Hospitals easily compete with shopping malls and high-rise office buildings in size and number of people, yet hospitals are notoriously more difficult to navigate. With the sheer number of parking lots, entrances, separate and connected buildings, departments, restricted access areas, and individual offices, it can be a serious challenge for patients, guests, and even staff to find their way.

It’s easy to understand the inefficiencies of having people get lost – from raising levels of anxiety to the costs of missed appointments – but there are many other implications of a facility that’s difficult to navigate.

As digital wayfinding and signage improve and real-time wayfinding is being incorporated through wearables with haptic capability and other apps and hardware, we’ll continue to see improvements that will benefit guests, visitors and those who work at a hospital or healthcare campus.

Immersive and interactive media is one of these tools, and a powerful one at that. Below I discuss several opportunities for interactive media to support hospitals operations, patients and families.

Asset tracking

When it comes to hospital efficiency, asset tracking is one of the biggest hurdles. Beds, equipment, wheelchairs — much of what’s in a hospital is designed to move, which can make asset tracking a serious challenge.

Launching an interactive map with built-in asset tracking — via RFID and beacons or other tech can give staff a hospital-wide view of assets. “Digital twinning” — terminology for the digital version of a physical object — is an approach being used in a host of other industries. With this asset tracking system, not only can staff find the location of items on a desktop or mobile device, but with an interactive map, they can find the fastest and efficient way to get to it and move it to the desired location.

On large campuses with city or private shuttles, transit tracking will provide staff and visitors a live view of where shuttles are, along with actual departure and arrival times for each stop.

Additionally, digital twins can provide data feeds to the map, such as the date and time of last maintenance and battery levels. The system also makes checking inventory much easier, as instead of spreadsheets, a staff member can look right into a digitised room and see what’s there in seconds.

Such a system can certainly improve efficiencies, but it can also improve patient care by making it easier for staff to locate critical items.

The all-important patient experience

The anxiety of a hospital visit is real and navigating a hospital building can add to the level of stress. Once an appointment is scheduled, a lot of this anxiety can be removed by sending the patient and their loved ones an interactive map and/or virtual tour that show the best parking area, entrance, and other areas of their visit.

These immersive experiences can be easily built with virtual tour software that integrates 360-degree images, to give a full experience that’s even VR-ready for those with the necessary hardware. Virtual tours are a powerful way to improve your web presence and provide greater peace of mind for patients, who can now “visit” a room or area before ever arriving on site.

Additionally, these tours can also highlight on-site wayfinding, such as colour-coded signs and other marking and signage to look for to help them get to their location.

On-site tools to locate amenities such as the gift shop, dining, wheelchair pick-up points and serene outdoor spaces will make patients feel more comfortable and cared for; the more comfortable visitors are, the better the overall service provided will be.

Staff support and training

Interactive maps help both newly hired staff orienting themselves and long-time staff helping guide someone else, and many hospitals find that their staff is among the most frequent map users.

Being able to navigate the hospital is vital for anyone who will be spending a reasonable amount of time in and between the buildings. Often, hospital staff will take half an hour or more to give new regulars a thorough tour but walking the halls and hearing an explanation only sticks for a few people. After the tour, most people will still be lost for their first few days and can sacrifice a lot of time asking other staff members how to get around.

Interactive maps with integrated virtual tours allow staff members to explore the entire facility as well as the best routes for their particular needs, even before coming to work. So, whether they are seasoned professionals or right out of med school, hospital staff members can plan ahead and eliminate one part of a busy day.

Additionally, interactive media can be used for training purposes, showing staff via desktop or mobile device how best to navigate the hospital/campus, find supply rooms, and cafeterias, among other training needs.

Energy and facility management

Once floor plans are built into the digital map, there are many additional data tracking tools that can be added to the system. Dynamic maps have the ability to show energy usage data, HVAC maps, construction, closures, routine maintenance loops, and additional facility information, all in one, highly visual hub of information.

With all energy usage and facilities data located in one space, managers can detect and diagnose issues more quickly and efficiently. And real-time video feeds can take them to a specific location, saving them a drive or walk. With data feeds linked into a location-aware system, a hospital can improve its operational costs and efficiencies. By plugging in the right data feeds, a digital map can become a smart-technology hub.

Managing facilities often involves communication to visitors and staff regarding campus happenings that might affect how they get around. This could be maintenance on a particular elevator for one day, or campus construction over several months. In any communication, links to map images that give context will increase efficiency in the messaging.

Safety and security

Hospitals can use maps to provide handicap-safe routes for visitors and patients, by altering the usual navigation services to always take elevators and ramps. Also, map administrators can actively update a map to block off and put warnings on hazardous areas. In that emergency situation, hospitals can have pre-planned routes attached to its map and anyone can have access to that emergency plan if they have a mobile phone.

Digital maps and virtual tours are more than just physical wayfinding tools. They can serve as strategic solutions that help hospitals meet internal goals for efficiency and customer and employee satisfaction. From no longer needing thousands of static maps to asset tracking to fewer missed appointments, dynamic, interactive maps have a significant role to play in the modern hospital.

 

In the past two years, the Dubai Health Authority (DHA) was the first organisation in the UAE to implement the GS1 barcode standards on all pharmaceutical transactions in its hospitals and health centres. Utilising the world’s most widely used barcode system helps to minimise possible errors when dispensing medication.

Assigning each medicine with a barcode permits the traceability of products at every stage within the healthcare supply chain and helps to eliminate counterfeit medicines, improving patient safety.

Healthcare providers can secure greater benefits through adopting these internationally recognised GS1 barcodes further, and this is certainly the case in hospitals in the UK where it is mandatory to adopt GS1 standards.

Hospitals in the UK are demonstrating enormous success, implementing innovative technology, which is providing significant operational efficiencies at a critical time for healthcare. It is this appetite for inventory management and increased back office efficiency that is experiencing an increase and becoming recognised worldwide.

Ingenica Solutions has been instrumental in reshaping the British National Health Service (NHS) supply chain and procurement landscape, delivering successful projects and brining significant benefits across the NHS; providing solutions to enable track and trace of products, people, and equipment.

The healthcare providers we work with are using our technology to enable the automation of the replenishment process, improve how clinicians, procurement and finance staff work together to choose products and services that are cost effective in the short and long term, and crucially, offer the best outcome for patients. It’s encouraging for those involved in healthcare to realise that these benefits are transferrable and replicable across any healthcare organisation, in any country.

