The hazards of medical tourism; Foreign obesity surgery poses major health risk, doctors warn
Calgary Herald
Thu Apr 8 2010
Byline: Jodie Sinnema

Janine went to Mexico for a quick fix to her weight problem: stomach surgery that was meant to make her thin and give her more energy to keep up with her seven-year-old daughter.

Instead, the surgery left her with a hole in her stomach that leaked, causing her inner fluids to almost poison her on the trip back before emergency doctors in Calgary found the problem.

Eventually, after multiple infections and follow up procedures during long hospital stays in both Calgary and her hometown of Grande Prairie, Janine was left with a stomach the size of a pencil — not big enough to give her the nutrients she needs.

Only after bariatric surgeons in Edmonton gently stretched her remaining stomach to the size of a banana — a green one that has little give, Janine says with black humour — has she been able to eat small portions of yogurt, soup, fortified drinks or a few spoons of ground hamburger.

“It’s the green banana for the rest of my life,” said Janine, a 50-year-old who didn’t want her real name used. “You can go down 65 (pounds) by being stupid.”

Janine went to Tijuana, Mexico, for a $6,000 sleeve gastrectomy when she knew little about the procedure that cuts away a portion of the stomach. Nor had she thought about the ramifications of having a stomach one-third the original size, which requires a complete change in lifestyle even before the operation.

Edmonton physicians Dr. Shahzeer Karmali and Dr. Daniel Birch are starting to see more patients like Janine who head out of country as medical tourists, then bring their medical complications back with them.

There is little information about how many patients going for such surgeries return with dangerous complications. But the two bariatric doctors are warning potential patients about making the tourist trip for medical services, and are prompting the provincial government to keep closer tabs, since there are implications for care.

“I think the most important point is maybe a bit of a wake-up call for patients who choose to be medical tourists,” said Birch, whose research paper on the topic was published recently in the American Journal of Surgery online. The paper outlines cases of 10 Alberta patients who travelled outside the province to private clinics in Canada, the U.S. or Mexico, then returned needing urgent care at an estimated cost of $163,000 to repair stomach leaks and other complications.

One patient spent five months in hospital before being discharged. Another needed detailed care during a pregnancy.

“We’re certainly happy to see these patients and look after them,” said Birch, one of six Alberta bariatric surgeons. “I guess the concern is, can we provide care to all patients who leave the country and then come back?”

“The system is stressed, as you know,” Karmali said. “We’ve got our own patients to deal with. How do we deal with patients who go elsewhere? The problem is . . . we don’t have any idea what they did in the operating room.”

Most surgeons require patients to demonstrate a change in lifestyle before the operation, since they won’t be able to consume food indiscriminately post-surgery.

Teams of surgeons, psychiatrists and dietitians come up with a treatment plan and help patients long after they have surgery to help them lose weight.

But Birch said many medical tourists don’t create a plan before responding to ads selling stomach surgery with the “best prices” and “best care.” Patients fly in and expect to fly out within days, without realizing it’s major surgery.

“This is a major abdominal procedure,” Birch said, noting he isn’t convinced surgery alone can bring obese people to a healthy weight for life.

Chatter in online forums suggests price is dictating people’s choices. One person said prices at private clinics in Calgary, Vancouver and Victoria ranged from $18,000 to $21,000 for a sleeve gastrectomy; it was $5,200 to $10,000 in Mexico.

“What we’ve seen is that there’s an emerging concept of globalization of health care, so patients might continue to travel, regardless of what is offered in their home,” Birch said.

“I think this is going to continue, and I think it will be more complex and we’re going to have to figure out how to deal with it.”