Given the virtual impossibility to access timely bariatric care in Canada, it is no wonder that many patients, who can scrape together the money, are heading South of the border or even to exotic destinations like Mexico or India for bariatric surgery (I guess this is Canada’s version of a two-tier healthcare system).
Knowing that there are plenty of good and experienced bariatric surgeons in other countries, this may not really be a problem - that is, until things go wrong: and then things can very quickly get very ugly.
In a paper just released online in The American Journal of Surgery, my surgical colleagues and I report on our experience with 10 Albertans, who decided to bypass the long waiting times and ended up running into considerable problems upon their return (you can also read the story in yesterday’s Edmonton Journal).
Not only did they experience significant medical emergencies, but fixing their problems (where possible) ended up costing the public health care system over $160,000, money that could have been better used to provide proper bariatric care to some of the several 1000 patients on our waiting list.
Again, the problem here is not that there are no good surgeons outside Canada - the problem is that bariatric surgery is far more than about simply finding someone who knows how to operate and fixing a date for the operation. As I’ve blogged before bariatric surgery is far more than just about surgery.
More importantly, when things occasionally go wrong (as they will even with the most experienced surgeons), you definitely want to have your surgeon and the medical team close to home and not thousands of kilometers away in a foreign country.
So how common are serious complications from medical tourism for bariatric surgery? As the province does not keep exact tabs on how many people leave the province for surgery, we have no way of knowing. Are the cases we saw 10 out of 100, 10 out of 1000, or even only 10 out of 10,000 - no one knows.
The bottom line is that while medical tourism may work great for some health problems, bariatric surgery is probably not one of them.
If you have any experience with patients, family or friends who have had to travel out of your province or even abroad for bariatric surgery, I’d love to hear the story - the good, the bad, or the ugly!
AMS
Edmonton, Alberta
In The News
March 29th, 2010 at 9:33 am
So, these people cost the public health care system $160,000
March 29th, 2010 at 9:38 am
Anonymous: That is true, but because we do not know how many people leave the province on their own dime and perhaps do fine, thereby saving public costs, it is hard to say if there is a net gain or loss for the province.
The bottom line is that bariatric surgery, because of the possibility of complications and the need for long-term management is probably not the type of surgery best suited for medical tourism.
Our paper also indicates the need for more research on how many people are actually opting for private out-of-province surgery and what the outcomes and long-term costs to the public system may be.
a
March 29th, 2010 at 10:28 am
True, if people get successful surgery they save the system money.
I’d say the need for research is in prevention.
Focusing on bariatric surgery while many many more people are becoming obese is the job of the Sorcerer’s Apprentice.
Of course it’s good that sick people are treated,
but unless the tendency to overweight and obesity is turned around, we will need whole hospitals for nothing but treating obesity, (like the old TB sanatoriums) and armies of all the specialists you mention for the rest of patients lives.
The increased numbers of obese people is more of a financial threat to the system than dealing with a few cases of complications from foreign surgery.
March 29th, 2010 at 5:07 pm
Hi Dr. Sharma,
Perhaps I am in a unique position to comment on this. You must know that your implication that the complication rate or risk is higher out of country than in country is simply not true. You must be aware of the Ontario experience (OHIP). OHIP selected a few out of country centers to work with and the complicationm rate is much lower than any published statistics. Perhaps Alberts should follow Ontario’s example and select a few know centers for out of country referrals. As for going to Mexico, what can I say, if you can’t drink the water you should not get surgery there. I would be more than happy to care for the 1000 people on your waiiting list over the next 12 monthsa and you can rest assured you will not see those complications.
Bill
March 29th, 2010 at 5:38 pm
Graber: OHIP selected a few out of country centers to work with and the complicationm rate is much lower than any published statistics.
Thank you for your comments and I agree that the fact that complications are seen are by no means a reflection of the inferiority of the surgical skills at these remote site, many of which may have far more experience with the actual surgery than any sites in Canada.
The problem, as explained in my post, is with regard to individual patients, who, when they do run into problems, do not have the benefit of having the surgeon who operated on them around.
We also find (as reported in the paper) that most patients presenting with complication were ill-prepared for surgery and had in no way made arrangements for competent long-term follow up.
This continues to be a problem in Ontario, where there is no systematic follow-up of patients who have undergone out-of-province surgery and are largely left to their own devices when complications occur.
AMS
March 30th, 2010 at 8:07 am
From my experience, in Canada, with surgery (not bariatric surgery) when complications occur it’s a good idea to see someone else.
