When he was 9 years old, Craig Carlson broke his collarbone horsing around in the living room.
And then he broke it again playing sandlot football — twice. And again wrestling in high school.
And again in a bike accident.
Six times altogether.
The bone had healed improperly time after time, its ends overlapping.
When he broke it a sixth time, falling into the handlebars of his bike, Carlson began to research his options.
After more than a year of research, Carlson joined the ranks of medical tourists who travel overseas for less-expensive medical care.
The result was a vacation in China and Nepal, followed by orthopedic surgery in Kathmandu, Nepal.
The cost for both vacations, 70 days abroad, and health care was less than $9,000 — several thousand dollars less than surgery alone would have cost in a Lincoln hospital or surgery center.
Exotic trip start of journey
In early August, Carlson went on a road trip in Tibet with friends, going into Buddhist monasteries and temples, through rural villages, ending at the foothills of Mount Everest.
He also spent a few days in the jungle of Nepal, where he rode an elephant, walked through the bush, spotted a few highly endangered black rhinos, paddled a dugout canoe, saw some crocodiles and made new Facebook friends in foreign places.
Then he spent part of the next week at a new private hospital in Kathmandu, where an experienced orthopedic surgeon, Dr. Chakra Raj Pandey, cleaned up the scar tissue, stimulated the ends of the bone, placed them together and attached them with a Swiss titanium plate and seven screws.
Carlson recuperated for five days in the hospital, cared for by hospital staff, ordering take-out from nearby restaurants for his meals. He spent four more days resting at a nearby apartment owned by the doctor.
The surgery was successful. Carlson, a property manager, is back in Lincoln with a five-inch scar and many good memories.
But despite all of his careful planning, a last-minute visa problem almost derailed the surgery.
Carlson is a patient person, said friend Brian Hull, who was part of the China trip. "He did all his research and just stayed the course."
Carlson began his research on how best to fix his clavicle by looking first at nearby options.
He contacted several local doctors, spent about $2,000 on X-rays, a CT scan and office visits, so he would understand the medical situation.
He decided the best long-term solution for him was surgery.
Without it he would have low-grade pain, be in constant danger of another break, have pain after swimming or canoeing and would never swing a golf club.
Carlson got two estimates for the hour-and-a-half outpatient orthopedic surgery: $12,500 in Lincoln and $17,000 in Omaha.
Carlson had a high-deductible hospitalization insurance policy: $90 monthly premiums with a $5,000 deductible.
This was considered outpatient surgery. When his insurance carrier said no coverage, Carlson decided to look outside the country.
The insurance company paid for the sling he wore after the surgery.
"I got what I paid for," he said. “Next to nothing.”
Carlson spent about $2,500 for the surgery and the hospital stay at the Grande International Hospital in Kathmandu. That included take-out meals, laundry, a haircut and a 20-minute massage from the barber.
He paid the bill with a credit card from his Health Savings Account, saved income that is not taxed and can be used only for medical expenses.
The total trip — vacation and health care — cost about $9,000 but was still $3,500 less than surgery alone in the United States.
And he had excellent care, Carlson said. In fact, he was treated like a king by hospital staff and became friends with the administrators.
Veteran traveler did homework
Carlson is a veteran traveler who has been to 35 countries. Several times he has driven a car to Belize and sold it before returning home.
So he was comfortable turning to medical tourism.
He did his homework, including reading several books.
He learned that India and Turkey are magnets for patients from many different countries; that Thailand specializes in cosmetic surgery, an outgrowth of taking care of Vietnam veterans during that war. He learned that many overseas hospitals have accreditation similar to U.S. hospitals.
He also learned that the United States has the most expensive health care system but ranks 46th in health care efficiency.
Carlson contacted some of the agencies that put medical tourism packages together.
It's like using a travel agent. It costs a bit more, but all the details are worked out by someone else, Carlson said.
But he found the agencies were swamped.
Carlson began working out his own plan: a trip to China and surgery in India. After all, he's the kind of guy who generally avoids packaged tours, hires his own guides and uses Lonely Planet guide books.
And he had an Indian connection. The husband of Carlson's mother had a nephew who was married to a woman whose father is a doctor in India.
He had three estimates for the surgery and a five-day hospital stay — $2,500 and a stay with relatives, $4,800 at a hospital that catered to overseas clients and $4,200 at a hospital above a Pizza Hut.
But Carlson never made it to India.
Surgery in Kathmandu
While he waited in Kathmandu for his flight to India and worried about getting a necessary visa that was exceptionally slow in being processed, Carlson discovered a local surgeon, a fancy new hospital and an even less-expensive price.
In order to get X-rays the Indian surgeon wanted, Carlson ended up at the Grande International Hospital in Kathmandu, an eight-month-old private hospital with the latest equipment, even plans for a helio-pad on the unfinished top floor.
Carlson was impressed with the clean, modern hospital and with the $15 bill for X-rays. He was even more impressed by Dr. Pandey, in his 40s, "experienced but not burned out.”
Carlson's brother-in-law, a doctor in Illinois, did a search on him and reported back that the doctor “looks impressive.”
Pandey was enthusiastic, with English as a strong second language, and without the American physician arrogance, according to Carlson.
The doctor apologized profusely for being late to the first appointment. He carried Carlson's bag when he moved from hospital to apartment.
The Turkish-trained doctor not only wants to cater to foreign patients, but he seemed genuinely interested in using his talents and money to help provide surgery for the very poor in his country, Carlson said. The doctor has set up a nonprofit to build a 50-bed hospital for the poor.
Carlson canceled his surgery in India and stayed in Kathmandu.
The hospital was trying to teach its nurses what residents of the Western Hemisphere expect, so Carlson was both guinea pig and paying patient.
"It was kind of a win-win for both of us.”
There were some differences in care. The procedure was not outpatient surgery in Nepal, so Carlson was in the hospital for five days.
Families came to the hospital to help care for and feed patients. There was a sink in every room so family members could wash the dishes and a futon for sleeping.
After a meal of bread and a boiled egg, the hospital staff set up a system where Carlson ordered from nearby restaurants and a delivery man brought the food to his room.
There was no TV in any of the rooms, the doctor had the nursing staff do Carlson's laundry and the paperwork required before his surgery was a single sheet of a prescription pad.
But the care was excellent, and the medical equipment new and modern.
American system is 'mess'
Through his research, Carlson learned about the crazy pricing system in the United States.
"It's a mess," he said.
Take the CT scan one Lincoln doctor felt would be helpful.
It would cost $1,583 with insurance, but $1,020 without insurance at a Lincoln hospital.
At a Lincoln clinic, the CT scan price began at $800, but Carlson negotiated down to $563 by paying on the day of the test.
Now he's back to negotiating again for a follow-up X-ray Pandey wants emailed to him next week.
Carlson said his goal in sharing his story is to let people know there is this option.
There are safe, modern hospitals, even hospitals with accreditation, excellent doctors and good care in other countries.
Plus, Carlson said, his first journey into medical tourism was "just an incredible experience."