Istanbul is famous for its incredbile architecture, beautiful mosques, and medical tourism.
A year and a half ago, I developed a strange pain in the big toe of my right foot. It persisted longer than expected, and it finally became difficult to walk. So when Michael and I happened to be getting medical checkups in Bangkok last year, I had it examined by a podiatrist.
I learned I had something called hallux rigidus: essentially, arthritis of the big toe, caused by “bone spurs” — that is, little growths in the nearby bones of my foot.
Pack your bags, we’re going on an adventure
Subscribe to our weekly newsletter for the best LGBTQ+ travel guides, stories, and more.
The pain was very unlikely ever to go away, my doctor said, but he explained my various options, including surgery. The price for this surgery (at one of Bangkok’s top hospitals) was $5600 USD.
At the time, I was on SafetyWing’s Nomad Insurance — travel insurance for only “medically necessary” procedures, true, but being able to walk seemed fairly necessary to me.
Infuriatingly, SafetyWing refused to tell me whether they’d pay for the surgery. (And three months later, they also denied payment for even that initial consultation with the foot doctor. So the answer was clearly, “No, this procedure is not covered.” Which you’d think they could’ve, you know, said.)
But in all the time it took to get a clear answer from SafetyWing, a strange thing happened: the pain in my foot mostly disappeared. I could walk again!
I ultimately concluded that I had subconsciously changed the way I walked, a testament to how amazing and complicated the human body is.
Plus, I bought different shoes.
The big takeaway is I went on with my life.
But by the end of 2023, some of the pain had returned. Worse, I realized I had become so cautious that I avoided activities I had previously enjoyed. Michael and I are extremely active — mostly because we enjoy it, but also because we like how this increases the odds of our being able to stay active for as long as possible.
Last month, I knew we would be in Istanbul, Turkey—a city known for excellent (and affordable) medical care. So I said to Michael, “I think I should finally have that surgery on my foot.”
Michael agreed, and what follows is the story of what happened.
Spoiler alert: If I had to do it all over again, I’d change a few things.
Istanbul is famous for its “medical tourism.” There are lots of first-rate medical facilities, which often cater directly to tourists. However, the cost of living here is much lower than in many Western countries, making everything a relative bargain for people like Michael and me.
In fact, he and I lived in Istanbul for almost three months in 2021 (and loved it), and it was extremely common to see foreigners out and about sporting bandages—often for cosmetic surgeries like nose jobs, face lifts, and hair implants.
We also have friends who had previously had surgical work done here, and we knew one who had used a “medical advocate” to help them arrange everything.
They highly recommended that advocate, so I contacted her and explained what I needed. I sent her my x-rays from Bangkok, and she found the right doctors and then spelled out two different options:
- If I paid via credit card, the operation would cost $6500 USD and take place at Acibadem International Hospital.
- If I paid cash, it would cost $4000 and occur at Kolan Hospital.
We liked these prices. My research suggested that the surgery would cost anywhere from $8000 to $70,000 in America. My gut told me that it would be at least $20,000 in our hometown of Seattle.
I still keep a “full” insurance policy back in America, but despite my $9000 annual premium, it has a ridiculously high deductible of $6000 and 20% on any “specialist” care after that. And since the American healthcare system is clearly insane, I was assuming there would be “hidden” costs — co-pays, for example, and my paying for expensive prescriptions and outrageously priced convalescent equipment — that would push our post-insurance costs to at least $10,000, or maybe way beyond that if there was any ridiculous “out of network” issue.
Since SafetyWing ultimately declined to cover the surgery in Bangkok, I assumed our current travel insurance provider, Genki, would not cover it in Istanbul either.
But what was this deal about the two different hospitals — and the steep discount for paying in cash? Our advocate had assured us it would be the same two doctors either way, but we wouldn’t get a receipt at the cheaper hospital. This seemed a bit dodgy: was it legal? And how would we get that much cash in a foreign city?
Our independent investigation confirmed that paying in cash is a very common practice in Turkey (and also nearby Greece).
I asked the advocate if the quality of medical care would be the same in both hospitals, and she assured me it would be.
Again, our independent investigation confirmed this. Our medical advocate thought that unless we needed a receipt for insurance purposes, we’d be crazy to pay $2500 more for the same surgery by the exact same doctors.
