When flying or driving into Mexico, travelers are allowed to bring in certain medications, but others are prohibited. It is illegal, for example, to bring in certain common over-the-counter medicines, such as inhalers and some some allergy/sinus medications. Products that contain stimulants are prohibited, specifically medicines that contain pseudoephedrine (such as Actifed, Sudafed, and Vicks inhalers) or codeine. This is largely because the ingredients can be used to manufacture street drugs.
All prescription-level medicine (even if approved) must be accompanied by a current signed prescription from a medical professional.
Millions of taxpayer dollars are being spent in Canada repairing botched stomach-shrinking surgeries performed outside the country, suggests new research into the growing phenomenon of bariatric medical tourism. Researchers who surveyed Alberta surgeons estimate that that province alone is spending a minimum of $560,000 annually treating complications in people who have traveled to Mexico and other destinations for cut-rate bariatric surgery.
Doctors say abysmally long wait lists in Canada for virtually the only obesity treatment proven to provide long-term weight loss is driving people out of the country for surgery. Yet most don’t receive coordinated, long-term post-surgery care.
When things go wrong, Canadian doctors and surgeons are left to treat them. And their care is entirely funded by the public purse.
Medical travel companies and websites are luring obese Canadians with offers of discount prices, private drivers for pre-op “shopping and sightseeing,” and post-op recovery in four-star resorts. Clinics in Tijuana are offering surgeries such as Roux-en-Y gastric bypass, where the stomach is stapled down to a small pouch about the size of a golf ball, for as little as US$5,900. In Canada, the same surgery at a private clinic can cost $19,500.
But many medical tourists are returning home with potentially catastrophic complications, including anastomotic leakages, where intestinal contents leak through surgical staples into the abdominal cavity, increasing the risk of life-threatening sepsis.
“It’s almost like your stomach ruptures,” says Dr. Shahzeer Karmali, an associate professor of surgery at the University of Alberta, and one of the authors of the newly published paper.
Complications can be a nightmare to manage and repair “because we don’t really know what they’ve had done,” Karmali says. “There’s no real operative report; we don’t know exactly what happened elsewhere. It’s hard for us to figure out what was done, and how to fix it.”
One woman in her 20s who underwent surgery in Mexico had to have “essentially her entire stomach,” as well as part of her esophagus, removed, he says.
She will need to be fed through a feeding tube for the rest of her life.
Despite increased funding in Ontario and other jurisdictions, wait lists average five years across Canada. Only 1 percent of eligible patients are offered access to surgery. “Consequently, many patients turn to medical tourism despite potentially severe complications,” the Alberta researchers write in the Canadian Journal of Surgery.
Earlier work by the same group estimated a complication rate of 42 to 56 percent for out-of-country weight-loss surgery. In Canada, unplanned re-admission to a hospital within 30 days of bariatric surgery was 6.3 per cent in 2012-2013, according to the Canadian Institute for Health Information.
Karmali says Canadians living with obesity are being shortchanged because of lingering stigma and bias. “The stigma is that these people just eat too much and don’t exercise enough and they can fix themselves,” he said. “The reality is, it’s a significant problem and when people become severely obese it is very hard to ‘fix.’” Surgery not only improves weight and overall life expectancy, it helps reduce the drain on the health-care system and economy.
A Senate committee report released this month pegged the cost of obesity at upwards of $7.1 billion a year in health care and lost productivity. The committee made 21 recommendations to combat obesity, from overhauling Canada’s food guide to banning food advertising to children. But it was silent on reducing wait times for bariatric surgery.
Karmali and colleagues surveyed Alberta general surgeons to estimate the cost of revision surgery, ICU stays, and other interventions to treat complications in “BMTs” — bariatric medical tourists. In all, 25 doctors responded to the survey. Together they treated 59 out-of-country surgery patients in 2012-13.
Complications included slipped bands, leaking, abscesses and blood clots. The estimated average cost per medical tourist was just under $10,000 — an “extremely conservative estimate” that doesn’t include total hospital stay, blood work, nursing care, and other costs.
By comparison, the average cost of bariatric surgery performed in Alberta public hospitals was just under $14,000. “Alberta does not seem to save much money by limiting the annual volume of bariatric surgeries,” the authors write.
Studies suggest bariatric surgery accounts for a growing proportion of Canadian medical tourism, with Mexico one of the most popular destinations.
According to Statistics Canada, one in four adults in Canada — more than six million people — are obese.
Source: National Post