In practice

GS1 data standards are used in healthcare to enable the track and tracing of products, caregivers, locations and patients. The impact of utilising barcoding technology in healthcare is immense, from the clear cost saving and efficiencies, the benefits that are widely recognised, to the lesser talked about but incredibly vital role it plays in supporting better patient safety and saving lives.

Inventory management is one of the pillars of the GS1 programme and really drives change, efficiency and patient safety. So, what’s innovative about inventory management in healthcare?

In the past, the management of inventory in hospitals has been achieved through largely manual processes, which essentially involve checking a shelf to see if more is needed to be ordered, frequently only minutes before a planned operation. Hospitals have been highly reliant on manual input or incumbent knowledge, and are therefore expensive to run. Visibility of supplier performance in this common scenario is largely anecdotal from clinicians and so a procurement officer would have little hope of evaluating a supplier’s performance over a period of time or within a department, let alone across a hospital or groups of complex hospitals. As a result, a range of informal, person reliant processes and systems emerged.

Hospitals often have many different systems managing various functions of the organisation, and often none of these will use the same data structures or integrate fully with each other. This means that usable data to understand what is happening in the organisation is difficult to patch together. Many of these systems are not built with healthcare management as their core purpose. A good inventory management system will help connect and gather data from a multiplicity of sources of validated data – providing a single robust core of management data from which to base decisions.

Real inventory management is indeed a core enabler to change in healthcare, and improvement to management of the supply chain. In healthcare though it is far more than that, it is a core enabler to so much more; including improving patient safety, reducing the running costs of a healthcare organisation, and tracking and tracing products.

The implementation of a robust inventory management solution forces good practice in procurement and the adoption of common standard operating processes across an organisation. This opens up a host of possibilities around how a product is bought, replenished and distributed by the organisation; the internal supply chain.

As an example, we may know what supplies hospitals are buying, but do we know what supplies are actually being used? A large percentage of hospital budgets are spent on non-pay goods, which can equate to tens of millions per hospital on goods ranging from a box of tissues to high value medical implants; therefore, understanding what is actually being used is essential.

Impact of inventory management

Innovative inventory management in healthcare has a huge impact on value, not just costs, which is crucial at a time when healthcare providers across the world must maintain a constant eye on spend. Procurement has been subject to enormous scrutiny and attention, and hence new, better ways of working are now rapidly being adopted.

Overhauling inefficient tools as addressed earlier, and adopting processes used successfully for many years in the commercial sector can and is, enabling the changes healthcare so desperately needs. However, in a multi-faceted, challenging clinical environment, inventory management is more complex than in the commercial world. Standard finance applications have been shown to be too difficult to adapt to the healthcare inventory management environment, hence the development of dedicated systems.

The benefits of an innovative inventory management system extend across an entire hospital, across all departments: clinical, finance, procurement, ICT, and beyond.

Clinical

1. Improves patient safety

– Enables access to reliable and robust data to make informed decisions

– Minimises risk of errors

– Releases clinical time back to patient care

2. Reduces clinical time spent on administrative duties

Finance

1. Enables strategic financial decisions

– Enables access to reliable and robust data to facilitate price comparison

2. Enables greater financial efficiencies

– Enables understanding of the true cost of patient care

– Determines the real cost drivers across the organisation

3. Provides better cost information

– Reduces man hours on reporting

Procurement

1. Improves product visibility and transparency

– Real time access to status of stock, purchase levels, supplier performance, pricing trends

2. Better stock and data management

– Reduces wastage

– Reduces inefficiencies

ICT

1. Supports the use of GS1 data standards

– Enables data to be compared, shared and analysed

2. Flexible, robust, innovative technology

There are still some hospitals that have no reliable electronic inventory management system, relying on clinical and supply chains team local knowledge to manually create orders; an option that simply cannot support the demands and requirements of hospitals in today’s healthcare environment.

The challenges for these organisations are clear; lack of data, lack of visibility and transparency across the supply chain, the cost of over and under-stocking, and wastage. All of which create inefficiencies and have a huge impact on budgets.

Healthcare providers worldwide face the same procurement and supply chain management challenges, and to resolve these common issues, which are often aggravated by inefficient practices, inventory management is core.

For instance, in the UK in recent years, as the benefits are more widely reported, there has been a real change in the value that hospitals place on inventory management. There has been exceptional progress; best practice, which is now actively being shared across the industry, across the world. Greater collaboration is also evident as hospitals work with others to take procurement and supply chain practices to the next level.

There are many well-recognised best examples to cite on inventory management; projects that have saved millions of pounds, projects that have helped return clinical staff to patient care — all projects that are easily replicable by other healthcare providers seeking to reduce spend. The British NHS is certainly a window on the world, and the long-term impact of innovative inventory management is considerable; it delivers value for money across healthcare, worldwide and improves outcomes for patients.

Chatbots and Artificial Intelligence (AI) can seem complicated especially when trying to figure out how these tools can be applied in healthcare. Nevertheless, chatbots are the simplest pathway for any provider group or healthcare business entity to introduce the new technology into their business processes.

What are chatbots?

Anytime a customer engages with the “person standing by” on a website, and the customer is told to click on the “word balloon” in the corner (to escape wait time) it is highly likely the customer is going to talk to a chatbot. The chatbot is programmed to answer the most common questions for which the customer is seeking an answer. Chatbots replace the “live” customer service agent of past decades with an algorithm; a programme that can be quite simple or quite sophisticated.

“Having one person call one person takes a lot of human capital,” says Dr. Z. Brown of Northwell Health Solutions.

Apply chatbots to any frontline patient interaction

The applications to which chatbots are being assigned is growing and will continue to grow. Here are a few of the popular ideas for deploying chatbots:

1. Virtual assistants handle simple, repetitive tasks.

2. Chatbots interact with the patient/consumer using keystrokes (from laptop or phone) or voice.

3. Chatbots can address each inquiry as a new or familiar inquirers (patients).

4. Chatbots work with patients, healthcare centres, insurers and providers.

5. Programming can be fairly simple if one uses a platform based upon natural language processing (NLP).

6. Chatbot are not apps although a bot can point the inquiring party to an app.

7. Chatbots collect information the user and the provider want collected.

Chatbots are one component of my Healthcare Information Technology class. Chatbots are well known to my millennial students who prefer a passive interaction. Accessing information need not have a living breathing person on the other end. When the other end is occupied by an algorithm – like a chatbot – that is even better! A decade or longer of texting and social media has closed the era of “live” conversation. Besides, chatbots can simulate conversation faster than you can say “I have a question.”

