This document discusses the risks and challenges of medical tourism for bariatric patients. It provides extensive guidance on how to properly research medical tourism options to ensure safety. Key points include: extensive research is required and should include verifying surgeon credentials, facility licenses and safety standards; following up with regulatory bodies directly; understanding risks like lack of follow up care and complications; and considering quality of care is more important than cost savings. Proper research and high standards are necessary due to the lack of oversight for many medical tourism providers.

1. Understanding Medical Tourism
For Bariatric Patients

2. Medical Tourism
Medical tourism or health tourism is
the travel of people to another country for
the purpose of obtaining medical
treatment in that country.

3. Benefits of Medical Tourism:
• Affordability
• Access to faster care
• Access to care not available at home
• Access to highly trained specialists

4. Risks of Medical Tourism:
• Safety
• Lack of oversight
• Lack of accountability
• Fraud
• Complications, Infections, and
life-threatening or poor results
• Lack of follow-up and support

5. • Canada and the U.S. have high
standards of quality and regulatory
agencies and oversight organizations to
help insure competence and
experience.
• Many medical tourism providers lack
this oversight, putting patients at
undue risk.

6. Medical Tourism
It is almost impossible for
patients to know whether a
foreign hospital meets even
minimal standards of
safety and care.

7. • For patients travelling outside of
Canada, there is a lack of preoperative
testing and minimal follow-up care, if
any.
• This is especially unsafe for bariatric
patients, who require pre-and post-
follow up and support.

8. Research

9. Do Your Research?
• It's not enough to tell someone to "do
their research".
• Just speaking to people who had
surgery at unsafe places often doesn't
reveal useful information.
• Seeing videos or testimonials are not a
good way to determine if a place is safe
?

10. Research is NOT:
• Talking to others who have been there
• Looking at videos or testimonials online
• Speaking with other patients in chat
rooms or online about their experiences
• Company websites can
make almost any
claims they want

11. Research IS:
• Verification of surgeon’s credentials
directly from the appropriate authorities
• Verification of licenses, certification,
inspections and memberships for clinics
• Asking specific questions about safety,
processes, protocols, equipment and
checking the answers for accuracy and
transparency.

12. Looks Aren’t Everything
• Just because a place looks
clean, and they tell you it is
safe does not make it so
• If a clinic is not regulated or
inspected independently,
profits will likely come before
patient safety

13. • Hospital acquired infections and many
complications are often diagnosed after
the patient is long-gone
Medical Tourism Realities

14. Understanding
Foreign Laws

15. • There is little recourse for Canadian
patients who experience fraud
Medical Tourism Realities

16. • Financial responsibility for complications
falls on the patient and their families
Medical Tourism Realities

17. • Foreign hospitals won’t start treatment
without payment, even if the
complication is theirs.
Medical Tourism Realities

18. Risks to be Aware of
• improperly trained or certified medical
staff,
• inadequately sterilized operating
theatres,
• outdated equipment and instruments,
• early discharge and inadequate
postoperative care
• as well as significant language barriers.

19. Risks to be Aware of
• This puts patient safety at risk and
leaves any complications on the
doorstep of the Canadian public health
system - often without the local medical
experts required for effective treatment
of bariatric complications.

20. Demand Evidence
The only guarantee patients have to safe
medical care are independent proof of:
– Safety Standards
– Processes
– Regulation
– Oversight
These basic standards are missing in
most foreign countries.

21. • Consumers have few ways to determine
whether the facility and provider they
are considering have the credentials,
experience, training or even familiarity
with the procedure that is being
claimed.

22. Buyer Beware
• Without oversight and regulation, any
provider can claim to be safe, while in
reality they are cutting costs by failing to
provide standards of care that are
expensive to provide, such as proper
sterilization and safe OR equipment and
staff with appropriate credentials.

23. Center of Excellence
• A Center of Excellence Designation
is the only way to check if the
hospital or surgical facility is in
compliance with the standards we
would expect from a U.S. or
Canadian surgical facility.
• This is the only
independent verification
possible for consumers.

