UPDATE: On June 27th, 2006, from 10 am - 12, Maggi and Howard traveled to Washington D.C. to testify before the U.S. Senate subcommittee on Aging regarding their experience in India and the state of healthcare in the U.S. Watch them on C-span.

The book that chronicles this event is State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India, will be published in August, 2007 by New Harbinger Publications.

February 1, 2005
Howard’s heart is ALL GOOD! (THEK HAI, in Hindi!)

He is back at work full time, climbing ladders, framing houses, digging footings. Last month we watched while a crane raised a roof of a garage, Howard’s crew built the second floor addition, and the crane repositioned the roof on top! An amazing procedure to watch under any circumstances, but to see Howard racing up and down, laughing and eating pizza did all of our hearts good.

CNN (from DC) aired a brief piece on Howard’s Heart in January, which was picked up and aired on local news channels.

Check out the latest and most in-depth article in Bloomberg Magazine by Abhay Singh, a terrific reporter with whom we spent our last day in Delhi! (Bloomberg Magazine article)

Maggi is at work writing about the Indian journey, looking for an agent who might be interested in this timely book. We receive lots of emails and phone calls from the complete range of people who are touched in some way by Howard’s story – patients in need of medical care, students writing papers on healthcare, business entrepreneurs wanting to assist people who want to go to India, reporters, and occasionally from our friends at Escorts Heart Institute. Oh how we miss them!

December 23, 2004
Howard is doing so well. He is back at work (the physical part only part time), but enjoying starting back in, working in his shop.

He built a cabinet for a friend for Christmas. He is regaining his strength and is doing a few push ups and situps in the morning in addition to his walking quite a lot, etc. He feels great, his blood is steady at the right thinness, and he will only have to be on Coumadin for a couple more months to insure the valve is completely "adopted" by his own body tissue (and there will be no more clots running around loose). There is really nothing is isn't doing except getting up on roofs or riding his bicycle. He regained all of his weight that he lost, in fact, a bit extra for this holiday season, like everyone else does. No one can believe he only is 3 months from surgery, his color is so good, etc.

The main point about the hospital charges here, which no reporter has really hit on, is, I asked the CFO at Durham Regional Hospital to just charge Howard the usual and customary fee, as they would be paid by any insurance company. In our meeting, back in September, they admitted that their initial estimate of $200,000, was inflated, as is the case with all charges. They never expect to get the entire amount they charge. (Except from self-pay patients.) In fact, we have heard from doctors across the country who said, "Any insurance company would only pay about $40,000 of that. Why won't the hospital just accept that much from a self-pay person like Howard?" My point exactly.

CNN from New York has called, and they hope to do a story in conjunction with their trip to India soon.

60 Minutes has called. Everyone wants to know if other Americans are going to Escorts. If any Americans are thinking about India as an option, please let us know.

Abhay Singh's piece in Bloomberg Magazine will be out in January.

Dhany Waad Party Photo We had a terrific dhanny waad (thank you) party, catered by Tandoor Restaurant and J&J's Deli. Howard and I wore our kurtas and pajamas and my dupata that we got at the last minute at Fab India (thanks to Washington Post reporter, John Lancaster's wife's recommendation). We served the sweets and snacks we brought home from Jodhpur...and oh yes,... mango juice and Kingfisher beer, the Indian beer I tried in Delhi.

Dhany Waad Party Photo We danced, as we had hoped we would be able to do, even from Howard’s hospital room in Delhi. Thanks to all who helped us welcome home Howard's new heart, and for the additional contributions to Howard's Heart Fund which will help so much with the ongoing medical expenses.

In this, our season of celebration and "giving" and thanks, our family has decided to give to families in need instead of buying senseless gifts for each other. We have so much to be thankful for, with Howard’s complete recovery, and have all we really need.