In the end, we agreed to go with the cash option. We scheduled the initial consultation with the doctors for a little less than a week after our arrival, with the actual surgery two days after that. I figured that would give me time to get that much cash — either Turkish lira or US dollars.
At this point, we had committed no money, and Michael and I planned to use that initial consultation to decide for sure whether we’d ultimately go through with the surgery. In addition to the “cash” issue, we were also a little concerned that the doctors had decided the exact surgery I needed, even before an examination, just based on some screenshots of x-rays from Thailand the year before.
We arranged for an Airbnb fairly close to the hospital, but once in Istanbul, getting $4000 cash turned out to be more difficult than anticipated. My American credit union had advised me to raise my daily ATM limit and then simply go into any local bank for the money. But we tried three different Turkish banks, and none allowed this.
Meanwhile, cash machines in Turkey sometimes give US dollars. Many locals prefer dollars since the lira has been so unstable and inflationary. But these cash machines also have ridiculously high fees—anywhere from six to ten percent—and often have their own daily limits.
We solved this problem by raising the daily limit with my credit union and then going to a shopping mall, which had a variety of cash machines with high daily limits. We ended up paying a six percent fee, which added $240 to our cost. I also wasn’t thrilled about carrying that much cash or keeping it in our apartment for a few days.
We planned to meet with the doctors on Monday, but on the Saturday before, we had dinner with a very tuned-in Turkish friend, Farouk, and we told him all about why we were in town.
He listened and said, “I am very sorry to say that Kolan is not a great hospital. It is second or even third-tier.”
I instantly began freaking out. This was my worst nightmare coming true! Had I made a huge mistake in trusting our advocate? But Farouk did say that the hospital where my doctors typically worked — Acibadem — was one of the best in the city.
That night, I texted our conversation with Farouk to our medical advocate. She assured me again that everything was perfectly fine and that I had nothing to worry about.
I was still worried. That Monday meeting with the doctors was now more important than ever. If anything seemed off, we planned on simply walking away and scheduling another appointment at one of Farouk’s recommended hospitals. After all, we’re nomads, which gives us great freedom: we had already planned to be in Turkey for almost three months.
But the meeting with my two doctors, who happen to be brothers, went great. They spoke decent English and seemed extremely professional. They examined my foot and subsequently explained away some of my specific concerns: they weren’t just working from x-rays — I had forgotten I also sent them the previous doctor’s full report. Plus, they would take more x-rays at the hospital before the surgery.
They also explained how there were three different levels of surgical intervention for my kind of problem, and they were quite sure that the simplest one would work for me. I got no sense whatsoever they were trying to pressure me into a more expensive procedure. But given that I had tried everything else, this did seem to be my only option.
They also gave me their personal phone numbers and told me to call or text them anytime about anything.
They had won my trust, so Michael and I decided to proceed with the surgery. But we still hadn’t paid anyone anything, and once again, we told ourselves: if anything seemed odd about the hospital on Wednesday — if there were any red flags at all — we could still walk away.
But on Wednesday, the hospital also looked fine—modern and clean. I immediately noted that the other patients seemed to be middle-class professionals, although they all looked Turkish.
In short, this appeared to be an upper-end hospital but a local one. And sure enough, no one except our doctors spoke much English (but, of course, everyone had Google Translate).
However, I was surprised and concerned that our medical advocate had not shown up in person — although she frequently checked in via text, monitoring my progress. Someone from the doctor’s office was there to guide us in person, but her English was quite weak.
We did the long check-in, signing a zillion forms — many in Turkish, although I could at least scan them with Google Translate. It all seemed very typical.
In my private hospital room, the doctors met with me, and I met the anesthesiologist, who also spoke very good English. The plan was for me to have an epidural, which is a procedure often used in childbirth, rather than a general anesthetic.
The doctors all left, and the doctors’ assistant finally asked us for the $4000 in cash, which we handed over. A small part of me expected her to thank us and casually excuse herself, and then all of these so-called “doctors” would simply vanish, leaving Michael and me alone in a Turkish hospital — and $4000 poorer.
“If that happens,” I’d said to Michael earlier, “I’ll be annoyed, but I’ll also be genuinely impressed that they managed to pull off such an intricate and complicated long-con.”
