HJLR May/Jun 2019

Healthcare Journal of LITTLE ROCK I  MAY / JUN 2019 53 Nathaniel Smith, MD, MPH Director and State Health Officer, Arkansas Department of Health such as hip and knee replacements, other orthopedic surgeries, cardiology care, and oncology care. Common destinations in- clude Thailand, Mexico, Singapore, India, Malaysia, Cuba, Brazil, Argentina, and Costa Rica. Data from a survey of U.S. travelers suggest that upwards of 300,000 people list healthcare as the reason for traveling abroad each year. Amajority of medical tourists use a medi- cal tourism company or concierge service to coordinate trips and to identify foreign healthcare facilities and providers. Some medical tourismwebsites advertise that pro- cedures outside the United States can be 30- 60 percent cheaper. A person may choose medical tourism because the cost is less; some procedures, treatments, or medica- tions may not be offered in the United States; or immigrants may prefer to receive care in their home country. While some people have good outcomes after receiving medical care abroad, substandard surgical care and poor infection control can also occur. There are many risks to consider when deciding whether to travel abroad for medical treat- ment, including inadequate communication due to language barriers and discrepancies in legal requirements for disclosure. Medical terminology can be difficult to understand even without a language barrier. Patients also need to be able to give their full medical history to avoid complications or mitigate underlying problems. Other risks vary by the procedure and the geographic location where it is taking place. Risks include poor quality of medication and blood supply; a lower standard of care; lim- ited access to the provider; and an increased chance for blood clots if you travel too soon after surgery. If there are complications from the procedure, local providers may refuse to provide follow-up care, and insurance may not pay for that care. Another potential post-operative compli- cation is antibiotic resistance. Antibiotic re- sistance is a problem globally, and there is a chance a patient could become infected with a highly resistant infection that has limited treatment options. An example is the highly drug-resistant infection related to surgery in Tijuana, Mexico. Mexican health officials identified the cause as poor infection control practices at the hospital in question, includ- ing unsafe processes for cleaning surgical equipment. The patients involved in this outbreak were diagnosed with an antibiotic- resistant form of Pseudomonas aeruginosa bacteria. According to the CDC, infections caused by this particular strain are rare in the United States and are difficult to treat. This particular antibiotic-resistant organism had never been reported inArkansas before. There are risks anytime a person receives medical treatment, whether in the United States or abroad. That is why the most im- portant step a person can take is to be well informed about the procedure, the treat- ment, the provider, and the facility where the procedure or treatment will be performed. The CDC recommends anyone consider- ing medical tourism to take the following actions: • If you plan to go to a country where you do not speak the language, determine ahead of time how you will communi- cate with your doctor and others caring for you. • See a travel medicine practitioner four to six weeks before the trip to discuss travel and risks related to having the procedure in that location. • Inform your regular healthcare provider about your plans for travel and this pro- cedure. Be sure to talk about other medi- cal conditions that may impact having a successful procedure. • Check the qualifications and credentials of the providers and facility where the procedure will be performed. There are international accrediting groups that have lists of standards that facilities need to meet to be accredited. • Get a written agreement from the facility that defines the treatment, supplies, and care included in the cost of the trip. • Take copies of your medical records, including lab work and information on allergies, and all your prescriptions, in- cluding brand names, generic names, manufacturers, and dosages. • Arrange follow-up care with your local provider before you leave. • Get copies of all your medical records be- fore returning home. Overall, anyone considering medical tourism should research and evaluate the risks before having a procedure abroad. It is also important to discuss decisions about medical tourismwith a primary care physi- cian or a local healthcare provider. n Pseudomonas aeruginosa “According to the CDC, infections caused by this particular strain are rare in the United States and are difficult to treat. This particular antibiotic-resistant organism had never been reported in Arkansas before.”