Medical tourism boom raises superbug risk

Medical tourism companies say more people are choosing to have serious surgery overseas in a shift from the cheap, cosmetic procedures the industry has traditionally performed.

Global Health Travel managing director Cassandra Italia said her company flew about 40 Australian patients a month to countries such as India, Thailand and South Korea for treatments including spinal, orthopedic and bariatric surgery.

"In the last year and half, we've seen about a 70 per cent increase in people coming to us just because they don't want to sit on waiting lists," she said. "Some people are accessing their superannuation or re-mortgaging their houses to get their surgery done."

But the trend has alarmed experts, including the Austin Hospital's director of infectious diseases, Lindsay Grayson, who said many Australians had returned from overseas surgery extremely ill because they received poor care and picked up foreign superbugs organisms resistant to antibiotics.

Professor Grayson said the emergence of a new superbug known as NDM-1 which originated in India and has been found in several Australian patients who had travelled overseas was "genuinely scary" because unlike other bugs, it could proliferate and colonise other healthy gut flora inside people's intestines, making them resistant to antibiotics.

"This is an incredible threat to the way we practise medicine at the moment, because the NDM-1 gene is resistant to everything except for two drugs, one of which is extremely old and toxic for the kidneys and another which is a very new drug but not very effective," he said.

"So this is making us very alert to any return traveller, let alone a medical tourist."

Peter Collignon, director of the infectious diseases unit and microbiology at Australian National University, said the threat from NDM-1 was so great that Australian hospitals should be made to isolate return medical tourists until they know they are not carrying superbugs that could contaminate hospitals.

"These people are risking bringing superbugs into our hospitals and that increases the risks for everyone else," he said.

Ms Italia said gender-selection IVF procedures were booming in Thailand because of the ban on it for non-medical reasons in Australia. Knee and hip replacements were increasingly popular among Australians not willing to wait six to 12 months for the procedures in the public hospital system, she said.

Central Queensland University economics lecturer Anita Medhekar, who is doing a PhD on the economics of medical tourism, said the industry was worth about $2 billion a year in India alone. She said top hospitals in Thailand and India were offering surgery for less than a third of the price charged in Western countries, describing it as "a win-win" for patients and developing countries.

Others disagree, arguing it drives up the cost of healthcare for local people in countries dealing with such issues as high infant and maternal mortality.

Ms Medhekar said the Indian government was promoting the country as a destination and whole medical cities were being created, complete with research centres and five-star hotels.

Ms Medhekar said groups including the not-for-profit Joint Commission International offered accreditation programs for hospitals around the world to establish minimum standards of quality and safety.

But Professor Collignon said such programs did not address the problem of antibiotic-resistant superbugs such as NDM-1, which has been found in the water supply in Delhi. "They are in a country that has very high amounts of antibiotic resistance . . . Those programs look at processes more directly to do with patient safety and don't take [superbugs] into account," he said.