In the days following her gastric sleeve surgery, Lucy Marshall, 28, has been dreaming about cheese. “I don’t even want to think about food,” Marshall says via video call from a hospital bed in Mersin, Turkey. “Although, I have had some lovely dreams about cheese.” When I spoke with her, she was struggling to even drink water. Her stomach capacity has been reduced to the size of an egg, although it will expand to hold about four times as much over the year. The surgery entails removing around 80 percent of the stomach to reduce the amount a person can eat. For the first four weeks post-op, Marshall is only allowed to consume liquids and pureed foods.
Marshall arrived in Turkey only hours before her surgery, one of an increasing number of people who are choosing to travel to the country for medical treatment. It is now one of the most popular destinations, alongside Eastern European countries, such as Lithuania, Poland and Latvia, for Brits seeking weight loss surgery owing to its low prices – up to 50 percent cheaper than costs in the UK – and accessibility. Marshall decided against the NHS because of wait times that could stretch to several years and the tight eligibility criteria.
“At first, I was like there’s no way I’m going to Turkey, I’m not crazy,” she says. But the more research she did, the more she became certain it was the country for her.
Turkey has become a hotspot for medical tourism in recent years, attracting nearly 600,000 people for health services in the first half of 2022, according to the website of USHAŞ, a Turkish state owned healthcare company. The International Society of Aesthetic Plastic Surgery ranks Turkey among the top ten countries performing the most popular aesthetic surgeries, including breast augmentation, eyelid surgery, tummy tuck procedures, liposuction and rhinoplasty. Turkey also ranks fifth for the total number of aesthetic procedures carried out in 2020, at just short of 950,000.
But the country has also started to garner a bad reputation: Earlier this year, the British government updated its travel advice to say they were aware of 20 British nationals who had died following medical visits to Turkey since January 2019. The medical tourism industry is not internationally regulated, so there is little comparative data available on the rates of post-procedure complications in different countries.
During the months prior to her surgery, Marshall joined a Facebook group for victims of botched surgeries in Turkey. “I wanted to hear all the good, bad and the ugly,” she says. She zig-zagged between excitement and fear – impatient to get closer to achieving her weight loss goals, but terrified of what to expect. But Marshall knew she wanted to go ahead with the surgery. “I’m desperate for the help now,” she told me. “Seeing the successes of other ladies has really spurred me on and I want that to be me next.”
Scrolling through Facebook pages catering to people considering surgery abroad, Marshall became enamoured with people’s transformation journeys and the speed with which they dropped clothes sizes.
Social media has become a stomping ground for Turkey’s medical tourism industry, which relies greatly on word of mouth marketing. Companies set up private groups for prospective patients where they share success stories. In public advice groups, people – mostly women – share their progress, or recommend what clothes to pack when planning for Brazilian Butt Lift (BBL) recovery. Others seek recommendations for specific surgeries, knowing precisely what they want, down to their preferred incision for a breast augmentation.
From all her scouring, two names stood out to Marshall. One was a surgeon based in Egypt, the other was Dr Tuna Bilecik – known across many Facebook pages as Dr Tuna – in Mersin, Turkey.
When Rachel Kibble, 34, flew to Turkey in 2017 to have weight loss surgery with Dr Bilecik, she never expected to become his business partner. Like most prospective medical tourists, Kibble discovered her surgeon online. She messaged Bilecik on Facebook and bombarded him with questions to make sure he was right for her. “He said ‘just trust me’ and I did,” she says. She was his first British patient.
After the surgery, Kibble kept in touch with Bilecik, who would connect her with British patients seeking support. “It put them at ease to know that I had been through the surgery and was English,” she says. In 2020, Kibble set up The Mediterranean Weight Loss Clinic, with Bilecik becoming the company’s in-house surgeon.
Turkey’s healthcare system has steadily become more privatised over the past 20 years, enticing surgeons to leave the public health service after serving up to 600 days of compulsory service.
As the medical tourism sector has developed, surgeons have started their own clinics, hiring booking assistants, chauffeurs and translators, while agencies have started to hire their own in-house surgeons. Other companies function as agencies, intermediary platforms between private surgeons and patients, helping to organise their trips.
When prospective patients contact a company, often via WhatsApp, an assistant or rep – usually a past patient – will get in touch to find out what the person is looking for, their availability and to give a phone consultation.
“Absolutely everything is done via WhatsApp,” says Marshall. “[A coordinator] called and gave me a consultation, which I also find quite strange because these aren’t medical professionals, these are just ladies who have gone through the same things as me.”
Kibble said that Dr Bilecik reviews patients’ medical consultation forms and may come back with further questions before recommending which surgery is best. He only speaks to patients before they arrive in Turkey if he needs to, Kibble confirmed.
For many patients, the first time they see or speak to a medical professional is when they arrive at the hospital the day before their surgery. Chrissy Forster, 38, who had weight loss surgery with Get Slim in Turkey in April 2021, says within a month and a half of her first messaging the company over Facebook, she was on her way to Turkey for surgery. She had by that stage only filled out a medical questionnaire.