But once we’d paid the cash, we didn’t get kicked out of the hospital. Recognizing Michael was with me, the staff brought him lunch and even suggested we change to a room with two beds so he could spend the night with me.
I never felt any weirdness about our being a gay couple — but then, I never have in any of the many Muslim countries we’ve visited or lived in. In general, I’ve found Muslims to be some of the most hospitable people on Earth. When it comes to LGBTQ+ folks, the vast majority practice a kind of “Don’t Ask, Don’t Tell.”
Then again, these folks often have a vested financial interest in keeping “rich” Westerners like Michael and me happy, and things might be very different if we were gender-nonconforming. Also, we are often assumed to be brothers.
After some waiting, the nurses took me to surgery. I confess, once in the operating room, several things immediately gave me pause.
First, the surgical room was smaller than I expected — much smaller than even my hospital room. And while it was all very clean, there was a clear plastic canister nearby with something decidedly bloody inside, as if it had just been sucked out of someone in a previous surgery. This did not seem normal.
Then, once they were preparing me for the actual surgery, one of my doctors asked me, “Would you like the general anesthetic?”
“Uh, I want what you recommend,” I said. “And back at the office, you recommended an epidural!” Maybe he was reacting to the anxiety on my face, thinking I might now want to be completely out for the procedure, but offering to change strategies this late in the game didn’t seem normal either.
But at this point, with a team of eight or so scrubbed and assembled and me mostly unclothed on a table, it was too late to back out.
I ended up having the epidural, which cut off all feeling below my waist. I was awake for the whole surgery, and the doctors kept checking in, as did the very kind nurses; it’s incredible what a difference a gentle smile makes at a vulnerable time like that.
But I was still uneasy that everyone spoke Turkish — and I’m pretty sure only the doctors and the anesthesiologist spoke English.
Back in my hospital room, the doctors quickly appeared to tell Michael and me that everything had gone great. The plan was for me to spend the night — something I seriously doubt would have happened in America (nor, I think, would they have given us a double room and let Michael stay all night — with meals! — at no extra cost).
A nurse had inserted a catheter right before the surgery — without explanation since she didn’t speak English. Frankly, it had surprised me. Now, as the epidural wore off, I did feel increasing pain “down there.” Plus, Michael and I both noticed my catheter bag was quite pink in color, indicating a fair bit of blood in my urine.
At this point, my doctors had left the hospital with a promise to return later that night. But I wanted answers now, so Michael tracked down the nurses. It was awkward and frustrating to have to explain everything using Google Translate.
The nurses finally took photos of the catheter bag, which they sent to my doctors, who assured us it was a normal amount of bleeding.
But as the epidural wore off, the pain was increasing fast, too. I had already been given a liquid form of paracetamol in my IV drip, but it didn’t seem to be making much of a difference.
This time, rather than deal with the nurses, Michael contacted the doctors directly via WhatsApp, and the nurses soon arrived with something much stronger.
Finally, right before midnight, the doctors showed up again and declared everything fine. With painkillers and Xanax — and Michael being so attentive and great — I slept fairly well.
The next morning, the doctors visited again and reported that everything looked as it should. My foot felt okay, but that catheter had done a number on me. A nurse had taken it out the night before, but there was still blood in my urine — and a lot of pain in an area where I really didn’t want any pain at all. The doctors assured me this was normal too.
Before leaving, I was given various painkillers and antibiotics, and we scheduled four follow-up visits at their office for the ten-day recovery period.
They also said that, if necessary, they could come to our apartment — something I am absolutely sure would never ever ever EVER happen in America in 2024.
The follow-up visits went great, and while I got fairly stir-crazy in our apartment during the ten-day recovery, I can now walk mostly normally again.
The original pain in my foot? Well, there’s still a little pain from the surgery, so it’s too soon to know, but my doctors assured me that I should be fully healed in another month or so, and my situation was caught early enough that this particular surgery was almost certain to work. But in 20 years? I could possibly need some kind of surgery again.
Since the operation, Michael and I have thought and talked a lot about the experience. What did we think? And what would we do differently?
In the “pro” column:
- I loved my doctors; I was lucky to have them. Plus, Muslim hospitality, in general, is amazing.
