How does an expat abroad with no health insurance find a fabulous breast cancer team? The answer to that question is likely similar to how I would have answered it back home: word of mouth. But where does an outsider – a foreigner – get reliable recommendations?
Hey doc, where would you send your daughter?
My stereotactic biopsy results came back as malignant, with high-grade DCIS in a large area relative to my breast. My first consultation following that news was with an English-speaking oncologist in Croatia who had previously examined me with an ultrasound after my mammogram.
Because the DCIS area was so large relative to my breast, she said mastectomy was my only option. She also recommended tamoxifen for up to ten years because I’m premenopausal.
I knew I’d get more opinions, but I also knew, deep down, that I was looking at the removal of my breast.
We reviewed my risk for recurrence, if I would benefit from genetic testing, if prophylactic mastectomy was possible, and what reconstruction options might be possible in general terms because she was not a plastic surgeon (but I knew practically right away I did not want reconstruction).
And then we asked her the most important question of all:
Where would you send your daughter, your sister, your mother, for a mastectomy?
Her response was without a millisecond of hesitation: Prof. Dr. Zdenko Stanec in Zagreb. He’s an excellent surgeon who specializes in breast cancer, she said.
We also asked what if she could send her family anywhere in the world – where would she chose? She said her first choice still would be her Croatian colleague in Zagreb, but we pressed her for choice number two. She suggested “a breast clinic” in Milan, where there were several with international recognition. She could not name a name, however.
The charge for her consultation on my biopsy results was $32.
Later that same day, we took a long bus ride to Sarajevo, Bosnia and Herzegovina, on a pre-planned trip and we’d already rented an apartment. However, we were prepared to cut the trip short, if I decided on my next course of action before the end of the month.
Some options I considered
Research kept me busy when I wasn’t wallowing in bed or wandering around Sarajevo.
- I contacted friends in other countries who work in health care, to ask for recommendations on breast cancer clinics abroad.
- I contacted U.S. embassies for names of doctors who spoke English. (The State Department will never ‘recommend’ a doctor, but often will keep a list of English-speaking medical facilities for Americans abroad.)
- I was in contact with two breast cancer clinics in London that cater to international clients. They gave me tentative treatment plans and prices, based on the information I provided about my diagnosis, but any ultimate plan would be based on an in-person visit.
- I went to the Sarajevo university hospital where breast cancer is treated, and made a consultation appointment since I was in that city.
- I began to review breast cancer clinic options in India and Thailand, where doctors speak English.
- I considered treatment back home in the U.S. without health insurance, but with a price tag exponentially higher than abroad, that route seemed foolish when I knew I could get quality care elsewhere in the world for a fraction of the price.
I also researched the doctor the oncologist recommended. And then my husband Tedly suggested I do something else — contact the radiologist who performed my biopsy.
That radiologist initially gave me my diagnosis. A brave and kind man. He also had given me his personal email. He asked me to let him know how it all worked out because he would be curious about my outcome.
I wrote to him from Sarajevo, explained where I was and that I was still working out a solution. I asked him: ‘Have you heard of Prof. Dr. Stanec in Zagreb?’
His response was quick: Yes! He said he had personal friends, and relatives of friends, who had gone to Dr. Stanec in Zagreb for treatment. He said he had never heard one single complaint. This radiologist was the second medical professional in Croatia to recommend Dr. Stanec. I took it as a good sign.
I researched Dr. Stanec and his private-pay clinic in Zagreb. I liked everything I found. I decided we would take a trip for Sarajevo to Zagreb and visit Dr. Stanec. I made an appointment.
I also l looked into two more breast cancer clinics in Zagreb where doctors spoke English. I requested more appointments.
And so off we went for the long bus ride from the heart of Bosnia to the Croatian capital.
Comfort level achieved
I went to visit Dr. Stanec, and then another clinic; I declined the appointment with the third clinic. It wasn’t necessary – I knew Dr. Stanec was right for me.
We sat with him for an entire hour. He answered every question I had — and I had many. He took his time and looked at my biopsy results, mammogram images, ultrasound images. He was kind, clear, direct. He was experienced. He performed mastectomies each week for several years. He taught at the university. He came highly recommended through everything I saw in my research and through two medical professionals in another part of the country.
Those factors are great – and you expect your surgeon would be competent and talented. But these next factors pushed me into a complete comfort zone with this man:
- He was honest: he didn’t push reconstruction on me (I had already decided against it – but that’s another story.)
- He asked me a few questions, including what my goals were with this operation.
- He laid out four options he could do for me in drawings on paper.
- He made a few jokes, which relaxed me and my husband.
By the way, my goals for this surgery were:
- have a double mastectomy as safely and quickly as possible (left breast infested with high-grade DCIS, right breast as a prophylactic measure)
- determine if the cancer was completely removed or if I’d need further treatment
- lower my chances for recurrence as much as possible
- heal as quickly as possible without any more surgeries
- have the operation done for a relatively reasonable price
We left his office, and I said I’d think about it, but I knew – he was the one. Still, I slept on it. I hadn’t felt as comfortable with any else. So, the next morning I made an appointment for a bilateral mastectomy with Dr. Stanec and his team for the following week.
We rented an apartment in Zagreb for a month, and then we got back on the bus to get the rest of our stuff in Sarajevo, and we returned, again, to Croatia, where my breasts would be amputated.
In my next post, I’ll share the differences between having this surgery abroad and in the U.S., including drain guidelines, length of hospital or clinic stays, and costs.
The information contained in this blog is not intended to be used for medical diagnosis or treatment. It should not be used in place of the advice of your doctor or other qualified health care provider.