NOT NECESSARILY A BENIGN PROCEDURE MARY E. HANLEY, DO, … - Hanley... · 2018. 3. 7. · • psh:...

AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio

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NOT NECESSARILY A BENIGN PROCEDURE MARY E. HANLEY, DO, UHM

•MEDICAL DIRECTOR

• WOUND RECOVERY & HYPERBARIC MEDICINE CENTER

• ROPER ST FRANCIS HOSPITAL

• CHARLESTON, SOUTH CAROLINA

CHARLESTON DEFINITION

• A person who leaves his/her country to receive medical care /treatment.

DEFINITION

• Medical tourists elect to travel across international borders to receive some form of medical treatment

• Treatments may span the full range of medical services

• Most common: dental care, cosmetic surgery, elective surgery, and

• fertility treatment – OECD, 2010

• No agreed definition of medical tourism exist; as a result methods applied by countries vary substantially

• Some countries count foreign patients’ visits to hospitals whereas others count the entry of individual patients into the country

• Other countries record nationality but not place of residence of patients, can be problematic when migrants return to home country for treatment – WHO, 2011


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WHY DO THEY TRAVEL? $$$$ WHERE ARE THEY GOING?

Ireland 2005 KOREA


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MALAYSIA 2011 SURVEY OF MIDDLE EASTERN COUNTRIES

THAILAND INDIA

OVERSIGHT OVERSIGHT

• WORLD HEALTH ORGANIZATION: Expressed concerns back in early 2000’s regarding organ procurement and transplantation practices in foreign countries.

• JOINT COMMISSION INTERNATIONAL: Group that is trying to bring standards of JCAHO with regard to safety, sanitation, and standards of practices in foreign hospitals. Voluntary certification.

• Beware of where you get your information. Many for profit companies selling “packages” for patients seeking surgery abroad.

• Also concern over diversion of care and services to cash paying foreign patients from locals.


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Human organ trafficingOrgan Trafficing

• financial gain on the organ as such (commercialism) and/or lack of consent of the donorand/or transplantation outside of the established system

• TRANSPLANT TOURISM

• involves the donor, the recipient or both crossing national boundaries for the recipient to access a trafficked organ.

MEXICO 2010 MARCH 2017

Organ Trafficing 2005-6

• Major Countries:

• China: Kidney, liver, lung, heart < 12,0000

• Phillipines: Kidney < 700

• Pakistan: Kidney < 3000

• Columbia: (Cadaveric only) Kidney <1000

• India: Kidney < 4000

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MULTIPLE INTERNET COMPANIESSOME FAMOUS MEDICAL TOURISTS

KING HUSSEIN OF JORDAN 1939-1999 SHAH OF IRAN DIED OF CANCER IN EGYPT IN 1979

SAUDI ARABIAN ROYAL FAMILY But what if something goes WRONG?


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CASE STUDY: MARIA 26 YO FEMALE• PMH: NEGATIVE

• PSH: S/P BREAST AUGMENTATION 3 YEARS AGO, SAME SURGEON IN COLUMBIA

• NO COMPLICATIONS FROM THIS PROCEDURE REPORTED.

• SOC: SINGLE, 1 SON 1 YEAR OLD, ETOH SOCIAL, TOBACCO 1 PACK A MONTH.

• NO ILLICITS. WORKS FOR A BANK.

• FAM HX: MOTHER AND SISTER OF PT HAVE HAD BREAST AUGMENTATIONS

• WITH SAME SURGEON IN COLUMBIA WITH NO COMPLICATIONS.

CASE STUDYMARIA 26 YO FEMALE• RETURNED TO THE US WITH LARGE, OPEN, DRAINING NECROTIC

WOUND.

• WENT TO PCP WHO REFERRED HER TO WOUND CENTER.

• MODERATE AMOUNT OF NECROTIC FAT AND TISSUE PRESENT AT FIRST VISIT. REQUIRED EXTENSIVE SUBCUTANEOUS DEBRIDEMENT.

• EVENTUALLY WOUND CLEANED ENOUGH TO BEGIN NPWT.

MARIA 9/26/2017 MARIA 9/26/2017

Maria10/3/2017

MARIA 10/10/2017


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MARIA 10/20/2017Maria NPWT STARTED10/25/2017

Maria 10/27/17 MARIA 11/21/2017

MARIA 12/15/17 LESSONS LEARNED FROM MARIA’S CASE


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LESSONS LEARNED FROM MARIA’S CASE

• DO NOT LET YOUR RELATIVES OPERATE ON YOU.

• CAVEAT EMPTOR (BUYER BEWARE) IS THE LOWER PRICE WORTH YOUR LIFE?

• STERILIZATION AND RE-USE OF EQUIPMENT- WHAT ARE THE PRACTICES IN THE COUNTRY YOU ARE TRAVELLING TO?

• ANESTHESIA AND CRITICAL CARE FACILITIES: WHO ADMINISTERS AND MONITORS ANESTHESIA? IS THERE AN ICU? BLOOD BANK?

• REMEMBER, NO SURGEON WANTS TO TAKE ON ANOTHER SURGEON’S COMPLICATION. WHAT WILL YOU DO IF SOMETHING GOES WRONG?

KNOW YOUR HOSPITAL

KNOW YOUR SURGEON! KNOW YOUR ANESTHESIOLOGIST

PLAN FOR COMPLICATIONS

• WHO WILL CARE FOR YOU WHEN YOU COME HOME OR IF YOU HAVE AN EARLY OR LATE COMPLICATION?

• IF YOU FAIL TO PLAN, YOU PLAN TO FAIL!

HAWAII 2017


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MAHALO! QUESTIONS????

NOT NECESSARILY A BENIGN PROCEDURE MARY E. HANLEY, DO, … - Hanley... · 2018. 3. 7. · • psh:...

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