Clinical and ethical perspective of neurosurgical care in patients from beyond the southern border of Turkey: challenges of patients in war

Abstract

Because an increasing number of patients travel internationally to seek medical care, Turkey offers comprehensive and outstanding services under extraordinary conditions as a neighboring country to countries that have been at war for long periods. In the past 5 years, the number of foreign patients arriving in Turkey for surgery has increased fivefold. The clinical and surgical data for non-immigrant foreign neurosurgery patients presenting for elective surgery within a 3.5-year-period are reported in this study. Data for 148 patients were assessed. The majority of these non-refugee patients were from Iraq. Ethical and social problems related to patients’ hospitalizations, follow-up, and adjuvant therapies are discussed, as well as the variety of surgeries performed. In total, 167 neurosurgical procedures were performed. Fifteen patients were previously operated on in other hospitals. Forty operations were performed for intracranial tumoral lesions including endoscopic transsphenoidal approaches. Nine shunt operations for hydrocephalus and six for congenital diseases were conducted. Eighty-four operations for spinal degenerative diseases/traumas and four for spinal tumors were performed. Eleven functional neurosurgery and four peripheral nerve procedures were performed. Other types of operations were also included. In a major surgery branch, it is generally difficult to treat foreign patients due to surgical, language, cultural/social, financial, and ethical problems. These problems and solutions are also discussed. Turkey is a preferred destination for medical tourism incorporating health screening, hospitalization, and surgical operations. Given the abundance and seriousness of surgical interventions, it is clear that larger and better supervised official organizations should be established, including paramedical and social workers as well as health care professionals.