Building a chatbot is like planning an important conversation. Suppose you are going to meet with a vendor that wants to talk about fees or referrals or anything else related to business. The information is important. The encounter must be engaging, warm and polite. You want to plan ahead. Identify topics you can expect to come up. Figure how you will respond.

Apply this to a patient encounter. The steps that have preceded every patient encounter for generations are completely predictable. Most can be handled with a chatbot instead of a human.

The chatbot approach covers the same tasks. The headers – intent, action and information - are terms that define steps in building a chatbot.

How to think like a chatbot

The INTENT is the predictable conversation, which the patient will initiate. The ACTION completes the predictable activities that recede and follow the patient visit. The INFORMATION is what gets collected, which describes, summarises and logs the patient visit.

What does every patient want (INTENT)? To easily arrange meetings. Less interaction with the office is better than more. The inquiries which typify many kinds of patient behaviour are dictated by custom. These are predictable encounters.

What does the front desk want (ACTION)? Let the chatbot respond to the patient intention. The chatbot can look up dates and find open time slots. It can confirm to the patient if there have been any changes in employment or insurance coverage. If there has, the bot can fetch this after the phone call and before the appointment; easier when the employer and insurer has AI capabilities. Otherwise the medical assistant will have to make a phone call!

When the medical visit is completed, how are the records populated (INFORMATION)? Information summaries are logged in the EHR. Data can also be texted to the patient’s wearable device or to an email.

“We’re surrounded by work that is being done over and over by humans that’s not necessarily the best use of their time,” says Greg Johnson, CEO LifeLink.

Can chatbots be warm and fuzzy?

A chatbot can be quite personable. It is all up to the programmer. Warm conversation is also predictable; even seasonal. Greetings change with generations. You may have noticed the standard “openers” or “closers” for commonplace conversations.

Popular warm greetings or sign offs include “I hope you are having a great” or “I hope all is well with you.” If you are going on a trip for business, you will almost receive the warm “safe travels.” Whatever happened to bon voyage?

These friendly greetings are easily programmed in a chatbot. We want the chatbot to be familiar, certainly polite, and even nice. Once we get used to engaging with a chatbot we also want it to do more for us! Looking for chatbot is a lot like shopping for any desirable product; shoes, briefcase, vehicle. Relying on chatbots can quickly become habit forming.

A local burger and fried chicken stop in Denver, U.S. implemented a chatbot this month to handle the drive-thru window. “The system takes a lot of friction out of interactions between customers and employees,” the owner said, noting that the AI was designed to sound like an amiable woman’s voice.

“The AI never gets offended and it will just keep talking to you in a very calm and friendly voice.” Employees that are commonly assigned these repetitive tasks may also appreciate the relief from the routine.

Can a Virtual Assistant (VA) become the perfect employee?

Conversational interaction distinguishes this interactive bot from the earliest “fetch-bots” Siri and Alexa and Google Assistant. The VA handles predictable repetitive questions. The VA can learn from the different ways in which a question is asked. The more the VA chatbot gets a question in a different form the better the bot can become at answering the question. The VA saves time and increases practice efficiency. And time is money.

A chatbot is an algorithm (commands) that can record data on the fly and make a searchable record. The record includes searchable indicators, e.g., timestamp, contact’s address/phone, call length, etc.What exactly are chatbots? Algorithms make up chatbots. Algorithms are programmes. The greater the number of programmes/algorithms the more complex the chatbot. At the least, chatbots should replace the most simplistic time-consuming redundant tasks.

Also, consider that hardware speed, frequency of use (beyond comprehension), and the growing preference for “more passive, text-based communication” places chatbots in position to replace time intensive, active communication when called upon to respond! Better to respond when we feel like it; when it is more convenient to the person being prevailed upon.

Chatbots leverage several basic laws of computing that guarantee their proliferation. Computing power and speed is close to becoming limitless. Moore’s Law held that CPU speed would double every two years. Once CPUs are the size of atoms speed will become irrelevant. All speeds will be immediate. Other considerations are the concepts or machine learning and deep learning. The machine learns on its own. This ability makes the chatbot astute. Independence is in the future. Alexa, Siri and Google Assistant learn from frequency of use. Each derives from a database that grows with each interaction. Speed and algorithms are part of the engines driving the AI Assistants.

Ready to welcome the new employee?

Integrating a chatbot into a new or current business model means the “programme” will function as a new employee; rapidly co-existing amongst other technologies is becoming commonplace in healthcare; such as mobile apps, remote clinical devices that collect and transmit digital health data, secure clouds and more. Chatbots are attractive to small businesses and the largest powerhouses around the world. Healthcare can deploy the chatbot within a half hour of time and receive the endless benefits other sectors have rapidly seen. Adopt one? It is too simple not to.

Innovative chatbot platform launched in UAE

Medcare, a UAE-based hospital group, recently announced the launch of its new “virtual health assistant” chatbots. The two new health assistants use advanced artificial intelligence (AI) algorithms to learn about the patient in order to personalise responses and give accurate information in real-time.

The health assistants are reportedly the only chatbots in the region that allow the patient to manage all aspects of their appointments online including booking, rescheduling and cancelling, permitted by real-time back-end database integration.

A distinctive feature of the chatbot technology is that it has been humanised to make the health assistants intuitive, patient-centric and patient-friendly. Patients will be able to “talk” to the health assistants and use this new platform throughout their entire healthcare journey. They will also be able to see lab reports online, check insurance coverage and locate the nearest Medcare facility in order to receive timely treatment.

A recent trend in healthcare has been the increasing shift to a value-based model that is focused on improving the quality of patient outcomes while enhancing care and implementing initiatives that control costs.

A recent report titled ‘Value in Healthcare: Accelerating the Pace of Health System Transformation’ by World Economic Forum, in collaboration with the Boston Consulting Group (BCG), highlighted that in a world characterised by an ageing population, and with more people suffering from long-term chronic disease, and increasing costs, improving healthcare value by delivering better health outcomes to patients at lower costs has become a critical imperative.  

