NOT NECESSARILY A BENIGN PROCEDURE MARY E. HANLEY, DO, … - Hanley... · 2018. 3. 7. · • psh:...
Transcript of 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
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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WHY DO THEY TRAVEL? $$$$ WHERE ARE THEY GOING?
Ireland 2005 KOREA
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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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.
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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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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AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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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?
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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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
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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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
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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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
AOCOPM Midyear Educational MeetingMarch 8-11, 2018, San Antonio
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MAHALO! QUESTIONS????