Thursday, August 6, 2009

New Saudi health minister takes aggressive approach to reform

It’s a rare thing these days to see a change in leadership in a Saudi ministry, and then for Saudis to witness a sea of reforms occur within a short period of time.

That’s what’s happening at the Ministry of Health following the February appointment of Dr. Abdullah Al-Rabeeah by King Abdullah.

Al-Rabeeah is faced this year with the monumental task of ensuring that Haj is held while minimizing the spread of the swine flu. But if his performance over the past seven month is any indication, he is the right man for the job.

It’s unusual that a cabinet minister takes the time to meet with average Saudis, but Al-Rabeeah, a medical doctor, has made it a point to be accessible to rank-and-file medical staff personnel and even patients.

Just a few months into the new job, Al-Rabeeah announced a series of health reforms to provide better care to patients. The reforms include a new salary schedule for Saudi physicians and pharmacists, who are notoriously underpaid. The new scale will boost salaries by 41 percent and standardize government medical personnel salaries. He also plans a pay structure based on categorizing pharmacists’ positions as pharmacist, senior pharmacist and consultant pharmacist.

Al-Rabeeah also wants to bridge the gap between patient and doctor by developing awareness programs.

But more importantly is the lack of physicians available to treat patients. By late 2008, there were 4,000 patients for every one doctor. Al-Rabeeah hopes to bring that ratio down to 400 patients per doctor. I’m also hopeful that the Health Ministry will complement the Kingdom’s 50,000 doctors by retaining and adding as many Saudi physicians as possible to that number and train more female Saudi nurses.

Al-Rabeeah’s medical training makes him a rare breed among top echelon Saudi government officials. He knows what he is talking about. He is largely responsible for Saudi Arabia’s global reputation in separating conjoined twins. The last successful effort by his own multidisciplinary team occurred recently with the separation of Moroccan twins at King Fahad Medical City. It was the one of nearly two dozen such successful procedures performed in Saudi Arabia.

All of this brings me back to the swine flu epidemic and its potential impact on this year’s Haj.

In June, Saudi health officials recommended that the elderly and very young not join Haj this year. The World Health Organization and the Egyptian government also excluded pilgrims over the age of 65 and younger than 12 from attending. While this will help reduce the number, the fact remains that last year 2.5 million pilgrims performed Hajj. While a reduction in numbers is expected this year, the number still is expected to be extremely large.

The challenges are almost too difficult to comprehend. Worldwide the number of swine flu cases is approaching 150,000. More than 700 people have died, including four Saudis. Those deaths occurred in Al-Ras, Abha, and two in Dammam.

Although not directly related to Haj, the Health Ministry announced recently that it plans to establish an electronic network to improve communications between the Kingdom’s 20 health districts to monitor swine flu incidents. The project includes 500 mobile surveillance machines distributed to physicians, medical support personnel and community leaders.

It remains to be seen whether the project will make a difference in identifying swine flu cases in a timely manner as Haj approaches. But what is encouraging, though, is the Health Ministry’s aggressive proactive approach to stemming the tide of the swine.

Saudi Arabia has experience in dealing with epidemics during Haj seasons. Southwest Saudi Arabia was hit with the Rift Valley fever epidemic in 2000-2001 and there have been similar dengue fever outbreaks. These outbreaks pale in comparison to the deadly swine flu, but Saudis and visiting pilgrims can perform Haj this year with a high level of confidence that Saudi Arabia is prepared.

1 comment:

Chiara said...

A topical and well written post!

I agree the new Minister of Health is the right man for the job. However the lethality of swine flu is overrated. It is less lethal than regular flu, but more communicable because the current vaccines don't protect against it and younger people lack immunity to similar strains of virus, that those who are a bit older do have do to surviving past outbreaks of similar flus. This too has taken clinical epidemiologists by surprise, since usually only the very old, very young and the immunocompromised die of the flu.

The biggest problem with swine flu and the Haj is all the people who might be sick for 5 days, contagious for 3-5 or if children sick and contagious for up to 7 days. That is alot of bedridden, feverish, coughing, sneezing, achy people requiring fluids, analgesics and antipyretics. It may also mean a number requiring hospitalization for rehydration.

The second biggest problem is swine flu hysteria, and stampeding pilgrims which can lead to deaths as in the past.

Anyone who is able to delay the haj shouldn't go this year, nor should anyone with chronic health problems, or immuno-compromised, or Saudi-based and showing symptoms as haj starts (though by the time of the onset of symptoms most people aren't contagious anymore).

survived "swine flu" in June