In an interview with Arab Health Magazine, Jad Bitar, Partner and Managing Director at BCG shared: “Today, we are starting to move away from strictly curative and preventative models to value-based healthcare.

“It is not only about minimising mortality and keeping you healthy, but about ensuring top outcomes not only as science or the clinicians decide but also factoring in what is important to the patient, and to the least cost possible.

“For instance, I can have a million-dollar treatment for cancer and might save five per cent. But the question is that, am I, with this additional dollar able to have an impact on the most number of people the way they want? Some individuals with cancer would prefer to go into palliative care at home and die peacefully. The opinion of the patient is paramount when you are measuring value; it’s not only a clinical perspective that we need to save people at any cost. This is a new concept, which has been around for the last few years.”

Bitar explained that what value-based healthcare brings to the table is a major challenge to clinicians and managers in the healthcare system. It is telling them that the way they have been operating is good, but it can be improved. Clinicians have been focused on treating diseases, but now they need to step back and think about the humans in front of them and engage with them.  

The report defined value as the health outcomes achieved for defined population segments (for example, all individuals suffering from a particular disease or belonging to a specific risk group) for a given cost. It explained that value-based health system’s goal is to improve outcomes and reduce costs through the provision of improved, segment-specific clinical interventions.

He said: “The clinician is no longer the unique pilot, they are co-designing, and we have seen this in the last 10 years. This is known as consumerism in healthcare where patients are becoming more and more involved in defining what they want. Today, physicians need to be ready to engage in a dialogue, and it is one of the important components of value-based healthcare.”

The second factor of consideration is for the manager. According to Bitar, they have been focusing on the wrong KPIs, such as how many doctors they have, how many beds and MRI machines they have, etc. The managers tend to focus on, for instance, if the average length of stay has been reduced, but value-based healthcare says that the focus should be on outcomes.

Bitar gave the example of prostate cancer. The factors for consideration should not only be the mortality rate and how many patients survived the procedure, but other factors important to the patient such as the incontinence rate as well; after the treatment, were they able to have a quality life. It’s not only about saving lives, it’s more than that.

The focus of value-based healthcare is more on quality of life. When you talk about value it is not just in financial terms, but to highlight the value for all the stakeholders – for the system and clinician but for the patient too. However, it is not only about the value and benefits created, but also the cost at which the clinicians and the management are able to deliver this benefit.

According to the report, one critical enabler of value-based healthcare is health informatics – information technology software and systems, as well as methodologies for the collection, management, use and analysis of health data. The report calls for a comprehensive agenda for accelerating the development of global health informatics standards. This agenda includes a call to action for the creation of a “digital health bill of rights” that puts patient empowerment at the centre of informatics standardisation efforts. It also defines approaches for assessing current standardisation initiatives, endorsing emerging standards, developing new use-cases and publishing guidelines for the implementation and adoption of global informatics standards.

He concluded: “In the last few years since the value-based healthcare model has been adopted, we are seeing some very interesting experiments all over the world."

The increasing burden of non-communicable diseases (NCDs), and an ageing population, is creating a global healthcare crisis. Living longer is associated with increased health challenges, at the cost of high medical care, and putting pressure on the limited resources available. Rising pressure to curtail healthcare costs, while managing these chronic diseases, is becoming a serious concern for governments and health authorities globally.

In the Middle East, NCDs have been growing in prevalence due to citizens of the region adopting more sedentary, unhealthy and westernised lifestyles. According to the International Diabetes Federation, Saudi Arabia and the UAE ranked 10th and 12th respectively in the prevalence of diabetes globally in 2018. As such, it has become more important to track disease trends and monitor chronic patients’ adherence to treatment schedules and recovery progress.

Technology is constantly evolving across the globe, adapting to current challenges in a myriad of industries. The healthcare industry has not been immune to this transformation, with medical and digital technologies assisting in the mitigation and prevention of both communicable and NCDs. Below is a look at five trends that are set to transform the current healthcare landscape.

1) Role of AI in augmenting healthcare workflows and decision making

Across all regions in the world, AI-based cognitive technologies are proving to be most useful for drug discovery and research, clinical decision support, and medical imaging and diagnostics capabilities. Key use cases, such as elimination of unnecessary procedures and costs; in-patient care and hospital management; patient data and risk analytics; claims processing; and optimising drug discovery processes, represent more than 80 per cent of the workflow market contribution.

Frost & Sullivan anticipates operationalising AI platforms across select healthcare workflows would result in a 10–15 per cent gain in productivity in the next two to three years. The UAE and Saudi Arabia have been leading the rollout of AI in the region, with a focus on the financial and public sector, particularly in administration, public utilities, and healthcare.

2) A shift in public policy

By volume, Saudi Arabia is expected to see the majority of benefits of AI; however, the UAE is seeing the bulk of the implementation in the region, with the highest investment and projects per capita. As GCC countries pursue economic diversification (from oil towards services), the healthcare services industry will emerge as a high growth alternative in the region. Key strategies are being implemented by these countries that aim at improving their technological capabilities through AI.

An example is the UAE, which launched its first AI strategy in October 2017, with the healthcare target being to drastically reduce NCDs and other dangerous diseases by 2031. The country aims to become the global hub for AI and its governance by 2031 and has set up a ministry solely focused on the technology. The Dubai Health Authority (DHA) also introduced a smart home care project in November 2018, which involves patient monitoring as part of its DHA Strategy 2016–2021. This programme ensures home-bound patients can be monitored effectively and efficiently from their homes, without the need to visit the health facility after treatment or a procedure. AI will be useful in mining the data, achieving greater insights through analysis.

3) Diagnostics through multiple technological solutions

Within healthcare, the sectors which have received much attention from innovators are remote diagnostics and patient consultation. The UAE start-up technology company, Quanterium Blockchain Solutions has been one of the principal innovators in the country, using AI and Big Data, Internet of medical things (IoMT), blockchain, robotics as well as augmented reality (AR) and virtual reality (VR), with solutions such as 3D diagnostics, patient records and other healthcare management platforms. These are in line with the global trends, putting the region as a future leader in this space.

