I know two couples who have been dealing with infertility issues. After exploring all the options, both have decided to go with IVF (In Vitro Fertilization). One couple has excellent insurance and was able to proceed with the process here in the United States. The other could not afford to have it done here, but being originally from India, they instead went home and had the IVF procedure there.

I know that the first couple is pregnant with triplets. I have not yet heard the results for the other couple, but we are praying they are successful as well.

Most Americans react with shock when told that someone would choose treatment in India over that offered here in North America, but there are some who are making that exact choice:

Three months ago, Howard Staab learned that he suffered from a life-threatening heart condition and would have to undergo surgery at a cost of up to $200,000 -- an impossible sum for the 53-year-old carpenter from Durham, N.C., who has no health insurance.

So he outsourced the job to India.

Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to the Indian capital, where doctors at the Escorts Heart Institute & Research Centre -- a sleek aluminum-colored building across the street from a bicycle-rickshaw stand -- replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including roundtrip airfare and a planned side trip to the Taj Mahal.

When someone talks about India, most people immediately think of the abject poverty of Calcutta. The truth is that India is both backwards and modern, depending on what part of the country you are in. I don't find it threatening that medical care is one area where India is starting to serve an international audience:

The trend is still in its early stages. Most of the foreigners treated in India come from other developing countries in Asia, Africa or the Middle East, where top-quality hospitals and health professionals are often hard to find. Patients from the United States and Europe still are relatively rare -- not only because of the distance they must travel but also, hospital executives acknowledge, because India continues to suffer from an image of poverty and poor hygiene that discourages many patients.

Taken as a whole, India's health care system is hardly a model, with barely four doctors for every 10,000 people, compared with 27 in the United States, according to the World Bank. Health care accounts for just 5.1 percent of India's gross domestic product, against 14 percent in the United States.

On the other hand, India offers a growing number of private "centers of excellence" where the quality of care is as good or better than that of big-city hospitals in the United States or Europe, asserted Naresh Trehan, a self-assured cardiovascular surgeon who runs Escorts and performed the operation on Staab.

Trehan said, for example, that the death rate for coronary-bypass patients at Escorts is .8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former president Bill Clinton recently underwent bypass surgery, was 2.35 percent, according to a 2002 study by the New York State Health Department.

Of course, there are some conditions where traveling that far is completely out of the question. If I should ever have a stroke or a heart attack, I pray my lovely Queen (May She Live Forever) takes me to a local facility.

(Hat-tip to my friend Sam)