24. Common Practices
in Foreign Countries

25. Medical Tourism
• Common practices in unregulated
clinics:
– Instead of titanium staples, stainless steel
staples meant for veterinary clinics
– OR tables propped up on 2x4 wood blocks
– Missing OR equipment such as
capnographers to measure oxygen levels
– Reused laparoscopic equipment shared
from patient to patient
– Unlicensed staff

26. Actual OR
In Mexico

27. Ongoing Support
Doubles
Weight Loss

28. It’s Not Just Surgery
• Weight-loss surgery is NOT just about the
surgery.
• In fact, any experienced and trained
bariatric surgeon will tell you that it is really
only worth about 10 percent of the success
equation.

29. It’s Not Just Surgery
• The other 90 percent is found in the pre-
care, the education, the skill training,
the support portion, the follow-up care,
and the behavior and lifestyle changes,
among others.

30. Quality Care Costs Money
• When a patient seeks surgery out of the
country, there is usually little to no pre-
surgery care, screening,
testing/evaluation, education or skill
training simply because there is not time
in the trip or in the schedule and it is
costly to provide.

31. Quality Care Takes Time
• Appropriate pre-surgical programs can
take anywhere from four weeks to six
months
• (excluding patients with particular
issues that require treatment longer
than six months).

32. Medical Tourism
• The pre-surgical medical
assessment, evaluation and
training are almost universally
missing in medical tourism,
and patients may never even
see an internist.
Decisions are made based on
ability to pay, rather than safety.

33. Questions to Ask
• What are the
surgeon’s credentials?
• Have you checked
directly with the
governing bodies?

34. What Happens if there is a complication?
What is their complication rate?
• If they give you a number, or %, how do they know? How do they
track?
• Where do you enter your medical information? Who has it?
• What kind of medical information system do they use?
• Who do they report their data to?
• Is there oversight?
• How can you verify their claims? There should be reporting agency
such as the SRC
Questions to Ask

35. Questions to Ask
• Does the facility have appropriate
emergency and back-up measures and
systems like an emergency room or
critical care facility?

36. Questions to Ask
• What other medical procedures does
the clinic perform?
• How many operating rooms does it
have?
• Is there a back‐up OR, prepped and
ready to operate in, in case of an
emergency complication?

37. Questions to Ask
• Is the OR dedicated to bariatric patients or is
it used for everything from kidney transplants,
hip replacements, to neurosurgery to
hysterectomies?
• Have they just rented an OR from a private
clinic (this is common practice in Mexico with
both less reputable private clinics and
established hospitals).
• If the surgeon is just renting an OR, you need
to ask yourself why.

38. Questions to Ask
• A clear warning sign of danger would be
a clinic that specializes in an area
unrelated to bariatric surgery – ie.
Obstetrics Centers, Renal Units, Day
Surgery Centers, etc.

39. Questions to Ask
• Are they using black market implants,
medications, surgical implements and
other materials or equipment?
• Veterinary supplies or re-used
equipment is common practice in
unregulated clinics and hospitals.

40. Questions to Ask
• Is the surgical suite really sterile, or is it
just separated from the waiting room by
plastic sheeting or open doorways?
• Have they sterilized the OR from the
previous patient?
• Are you at risk for blood born
diseases such as hepatitis
or HIV?

41. Questions to Ask
• Are the medications,
supplies and other
materials outdated,
recalled, expired or
stored correctly?

42. Questions to Ask
• Are they using equipment no longer
considered safe from any time after the
second world war?

43. Questions to Ask
• Is the equipment tested? By whom?
• When was the last inspection?

44. Questions to Ask
• Will there be a language barrier I have
to overcome in trying to get information?
• What happens if I begin to put the
weight back on?
• Who will help me then?

45. Is the surgeon really a
doctor?
• Check to see if the surgeon is
really who they say they are and
actually has the credentials they
are advertising.
• Just like in Canada, both the
United States and Mexico have
the equivalent of the College of
Physicians and Surgeons.
• You can find out if that surgeon
really is "Board Certified" or if they
are just claiming to be.

46. Is the surgeon really a
doctor?
• You can also ask for
the Doctor's License
number for any
Mexican doctor.
• Every surgeon will
have two numbers,
one for general
medicine and one for
general surgery.

47. Checklist: Medical Team
• Who is the Anesthesiologist?
• What are their credentials?
• The surgeon is very important, but it’s
actually the anesthesiologist who keeps
you alive during surgery.

48. Checklist: Medical Team
• Who is the Anesthesiologist?
• In Mexico, a general practitioner can
take a several day course on
anesthesiology and that’s all that stands
between a patient and potentially
serious complications, such as brain
damage and even death.

