The family of a father of four who died on his return to Ireland after undergoing a weight-loss operation in Turkey say they are left with unanswered questions about the standard of care he received.
Cristian Nascimento (26) died at Cavan General Hospital after a sudden cardiac arrest in August 2023, 21 days after undergoing surgery at a clinic in Istanbul.
His wife, Karolyane Nascimento (28), said she had tried to get information from the clinic about health checks that were done before and after the surgery, and whether they had identified a pulmonary embolism prior to the operation. However, she has received no documentation – “the only thing I have is his flight tickets”.
Mr Nascimento arranged the surgery through WhatsApp and his wife has been using the same means of communication to try to get answers.
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“He had his check-up done before undergoing the surgery in Turkey. I am not sure if he had access to his medical assessments or even knew that he had a pulmonary embolism condition. I didn’t have access, either.
“I questioned the hospital and its medical team’s decision to proceed with the surgery.” If they knew he had a pulmonary embolism, she asked, how could they not monitor him afterwards? “He wouldn’t want to die, nobody wants to.”
Mr Nascimento, who moved to Ireland as a child from Brazil and worked in the meat processing industry here, was 200kg (31 stone) when he decided to undergo the procedure known as bariatric surgery.
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Following a friend’s recommendation, he booked the private clinic in Istanbul and, four weeks later, he embarked on a four-day medical tourism trip.
“He was feeling very fatigued before making this decision. He was working in a slaughterhouse from 9am to 8pm and felt a lot of pain in his leg as he was overweight,” Ms Nascimento said.
Her husband paid €3,000 which was to cover a preoperative examination, diet plan, accommodation, post-operation support, counselling and transport. In Ireland, the cost can reach €12,000.
Ms Nascimento said her husband only came to see a GP for a consultation in Ireland after the procedure when he began to deal with the surgery aftermath.
“He responded well to the surgery and was losing a kilo a day. He lost 20kg and was very happy because this is something that he tried: losing weight and going on diets.
“It was five days before he died that the complications began. And then Cristian got really sick and was sweating a lot. I said to myself that he wasn’t well. We drove to hospital that day, and he asked me to wait for him in the car. He said, ‘I love you’ and, after 10 minutes, a nurse came letting me know that my husband had passed away,” she said.
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Prof Helen Heneghan, bariatric surgery specialist at St Vincent’s University Hospital, Dublin, said it was difficult to say how many people travelled abroad as they did not have to declare it anywhere. However, it is estimated “75 per cent of people go to Turkey, and about 25 per cent go around Europe or further afield. Any surgery carries the risk profile, and for bariatric surgery, it’s low risk but can be serious even if they’re rare. The biggest concern is how patients are managed afterwards,” she said.
Prof Heneghan said weight-loss operations have a slightly increased risk of blood clots when added to air travel, which can lead to a pulmonary embolism and be fatal.
Mr Nascimento’s sister, Criscielle Nascimento (33), said her brother’s death “was and still is a nightmare”. She too underwent weight-loss surgery, having arranged the procedure before her brother died.
She believes her brother may have been told that surgery was a risk but went ahead anyway because he was so desperate to lose weight.
“When Cristian had the surgery, he made a video call and had a respiratory mask on,” she said.
“The doctors clarified to him that he had two options: lose [the battle over his weight] or lose weight. You won’t give up since you already travelled, paid and are there. When I did all the exams, the doctor asked if I wanted to proceed with the surgery. So I think my brother was naive.”
Criscielle Nascimento underwent a weight-loss operation in September 2023 at a different clinic in Istanbul.
“Everything was dealt with through WhatsApp. The bad side of it is the follow-up care. It is complicated. It’s been two months since I had the surgery… I haven’t received any diets from them.
“We feel somewhat abandoned and helpless. I don’t have a GP here. So, I’ve been researching online about vitamins and diets. I was 95 kilos, and I’m entering the fourth month with 77. It was swift,” she said.
