bigger. But women generally don't build muscle the way men do—unless they go on an all-out weightlifting binge. In fact, increasing muscle mass may actually make you look leaner. Also, greater muscle definition makes your arms and legs look younger. You could be younger in other ways as well. Some research has shown that strength training may help your memory as you get older and helps stop the bone loss in aging that could lead to osteoporosis. Finally, muscle burns more calories than fat, so the more muscle you have, the more calories you burn. Many midlife women find they gain a pound or two a year. That may not sound like much, but it adds up. Holding the line is critical. In a 2006 University of Pennsylvania study of overweight and obese women, strength training dramatically reduced the increase in belly fat, which is important, because too much abdominal fat puts you at risk for heart disease and diabetes. If you haven't been exercising regularly, talk to your doctor before starting, to make sure you don't have any medical issues that would cause a problem. For people over 40 who are generally sedentary, the American College of Sports Medicine recommends weight training an average of three times a week for about 20 to 45 minutes per session. Also, let muscle groups rest 48 hours between sessions. Generally, the ACSM says working with machines is probably safer in the beginning than using free weights. You might also invest in a few sessions with a qualified personal trainer to learn how to use the machines correctly.

5. Smile more
Take a look in the mirror and you'll see that gravity does a number on your face as you age. You may think your expression is set at neutral, but to others the downward drooping may make it look as if you're scowling. So try to smile more and lift your look. Researchers have also found that smiling can benefit your mood. It's one of those "fake it 'til you make it" phenomena. Studies have indicated that moving the muscles that make you smile may trigger chemicals in the your brain that actually make you feel better.

6. Get enough sleep
If you're tired you automatically look older. People who don't get enough sleep—at least seven hours a night for adults—are also more likely to be at risk for heart disease and diabetes, among other medical problems. So resolve to pay attention to your sleep habits. Try to get up and go to bed at roughly the same time every day. Keep your bedroom somewhat cool, dark and quiet. Use it only for sleeping and sex—not to watch TV or pay bills (stimulating or stressful activities that can keep you up). If these measures don't help, talk to your doctor about any underlying emotional or physical issues that may be interrupting your sleep.

Yes, you're not getting any younger. But if you follow these six simple steps you may look and feel younger, which is as good as it gets. And, remember, when the compliments start coming, just smile!

Outsourcing child birth

ANAND, India - Every night in this quiet western Indian city, 15 pregnant women prepare for sleep in the spacious house they share, ascending the stairs in a procession of ballooned bellies, to bedrooms that become a landscape of soft hills. A team of maids, cooks and doctors looks after the women, whose pregnancies would be unusual anywhere else but are common here. The young mothers of Anand, a place famous for its milk, are pregnant with the children of infertile couples from around the world.

The small clinic at Kaival Hospital matches infertile couples with local women, cares for the women during pregnancy and delivery, and counsels them afterward. Anand's surrogate mothers, pioneers in the growing field of outsourced pregnancies, have given birth to roughly 40 babies.

More than 50 women in this city are now pregnant with the children of couples from the United States, Taiwan, Britain and beyond. The women earn more than many would make in 15 years. But the program raises a host of uncomfortable questions that touch on morals and modern science, exploitation and globalization, and that most natural of desires: to have a family.

Check out www.medicaltourisminthailand.com for details on all aspects of medical tourism.

Dr. Nayna Patel, the woman behind Anand's baby boom, defends her work as meaningful for everyone involved.

"There is this one woman who desperately needs a baby and cannot have her own child without the help of a surrogate. And at the other end there is this woman who badly wants to help her (own) family," Patel said. "If this female wants to help the other one ... why not allow that? ... It's not for any bad cause. They're helping one another to have a new life in this world."

Experts say commercial surrogacy — or what has been called "wombs for rent" — is growing in India. While no reliable numbers track such pregnancies nationwide, doctors work with surrogates in virtually every major city. The women are impregnated in-vitro with the egg and sperm of couples unable to conceive on their own.

Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment. Experts say it could take off for the same reasons outsourcing in other industries has been successful: a wide labor pool working for relatively low rates.

Critics say the couples are exploiting poor women in India — a country with an alarmingly high maternal death rate — by hiring them at a cut-rate cost to undergo the hardship, pain and risks of labor.

"It raises the factor of baby farms in developing countries," said Dr. John Lantos of the Center for Practical Bioethics in Kansas City, Mo. "It comes down to questions of voluntariness and risk."

Patel's surrogates are aware of the risks because they've watched others go through them. Many of the mothers know one another, or are even related. Three sisters have all borne strangers' children, and their sister-in-law is pregnant with a second surrogate baby. Nearly half the babies have been born to foreign couples while the rest have gone to Indians.