Dhany Waad Party Photo Maggi has made a commitment with Howard and her family to begin writing the story in January, to help people know they have choices. We continue to meet people and hear from people who have no insurance, who have heart disease, who need dental work, etc. One friend had an abscessed tooth (and no insurance) and was told he needed IV antibiotics. He was admitted overnight and got a bill for $7500 the next morning. We feel committed to this cause, and will figure out how Maggi can write full time so the story is timely and not stale. We believe things will work out.

Happy Holidays to everyone.

Maggi and Howard

Howard and Maggi at the Dhany Waad Party
Escorts Heart Institute And Research Centre
Okhla Road, New Delhi - 110 025 (INDIA)
Phone: 91-11-26825000, 91-11-26825001
Dr. Naresh Trehan extensions: 4200,4210,4211
Fax: 91-11-26825013 / email:

Press Coverage:

  • Introduction, Healthy Competition: What’s Holding Back Health Care and How to Free It, Michael F. Cannon and Michael D. Tanner. CATO Institute, Washington, D.C. 2005. pp 8-9.

  • Indian Hospitals Lure Foreigners With $6,700 Heart Surgery, by Abhay Singh in New Delhi. Bloomberg News

  • Heartfelt Thanks, by Vicki Cheng. Raleigh News and Observer

  • Surgery leaves no regrets, by Vicki Cheng. Raleigh News and Observer

  • Surgeries, Side Trips for 'Medical Tourists,' by John Lancaster, Washington Post, October 21, 2004

  • India: The one-stop place for Heart Repair. Hindustan Times

  • Outsourcing blues? Have a Heart, by Chidanand Rajghatta. The Times of India

  • Man in India for heart surgery, by Kadi Hodges. Chapel Hill Herald

  • Americans increasingly find health care abroa, by Vicki Cheng. Raleigh News and Observer

  • Article on Medical Tourism in Asia in December 2005 issue of Currents. (This is a publication by a Dutch Bank, MeesPierson Asia, based in Singapore. The publication is circulated to some 3,000 of the bank’s private wealth clients and its offices across Asia and Europe.

  • Medical Tourism: Americans Find Low-Cost Treatment in India, by Subhash Vohra, Voice of America, March 18, 2005

  • Real Competition Is the Cure for Health Care, by Michael Cannon. Employee Benefit News, October 2005.

  • Public Health: An Unhealthy Trend, by Asha Krishnakumar. Frontline: India’s National Magazine, Nov. 20 - Dec 03, 2004

  • Medical Tourists, Sepia Mutiny, October 21, 2004.

  • Hindu Press International. New Delhi, India November 8, 2004

  • Thank you!

    We are overwhelmed by the enormous support and encouragement of so many friends and family. In particular we want to thank Maggi's son, Bryan Maxwell and his professor from Stanford, Dr. Sakti Srivastava, who have been instrumental in connecting us with Dr. Naresh Trehan at Escorts Heart Institute in New Delhi.

    Open Hearted
                                          for howard

    Poets avoid cliché topics
    like butterflies, love, hearts,
    but if I wrote to your valve,
    readers might think this
    an auto parts poem.

    The doctor speaks of your heart
    as a parachute, your breath
    filling it to a high white cloud,
    falling on exhale like silk around ankles.
    Your anchor strings have snapped
    and blood fills your lungs
    where air is meant to be clear
    as sky before the jump.

    "You need a seamstress," she says,
    and I imagine delicate tatting
    and spinning of broken threads,
    but here at home, at a price
    beyond anyone’s cache,
    beyond the choice between your heart
    or college tuition for your son.
    So we must fly days long into tomorrow
    to the land of spices and silk.
    We will fly
    we fly,
    so your heart will open
    and you may fly.

    Thursday, 11/04/04
    Howard responded well to the heparin and is back home, back at paperwork, drawing plans, and meeting with customers. So far, so good! Thanks to all who have helped by bringing by food for Aran and Howard!