In the wake of rising medical costs, precision diagnostics has thus become more important than ever as it provides personalised care to patients, particularly chronic ones. This means that diseases can be diagnosed more accurately, an effective treatment programme can be put in place, and continuous monitoring of the patient made possible. This essentially improves the quality of care that a patient can ever receive, leading to better health outcomes and increased life expectancy.

Recently, the majority of health technology start-ups in the region have been focused on radiology solutions, with innovators designing various algorithms that use deep learning to interpret medical images, thereby accurately diagnosing diseases such as breast cancer and tuberculosis on X-rays. Global consensus is that these solutions have an accuracy of over 98 per cent and are not prone to errors that can be found with diagnostics through the human eye.

Furthermore, diagnoses can be made within minutes, cutting down on waiting times for the transfer of the captured images to a radiologist in a different location from where the radiological image was captured. With radiologists in short supply in parts of the region and the developing world, this is good news for its overall healthcare vision, expanding opportunities for radiological telemedicine in these countries.

4) Wearables to improve patient experience

The Middle East’s wearables market is expected to grow significantly over the next few years, working with AI to track NCDs and other vital signs. Biosensors embedded within these devices continuously monitor a patient’s progress, while building a database of information through Big Data that can be analysed in multiple ways, leading to greater population health insights and better patient management.

With one of the highest prevalence of diabetes in the world, Saudi Arabians can realise massive benefits by curbing growth of the disease through wearables and remote patient monitoring.

5) Focus on the future

Spanish-based MedLab Media Group (MMG) which created the MedsBla application is working with both the private and public sectors in Saudi Arabia to develop various customised AI solutions using natural language processing. The MedsBla application is an encrypted communication platform for medical professionals using AI to aid their decision making. With over 100,000 users globally since its launch in late 2018, this looks to be a fruitful partnership for Saudi Arabia and the Middle East.

Digital health technologies have been gaining momentum over the past few years and history suggests that exponential growth in the application of technologies such as AI, Big Data, blockchain and IoMT will be seen over the next decade, impacting almost every facet of our lives.

Conclusion

AI has emerged as a key technology applicable to multiple sectors of the economy, and various applications. When combined with other new technologies such as blockchain and IoMT, the expected benefits are exponential.

With a significant amount of groundwork and investment put in by Middle Eastern governments and private companies, the region will join the ranks of the top Western countries in healthcare innovation within the next decade.

 

With 13 Nobel Prizes for medicine awarded to French teams till date and enjoying one of the best life expectancies in the world at 82.8 years (UN, 2018), it is not surprising that health is a serious business that gets a lot of attention in France.

This was evident at the recently concluded edition of the Arab Health Exhibition & Congress in Dubai, where more than 140 French companies – 30 of them marking their debut – presented the very best of French healthcare excellence and innovation to an audience of 84,500 plus healthcare and trade professionals attending the event.

To showcase the exceptional strengths that France enjoys in the medical world to a competitive market and to present a coordinated offer of goods and services on a global platform, the “French Healthcare” brand was recently launched internationally by Business France, the agency supporting the international development of the French economy, in partnership with the French Healthcare Association.

Speaking on the sidelines of Arab Health 2019, Jean-Patrick Lajonchère, Special Advisor for Healthcare Export, explained that “this innovative initiative intends to promote the French vision in terms of worldwide health, and is aimed at bringing together French companies, researchers, and healthcare professionals to jointly promote their activities internationally.”

Innovative initiative

Presenting for the first time at Arab Health under the collective brand ‘French Healthcare’, he adds that the initiative has the ambition to “build momentum through a collective approach so as to boost the influence of French expertise, know-how and technologies in the healthcare industry. French Healthcare is a brand that seeks to promote French assets including its globally recognised public health model, cutting-edge research, and pharmaceutical industry, amongst others.”

Many companies had difficulty in making known to international markets that they were French, but now under the label of the new brand, the identity with France is easily recognisable.

France is renowned as an innovator in the life sciences sector and recently presented an incredibly encouraging success story for a genetic disorder with complete clinical remission of a patient with sickle cell disease with correction of hemolysis and biological hallmarks of the disease.  

Jean-Patrick Lajonchère

France, which came out number 1 in a World Health Organization report comparing 191 countries in 2000, is now taking steps to ensure that its healthcare system is more efficient and sustainable for the next 50 years. According to new reforms unveiled in September last year, healthcare spending in France is set to increase by 2.5 per cent in 2019, higher than the original target of 2.3 per cent. This amounts to an additional 400 million euros in a nearly 200-billion-euro budget.

France has a community-based healthcare system consisting of 353,000 healthcare professionals, 3,089 hospitals (1,389 public sector, 691 privately run non-profit hospitals and 1,009 private clinics), France is the top OECD (Organisation for Economic Co-operation and Development, an intergovernmental economic organisation with 36 countries as members) country for access to healthcare and has the lowest remaining balance for healthcare (the amount payable by patients) of any OECD country.

A leader in the Life Sciences

“France’s chief strengths and legacy in the healthcare and life sciences field,” he says, “stems from its formidable network of globally acclaimed medical universities and research institutions that are renowned for their innovation capacity and competitiveness.”

France places clinical research at the heart of the medical profession and four French institutions were counted as the 25 best public research institutions in the world, according to a 2017 ranking by Reuters. The depth of innovation in these scientific research centres are reputed for developing cutting-edge medicine which brings new solutions and benefits for people across the world. Amongst its other pioneering feats include the first partial face transplant, the first total face and eyelid transplant and 3D laser-assisted bio-printing of human tissue.

Medical technologies: A dynamic French industry

France also enjoys a solid manufacturing base with a strong culture of re-exportation, he adds, and is imbued with a technology-intensive expertise and a strong capacity for innovation. “The country is ranked 4th in the world and 2nd in Europe in terms of revenues for medical devices and technologies, covering products and equipment in a wide field ranging from syringes and in-vitro diagnostics to MRI scanners, and is 2nd in terms of market size after the U.S.,” he says.

The medical devices sector, he adds, stands out for its three-pronged growth model: innovation / internationalisation / external growth, with exports as the main driver. “According to 2017 statistics, 1,340 medical equipment and facilities providers in France generated €28 billion in revenues and 85,000 jobs in France,” explains Lajonchère. “More than half of these companies conduct R&D. This sector has strong development potential particularly due to continuous innovations, the development of eHealth and its recognised industrial, scientific and medical expertise.”

