Emerging into the teeming chaos of people, cows and honking vehicles outside Bangalore airport, retired teacher John Stauffer wondered if he had been mad to come to India for brain surgery.
On arriving at Wockhardt Hospital, the American's unease soon faded. The calm atmosphere, the gleaming high-tech equipment and the soothing manner of the consultant neurosurgeon instantly reassured the 66-year-old.
Mr Stauffer had flown from Grand Rapids, Michigan, to have a brain tumour removed for a fraction of the price it would cost him in the US, and he is one of a growing number of health tourists to India.
Some 175,000 foreigners have made the same journey this year, according to the Confederation of Indian Industry, up 25,000 from last year. Next year, 200,000 are expected.
The figures underline the remarkable success of India's medical tourism industry, despite warnings that the country's poverty and reputation for poor hygiene would put people off.
Not only are there more such tourists, but they are coming for increasingly complex treatments. The healthy patients who have flown to India for cosmetic surgery or dental work for a decade are now being joined by sick people, some in terrible pain.
They are seeking knee replacements, bariatric surgery for obesity, heart bypass operations, spinal surgery and, in some cases, transplants. Mr Stauffer came because he had no medical insurance and the tumour was life-threatening.
"Otherwise I would have had to mortgage my home to get the treatment," he said.
He was treated by Dr Deshpande Rajkumar, a pioneering surgeon who removed another patient's tumour through the nose earlier this year.
Foreigners who have surgery in India come because of long waiting lists in Britain, high prices or lack of insurance in America, and a dearth of expertise in parts of Asia, Africa, and the Middle East.
Dr Vijay Bose, an orthopaedic surgeon at Apollo Hospital in Madras, operates on around 16 foreigners every month â€“ mainly Americans, Canadians and Britons â€“ who want hip-resurfacing, which enables a more active life than traditional hip replacement. The procedure is new and has not yet been licensed in the US, so Americans fly to be treated by Dr Bose.
All India's major private hospital groups report a growing number of foreign patients, of whom around 20 per cent are from Europe.
In the past six months, Wockhardt Hospital alone has treated 100 Britons for joint replacement, spinal decompression (for chronic back pain) and heart disease.
Would-be patients often have long talks with the doctors before flying in.
"The 'tourist' element of medical tourism has gone," said Anas Wajid, head of marketing at the opulent Artemis Health Institute at Gurgaon, near New Delhi.
"Patients might have a break after their treatment to see India, but they come because they are sick and want to be relieved of pain."