Ritu Sodhi, a furniture importer from Los Angeles who was born in India, spent $200,000 trying to get pregnant through in-vitro fertilization, and was considering spending another $80,000 to hire a surrogate mother in the United States.

"We were so desperate," she said. "It was emotionally and financially exhausting."

Then, on the Internet, Sodhi found Patel's clinic.

After spending about $20,000 — more than many couples because it took the surrogate mother several cycles to conceive — Sodhi and her husband are now back home with their 4-month-old baby, Neel. They plan to return to Anand for a second child.

"Even if it cost $1 million, the joy that they had delivered to me is so much more than any money that I have given them," said Sodhi. "They're godsends to deliver something so special."

Patel's center is believed to be unique in offering one-stop service. Other clinics may request that the couple bring in their own surrogate, often a family member or friend, and some place classified ads. But in Anand the couple just provides the egg and sperm and the clinic does the rest, drawing from a waiting list of tested and ready surrogates.

Young women are flocking to the clinic to sign up for the list.

Suman Dodia, a pregnant, baby-faced 26-year-old, said she will buy a house with the $4,500 she receives from the British couple whose child she's carrying. It would have taken her 15 years to earn that on her maid's monthly salary of $25.

Dodia's own three children were delivered at home and she said she never visited a doctor during those pregnancies.

"It's very different with medicine," Dodia said, resting her hands on her hugely pregnant belly. "I'm being more careful now than I was with my own pregnancy."

Patel said she carefully chooses which couples to help and which women to hire as surrogates. She only accepts couples with serious fertility issues, like survivors of uterine cancer. The surrogate mothers have to be between 18 and 45, have at least one child of their own, and be in good medical shape.

Like some fertility reality show, a rotating cast of surrogate mothers live together in a home rented by the clinic and overseen by a former surrogate mother. They receive their children and husbands as visitors during the day, when they're not busy with English or computer classes.

"They feel like my family," said Rubina Mandul, 32, the surrogate house's den mother. "The first 10 days are hard, but then they don't want to go home."

Mandul, who has two sons of her own, gave birth to a child for an American couple in February. She said she misses the baby, but she stays in touch with the parents over the Internet. A photo of the American couple with the child hangs over the sofa.

"They need a baby more than me," she said.

The surrogate mothers and the parents sign a contract that promises the couple will cover all medical expenses in addition to the woman's payment, and the surrogate mother will hand over the baby after birth. The couples fly to Anand for the in-vitro fertilization and again for the birth. Most couples end up paying the clinic less than $10,000 for the entire procedure, including fertilization, the fee to the mother and medical expenses.

Counseling is a major part of the process and Patel tells the women to think of the pregnancy as "someone's child comes to stay at your place for nine months."

Kailas Gheewala, 25, said she doesn't think of the pregnancy as her own.

"The fetus is theirs, so I'm not sad to give it back," said Gheewala, who plans to save the $6,250 she's earning for her two daughters' education. "The child will go to the U.S. and lead a better life and I'll be happy."

Patel said none of the surrogate mothers has had especially difficult births or serious medical problems, but risks are inescapable.

"We have to be very careful," she said. "We overdo all the health investigations. We do not take any chances."

Health experts expect to see more Indian commercial surrogacy programs in coming years. Dr. Indira Hinduja, a prominent fertility specialist who was behind India's first test-tube baby two decades ago, receives several surrogacy inquiries a month from couples overseas.

For now, the surrogate mothers in Anand seem as pleased with the arrangement as the new parents.

"I know this isn't mine," said Jagrudi Sharma, 34, pointing to her belly. "But I'm giving happiness to another couple. And it's great for me."

Top secret Super Food

WebMD Feature from "Men's Health" Magazine

By Matt Goulding

Packed with protein, loaded with fiber, and older than Peru, quinoa is one of the most nutritious foods on the planet

Francisco Pizarro might have known a thing or two about New World conquest, but he would have made a lousy nutritionist. After toppling the Incan empire in 1532, the Spanish conquistador filled his ships with potatoes and corn--destining them to become major players in the European diet--while leaving a third crop to wither. Turns out, the fields Pizarro neglected to harvest were filled with the world's most nutritious grain: quinoa [pronounced KEEN-wah].

"Quinoa is a true wonder food," says Daniel Fairbanks, Ph.D., a professor of plant and animal science at Brigham Young University. "It has about twice the protein of regular cereal grains, fewer carbohydrates, and even a dose of healthy fats." Plus, it's considered a "complete" protein, which means that, like meat, eggs, and dairy, it packs all of the essential amino acids your body needs to build muscle.