49. Unlicensed Clinics
Once you have
established whether
the surgeon you are
considering is
licensed, now you
must research the
quality of the surgical
team and facilities.

50. Checklist: Facilities
• Is the facility licensed?
• By whom?
• When does its license expire?
• What surgeries is it licensed for?
• When was the last inspection?
• Who did the inspection?

51. Checklist: Facilities
• Is the Facility a Dedicated Bariatric
Center or a Rented OR?
• How safe is the facility?
• Is it a private clinic?
• Is it in an upscale area or in a
rougher part of the city?
• Do patients share a recovery room?

52. Checklist: Facilities
• Do the staff all speak English?
• Language barriers are a serious health
risk, especially in the event of an
emergency.

53. Checklist: Follow Up
• What kind of follow-up do they have?
• If the surgeon doesn’t speak English,
how can he communicate with you or
your family doctor if needed?
• What kind of staff do they have here in
Canada?
• Do they have nurses, nutritionists, and
counselors on staff?

54. Checklist: Follow Up
• What kind of training does their staff
have?
• What about support groups? Is it a valid
support group that adheres to the
standards and protocols of the ASMBS?
• Are there support group materials and
lesson plans or are they simply social
gatherings?

55. Checklist: Follow Up
• What kind of tracking do they do?
• What procedures do they have in place
in the event that you have inadequate or
slow weight loss or gain?
• What type of postoperative guidelines
and information do they provide? Is it in-
depth, or is it one page?

56. When I’m Back Home
• Who will do my blood tests?
• Can I find a practice at home that
will let me come to their support
group?
• Do I understand the importance of
a support group?

57. When I’m Back Home
• If I have emotional difficulties, who will
see me for these?
• How will I find reliable resources and
educational materials?
• Who can I call when I have questions or
am experiencing problems?

58. When I’m Back Home
• What if I have a complication, who will
see me?
• What if I develop adhesions or a hernia
– will a local surgeon take on my case
to help me?
• How will my surgeon communicate?

59. When I’m Back Home
• Can I trust that an emergency room in
my community will know how to treat
me, especially if I arrive unconscious
and unable to relay my situation?
• What happens if there isn’t qualified
medical professionals locally?

60. When I’m Back Home
• Who will monitor my nutritional status?
• What ongoing blood work will I need?
• What if I need medications for specific
issues related to my obesity or my
surgery?
• How will my family doctor
know what to expect?

61. Questions to Ask
• Will I be made aware of what I am
supposed to do following surgery, when
I am supposed to do it, for how long,
why I am supposed to do it, and how it
will help me?

62. Checklist: Your Privacy
• What happens to your medical information?
• Who has access to it?
• What safeguards do they have in place to
protect your privacy?
• What happens to your information after
surgery?
• How long are records kept?

63. Verify, Verify, Verify
• Google can be an effective research
tool. Type in your surgeon's name and
the following keywords to see what
comes up:
– Lawsuits, Infections, Malpractice,
Complaints, Disciplinary action, Arrest,
Legal, Court, Reviews, Scams,
Complications. Beware, etc.

64. Seeing is Not Believing
• Just because a surgeon has documents,
credentials, certificates and licenses that look
authentic – does not mean they are. You
must check directly with the organizations in
question.

65. Questions to Ask
• Does the surgeon require a preoperative
diet? For how long?
• Are their differing requirements depending on
BMI?
• A good indication of the quality of the surgeon
is the depth and quality of the pre- and post-
operative instructions.

66. If I’m Already There
• Poor or run-down transportation,
• A bad neighbourhood,
• Nurses, etc. taking blood without wearing
gloves,
• Medical team with a lack of English skills,
• Being allowed food 24 hours before surgery
• Untidy examining rooms,
• Not staying overnight in hospital after surgery

67. If I’m Already There
• What to do if you arrive and there are
red flags?
– Be prepared to leave
– Have a plan in place
– Someone should know where you are
– Listen to your intuition
– If something doesn’t feel right, do not
continue with the surgery
– Your life is not worth the risk

68. Medical Tourism
Is potentially contracting HIV or Hepatitis
or finding out that you have stainless steel
staples meant for animals worth saving a
few dollars?

69. You are Worth It
• If after reading all this, you are still
considering medical travel, then
remember: you get what you pay for.