March 30th, 2010 at 9:53 am
Hi Arya
I loved this blog and hope that anyone considering bariatric surgery such as having the Laproscopic Adjustable gastric banding procedure done outside of Canada reads it. We are constantly hearing from patients who have accessed care outside Canada looking for a clinic to perform and manage their ongoing band adjustments (fills), weight lose and/or in a small % of cases fix slips or erosions caused by the band. In most cases clinics will not take on these patients because of all the “unknowns” surronding the surgery that was done and the risks that are associated with these patients. It might seem cheaper to have procedures done outside of Canada vs. Canadian prvate clincis offering banding but in the end the risk is definely not worth it
April 7th, 2010 at 5:33 pm
Hello Doctor:
Several people I know including co-workers and friends have suddenly taken advantage of medical tourism for bariatric surgery and travelled to Mexico for VSG surgery. They were facilitated by a medical tourism company that heavily markets and advertises in the area I live. I’d like to spread the word about risks, because it seems so easy that everyone wants to do it.
I wonder, how can they get enough calories after surgery to do strenuous physical exercise? I know on days when I train in karate I have to take in about 2,000 calories to provide me with the energy for my training.
Also, why is medical tourism in bariatric surgery more risky than in other types of surgery, like cosmetic surgery for example?
Any advice you can give me on getting the word out about the risks to people I know who may be considering this would be appreciated.
Thank you,
April 14th, 2010 at 1:10 pm
Dr. Sharma:
I wanted to add that, these patients are being advised by medical tourism *companies*, they are buinesses and the people who are advising these patients are not doctors. Because they are not doctors or surgeons they are not regulated by any ethical guidelines by which a Dr. like yourself would be who is counselling a patient to receive bariatric surgery. The evaluations done by the surgeon in, say, Mexico is mainly on the fitness of the patient for surgery and has nothing to do with whether they have tried any other methods to manage their obesity or not. Also, I don’t even think a patient has to be morbidly obese, but can receive surgery in Mexico if they only have, say, 60 lbs to lose. Then, like you said when these people are self-referring, there is no support there for follow-up care except, the medical tourism company, and the doctor in Mexico who is only available to answer questions but is not at all involved in follow-up with the patient.
I really find it troubling, the fact that these businesses are not regulated, that people who are not doctors are advising “patients” on major surgery, and that there are apparently no ethical guidelines for them to market and sell the surgery.
I would really like to know what you think.
Thank you.
October 27th, 2010 at 10:04 am
I am from Ontario, Canada and will be going to Uticah, NY for bariatric surgery in November at my own expense. I specifically chose to go out of province because after much research, I found that Dr. Graber has successfully performed over 2500 weight loss surgeries, that is an awesome track record. Ontario, up until recently, had been sending their patients to Dr. Graber in Uticah and nobody complained about the potential after care costs then, so why now? Even though I am paying myself, it is worth every dollar to know I will have a very knowledgeable and experienced surgeon. His clinic works in hand with my family physician for after care follow-up. I know I will be in good hands.
I am sure that in a few years, Ottawa will have ironed the bugs out of their program and will produce some awesome surgeons with great results, I just don’t want to wait.
December 31st, 2010 at 12:25 am
I am from Edmonton and am headed to mexico on Sunday for surgery. I am having the vertical gastric sleeve procedure. I am indeed nervous but have been doing so much research and following what my family doctor is saying that I feel pretty sure about going. The dietician is advising me as well. None are happy to tell the truth but are being supportive.
I have struggled for years with trying to lose 100 pounds. I have been through the emotional eating classes and many of the programs given by the Primary Care Network. I am simply tired of trying and tired of waiting.
Perhaps some think this is the easy way. I think it will be a lot of work because now there is more to lose. Not just mentally but physically too. What if I don’t get enough support at home in Edmonton? What if I don’t have enough inner strenght to eat properly FOREVER. What if I have complications? What if I die?
All of these questions occur to me but I just had to move ahead and make a decision. I have decided and I can only hope for the best.
January 7th, 2011 at 4:09 pm
I ahve now had the surgery and am recovering at the hotel. I was in the hospital for two nights three days in total. I thought I was going to die of fright being in another country and having this suregery. The care team including Dr. Ramos kelly have been amazing and made sure everything is taken care of. I will keep you more in the loop once I get home
pamela
February 18th, 2011 at 8:12 am
I had gastric sleeve done in Mexico and it was a wonderful experience. I wasn’t afraid of having it done there because of the negligence that occurred from having my c-section surgery done in Canada previously. I think it’s EXTREMELY important to research, research, research. Also, a proper aftercare program is vital to long term success.
