Saving on Surgery by Going Abroad

The number of U.S. patients who came to Wockhardt doubled in 2007.

JCI standards also call for various means of minimizing infections, including collection and review of infection statistics and any necessary corrections. At Wockhardt, water used in surgery and laboratories is filtered and regularly tested. Western patients always get bottled drinking water ("for comfort," says Arshanapalai Malathi, head of medical services). Dispensers of disinfectant alcohol gel at the foot of each bed for hand cleaning are hard to miss.

A safe blood supply cannot be assumed—especially in a developing nation. "When we started watching the development of medical tourism," says Karen Lipton, CEO of the AABB, the association that represents American blood banks, "we asked ourselves, 'Where is the blood coming from? How well do they screen donors? Who's making the judgment about the safety of these products?' " Patients can and should ask a hospital representative these questions, but there is no way to verify the answers. On the other hand, says Lipton, the hospitals "don't want to do anything bad—the last thing they want is for people to go back home and have problems."

Bar-coded blood. Lipton urges patients to also ask a hospital how blood gets to the right patient. She strongly advocates a bar-coded bracelet or other wearable accessory that is scanned before a transfusion. At Wockhardt, which tracks blood in ledgers and on paper slips, there have been two near misses in which patient and blood did not match, says blood bank director Jyoti Balani. Both errors were caught in time, she says, and blood-borne infections are nonexistent. "We try to avoid transfusions," says Balani. "I can't remember any international patient in the last six months who needed blood." Banked blood comes largely from "replenishment donors"—local residents with a hospitalized relative are expected to donate. All blood is screened for HIV, hepatitis, syphilis, and malaria.

Joint-replacement patients are a special class in all hospitals because of the consequences of infection: An artificial joint that harbors a deep infection often must itself be replaced. For Barnum's operation, surgeon Sanjay Pai and his team, like those at good U.S. hospitals, sealed off their skin, even breathing filtered air pumped into hoods covering their heads. Wockhardt, like its competition, has to be persuaded to go public with its rates of postsurgical infection. Says Pradeep Thukral, head of international marketing, "Our competitors can claim that their data is better, and who can prove them wrong?" But the statistics are comparable to those of good U.S. hospitals—a 1.1 percent rate of surgical infection for heart-bypass patients, he says, and zero for joint replacements.

In Asia, nurses play a much smaller role in care than they do in U.S. hospitals. Emily Slaback, a former ICU nurse from Haslet, Texas, whose left hip and knee were replaced at Wockhardt in February, says they are more like nurse's aides. They are not expected to check patients as often or as closely, so patients have to take responsibility. Calling a doctor's attention to a bruise, for example, could prevent a bedsore that might become infected and prolong the stay. And while nurses who care for Americans are trained in English, their command is often incomplete. After his first surgery, Barnum was given a special mattress to prevent bedsores. He asked the nurses for the same mattress after his second surgery but couldn't make himself understood—or, as he says, perhaps they felt he didn't need it.