Unfortunately, not much has changed in the almost 500 years since Pizarro pillaged the Incas. More than ever, nutritionally inferior foods, such as corn, potatoes, rice, and wheat--especially the refined versions--fill our plates, while quinoa gathers dust on grocery-store shelves. And that's a shame, because besides being great for you, quinoa is the rare culinary triple threat: delicious, easy to prepare, and ultraver-satile. Ready to harness the full power of this superfood? Here's everything you need to know to make it a staple at breakfast, lunch, and dinner.

The User's Guide to Quinoa

Quinoa has an addictive nutty flavor, cooks up quicker than rice, and can be used to make pilafs, risottos, salads, soups, and even desserts. The downside: Few men know where to find it, let alone how to prepare it. Typically, you can locate quinoa in the rice aisle or the health-food section of your grocery store. You can also stock up at edenfoods.com.

As for preparation, the simplest way is to cook quinoa like pasta: Fill a large pot or saucepan with water, and bring it to a boil. Add just about any amount of quinoa, turn the heat to low, and cook until tender, about 20 minutes. Drain the water and allow the quinoa to cool.

Cook up a big batch and store it in Tupperware in your refrigerator, and you'll have a ready-to-eat side dish--like rice or pasta--that goes with just about any meal. (To warm, microwave it for 60 seconds.) Or you can be far more creative. For instance, quinoa can be used to...

Power up your breakfast: Combine a cup of cooked quinoa with 1/2 cup milk and 1/2 cup frozen blueberries, and microwave for 60 seconds. This makes a great alternative to oatmeal.

Redefine dessert: In a blender, puree two very ripe bananas with 2 cups whole milk. Combine the mix with 2 cups cooked quinoa, 1/2 cup raisins, a tablespoon of sugar, and a teaspoon of cinnamon, and simmer for 10 minutes. If you're celebrating, add a glug of dark rum at the last second. Creamy and sweet, it's a healthier version of rice pudding.

Even better, use the recipes and variations that follow and you can turn this simple grain into more than a dozen dishes.


Quinoa as a Salad

1 cup uncooked quinoa
8 asparagus spears
2 oz crumbled goat cheese or feta
1/4 cup green olives, pitted and coarsely chopped
4 Tbsp chopped sun-dried tomatoes
1/2 Tbsp olive oil + a drizzle for the asparagus
1 Tbsp balsamic or red-wine vinegar
Salt and pepper to taste

1. Preheat the oven to 400°F.
2. Boil the quinoa according to the instructions on the previous page.
3. While the quinoa cooks, prep the asparagus. Remove the woody ends by gently bending each spear until it breaks--it'll naturally snap off at the right place. Lay the spears on a cookie sheet or baking pan and drizzle with the olive oil and a pinch of salt. Place in the oven and roast for 10 minutes.
4. Chop the asparagus into bite-size pieces and add to the quinoa, along with the cheese, olives, sun-dried tomatoes, oil, and vinegar. Season with salt and pepper to taste.

Makes 4 servings; great with grilled pork tenderloin or roast chicken.

Per serving: 238 calories, 9 grams (g) protein, 34 g carbohydrates, 7 g fat (2 g saturated), 4.5 g fiber, 290 mg sodium

How to Change It Up

Try mixing the cooked quinoa with any of the following combos:

* A sliced avocado, the segments of one grapefruit, a handful of chopped green onions, and the juice of half a lime. Goes great with grilled fish.
* Half a cup of dried cranberries, 1/4 cup chopped walnuts, 2 Tbsp crumbled blue cheese, and 1 Tbsp each balsamic vinegar and olive oil
* Two cups of baby spinach or arugula, 8 oz grilled chicken, and ¼ cup roasted red peppers.


… as a Stuffing

1/2 cup uncooked quinoa
1 tsp olive oil
1/2 yellow onion, chopped
2 cloves garlic, minced
2 roma tomatoes, seeded and chopped
6 oz shrimp, peeled and deveined
1/2 cup canned black beans, drained and rinsed
1/2 tsp cumin
Handful chopped fresh cilantro
Salt and pepper to taste
2 red bell peppers

1. Cook the quinoa according to the instructions on the previous page.
2. While the quinoa simmers, heat the olive oil in a sauté pan over medium heat, and add the onion, garlic, and tomato. Cook the mixture until the tomato is soft and the onion is translucent, about 3 minutes. Add the shrimp, black beans, and cumin, and cook for another 3 minutes, until the shrimp is just pink and firm. Add the cooked quinoa and cilantro, stir to blend, and turn off the heat. Season to taste with salt and pepper.
3. Preheat the oven to 400°F.
4. Cut the tops off the peppers and remove the seeds. Stuff each with half of the mixture, place them in a baking pan, and cook in the oven for 15 minutes.