An interesting characteristic of the medical devices sector in France, he further adds, is that SMEs account for 92 per cent of its companies and growth in this sector is fuelled in large part by export. France exports €8 billion in medical devices per year, with a 5 per cent annual increase in export revenues.

French pharmaceuticals: A high performer and major exporter

Pharmaceuticals is another high-performance sector in France. According to Lajonchère, “The French pharmaceutical industry is constantly evolving within an extremely competitive environment and a strongly dynamic context. The quality of its research, its highly-qualified staff, its renowned industrial know-how and ability to adapt to changing market needs have all made France the key player in global pharmaceutical production that it is today.”

France is the 5th largest market in the world and the 2nd largest in Europe for human medicines, he adds. “2016 statistics reveal that revenues from pharmaceuticals exceeded €54.5 billion, nearly half of which were generated by exports. In addition, the dynamic and innovative pharmaceutical industry in France boasts about one of the biggest R&D spends in the French private sector, accounting for 9.8 per cent of revenues of all pharmaceutical companies.”

France is home to historical medical industries such as Sanofi and Ipsen, he adds. “Sanofi, for instance, is ranked the 3rd largest healthcare firm in the world and spent €5.5 billion on R&D in 2017.”

However, healthcare in France is not solely about a buoyant research environment, the availability of highly advanced technological devices, or medicines that meet the quality, efficacy and safety criteria required by the most exacting international standards, he asserts. “In France, the provision of healthcare is a national responsibility and is characterised by good access to high-quality care and a growing recognition of patients’ rights. Guided by the motto of the French Republic – liberty, equality and fraternity, the philosophy of French healthcare too mirrors these values. Liberty relates to the fact that you have the freedom to choose where you want to be treated, equality indicates that every individual has the same right to access to health, and as a welfare state, every individual pays for the other in the true spirit of fraternity. Thus, the three cornerstones of the French Republic are also the bedrock of the French healthcare system.”

French Pavilion at Arab Health 2019

The French Pavilion at Arab Health 2019, spread across 1,400 square metres, showcased French expertise in a wide range of fields and sectors and thus attracted large numbers of visitors.  From hospital equipment and furniture including medical beds, trolleys, wheelchairs, operating lamps, ergonomic chairs and gynaecological examination chairs to ultrasound diagnostic equipment, sonography equipment, Doppler, endoscopes and radiography units, it was representative of the industry’s latest trends and advancements.

“France’s expertise in prevention, risk management and hygiene in hospitals also took centre-stage at Arab Health this year as French Healthcare offered solutions in equipment sterilisation and disinfection, air treatment and purification, hospital waste treatment and management, ventilation system and effluent decontamination,” says Lajonchère. “Telemedicine solutions for patient monitoring and transmission of medical information were also in the spotlight at this year’s Arab Health exhibition.”

It is very important for French Healthcare to be at Arab Health, he adds. “This is a special hub for global health and trade professionals, and we value the opportunities it opens for us both in terms of expanding our market share and also in showcasing to the world the innovations in life sciences that has elevated France to emerge as a leader in world healthcare.”

Historically, France has been the leader in clinical research in haematology and cell and gene therapy while several French public research institutions are among Thomson Reuters 2016 Top Ten Global Innovators and the leading European health and biotechnology patent owners.

“Today, France is leading the way in new innovations in fertility technology,” says Lajonchère. “It is also funding research into new antibiotics to step up the global fight against antibiotic resistance.”

France also has a high level of expertise in the prevention, diagnosis, treatment, monitoring and education of diabetes care, he adds. “It was the pioneer in the development of artificial pancreas while in the field of oncology, France has one of the highest survival rates in the world.”

Emphasis on digital capabilities

As health ecosystems are constantly adapting to new medical innovative technologies to remain competitive and emerge stronger, so too is France, which has now made health a cornerstone of its US$1.8 billion Artificial Intelligence strategy. While the move seeks to turn France into a “start-up nation”, it also aims to prevent the scientific brain-drain that the nation is currently witnessing. By stimulating new approaches and rethinking current practices in healthcare, the government’s aim is to encourage and support projects that use new technologies that would eventually improve the quality of care for the benefit of patients.

With its emphasis on research, innovative and technological development, France is working hard to ensure that its healthcare system is not only the pillar of the welfare state but also one that prevents and protects against today’s and tomorrow’s health risks.

The recently concluded edition of Arab Health Exhibition & Congress generated business worth a whopping US$824 million, according to a GRS Explori Survey. Organised by Informa Healthcare, the 44th edition of the event took place between 28-31 January at the Dubai World Trade Centre and is one of the largest healthcare events in the MENA region.

Under the theme of ‘Innovation’, the highly successful edition of the event showcased the latest technological advances in medical equipment and devices. Arab Health 2019 welcomed more than 4,262 exhibitors, 64 exhibiting countries, 37 country pavilions, 5,328 delegates, 84,700 visitors, with 159 countries represented, and 106,972 professional visits, across the four days of the show.

The GRS Explori Survey further found that 97 per cent of exhibitors rated Arab Health as an important platform for their business, 93 per cent were overall satisfied with the exhibition, 84 per cent will be exhibiting again next year, and 82 per cent of overall exhibitors have exhibited before.

Major decision-makers right from owners/board directors/chairmen, senior managers, directors, vice presidents, executives, and senior government officials, were all present at the show, making key purchases for their businesses.

The Arab Health Congress continued its streak of attracting renowned speakers from around the world who delivered the highest quality programme of 11 Continuing Medical Education (CME) accredited conferences to local and international medical professionals.

The event also hosted the first ever ‘Innovation Hub’, working alongside government entities such as the UAE Ministry of Health and Prevention, Dubai Health Authority (DHA), Department of Health Abu Dhabi and SEHA. The hub gave an opportunity for attendees to immerse themselves in the latest healthcare innovations and explore technologies including Artificial Intelligence (AI), disease management and home care devices, mobile device accessories, telemedicine platforms, among other breakthrough advancements.

The Innovation Hub was also the platform for the inaugural Innov8 Talks. It included daily free-to-attend talks with discussions led by keynote speakers and hosted a series of pitch sessions for some of the world’s most creative and forward-thinking healthcare start-ups and SMEs to share and sell their ideas to an esteemed panel of judges.