March 30th, 2011 at 1:19 pm
The problem with OHIP or tax payers paying $ 160,000 is that OHIP & Canadian Doctor decide to stop patients from going out of counrty. I was approved to have my Bariatric surgery done in the US waited five months long months bent over backward for OHIP.18 hours before I was supposed to see ”THE CANADIAN SPECIALIST” I received a call from their office stating he was told by ”THE MINISTRY OF HEALTH” he could not see me! I then waited three more long months for the so called Bariatric clinic to pick up my file.Two years waiting for OHIP & Dr Treki to decide how much longer should I wait.Well I for one have had enough of the BULL***T games Dr Treki is playing with my life.I contacted the clinic in the U S and have decided to use the equity in my home.$25,500 US dollar to have my surgery done by ”EXPERIENCED SURGEONS”.I can not believe as a Canadian citizen and as a tax payer I and people like me have to put up with OHIP & CANADIAN DOCTORS games. The Canadian doctors will tell you if you have your surgery out of counrty you will not be seen by canadian doctors if something goes wrong.Considering I was waiting two years for a Canadian Doctor to approve me I say to hell with them all. FYI the Bariatric Treatment Center in Ypsilanti Michigan does 30,000 surgery a year and hasn’t had a patient die of them.In Canada (Guelph Bariatric clinic) mortality rate is very high reserch it online and you will understand OHIP got tried of their own Doctors complaining about the U S Doctors getting money when they should be.It’s all about who get the Canadian tax payers money not about helping Canadian people!
April 12th, 2011 at 6:43 am
I was reading the posts and alot of the info is correct but some is wrong. If you do your research you can still end up with a bogus clinic in another country. If you read what people say it is not neccesarily correct. Some services write bad things about docotrs just to discredit them because this is a competitive business in Mexico.
Some people have high expectations and you can never please them and then they trash the doctor and the service. I paid only $5,300 US dollars and could not have asked for better care from Dr. Ramos Kelly and his team. As for after care in Canada, if you are honest with your doctor about what you are planning to do then most likely they will provide you with after care. I had excellent results in mexico and excellent results with after care from my doctor here in Edmonton. Communication is the key.
Dr. kelly is brilliant and actually hates the fact that this type of service is not regulated enough. He wishes that people would take the time to do the research required and dig deep into it and not just accept what is posted on the internet. His follow up with his patients is outstanding. I had my surgery January 3, 2011 and I got a call from the patient advocate “Trish”j ust yesterday to check on me again.
The most important part of this is to be patient and talk to people and talk to your doctor. He/She may not like that you are going to go elsewhere but at least they will know what you are doing and respect you for your honesty. Get the records when you leave the hospital to give to your doctor here in Canada.
Pamela
August 23rd, 2011 at 5:13 pm
I am a disabled young person who wants gastric bypass surgery my insurance will not cover me I am entertaining surgery out of the us and want advice on centers with cheap prices but good track records
September 21st, 2011 at 10:14 pm
I also had bariatric surgery in Mexico recently and there is nothing negative I can say about the experience. I have felt completely supported before, during, and after my procedure by both my physician here as well as the company who assisted me in making arrangements. The health care I received in Mexico far surpasses any that can be received in Canada - how can Canadian hospitals compete with a facility that is staffed 24 hours a day by DOCTORS, not nurses or aids who are overworked and short staffed. As well, to my knowledge there is not one hospital in Canada to receive a medical center of excellence rating but this facility has. I was nervous going to another country but those worries were quickly calmed by the treatment I received from the minute my driver pulled up to the front door. As well, my medical assessment had to be approved by a panel in Mexico prior to having surgery. If i was not considered healthy enough, they would not have simply taken my money and operated. There is an incredible lack of support and services in this field in Canada - where obesity is an enormous problem only getting worse. Of course I would have much preferred to stay home for the surgery but it simply wasnt an option. The doctors here either are not trained, do not have NEARLY the same amount of experience, or the waiting lists are ridiculous.
October 2nd, 2011 at 5:00 pm
In August a bariatric surgery went wrong in Mexico. The doctor, who only contracts the operating room for a few hours and has no long term priviledges, sent me home. I have been in hospital for 45 days, I have had 4 procedures to repair the damage and still have no idea when I will be out of hospital. Every day brings a new complication or problem. I know I am taking up a valuable bed in a very busy post operative ward. I receive nursing care every hour and have for all these days. My Canadian doctor sees me every day and I am grateful for that. The surgeon in Mexico left a large hole in my stomach, it is called an anastomotic leak. For some it can take up to 5 months in hospital to recover. You won’t find that easily on the internet! I bought the surgery from a Medical Tourism company and they totally washed their hands….so my advice is stay away from Mexico and all the promises of easy weight loss.