Makes 2 servings

Per serving: 375 calories, 28 g protein, 52 g carbohydrates, 7 g fat (1 g saturated), 10 g fiber, 291 mg sodium
How to Change It Up

* Replace the shrimp, cumin, and cilantro with two links of chicken sausage and a 6 oz jar of marinated artichoke hearts.
* Replace the shrimp with 8 oz lean ground beef or ground turkey.
* Go Greek: Trade the shrimp, cilantro, cumin, and black beans for lean ground beef, a cup of frozen spinach, and 1/2 cup of crumbled feta cheese.


...as a Risotto

1 tsp olive oil
1 medium yellow onion, diced
2 cloves garlic, minced
1 cup uncooked quinoa
3 cups low-sodium chicken stock
1/4 cup fresh or frozen peas
2 oz prosciutto, cut in thin strips
Salt and pepper to taste
Parmesan cheese for grating

1. Heat the olive oil in a medium sauté pan or saucepan over medium heat, and add the onion and garlic. Cook until the onions are translucent and the garlic is lightly browned, about 3 minutes.
2. Add the quinoa and cook for another 3 minutes. Add 1 cup of the chicken stock, using a wooden spoon to occasionally stir the grains. When the liquid is mostly absorbed (about 10 minutes), add the remaining chicken stock. Continue cooking and stirring until the quinoa is tender (but not mushy) and most of the liquid has evaporated; the risotto should be moist, not soupy. At the last minute, add the peas and prosciutto. Stir until warmed through.
3. Remove from the heat, and season to taste with salt and pepper. Before serving, grate a bit of Parmesan over each portion.

Makes 4 servings as a side dish, or 2 as a main course

Per serving: 252 calories, 15 g protein, 34 g carbohydrates, 6 g fat (1 g saturated), 3 g fiber, 372 mg sodium

How to Charge It Up

* Replace the peas and prosciutto with a cup of shredded rotisserie chicken (or leftover grilled chicken), a cup of cherry tomatoes, and a handful of chopped fresh basil.
* Add 1/2 pound sliced mushrooms to the pan with the onion and garlic. Before adding the stock, add 1/2 cup of red wine to the pan. Peas and prosciutto are optional.
* Replace the peas and prosciutto with 1/2 cup canned pumpkin puree. Stir in a handful of chopped fresh sage a few seconds before you remove the pan from the heat. Goes great with pork tenderloin.

Behind the Scenes: From the Field to Flour

When you eat quinoa, you can see that you're truly eating a "whole" grain. (Quinoa is really a seed, but it acts more like a grain.) But did you ever wonder how far removed a piece of bread is from a kernel of wheat? Here's an insider's look, courtesy of Kendall McFall, a flour-milling instructor at Kansas State University.

Behind the Scenes: From the Field to Flour continued...

Step 1. A combine harvests the wheat and removes the whole-grain kernels from the stalks. The kernels are then transported to the mill.

Step 2. At the mill, corrugated rollers break open the kernel and scrape the carb-loaded endosperm away from the bran--the high-fiber outer husk--and the vitamin-rich germ.

Step 3. After the rollers pulverize all parts of the grain kernel, they're fed through sifters, which separate the larger bran and germ particles from the endosperm.

Step 4. The bran and germ are routed into different machines for further processing while rollers smooth the remaining endosperm fragments into a fine powder, or flour.

For Refined Flour

Step 5A. The endosperm flour is enriched--as mandated by federal law--with thiamine, niacin, riboflavin, folic acid, and iron. The flour may also be bleached at this point.

For Whole-Wheat Flour

Step 5B. The powdered endosperm, bran, and germ particles are combined in the same proportion as was present in the whole kernel to create whole-wheat flour. It is not enriched.

Step 6. The flour is packaged and ready to be made into bread.

Surgery in the Land of Smiles

Can you imagine spending about $800 on an air ticket, boarding a 14 hour flight to go half way around the world, checking in at a hospital you've only seen on the www and then placing your health and well being in the hands of a foreign doctor or dentist (who you have just met for the first time)?

Well, last year over 400,000 brave souls did just that at one Bangkok Hospital alone - and lived to enjoy their life savings that were still intact! If you are uninsured or your particular health problem or dental procedure is not covered - you do have a choice!

Check it out at www.medicaltourisminthailand.com