Bringing data to life

At Arab Health, GE Healthcare was looking at how to partner with the public and private sector in the region in order to elevate healthcare and to help provide solutions be it technology, or non-technology solutions that deliver better outcomes. Mohie El Rafey, Chief Marketing Officer, Eastern Growth Markets, GE Healthcare, highlighted that it could be clinical, financial or operational outcomes, but ultimately outcomes that deliver better patient care.

On the sidelines of the show, he told Arab Health Magazine: “Healthcare globally as well as in the region is undergoing a massive transformation. There are three things causing this transformation. The first thing is data. There is so much data that exists in hospitals, but that data is fragmented and siloed, not structured. What we are doing at GE Healthcare is partnering with hospitals to bring that data to life; bring analytics around it and make it simple and easy for people to utilise. But more importantly, make it timely and bring treatments when it matters the most to patients.”

El Rafey explained that the second transformation is the advent of AI. GE Healthcare has a platform called Edison where future applications are developed and embedded into devices, making it smarter and helping it to augment decision-making.

The third transformation, he shared, is around personalised medicine. How does medicine go away from being generic to more personalised? “In the future, treatments are going to be customised for you and this will be through AI enabled smart diagnostics and smart innovations of therapies or treatments, and whether it is monitored outside the healthcare environment of the hospital to make sure your health is maintained and sustained in the long-term,” he concluded.

Spotlight on clinical mobility

For Wayne Miller, Director, EMEA Healthcare Practice, Zebra Technologies, one of the biggest challenges in healthcare is that it is a massive employer around the world and therefore Arab Health becomes the perfect platform as it allows for meeting lots of end-users and getting relevant messages across. In Zebra’s context, it is clinical mobility.

Miller said: “This year at Arab Health we showcased mobility and how do we mobilise the clinician. That needs two things — a mobile device and digital patient records to do this. When people think about digital, they think about very complex systems, which they are. But they all start with a simple barcode — placing a barcode on patients’ wristbands, being able to read that with a clinical smartphone and then going into patient workflows, is the start of digital technology. At the show, we wanted to remind the healthcare sector that it is not as complex as they think.”

When asked about the future of clinical mobility, he emphasised: “Currently, clinical mobility is at the early stages of adoption. In a clinical setting, the smartphone has to be healthcare ready, so it’s disinfectant-ready, it works the full shift for the nurse, and it’s easy to scan. The UAE is a bright light in healthcare in the Middle East. I see a very bright future here and in the region for the adoption of technologies in healthcare. In fact, this region is investing a little bit ahead of what the other regions are doing.”

Enhanced patient experience

In line with the theme of the show, Royal Philips displayed a range of its innovative solutions and products. These included the Philips’ Ingenia Ambition 1.5T MR, which is the world’s first MRI system to enable helium-free operations. The company also showcased two new ultrasound platforms – one for cardiovascular and the other one for general imaging and obstetrics. An interesting innovation on the floor was its eICU programme, a virtual ICU that can monitor patients in the ICU remotely, so the coverage and standardisation of care across a hospital is much higher. The programme combines predictive analytics, data visualisation, and advanced reporting capabilities to deliver vital information to bedside caregivers.

Robert A. Cascella, CEO Diagnosis and Treatment, Royal Philips, said: “It was a great Arab Health this year. We feel like customer engagement was at the highest level and there were good deal discussions around our solutions businesses. We felt we had a lot of strategic discussions about larger projects that concern all of our products and all of our services.

“Our quadruple aim is that all of our products are designed to improve outcomes, lower the cost of care delivery, take some of the burden away from the staff, and enhance the patient experience. It allows us to create technology that is first time right. So, our customers and partners don’t have to keep redoing imaging or interventions.”

Arab Health 2020

Arab Health 2020 will take place from 27-30 January at the Dubai World Trade Centre. For the next edition, the exhibition show floor will be split into sectors according to main product categories. The change for the event would be that the exhibitor stands will be located on the show floor according to a particular product category applicable to their business.

The shift is aimed at ensuring better quality leads as the traffic within the halls will definitely surge with the relevant audience interested in the product category. Furthermore, the close proximity of related exhibitors in a hall is bound to increase the number of visitor meetings that can take place in a time frame, when compared to walking through 64,000 plus square metres of exhibition space.

The eight sectors at the show will include — Medical equipment and devices, disposables and consumer goods, imaging and diagnostics, preventive and post-diagnostic treatments, healthcare and general services, healthcare infrastructure and assets, IT systems and solutions, and orthopaedics and physiotherapy/rehabilitation.

For more information visit www.arabhealthonline.com  

Mental health is an important component of peoples’ overall health, which revolves around the individual emotional well-being. Good mental health hygiene involves a dynamic process that consists of being confident to manage any challenging situation effectively. It in fact empowers individuals to make responsible choices, work productively, helps to realise their full potential, and provides meaningful contributions to the society while living their life at their fullest.

Reasonable levels of stress, low mood, emotional tension triggering fears or anger, are healthy responses to particular events that allow individuals to recognise threats, find appropriate solutions, bridge the gap between discrepancies in opinions, and therefore establish and maintain satisfying social connections.  

Finding the balance

This emotional balance is not always experienced among individuals. Unfortunately, sometimes people can feel totally defenceless against the racing thoughts that play in their minds. They may find themselves unable to deal with their uncontrollable fears or prevent escalation of their anger. These feelings can become so overwhelming that coping with day-to-day life, work, leisure, and relationships can be perceived as an over demanding task.

Mental health problems can affect anyone at any age, regardless of their gender, social status, or financial situation. Additionally, they are also interspersed among population cross-culturally.

Mental Health spectrum

Within the mental health spectrum, mental health conditions can vary on a continuum ranging from good mental health, to poor mental health, up to a mental illness, which eventually emerge as a mental illness of mild, moderate or severe intensity. Moreover, a large proportion of the people who have a mental health disorder, demonstrate overlapping conditions rather than a single mental illness.

Therefore, the main mental health diagnosis often includes additional mental health problems gravitating around the main mental health disorder. This may cause mild to severe disturbances and inabilities or may impair people to cope with life’s ordinary demands and routines.

Over the course of life, from childhood, adolescence and throughout adulthood, mental health problems and illnesses can impact peoples’ life according to the severity of the circumstances. Commonly they may include: Anxiety Disorders, Mood Disorders, Psychotic Disorders, Eating Disorders, Impulse Control and Addiction Disorders, Personality Disorders, Post-traumatic Stress Disorder, Stress Response Syndromes, Dissociative Disorders, and many others.

