Is it safe to consider major surgical procedure as holiday fantasies?

Medical tourism is currently a billion dollar industry worldwide and many less developed countries are cashing in on unsuspecting, poorly informed people from developed countries, offering these procedures as “no frills holiday packages”. Australia is certainly a prime target for promotion of medical tourism for countries such as Thailand, Malaysia India, Indonesia and the Philippines. Recently, NIB – one of the country’s major private health insurance providers – floated the idea of sending their insured clients overseas for surgery, however, as far as I am aware, no definite information is provided on how they would organise the follow up of these patients in Australia and specifically who would pat for the revision procedures for patients who may need corrective surgery for complications.

It is human nature to look for “bargain deals.” This is especially true, when the cost of certain elective or cosmetic procedures in Australia may be considered to be disproportionally higher than the cost of these procedures in less developed countries mentioned above.

Australians are pretty fortunate to be living in a country with a very high standard of health service available to most people – that is either paid for in public system or is subsidised by Medicare or a private fund in the private sector. Not many developed countries can boast of such a robust health service that we currently enjoy.

Plastic or cosmetic surgery and dental surgery are probably the most targeted areas by the overseas hospitals and medical tourism companies. A staggering number of patients travel on “holidays” to these overseas destinations, have very little work up done, have very little post-operative care provided and have absolutely no follow up organised. Those who have a good result are then used to promote the industry and the unfortunate ones who require further corrective procedures, management of significant infections or who had poor cosmetic or functional results are largely ignored by the media and tourism companies.

Furthermore, there are no avenues for these patients to complain. The common story is that they can’t even get the past the reception desk when they call the hospitals for more information of for advice. What is more alarming is that often there is no adequate documentation and no proper follow up instructions given to these patients. Some of these procedures are almost unethical or illogical. Some patients have told me that the medical tourism operators advised patients that if they had complications they should report it to their GP, who could then refer them to the public hospital and they would be looked after ‘at no further expense’ to them. How convenient!

Over the years, I have had a fair share of patients with such complications. Examples are many, but some of the most interesting ones are as follows:

‘I’ had an abdominoplasty procedure performed in one of the reputed Bangkok hospitals. Post-operative, within days, she claims that she noticed blackened change of skin under her umbilicus. This concern was dismissed by her surgeon and se was advised to return back to Australia. She reported to Pindara A & E, with foul smelling discharge and blackening of nearly half the skin in the lower abdomen. She was referred to me and has so far required three operations, including removal of the substantial skin over her lower tummy and a large skin graft, and is likely to need at least one more major procedure for reconstruction. Fortunately, she was privately funded and the taxpayer estimated expense so far has run past the $20,000 mark; nearly three to four times more than what she paid for the ‘budget’ abdominoplasty procedure.

‘K” was seen a few years ago by me for ugly scars over her face and behind her ears and forehead. Her story was funny though tragic! She is a lady in her late thirties. She had an accident while travelling in a tuk-tuk in Thailand. She had a cut on her forehead for which she was taken to a ‘well known’ hospital for suturing of the cut on the forehead. All she remembers after “some sleeping drugs were administered” (her words – not mine), is someone asking her about doing a facelift at the same time while she was under. She apparently signed the consent and allowed it to be charged to her credit card (that she did not remember). She woke up with suture on her forehead cut and a ‘facelift’. According to her this did nothing to her face but caused fairly significant scarring in front and behind her ears – which required numerous injections of steroids and scar revision procedure.

‘N’ is a local Gold Coaster who went to Delhi, India, were a facelift surgery was performed. His reason for a consult with me within a couple of months of his surgery was significant asymmetry between the two sides, with one side much more tightly strung back than the other. The scars sub optimal too.

‘P’ is a Caucasian lady in her late forties, who had an abdominoplasty procedure performed in a well-known hospital in Kuala Lumpur, Malaysia. She woke up from general anaesthetic with second and third degree burns from diathermy (electrically induced heat), which took three months to heal and produced bad scarring.

There are dozens more patients and they are sometimes tragic and sometimes almost incredible medical ‘misadventure’. I have treated several patients with infected breast implants, nasal prostheses in Australian patients of Asian origin, poorly executed eye lid procedures, poorly performed liposuction procedures, and more in my plastic surgery practice, spanning over several years. The experience of other plastic surgeons and perhaps other specialists is no different. Quite often, the cost of treatment of these complications to Australian taxpayers runs into many thousands of dollars. I am treating a young Middle-Eastern student next week, who had multiple injections of an ‘off-label’ collagen in the Middle East, producing a significant knobby appearance of his chest. Such procedures are not performed in Australia by any qualified surgeon or doctor.

It can be argued that not all procedures performed overseas develop complications, and I am sure there are a lot of patients who do have satisfactory results and a positive experience from surgical procedures overseas. The big question is, are these procedures have potential risks. The Royal Australian College qualified surgeons in Australia (myself not excluded) also have our fair share of complications. But, at least we can be relied upon to provide a reasonable level of post-operative care and follow up, and most of us as a courtesy to our patients, also provide an appropriate suited service to manage these complications and endeavour to get a satisfactory final result.

I have no personal reservation for people who wish to have surgery overseas for financial or other reasons, but I do have a reservation about taxpayers (myself included) footing the bill for follow up and management of complications of these thousands of patients. Not only does this seem irrational and illogical, but it is evident that many of these patients seek further treatment in an already over burdened public system, thus potentially depriving other needy patients of their efficient and timely treatment.

If medical tourism is here to stay and thrive, can we at least legally compel the ever enthusiastic and entrepreneurial medial tourism companies or agents to pay for the treatment of complications, or follow up, say for an arguable statutory period of at least two years or so after these procedures? I certainly feel and hope that the burgeoning costs of treatment of complications of these patients who have been treated in an unregulated and uncontrolled environment, may eventually make the federal government thing about strategies to impose restrictions on these medical tourism operators.

This article was published in Pindara Hospital magazine and is reprinted with permission.

Dr Dilip Gahankari

Dr. Dilip Gahankari is a fully qualified specialist Plastic Reconstructive & Cosmetic Surgeon, fellow of the Royal Australasian College of Surgeons (RACS) and member of the Australian Society of Plastic Surgeons (ASPS).

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