Abstract
Aim
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.
Subject and methods
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.
Results
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.
Conclusion
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ACDF:
-
Anterior cervical discectomy and fusion
- V/P:
-
Ventriculoperitoneal
- LP:
-
Lumbar punctures
- NPH:
-
Normal pressure hydrocephalus
- RT:
-
Radiotherapy
- CHT:
-
Chemotherapy
- MRI:
-
Magnetic resonance imaging
- CSF:
-
Cerebrospinal fluid
- ICU:
-
Intensive care unit
- CT:
-
Computed tomography
References
Alghothani N, Alghothani Y, Atassi B (2012) Evaluation of a short-term medical mission to Syrian refugee camps in Turkey. Avicenna J Med 2:84–88
Aras M, Altas M, Yilmaz A, Serarslan Y, Yilmaz N, Yengil E, Urfali B (2014) Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war. Clin Neurol Neurosurg 125:222–228
Celik S, Dursun R, Aycan A, Gonullu H, Adanas C, Eryilmaz M, Gönüllü E, Akyol ME, Keskin S, Guloglu C (2017) The dynamics of prehospital/hospital care and modes of transport during civil conflict and terrorist incidents. Public Health 152:108–116
Dewachi O, Skelton M, Nguyen VK, Fouad FM, Sitta GA, Maasri Z, Giacaman R (2014) Changing therapeutic geographies of the Iraqi and Syrian wars. Lancet 383(9915):449–457
Duzkoylu Y, Basceken SI, Kesilmez EC (2017) Physical trauma among refugees: comparison between refugees and local population who were admitted to emergency department-experience of a state Hospital in Syrian Border District. J Environ Public Health 2017:8626275. https://doi.org/10.1155/2017/8626275
Kocamer Simsek B, Dokur M, Uysal E, Calıker N, Gokce ON, Deniz İK, Ugur M, Geyik M, Kaya M, Daglı G (2017) Characteristics of the injuries of Syrian refugees sustained during the civil war. Ulus Travma Acil Cerrahi Derg 23(3):199–206
Ozdogan HK, Karateke F, Ozdogan M, Cetinalp S, Ozyazici S, Gezercan Y, Okten AI, Celik M, Satar S (2016) The Syrian civil war: the experience of the surgical intensive care units. Pak J Med Sci 32(3):529–533
Secer HI, Gonul E, Izci Y (2017) Head injuries due to landmines. Acta Neurochir 149(8):777–781 discussion 782
United Nations High Commissioner for Refugees Syria regional refugee response: Regional overview. http://data.unhcr.org/syrianrefugees/regional.php (accessed Oct 22, 2013)
World Health Organization (2020) Global Health Observatory data repository. http://apps.who.int/gho/data/?theme=home&vid=19200andtheme=country
Acknowledgements
The institutions where the authors worked as of the date of this retrospective study are reported on the title page. Ethics committee approval was obtained from Yuksek Ihtisas University, since the authors were working at Yuksek Ihtisas University Medical School at that time, and the operations and patient follow-ups were done at the affiliated hospital. All data were anonymized to comply with ethical procedures and to avoid advertising a specific hospital name.
The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.
Author information
Authors and Affiliations
Contributions
Conceptualization: Pınar Akdemir Özışık, Kubilay Murat Özdener, Uygur Er, Ali Savaş.
Design of study: Pınar Akdemir Özışık, Kubilay Murat Özdener, Uygur Er, Ali Savaş.
Data acquisition and analyses: Pınar Akdemir Özışık, Kubilay Murat Özdener, Berkan Ural, Uygur Er, Ali Savaş.
Methodology: Pınar Akdemir Özışık, Kubilay Murat Özdener, Berkan Ural, Uygur Er, Ali Savaş.
Writing – original draft: Pınar Akdemir Özışık, Kubilay Murat Özdener, Uygur Er, Ali Savaş.
Writing – review and editing: Pınar Akdemir Özışık, Berkan Ural, Kubilay Murat Özdener, Uygur Er, Ali Savaş.
The manuscript was also edited for English by Enago, Crimson Interactive (certificate is uploaded).
All of the authors are members of the neurosurgical team. At least two surgeons of this surgical team participated in the surgery according to their interests for each case. Dr. Pınar Özışık was present at every surgery both as a primary surgeon and for assistance.
Corresponding author
Ethics declarations
The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee of the institute. Informed written consent was obtained from all patients prior to their enrollment in the study, indicating that all clinical, imaging and surgery records of patients can be used for scientific publication, research and educational activities. The ethical permission was obtained from Yuksek Ihtisas University Medical School. All neurosurgical operations were conducted and the patients were followed in Yuksek Ihtisas University Medical School affiliated hospital. All data were anonymized to comply with ethical procedures and to avoid advertising a specific hospital name.
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in the study involving human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the latest Helsinki Declaration.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Özışık, P.A., Özdener, K.M., Ural, B. et al. Clinical and ethical perspective of neurosurgical care in patients from beyond the southern border of Turkey: challenges of patients in war. J Public Health (Berl.) 30, 1431–1440 (2022). https://doi.org/10.1007/s10389-020-01434-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10389-020-01434-5