Practi-Med Dubai heralds beginning of new health care oasis in the Middle East

More than 1,200 physicians, nurses, allied health professionals, and students gathered in Dubai to hear about advances in disease diagnosis, prevention, and treatment from Harvard-affiliated faculty. Practi-Med Dubai,which was held December 8-10 at the new Dubai International Convention Centre, is the first in a series of lifelong learning programs developed by Harvard Medical International (HMI) and Dubai Healthcare City (DHCC). The conference’s overwhelming attendance demonstrates the eagerness of the health care community to raise the standards of health care delivery and education in the Middle East.

Adel Saeed Al Shamsi, CEO of DHCC (left, with Dr. Harvey Makadon): “We are here not only to treat, but also to improve the quality of life through wellness programs and facilities.”

Adel Saeed Al Shamsi, CEO of Dubai Healthcare City, said that the high attendance was an indication of the faith that regional health care professionals in DHCC’s ability to fulfill its mission. “Practi-Med is one of the tools that will enhance the quality of the physicians and patient care in Dubai Healthcare City. We want doctors to stay in touch and have updated information.” Harvard Medical International is collaborating with DHCC on the design of clinical, educational, and quality management initiatives to support the development of DHCC into a regional center of excellence for health care, research, and medical education.

Dr. Harvey Makadon, HMI vice president for health systems, built the concept for Practi-Med, which has been delivered in Brazil and Japan already. Makadon worked with Dr. Beverly Woo of Brigham & Women’s Hospital to bring together an impressive roster of physician-educators from Harvard-affiliated hospitals and beyond. The list of speakers included Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine, Dr. George Gura, a coronary specialist from the Mayo Clinic, and Dr. Joseph B. Martin, dean of Harvard Medical School (HMS), who presented on advances in neuroscience. Said Makadon, “Our intent was to cover a wide range of issues relevant to health care professionals in this region.”

Dr. Harvey Makadon: “When primary care providers are present in a community, they are in a position both to prevent problems before they develop or worsen, and to provide ongoing care and monitoring after diagnoses are made and treatments are initiated.”

Starting from the beginning: improving the health of mothers and children
That intention was carried out over the course of three days, with each day organized around a number of critical health care themes. The program for the first morning was entitled “Healthy Mothers, Healthy Children: Insuring the Health of the Region.” Dr. Raymond Powrie, associate professor of medicine at Brown University, provided the latest information about caring for medical conditions in pregnant women. “An important measure of a health care system is how it takes care of expectant mothers.” Powrie presented ten guidelines for the care of these women, and emphasized that “fetal well-being is dependent on the health of the mother. While some believe that the needs of the mother and infant are at odds with each other, in fact, they overlap.” He highlighted approaches to care, and cautioned the audience against thinking of pregnancy as a disease state. “Contrary to what some believe, greater harm is generally caused by withholding treatment than by providing it to pregnant women who have medical problems,” he said.

Also during the Monday morning session, Dr. Anita Feins, HMS assistant clinical professor of ambulatory care and prevention, covered the management of common medical problems in children, and Dr. Benjamin Sachs, professor of obstetrics, gynecology, and reproductive biology at HMS and Beth Israel Deaconess Medical Center, showed a harrowing movie that illustrated the different problems that can negatively affect patient care and safety in a hospital. “When problems like these occur,” he said, referring to the movie in which an expectant mother dies due to breakdowns in the hospital system, “hospitals are tempted to play the ‘blame game’ and assume that the fault is with a person, not the system itself.”

The Monday afternoon program was divided into two tracks: an update on common medical conditions, including viral hepatitis, heptocellular carcinoma, and osteoporosis, and a presentation of advances in cardiovascular disease.

Dr. Beverly Woo, co-designer of the program: “As health care providers, we have to think about how we can increase our skills to help our patients to make lifestyle changes and achieve major improvements in their health.”

Preventing and treating lifestyle diseases
The second day of Practi-Med Dubai addressed the theme of various chronic conditions that are becoming a huge threat to the health of this region, as they have already in other parts of the world: hypertension, diabetes, and obesity. Dr. Pedro Sanchez, Dr. Soheyla Gharib, Dr. David Brooks, and Dr. Woo, all assistant professors of medicine at Harvard Medical School and Brigham & Women’s Hospital, lectured during this session. The growing importance of these problems in the region was underscored by the overflow crowds that attended the lectures and eagerly sought an opportunity to participate in the question-and-answer sessions that followed.