“I feel really sad for myself that I was so desperate that I was willing to take such risks,” she says. She says she still thinks about those risks, despite that the surgery went well and she is happy with her decision.
Forster, like Marshall, felt willing to overlook what didn’t sit well with her during the booking process because she was desperate, and Turkey offered what she wanted both quickly and cheaply. She paid £3,250 for her flights, accommodation and surgery with Get Slim. They also threw in free teeth whitening and Botox as part of the package.
Marshall had her gastric sleeve operation at the Mediterranean Weight Loss Clinic for £3,100. She was quoted £10,500 with a private practice in the UK.
“Turkey is a leader in medical tourism because they have the cheapest prices, almost in the world,” says Jonathan Edelheit, the CEO of the Medical Tourism Association. But he shares concerns about the integrity of the industry that have proliferated in recent months. “It’s a little bit of a Wild West and that’s why you have to be careful,” he says.
“I’m not saying I’m botched, by any means,” says Dawn Benham, 43. “But the attention to detail wasn’t there and I’m asymmetric.” After having a mummy makeover – a combination of post-pregnancy procedures to the abdomen and breasts – at Irmet Hospital in April 2019, Benham realised one of her nipples was higher than the other, her areolas were different shapes and the liposuction on her stomach was uneven.
Benham is part of a 2,000 member-strong Facebook group for sharing claims against the hospital. Alongside the social media pages where patients give recommendations and advice, there are also numerous “botched” groups, where people share negative reviews. Their complaints range from concerns about gruesome scarring to claims of poor bedside manner. In more serious instances, people claim they have contracted sepsis and accuse hospitals of poor hygiene or tell stories about ending up in intensive care with post-surgical complications.
“I couldn’t fault the care that I had when I was there,” Benham says. “But I feel let down and that they’re not professional and that they just want your money and then don’t care what happens.”
When Benham got in touch with the hospital about a revision, she says she was told she needed to wait a year for the surgery to settle. A year later, she was told the surgeon who did her surgery no longer worked with Irmet and the hospital would consider people for revision at a later date. The pandemic came and Benham heard nothing. She got in touch with the hospital again and was told it may be too late for a revision but to send pictures nonetheless. That was in November. She hasn’t heard back since. Irmet Hospital did not respond to a request for comment.
“Perhaps they would have done a revision and been better at responding, but there’s so much demand they can’t keep on top of it,” says Benham. “It’s almost like, pile them high and get them through the conveyor belt.”
Mert Karakuzu, owner of medical travel agency Estetica Istanbul, says the industry is oversaturated. “When you are dealing with so many patients, you don’t focus on individual patients, you focus on the big number,” he says.
Estetica sees about 50 patients a month. Others, like Get Slim in Turkey, see hundreds of people a month. The Mediterranean Weight Loss Clinic saw 110 in June alone. Kibble says the number of procedures Bilecik does each day depends on which surgeries he is performing. The day we spoke he was doing eight. Kibble could not confirm if that was the maximum he would do in a day.
The Mediterranean Weight Loss Clinic has not escaped scrutiny from anxious patients hoping to leave no stone unturned before going for surgery. The company was forcibly struck off from the UK’s registry of companies in December 2021, prompting patients to ask why. Kibble says the company was struck off for the failure to submit a document on time and has now registered the company under a different name, MWLC Ltd.
As the medical tourism industry has grown, the Turkish government has introduced measures both to regulate the industry and encourage its expansion, including VAT exemptions for foreign medical patients. The country has set a target of attracting 1.5 million health tourists in 2023, aiming to generate £10bn in annual income from the industry.
In 2017, the ministry for health introduced regulations to try and standardise medical tourism that make it compulsory for hospitals, clinics and agencies to obtain an International Health Tourism Authorisation Certificate, in addition to regulating prices, promotion and requirements for surgeons who lead health tourism units where they work.
Kibble thinks the industry is heavily regulated, but Karakuzu disagrees. “It is not enough,” he says. According to Karakuzu, the government fail to closely implement regulations and close down illegitimate companies.
But it’s too soon to tell where things are going wrong in the industry, says Cheryl Palmer-Hughes, a solicitor with English firm Irwin Mitchell who is working on multiple claims arising from surgery abroad. “This [industry] has picked up massively over the past few years, so it’s only relatively recently that we’ve begun to see outcomes of inquests, for example, trying to establish what happened.”
She says cases range from allegations about surgical technique to the suitability of the patient for surgery or the ability of a hospital to respond to emergencies. These are issues that arise in medical practices around the world, she adds, but the firm sees a high proportion of inquiries related to surgery in Turkey.
One month post surgery, Marshall is starting to eat solids again. The recovery has been smooth and she’s nearly lost two stone. “Looking back, I think wow that’s crazy, I can’t believe I did that,” she says. But Marshall has no regrets: “I would do it again in a heartbeat.”