Can Plastic Surgery Save a Former Cocaine Capital?
On December 2, 1993, drug king Pablo Escobar received a fatal bullet through the ear as he tried to outrun Colombian police across the terracotta rooftops of Medellín. At the time of his death, he was one of the richest men on the planet. His drug cartel controlled 80 percent of the global cocaine trade and sustained the city. Medellín had become the drug capital of the world and one of its most violent places, with about 6,500 homicides in 1991 alone.
But now the city Escobar made infamous for cocaine is inviting you to see its safer new face. And while you’re down there, maybe you can get a new face yourself. Or some new bone marrow, for that matter. Medellín is back, and this time it’s touting itself as the hot new spot for medical tourism. It’s a poetic turn of events: A city once ravaged by globalization is diving into the growing trend of globalized medicine, where people priced out of the United States fly to South Africa for a two-in-one rhinoplasty and safari, or to India for a fast organ transplant. Medellín is in a great position to do this. The city is closer than Asia or Africa, has a functioning infrastructure, and an educated workforce. And, in a culture where plastic surgery is de rigeur, it has the specialists to deliver the goods.
Medical tourism has real potential to revive Medellín’s economy, but it also raises the question: At whose expense?
Why Medellín? Once a wealthy city in Colombia’s coffee-growing region, the city fell on hard times in the post-WWII-war period after the country opened itself up to global markets, which brought massive internal displacement. This exposed the city to narco-trafficking and spectacular violence. In recent years, however, the Medellín government has thrown itself into a huge, well-publicized urban-renewal campaign. With the help of the national government, headed by Medellín native Álvaro Uribe, the city has reduced the murder rate by two-thirds( despite a recent spike), built shiny new mass-transport to integrate the population, refurbished parks, and opened new libraries and museums.
A key part of the six-pronged revival plan is promoting Medellín as a destination for medical tourism. The point is to bring in people who aren’t quite rich enough at home but are affluent by Colombian standards. The task of chasing those dollars falls to the so-called Medical Cluster, a public-private partnership between the municipality of Medellín and the Chamber of Commerce. Its mission is to create superior medical and research centers that lure travelers from North America—mostly Hispanics from New York, New Jersey, and Florida—the Caribbean, and Spain. By 2014, the city aims to host 15,000 foreign patients a year and to rank as one of the top three medical tourism sites in Latin America. (The current medalists are Mexico, Costa Rica, and Brazil, though the continent is far behind Asia in terms of the volume of foreign patients and money its hospitals attract.) Since its launch in December 2008, the Medical Cluster program has secured 5,000 foreign patients and $7 million in revenue.
For this to succeed, however, the care must be top-notch. No problem. The Medical Cluster and its government backers have found all kinds of boosters: public financing to educate specialists abroad, plus credit from private banks to develop the city’s medical infrastructure—to the tune of $250 million over three years to build clinics with new technology. That means 1,000 more hospital beds, 10 million-12 million jobs in the city, and some very happy construction companies.
This is an impressive investment for any municipality, let alone one with such a troubled past and a population of just 2.5 million. But is it worth it for the average resident of Medellín? The classic dilemma of medical tourism is that it redistributes scarce resources away from those who need it toward people who simply want it. Hospital beds—or, in the worst-case scenario, organs—go to gringos shelling out for elective procedures instead of the locals who are actually ill.
Medellín’s government argues that is not the case. They say the new clinics will provide better health care to locals—and that part of the investment can be recuperated off of the backs of foreigners who spend still more on local hotels as they recover before the flight home. The government also argues that it’s a good use of human capital, which was wasted during the heyday of narco-trafficking. Colombians, and Medellín locals in particular, are highly educated. And they live in a largely developed and functioning state. Plus, it’s the perfect confluence of supply and demand. Most foreign patients come for plastic surgery (for rhinoplasties and breast augmentations). And in a culture where plastic surgery is so common that boob jobs are regularly raffled off on the radio, it’s no surprise that good plastic surgeons abound. The relatively small Medical Cluster member Clínica las Américas boasts no fewer than 12.
Moreover, the Colombians have preempted the thorniest issue of all: organ transplants. In 2005, the national parliament passed a law that gives Colombians the priority on all solid organ transplants. For this reason, medical tourists are limited to transplants of relatively plentiful bone marrow.
So Medellín seems to have this sown up. And that’s great, except that it obscures many reasons medical tourism exists—and this is worth keeping in mind now that everyone seems to think health care’s a battle won. Medical tourism is a market response to the medical inequity in America. “Most medical tourism uses doctors that are underutilized at the destination, and the people who use it are people who have been priced out at home,” says Tarun Khanna, a professor at the Harvard Business School who has studied medical tourism to emerging markets. People go abroad for health care because they are uninsured, or because their health insurance doesn’t cover the procedure and they can’t afford it.
And at first glance it makes sense: A cardiac bypass can cost $60,000 in the United States and $21,000 in Medellín. (Elective aesthetic procedures, though sexier, are not that expensive to begin with—a face lift usually costs less than $10,000 in the United States —so it makes a bit less sense to travel, since you’ll spend most of your money recuperating.) Some insurance companies, like Aetna and Seven Corners, have already started to get in on the great deals themselves, offering medical tourism packages to Americans.
But those savings come with big risks, which are often not well-known. First, flying to an operation is no vacation: You’re going to have surgery, and surgery hurts. It’s hard on your body, too, so you need time to recover, plus the return flight carries a high chance of fatal blood clots. And that’s if everything goes well in the operating theater. No hospital in Medellín has accreditation from the Joint Committee International, which is the only World Health Organization body to certify international sites in patient safety. Three Medellín hospitals are applying, and this is not to say that the hospitals are inherently sub-par; it’s just harder to ascertain the quality of care. But this can become a problem if something goes wrong: Medical records can be hard to get, says Dr. Alan Matarasso, a professor or plastic surgery at the Albert Einstein College of Medicine. Procedures have not been tested as rigorously as in America, and fixing the damage can be nearly impossible. “I just saw a boy who came back from Brazil where he had gotten some kind of injection in his cheeks,” Matarasso says. “We X-rayed it and couldn’t figure out what it was, or how to get it out.” The lumpy cheeks, he adds, are now irreparable.
Of course, plenty of procedures pass off without a hitch and the patients get to tour Colombia’s coffee regions, which also develop. But the larger point is this: It’s a happy symbiosis with a real American illness at its core.