Sanchez discussed the challenge of managing high blood pressure, particularly resistant hypertension. “This condition demands your human skills, in understanding the human nature of your patients, as well as your medical skills.” Gharib called Type 2 diabetes a worldwide problem, but one that can be prevented. “Early aggressive management is crucial.”

Obesity, like hypertension, can frustrate physicians as well as patients, according to Woo, who said, “You cannot snap your fingers and find a solution. As with problems like smoking and drug abuse, the doctor’s orders may not be carried out.” She encouraged the audience to consider not only the physical, but also the psychological impacts of obesity, in order to be more helpful to their patients. “Lecturing to patients is not working well. We need to counsel our patients through one stage at a time, first encouraging lifestyle changes involving their diet and exercise.”

Dr. Abdulla Ben Naqi, of the Amiri Hospital in Kuwait, chaired Woo’s session on obesity, and commented afterward, “This group of patients is very difficult to approach and deal with. Unless the subject is willing and motivated, the chances of success are really remote.”

Brooks’s lecture focused on ways that the medical world is trying to change biology, where changing behavior has proved difficult. He discussed different types of surgical treatments for obesity, including gastric bypass surgery. But he warned that these treatments do not represent a shortcut or quick fix. “We have to remember that surgery is only a tool,” he said. “In the post-operative stage, it is incumbent on the patient to maintain their weight.” Although he said that surgical treatment is, at this time, the “only viable alternative for long-term treatment of obesity,” Brooks noted that these are not cosmetic procedures, and that patients should know that these surgeries carry a substantial mortality rate.

During Tuesday afternoon’s session, Drazen and Makadon turned the focus to infectious diseases. Drazen, speaking about the lessons learned from the recent SARS epidemic, stressed the importance of communication between health care providers. Makadon called Dubai “the crossroads of the world now,” and said that the enhanced status of the UAE increases the risk of spreading HIV. In the Middle East and North Africa, there has been a 100 percent increase in the number of cases, though the overall prevalence remains low.

Physicians addressing the HIV problem in this region could benefit from some lessons that have already been learned in other parts of the world. Makadon said, “Preventing mother-to-child transmission of HIV by using antiretroviral therapy is one of the best stories of this epidemic.” But there is still work to do to remove the stigma from HIV in order to prevent its spread. “We have to figure out ways to make people who are at risk come forward and be tested,” he said.

Dr. Joseph B. Martin, dean of Harvard Medical School: “Even though we’ve had a successful conference with remarkable attendance, great things do not happen overnight.”

Building a health care system: the Dubai Healthcare City model
The third day of Practi-Med Dubai in part dealt with the challenge of supporting patient care and the work of health care providers through the development of patient safety and quality management systems. Dr. Tejal Gandhi, director of patient safety at Brigham & Women’s Hospital, first discussed the concepts of patient safety, and then spoke about how to create and implement a hospital patient safety program. “The biggest issue is lack of awareness of the issues, and lack of understanding of how to evaluate error,” she said. A lecture by Powrie focused on improving patient safety specifically in the context of treating pregnancy-induced hypertension. Makadon described Dubai Healthcare City as a model for how quality management can serve as a pillar for both clinical and educational programs.

During the afternoon session, Andrew Barrer, executive director of the HMI Dubai team, talked about building health care systems from the ground up, and touched upon one of the key elements of the Practi-Med program. “Health care systems around the world are beginning to integrate prevention,” he said. Dr. Mehul Mehta, vice president of HMI, introduced the Dubai Healthcare City model to the audience. “In Dubai, because there is no legacy, or traditional, health care system, we have the opportunity to create a health care system that integrates the best practices from everywhere.”

Adel Saeed Al Shamsi closed Practi-Med Dubai by announcing that the first building of the new medical complex would be ready for operation by end of 2004. He emphasized that DHCC will be more than a collection of physicians and medical practices. “We are here not only to treat, but also to improve the quality of life through wellness programs and facilities. We will not take any shortcuts regarding patient rights,” he said.

About Practi-Med
Practi-Med Dubai was presented in conjunction with the New England Journal of Medicine and the Emirates Medical Association. For more information about Practi-Med, visit the website at www.practi-med.com. Practi-Med was created by HMI as a forum to help bring advances in preventive health and frontline medical care directly to communities. Practi-Med communicates new diagnostic, treatment, and management tools for care of acute and chronic disease, with a focus on specific regional issues. Practi-Med programs are now planned for India, China, and beyond.