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Published: Nov 5, 2004
Modified: Nov 5, 2004 8:00 AM
Surgery leaves no regrets
Durham man's heart operation costs thousands less in India



Dr. Elizabeth Henke, a Durham cardiologist, right, says Howard Staab should recover well from his heart surgery. Staab and his partner, Maggi Grace, left, went to New Delhi because he has no insurance and the operation was less expensive in India.
Staff Photos by Ethan Hyman

On Sept. 28, Howard Staab was wheeled into an operating room in New Delhi, thousands of miles from his Durham address. In his hands, he clutched heart-shaped amulets of metal and stone. On his chest, in purple marker, were the words "dhanya waad."

"Thank you," it said to his Indian doctors.

Staab, 53, a self-employed carpenter-contractor, knew he was gambling when he chose not to buy health insurance, making him one of 45 million uninsured Americans. He thought he was healthy; solidly in the middle class, Staab, who lives with his teenage son, always paid his medical bills on his own.

When doctors discovered a potentially fatal leak in his heart, he learned that the operation he needed would have cost $200,000 at Durham Regional Hospital. A bill that high would drastically change his life.

"When you can't even sell your house and pay for your surgery, there's got to be something that gives," said Maggi Grace, Staab's partner.

So Staab rolled the dice again. He left the City of Medicine to have heart surgery in India on Sept. 23, when his story was first reported in The News & Observer.

Staab chose the Escorts Heart Institute and Research Centre in New Delhi. Dr. Naresh Trehan, a surgeon who taught at New York University for 11 years before founding the private hospital, performed the operation. When Staab's 17-day stay was over, Grace paid the bill with her credit card. It was $7,000.

Staab had hoped to return to his cheery custom-built home, his heart repaired, his finances intact. But there were complications. On Monday, about a week after returning to the United States, he ended up at Durham Regional Hospital anyway, tethered to an IV drip for a couple of days to receive blood-thinning medication, because his U.S. doctor feared a stroke. Still, he has no regrets.

"You guys have been all over the world, sampling medical care," said Staab's Durham cardiologist, Dr. Elizabeth Henke, as she was examining him Monday. "Would you do it again?"

"I would," Staab said.

"In a heartbeat," Grace replied.

Escorts has 325 beds, nine operation theaters, five cardiac catheterization labs and even robotic surgery capabilities, according to Trehan, who responded to questions by e-mail. Many of the surgeons were trained overseas. About 15 percent of patients come from other countries, and the trend is increasing every day. Still, Staab was the first American to receive mitral valve replacement surgery there.

Costs are lower at Escorts because overheads are much lower in India than in the United States, and patient volumes are much higher, according to Trehan.

"Health insurance in the U.S. is expensive. Thus, many cannot afford it," he wrote. "More and more patients will come to India or go to other countries for medical treatment, as was the case with Howard Staab. ... With similar if not better clinical outcomes, there should be no concern for undergoing complex surgical procedures in India."

An entourage greeted Staab and Grace at the airport and whisked them to a room stocked with fruit and cookies. They looked down from their fourth-floor picture window at the cows and rickshaws below.

On the day of the operation, Staab was shaved from the neck down.

"I'm getting close," he thought. He doesn't remember much else. "No one said, 'It's time,' " he said.

A surgical team worked for six or eight hours, inserting their instruments into a space between Staab's ribs to repair the faulty valve. Staab's heart didn't respond as doctors hoped it would; before he fully awoke from sedation, they went in again, to replace the valve with one made from parts of a pig's heart.

What he expected to be a five- to seven-day stay in the hospital stretched to more than two weeks. The doctors, who spoke English, responded to "any little blip that popped up with the surgery," Grace said.

During recovery, nurses paddled Staab's back or offered him a pipe of healing steam. For meals, she and Staab could order anything they wanted. Staab appeared in Indian newspapers and on TV. They felt like celebrities. The hardest part for Staab was being so far away from his loved ones, including his son. Grace posted updates on their Web site, http://www.howardsheart.com/

Sightseeing, too

As Staab was about to check out of Escorts, his vision suddenly went haywire. He saw shades of pumpkin and green, or a black-and-white pattern.

Henke said later that when the porcine valve was placed in Staab's heart, little blood clots probably formed in his heart. And one of those clots likely loosened and lodged in a place that affected his vision. Staab had suffered a mini-stroke.

The Indian doctors treated him with blood thinners, and his vision returned to normal. On Oct. 11, he was discharged. The couple checked in at a nearby hotel, until Staab was strong enough to fly home.

They tentatively explored their surroundings. They were jounced around in rickshaws. They saw camels and elephants in the streets, pulling ladders. They visited a temple shaped like a lotus blossom. They toured a furniture factory in Jodhpur. They passed tarps on the sidewalk where New Delhi's poor live, burning dung for fuel.

Along the way, there were alarming "events," Grace told Henke.

The day after he was discharged, Staab suddenly couldn't walk. His speech became slurred. He would get better, then worse again. Once, it took two men and Grace to get him up the stairs of the hotel. He couldn't hold his silverware. In Jodhpur, he needed a wheelchair.

On Oct. 23, they came home. Staab was able to walk from the plane to meet Grace's parents at the Raleigh-Durham International Airport, but his right leg was a little slow. He didn't have the same grip he used to. Still, he felt good; he thought he was recovering. He started doing a little work, talking with his construction crew and making phone calls. He and Grace planned a "dhanya waad" party to thank friends and supporters. He voted early.

"If we can spend so many billions on jets and bombs and warfare, we should save people's health," he said.

Back in Durham

On Monday, Henke examined him for the first time since his return. By the time the visit was over, she had started the process to get him admitted to Durham Regional because she feared another stroke. The dosage of the medication he received in India wasn't thinning his blood enough.

"You've been fine now for 10 days," she told Staab. "But I'm not a betting person. If it's happened multiple times, we will assume it could happen today. Tonight. The safest thing is to go in the hospital again."

Henke didn't blame the Indian doctors for Staab's condition. Everything that happened to him could have happened in the United States, she said.

"He had a series of unforeseen complications," Henke said.

She was also sensitive to Staab's uninsured status. She ordered the minimum number of tests she needed to keep him safe. She was surprised to hear that some have been angry that Staab chose to leave Durham.

"I can't think how anybody can criticize who has insurance," Henke said. "I think it's a trend that's going to continue."

Staab was disappointed at the prospect of another hospital stay. At Durham Regional, the nurses were friendly, but he and Grace watched closely for added expenses. Grace requested a toothbrush, but only if it wouldn't cost anything. They asked several times for a daily itemized bill, but no one was able to produce one before Staab checked out Wednesday morning, after doctors declared his blood thin enough. They applied for financial hardship status, but doubted they would receive a discount.

Staab spent a night in Durham Regional once, for an injury. He paid about $3,000. This time, he braced for another bill in the thousands. He wondered if his two-day IV treatment would cost as much as his operation in India.

"It won't bankrupt me," he said of his mounting medical bills. "It just means paying it off all the time, and working more."

Henke expected Staab to make a full recovery. She predicted that he'll be back at work within three months.

And, Staab said, if he needs another valve in the next few years, he'll return to India.

Staff writer Vicki Cheng can be reached at 829-4816 or mailto:vcheng@newsobserver.com



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