Prof Heneghan said, from her knowledge of overseas operations, patients often do not get an optimised medical assessment, which is “not a good practice as there is no follow-up”.
“The clinics where the patients had received their operations are not accountable for the problems afterwards. Patients have no recourse when something goes wrong… and clinicians involved in their care are not responsible or take accountability for it,” she said.
Under general guidelines, the weight-loss operation could be an option when the body mass index (BMI) is 40 or higher, but the indications are broad as it can be weight-related health problems and must be assessed by a psychologist, a dietician, a medical doctor and a surgical doctor, all of whom agree that the weight-loss operation is in the patient’s best interest.
Aline Cardoso (39), a pastor at Be Church Cavan, who also underwent a weight-loss operation in Turkey, had spoken to Mr Nascimento before he travelled. She said he “was fighting for his life”.
Describing her own experience, she said she tried to lose weight through diets and exercises after being diagnosed with diabetes.
She chose Turkey for its “affordable package prices as in Ireland the cost is unfeasible” and asked for a €3,700 loan to help with the gastric bypass operation that must be paid at the clinic in cash. “I went to Turkey by myself. That was madness,” she said.
“I lost 27 kilos in seven days. When I arrived in Ireland, I followed the dietician’s plan, who monitored me for about five months. I lost 47 kilos and have yet to reach my ideal weight. I’m weighing 76 and would need to reach 65,” Ms Cardoso said.
Two of the most common types of weight-loss operation are gastric sleeve, in which a portion of the stomach is removed; and bypass, a more invasive procedure where a small gastric pouch is created which speeds up weight loss.
Another Brazilian woman who underwent the same operation in Turkey said she identified a clinic through Meta ads. It was the sharing of patients’ testimonies on social media that made her decide to proceed with the operation.
Raíra Lopes (33) has been living in Ireland for 18 years and weighed 94kg before surgery. Six months later, she is 76kg. “I spoke to a doctor in Brazil and, as I made my medical assessments there, I knew everything was fine. I’ve paid €2,300. I think it was very cheap for the quality of the service that was delivered.”
“It went well, thank God. I was exhausted from gaining and losing weight over and over again.”
Identifying the cost of healthcare in Ireland as a barrier to treatment, she said: “I don’t trust the Irish health system. If Brazilian people come to Ireland, they will realise how lucky they are to have a free healthcare system. Here or in the US, there simply isn’t. I go to Brazil every year to do all my medical assessments.”
Prof Heneghan said some patients had to wait five years for their first assessment at St Vincent’s hospital weight management clinic and then go through nine monthly assessments with its medical team.
“The waiting list to get surgery and treatment here is too long. Even in the private sector, it’s up to one to two years, and it’s too expensive. When patients go abroad, it’s four times cheaper, and I honestly think that compromises the quality of care.
“It’s more expensive to treat complications of the surgery abroad than to provide the best treatment to the person in the first instance. Healthcare costs in the interest of treating complications from abroad are so significant. I do think the Department of Health and the Department of Foreign Affairs should investigate this and try to decrease the number of people going abroad for these surgeries where they’re not performing at high-quality institutions.
“If we can’t deliver it in a timely way here and people would benefit, then I think the best advice I could give is to research carefully. So they really do need to have the support of their GP if they’re going to do this safely,” Prof Heneghan said.
At least four citizens who went overseas for medical and cosmetic procedures died last year. The Department of Foreign Affairs said that “these figures are based on those notified to the department and may not represent all those who have died following medical and cosmetic procedures undertaken abroad”.
The department also states that “individuals should be aware that they may encounter communication difficulties in a non-English speaking environment” and it “cannot provide financial or legal assistance to individuals who experience difficulty following medical, dental or cosmetic treatment abroad”.
Ms Nascimento said that “people don’t understand the risk” of having an operation abroad. “When it comes to surgery, people think it’s straightforward. As many people say, [the weight-loss operation] is a tool for losing weight. He [Cristian Nascimento] thought the same and that everything would be fine because it was working for everyone else,” she said.
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