    Tuesday, 11/02/04
    Our visit with Dr. Henke (cardiologist) was both a celebration of successful surgery and a surprise of finding out that Howard's blood was not thin enough. So he was admitted to Durham Regional Hospital for two days of heparin drip to prevent any trouble with clots. Not exactly what we planned, but only a two-day delay for a critical reason. Howard has already been back to paperwork and the design part of his job and is feeling stronger every day.

    Sunday, 10/24/04
    We are home. Howard is feeling better than ever and actually walked all the way from the plane to meet Maggi's parents at the airport. Many, many thanks to all of you for your month-long prayers and good thoughts. We certainly felt them on the other side of the world, but it is SO GOOD to be home! Please click on the "WAYS YOU CAN HELP" box regarding phone calls and visiting Howard.

    Monday, 10/18/04
    Recovery improves. Plans change. Tomorrow, a friend is flying us to see Jodhpur, the "Blue City" and his furniture factory (Thanks to Neil and Mahendra). It's our first "test flight" to see how Howard's heart flies.

    Friday, 10/15/04
    GREAT NEWS! We just met with Dr. Trehan for the final checkup and all is well. He gave the go ahead to rest this weekend. Howard is regaining strength and energy every day. We are on the countdown until the day we can come home. Until now, we will begin to act like tourists and see India!

    Monday, 10/11/04
    Howard was discharged today! Dr. Trehan examined him, and we were "escorted" to our new home, The Centrum Hotel, within walking distance of Escorts Heart Institute. The staff here will provide food and a peaceful retreat for Howard for the next few days in our "room with a view" overlooking the bustling street and shops -- lots of new distractions for Howard. It was bittersweet to leave our Escorts family, but Howard needed a change of scenery in the worst way, after 18 days.

    Friday, 10/08/04
    The discharge papers were written, the records in a fat pink folder. I was driven around and chose the Centrum Hotel for our discharge R&R, and returned to the room to find Howard with temporary vision problem. In a whirlwind, we were in Dr. Trehan's office, had a neurological consultation, a CT scan (normal), an opthalmology consultation, dilation of eyes and later a follow up eye exam (perfectly normal now). But istead of moving into a hotel, Howard is now on his back with a precautionary heparin drip to prevent any clots, in case that's what happened to his retinal artery. No damage is done, his vision has returned to normal, though he still sees patterns and lights and colors which are disturbing, but will probably go away. We don't know exactly what happened, but better to be safe than sorry. Not exactly an uplifting day. Please pray for peace for our gentle friend.

    Thursday, 10/07/04
    Howard awoke, ready to dance. He'd done all of his exercises, tried to eat, though still has fairly limited appetite, is now on oral antibiotics. Howard is not quite up to conversation yet, as his voice is still very hoarse, and he tires easily. We'll let you know when we get discharged and land elsewhere. The doctors are discussing and will approve our "guest house" for Howard's R&R. It will be close by and approved by the docs here. Dr. Trehan has been in the US, but returns this weekend, then I think everything will begin happening. Howard is fine.

    Wednesday, 10/06/04
    Howard is recovering. It is slow and he doesn't like slow. But he is walking the halls, doing all the breathing exercises...I made him a Phys. Therapist's exercise chart we will follow each day, but from all doctors' reports, he is doing well. We are both in the room together, which is a good thing. We wish we had a cell phone and VCR because I can't take him out. Howard is really a beautiful color of purple and green on many places, his wounds are not infected, regaining his appetite is a problem from the antibiotics. He wishes we were not so far away, and after two surgeries, the process just takes longer. Patience.

    Tuesday, 10/05/04
    Howard is recoverying well: got all his bandages off today, is walking the halls 6 times a day, etc. No longer needs the ICU nurse, just needs a couple of days to regain strength and finish the course of antibiotics, etc. and then we'll be looking for a safe haven to recup in near this hospital in Delhi. Everyone is watching out for us. The 4th floor nurses and staff have become my Escorts family.

    Monday, 10/04/04
    Today Howard came from ICU to the 4th floor in a wheelchair. When the elevator opened, all the sisters were here cheering for him. He has is own ICU nurse for overnight in our room, so he receive round-the-clock care, get the humidifier("steam") and blow in the ball tube, and get meds for his hiccups (his biggest discomfort), etc. I was the first to get to walk him down the hall. He loves being upright!

    Saturday, 10/02/04
    I finally got to explain to Howard about his two surgeries, so he is less concerned about why it has been more days than we originally planned on. Today he was transferred to a step-down ICU unit. He is still on oxygen, but his lines and catheters are being removed one by one, and he is sitting up, eating Indian food, drinking tea at 4:00, listening to music, getting massages and his hair combed and braided by the "sisters" ... As he says, "I'm getting exquisite care!" We're out of the woods now. He has very little discomfort, is just tired. I think we'd all be tired.

    Thursday, 9/30/04
    More good news: Howard's heart responded to the valve repair of Tuesday by thickening the wall between two cusps of his mitral valve, (called S.A.M.) which was obstructing blood flow back into his body. Dr. Trehan decided it was best to go back and replace the entire mitral valve. They went in the same side opening, so they still did not have to cut his sternum. This is good news. He is now recovering again from the valve replacement (he got his "pig valve", or tissue valve, which was also his choice.) His heart is strong. He is doing well. Again, he will be weened from the ventilator slowly, hopefully by tomorrow. Then he can resume his tape of Oh Brother, Where Art Thou. Although we did not expect two surgeries, they always go for the repair first, and then replacement, if the repair is not the best solution. So, this is okay. A friend is arranging a place for us to rest when he is ready. Keep the prayers coming for a smooth and quick recovery.

    Tuesday, 9/28/04
    3:30 pm (5:30 am NC time)

    Howard went into the OR at 9 am listening to Oh Brother, Where Art Thou, with dhanyavaad (thank you, in Hindi) written on his chest in purple marker. By 3:30 I got to go see him in the Recovery Room. Report is: every best case scenario plan was implemented. They were able to repair the valve (did not need a replacement!). They did not cut his sternum, but were able to successfully do the repair intercostally (between the ribs), which will necessitate a much quicker recovery time (no bone to heal back together). He is on a ventilator to allow him rest. I may see him again at 6 pm. He is so healthy, has such a strong heart, they expect a speedy recovery. Thanks to all of you for your many prayers and positive energy.

    Sunday, 9/26/04
    3:45 pm (5:45 am NC time)

    Today is a day of rest. We saw Dr. Trehan last night and all of the specialists have been to see Howard today. We even got to leave the room, and walk to look out the windows to see the temples in the distance, the rickshaws down on the street. Howard will most likely go to surgery Monday afternoon, (that would be Sunday about 3 am for you.) So, begin your best energy and prayers to the east, for a fully repairable valve and quick surgery. Thanks for all your good thoughts.

    Saturday, 9/25/04
    Saturday night 7 pm here: Howard had his ultrasound and echocardiogram and catheterization all today. He has been seen by so many doctors and is in good hands, but keeps asking where the chocolate is.

    Good news: The TEE showed them that his valve is repairable!!! When they go in to repair it (the best of all worlds), and if they find they cannot, then he will get a new valve.

    More Good News: The catheterization showed no stenosis, no blockage in any arteries!! He reminds me, they are not just good but EXCELLENT! Monday will most likely be the surgery, which we are happy about, but even more tests and monitoring are being done today and tomorrow.

    Early Saturday, 9/25/04
    We arrived to personal escorts of Dr. Trehan's staff who scooted us past hundreds of passengers to get us through customs. A private car was waiting. Dr. Trehan phoned Howard and greeted him on the sidewalk of the airport.

    We were brought to a private room in the hospital with baskets of fruit and cookies wrapped for us. The nurses and doctor came and took his vitals and did an EKG, then we slept. All is well.

    Howard is only allowed one cup of tea before Dr. Trehan comes and orders tests this morning. Everyone is so incredible. No worries. Howard is waited on like royalty. We will be on India TV, as we are the first Americans to come here. Howard thinks perhaps he should have brought a tie. Tee and Catheterization and then surgery, most likely begin Monday.

    Tim Nelson from ABC, Channel 11 News interviews Howard. Aired at 6 pm Wed., Sept. 22.

    Dr. Trehan called from New Delhi the night of September 17, and Howard and Maggi are leaving Thursday, Sept. 23rd for surgery in India. Visas are here, tickets are in the works. We feel very confident with this decision since talking with Dr. Trehan, as going to Escorts Heart Institute was our first choice.

    The Story:

    Howard Staab, 53-year-old carpenter-contractor for 31 years, single parent of his 16 year old son, swam every morning for seven years. He switched to bicycling and just bought his first bicycle two weeks before he went to his doctor for a routine physical. His doctor was alarmed at the sound of his heart, and she ordered an echocardiogram immediately.


    “A flailing mitral valve with severe mitral regurgitation.“
    His new cardiologist, Dr. Elizabeth Henke, described the heart valves as two halves of a parachute – and Howard’s “anchor strings“ have snapped…suddenly, and no one knows why.


    Often, people with mitral valve prolapse or stenosis can take medication and be watched by their cardiologist for many years. Howard’s case is so severe that it will require surgery as soon as possible, to either repair or replace the mitral valve.

    The Personal:

    Howard has a work ethic that is unmatched. He is a person who prides himself in meeting deadlines and financial estimates that he promises his customers. He has volunteered as a carpenter with Habitat for Humanity. Howard is a non-smoker, prepares meals for his son with vegetables from their own garden in addition to whole and organic foods; forbids sodas, junk food and TV; and makes sure that he and his teenage son go for regular doctor and dental checkups. Howard has paid out of pocket for every visit, for every prescription, all of his life. He has even been known to pay for a friend’s dental emergency, simply because Howard could and the friend could not.
    Howard has been healthy, but Howard has no health insurance.

    His recent applications to obtain health insurance since receiving this alarming news about his heart, have turned up astronomical premiums for policies that also disallow any claims related to his heart for a year or longer, since it is now a pre-existing condition. Howard’s doctor says he cannot wait a year for his surgery.

    The Personal is the Political:

    Reactions to Howard's news range from, "He was irresponsible to not have health insurance in the first place," to "This kind of thing has been my worst nightmare…I also have no health insurance by choice," to "I can’t even afford health insurance for my children, let alone myself." Howard is not the only one who, though apparently healthy and physically fit, will face surprising news of this kind without health insurance in place. In fact, he is only one of about 45 million Americans who remain uninsured, either by necessity or by choice. (16-17% of North Carolinians were uninsured over the last three years.)


    Howard met with the CFO of Durham Regional Hospital, where he was told he could apply for Medicaid. But Howard is not broke. He is not an indigent patient. He makes a living and pays his bills. The estimate for the hospital bill alone is close to $100,000 - and they would like to receive "half up front, and the rest on a payment plan." The surgeon, the valve, cardiologist, anesthesiologist, radiologist, pathologist, and any prescriptions will bring the total up to the neighborhood of a staggering $200,000, if there are no complications.

    No insurance company would pay anywhere near this amount for these procedures for a patient with health insurance. The hospital and doctors must agree to accept whatever the insurance companies deem the "usual and customary fee" for any given procedure, and write-off the rest of their charges. But the self-pay patient faces the total charges, and often life-long payment plans.


    Howard looked into state-of-the-art cardiac facilities in India, Argentina and Texas, where top U.S.-trained doctors do the same procedures for a fraction of the cost. Of course, Howard would prefer to stay in the Triangle to be near his son and wide circle of friends. But who could resist these other options? After much deliberation Howard and his partner, Maggi, will fly to India for the surgery as soon as they can obtain the appropriate visas.


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