- I wasn’t concerned about being in a different culture — and Turkish/Muslim culture is fairly different from the West; Istanbul is a fairly liberal city and very sophisticated, but there are also large pockets of extreme conservatism. Then again, Michael and I have been traveling for many years now: seven years ago, this same experience might have felt very different to me, more “alien” and off-putting.
- When it comes to medical care, there is always some degree of uncertainty. In America, I would have understood the process a bit more, but the cost would have been much more opaque, causing a different kind of anxiety.
- That cost would also have been much higher in America, even with my insurance. The total in Turkey was $4240 (including ATM fees), and that was for everything: the surgery, an overnight hospital room (and a bed for Michael), meals, prescriptions, post-op equipment, and five out-of-hospital visits (and even the promise of an at-home visit, if necessary). But if you’re thinking about medical tourism and are not a nomad, you’d also have to factor in the cost of your transportation and recovery lodging. (Comfortable digs can be had for $1800-$3000 USD a month, and we’ll have an upcoming article discussing the pros and cons of Istanbul’s various neighborhoods.)
- Also: in America, I doubt I would have spent the night in the hospital for this particular procedure. And I doubt my doctors would have checked in on me so much and given me their phone numbers. I felt very, very much that this whole process was about me and what I needed — not what would cost the insurance company or hospital the least amount of money. (But I also recognize that this is the way Turkish doctors treat Westerners, not necessarily the way they treat their own poorer residents.)
- I asked a few friends who have had “medical tourism” done in Istanbul. Here is what they said:
- Friend one: “All in — pre-visit with doc, pre-surgery labs, surgery, four great hospital meals, interpreters, amazing private room with a fantastic view and overnight hospital stay et al: $6,700! I have a $2,500 annual deductible, but still, it was worth every penny. I didn’t want to leave [Liv Hospital]. Everyone was so amazing, giving me hugs as I walked out the door. I need to write their five-star review which I keep forgetting to do. It was an amazing experience: first time I’ve been in a hospital since I was born!”
- Friend two (who had the same doctors I did): “The surgical experience was one of the best medical experiences I’ve had. The surgeons were excellent and flawless with the procedure and the entire process. The best part of the process was the follow up; the surgeons made absolutely certain I made a full recovery.”
- This man’s wife: “It is essential you have someone to continue home care physical therapy after some ortho surgeries. As his home caregiver, I got excellent training and continued periodic house-call visits from the therapist.”
All that said, if I had to do medical tourism in Istanbul over again, here is what I would do differently:
- I would use a different medical advocate. It turns out mine had recently moved away from Istanbul and was working remotely, and if I had known that, I would’ve gone with someone else. Also, I think she was wrong — and our friend Farouk was right — about Kolan Hospital: it’s not the equivalent of Acibadem.
- Even better, I would skip an advocate and go through one of the following Istanbul hospitals, which are all considered “top” and also cater to Westerners. They will also sometimes either arrange nearby lodging for you or put you in contact with someone who can.
- In Istanbul, I would personally insist on one of the above hospitals or something similar, even if it meant paying more. Regular readers know I love myself a bargain, but I would never want to risk my or Michael’s life even slightly just to save a little money. There were a couple of things that gave me pause about Kolan Hospital, especially the language issue. I wish more of the staff had spoken English. It was weird and stressful to rely on Google Translate for something like this.
- Even at a better hospital, I would also want a translator available at all times. What if something really serious had happened?
- But if it’s an option at one of these hospitals, I would still pay in cash. It really is widely accepted as a means of doing business here, and it was an incredible bargain, saving Michael and me over $2000.
- That said, before paying in cash, I would consider the importance of a receipt. We Americans can often write off medical care on our taxes. And regarding this procedure not being covered by travel insurance, having recently researched the issue, I now suspect that while SafetyWing denied me, our current provider, Genki, might have paid out; they’re more liberal in payments in general, and after six months, they cover some pre-existing conditions. If nothing else, I wish I had asked.
More than anything, I’m happy to finally have this thing done, and I can’t wait for Michael and I to resume our regular activities — walking, hiking, romping, and meandering to different places all over the world!
Brent Hartinger and Michael Jensen are a gay “digital nomad” couple — two men who travel the world continuously, living in different countries for anywhere from one to three months at a time. Subscribe to their newsletter at BrentAndMichaelAreGoingPlaces.com.
Don't forget to share:
