Medical tourists go great lengths for cheap treatment, but with the rise of new ‘super bugs’ they may get more than they bargained for.  Alice Downey reports.

As more people travel to developing countries for cut-price medical treatment, researchers fear they may be aiding the spread of a new antibiotic-resistant ‘superbug’.  

A new gene called New Delhi metallo-beta-lactamase, or NDM-1, has been found in bacteria such as E. Coli. The gene makes bacteria highly resistant to a broad range of antibiotics, including so-called “last resort” antibiotics in the carbapenem family – the last line of defence against bacteria resistant to a large range of drugs.

Bacteria carrying NDM-1 are increasingly common in Bangladesh, India and Pakistan, but with cases also reported in the U.S.A and Europe, researchers say tourists travelling to South Asia for cheap medical procedures may be spreading them globally.

A study in the  Lancet Infectious Diseases  journal last week reported 37 cases of infection with NDM-1 positive bacteria in the UK. Researchers found many of those infected had recently undergone medical procedures in Pakistan or India.

University of Queensland infectious diseases researcher, Professor David Paterson, contributed to the Lancet study.  He says several cases of the ‘superbug’ have already been recorded in Australia.

“It appears that there have been a number of cases here [in Australia], all in people who have travelled to India for various reasons including medical tourism.”

The bacteria may have developed the resistance because of overuse of antibiotics in countries like India where prescribing controls are less stringent.

Professor Paterson says the spread of these new strains of bacteria could become a major global health problem because there are no treatment options on the horizon.

“It’s like we’re returning to a pre-antibiotic era, there’s virtually nothing that we have available to treat these infections,” he says.

Whilst Australian infection control standards are very high, the risk of contamination in other countries should not be ignored. 

So far, transmission has only been recorded through hand-to-hand contact in hospitals, but Professor Paterson says that could change.

“There are some concerns that if in places like India if the food or the water becomes contaminated, then it could be transmitted that way.”

Dr Meredith Jones is a medical tourism researcher at the University of Technology, Sydney. She says increasing numbers of people are travelling from the US and UK to developing countries for medical procedures like dental or cosmetic surgery.

“There is a worldwide rise at the moment in people travelling for cosmetic surgery, and it fits into a larger global trend for medical tourism in general,” she says.

Jones says that while Australian data is not yet available, there was evidence the high cost of elective surgery in Australia – up to four times more than in developing countries – makes medical tourism an attractive option.

Thailand, with its warm climate and close proximity is the destination of choice.

“Even when you factor in the extra costs of airfare and accommodation, it’s still going to be cheaper than having it done in Australia,” Jones says.

Dr Keith Mutimer of the Royal Australasian College of Surgeons (RACS) says that many people don’t fully understand the added risks of travelling for surgical procedures.

He says the risk of infection is high, because hygiene standards may be lower than in Australia.

“You are going to a facility that may or may not be accredited, you don’t know about the standards of accreditation – which is about infection control, nursing care, proper equipment in the hospital, backup systems – processes that we just take for granted in this country,” he says.

Jones says medical tourism is especially popular with consumers seeking cosmetic surgery, who want to disguise the fact they’ve undergone treatment.

“If you are away for three weeks or a month and you come back, you’ve got a better chance of people believing you if you just say you had a great holiday, ‘I feel really refreshed, I don’t feel tired anymore’ and people will say ‘yeah, you look great’.”

Local medical tourism companies like Destiny Meditravel and Global Health Travel market their services to Australian consumers online. These websites offer holiday packages which include accommodation, flights and surgery, and can be booked online or over the phone.

Global Health Travel offers services like cosmetic and orthopedic surgery and fertility treatments in a variety of Asian countries including the Philippines, Thailand and India. Their website claims their doctors are well trained and their hospital standards meet accreditation guidelines.

But Professor Paterson says that although hospitals may be good, people must be aware that the spread of infectious diseases can easily occur if proper hygiene measures are not observed.

“There most likely are a lot of hospitals that are affected and I think that it’s something that we do have to be very vigilant about,” he says.