I just finished reading the book, State of the Heart, by Maggi Ann Grace. The book chronicles the experiences of Howard Staab, Escort Heart Institute’s very first patient from the U.S. back in 2004. While told in 3rd person about Staab, it is much more about the experiences of the author, who accompanied Staab on the journey to New Delhi. It is nevertheless a fascinating read. Having been to New Delhi as a medical tourist, both to Apollo Hospital for surgery and Escorts Heart Institute (EHI) for a CT Stress Test and a Colonoscopy, I could relate to most of what Grace had to say. Those having regularly read my blog by now know that I developed a close friendship with Dr. Vijay Kumar, one of the cardiologists on staff at EHI. On my first visit to the hospital, he gave me a personal tour, taking me in and out of ICUs, Operating Theatres, Recovery Rooms, CCUs, and patient rooms. As Grace described Staab’s ordeal of going through two Operating Theatres and two Recovery Rooms, I was able to paint a vivid picture of the scenes in my mind, recalling the walk-through with Dr. Vijay, as he likes to be called.
She speaks of the oppressive heat of New Delhi, of the uniformed guards positioned by the elevators on every floor of the hospital, of being the only Caucasian in a sea of dark-skinned people who mostly speak a different language, of the incredible hospitality of the Indian people, and of the unbelievable poverty of some of New Delhi’s residents. Having been to New Delhi, I connected well to her insights. She spoke of the great food at Escorts, one of the few things to which I could not relate. As an inpatient, I spent two nights at Apollo Hospital where the food was mediocre at best. Okay, I’m digressing a bit.
The author does an excellent job communicating how expensive the cost of healthcare has become in this country. She tells us that the valve replacement needed by Staab might run as much as $200,000 at nearby Durham Regional Hospital. She was able to find a deal in Houston, Texas for about $45,000. At Escorts, the whole price tag, not including travel, was just under $6,000.
The book also underscores the need to have a travel companion whenever going to a foreign country for a medical procedure. For instance, Staab likely had several mini strokes after being discharged but before traveling back home. Without Grace by his side, he might easily have found himself in serious trouble. Furthermore, I became keenly aware that Staab and Grace leaned very heavily upon each other for physical and emotional strength.
After returning home to North Carolina, Grace related a post-surgical episode requiring a 2-day stay at nearby Durham Regional Hospital. Given that the memory of their experiences at EHI was less than three weeks old, she was able to point out the differences in the quality of the nurse care between the two facilities. The contrast quickly became apparent when Grace told of having to change Staab’s bed linens, retrieving her own sheets from the nurses’ closet. The trips to the ice machine also stand as unspoken reminders that she is no longer in India.
Grace closes the book with poignant praise for India and an implied challenge for the U.S. healthcare system. In her words, “India, the land of contradictions. Organized chaos. A third-world country with first-world state-of-the-art medical care available for a fraction of the cost of the same procedures here in the U.S. India, where the nursing care is unmatched by any I have experienced in American hospitals – where some nurses make the equivalent of $1.38 (U.S. dollars) per hour, and care for their patients as if they made thousands. India, where the generosity of the people is palpable, in the face of poverty we will never know.” Having been there as a patient, I wholeheartedly concur.
The book is not without its shortcomings. For instance, I was disappointed that Grace didn’t go into detail about how Staab decided on EHI. She rather glosses over that section, giving the presumably false impression that the decision was based on emotion rather than hard data. More insight into this process would have been nice, perhaps helping others in their own evaluations. Given that Staab was the very first American treated at EHI, I get the impression that he and Grace were pioneers in the medical tourism arena. As such, you won’t find in the book certain concepts you might take for granted today, such as choices among medical facilitators, Joint Commission accreditation, and having an independent representative act as an advocate on your behalf.
I was also a little put off by the strange spirituality practiced by Staab and Grace. As someone holding a strong faith in the God of the Hebrew Bible, I had a hard time relating to the eastern faith, or lack thereof, as expressed by the author. She also made a few sexual references that really didn’t add anything of substance to the book and might have been better left out.
My minor criticisms aside, the book is a great documentary. I highly recommend it.