Research suggests that mental health problems are the result of more than one event: multiple, linking causes such as genetics, biologic, unfavourable experiences during childhood, on-going challenges and major life changes; environment and lifestyle increase the risk of experiencing distress and determine whether someone would develop a mental health condition.

Clinical practice confirms that family history of mental health problems, traumatic life experiences, such as being the victim of a crime, sexual or emotional abuse, harassment, living in a war zone, being bullied, and other kinds of victimisation are highly associated with mental health illnesses.

Symptoms

Mental health problems and emotional imbalances may present under different forms with a combination of different symptoms.

Physical symptoms are usually easy to notice. The predominant recurrent symptoms include having unexplained aches and pain such as: chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, sleep disturbances, a rapid heart rate, chest pain, or fast breathing.

These symptoms are so commonly presented in primary care and often are purely related to organic diseases, which eventually are explored with further clinical investigation and pharmacologically treated according to medical protocols. However, unexplained aches and pain usually describe the physical component of a wider constellation of other mental health symptomatology so crucial in mental healthcare. This medicalised practice seems to underestimate the magnitude of cognitive, emotional and behavioural symptoms, which lead to misdiagnose mental health problems.

A high percentage of patients with mental health conditions who seek treatment in a primary care setting, in fact, report physical symptoms, which can make mental health problems very difficult to diagnose if not assessing their psychological conditions in terms of cognitive, emotional and behavioural key factors.

Mental health symptoms aren’t only displayed at the physical level but usually represent a combination of different conditions, which address cognitions and thoughts, emotions and feelings, and behavioural set of attitudes that people are more inclined of displaying as dysfunctional. Mental health symptoms, therefore, encompass the way people process thoughts, and the connotation and the intensity at which they experience emotions, which result in determining the pattern of their unhealthy behaviours.

Cognitive symptoms are related to the normal brain function. People may report having trouble concentrating for long, lack of attention and focus, memory difficulties, foggy brain, mental confusion, and other several symptoms, which are associated with the way they think.

People experiencing cognitive symptoms usually adopt negative mind-sets, irrational thoughts, intrusive thoughts, negative beliefs and statements about one self, assumptions against any evidence, memories difficult to control, or flash backs of past experiences.

Among cognitive symptoms that governs individuals’ thinking process, negative self-talk is the most common. It resembles a negative poem they recite in their inner dialogue. They are continuously committed to state to themselves a variety of statements reflecting their negative core belief about the way they conceive themselves, other people and life in general. Some say: “I am not worthy of love”, “I cannot make it”, “I am not good enough”, “I am not important”, “I will end up alone”, “Nobody understands me”, “Nothing matters”, “The worst will happen”, or “Life is a bad place to be”.

Alongside these statements, wishing of being dead, thinking of harming own self or others, are also part of people’s inner dialogue. These cause them to start questioning their values and the sense of their existence. They even ask themselves about their life purpose and the reason for living.

This thinking process may lead individuals to feel a sense of isolation or disconnection from family members, friends and other people and places they care about. Therefore, sets of recurrent negative emotions start to take over.

They may experience a variety of different emotions from sadness, mood swings, feeling confused, forgetful, worried, feeling scared, demotivated, helpless, hopeless, angry, or upset. Other emotional symptoms indicating imbalanced mental health conditions include having worrying dreams or feeling numb or disconnected from reality.

Behavioural changes

Mental health conditions can also be recognised by means of behavioural symptoms. Often, they are the result of a combination of cognitive and emotional symptoms. All of them are strictly interconnected to each other. Symptoms involving behaviours may include: difficulties in starting usual activities or getting through tasks as before. Peoples’ inability to perform daily tasks may consist of difficulties in taking care of their kids, getting to work or school or not being able to complete standard tasks such taking shower or cooking a meal.

Other typical behavioural symptoms of mental health conditions are changes in eating or sleeping patterns and manifestation of hostile behaviours such as yelling, fighting or frequent temper tantrums causing problems in relationships. In addition, repetitive behaviours, drug misuse, smoking, drinking, social withdrawal, dropping from leisure activities, are also behavioural symptoms of poor mental health condition.

Defeating stigma

Dealing with mental health symptoms can be physically and emotionally draining, often leaving people feeling vulnerable to the opinions and judgments of others.

Preparedness to cope with mental health problems heavily depends on people’s awareness on the importance of preserving and enhancing mental health. Mental health stigma seems to be still very commonly held in society. It is characterised by the difficulty of externalising a mental health problem, receiving mental healthcare or mental health treatment.

Unfortunately, prejudicial attitudes towards people who have mental health problems dictate a conviction that mental health is a sign of personal weakness. It is a common assumption that mental health conditions can improve with time without any form of specialised support.

These perceptions and misconceptions although unintentional or subtle, may most likely lead to reluctance in seeking help or treatment and as consequence may corner people into isolation. Apart from creating self-doubt and shame, this situation exposes individuals to an even weaker situation: it undermines their sense of self-efficacy and their self-esteem by engaging individuals into a tighter spiral of an increased critical self-thoughts and even more severe self-judgment.

Treatment options

The recovery from any mental health illness starts by recognising that mental health diseases are well described and understood among clinicians; that mental health diseases need appropriate clinical attention for a precise evaluation; and that mental health recovery is not an event but a tailored process: a unique journey for each individual that requires time and includes relapses.

More successful treatment for mental health conditions usually consists of multi-disciplinary approach including medication, psychotherapy, lifestyle education, unconventional form of therapy and other forms of support. According to the condition, treatments can be held in outpatient clinics, residential or semi-residential treatment facilities with daytime programmes or in hospitals according to the typology of the mental health problem, its severity and family circumstances.

While treatment with medications is aimed at reducing symptoms such as improving low mood, stabilising mood swing, controlling psychotic symptoms, reduce the symptoms of anxiety or panic attack, lifestyle changes such as reducing alcohol intake, balancing sleeping patterns, eating healthy and practicing regular exercise help substantially in increasing the quality of life, making the mental health condition more manageable.

Therapy

Psychotherapy plays a central role in identifying how experiences are processed by thinking process and mediated by emotions leading to unhealthy behaviours. In addition, psychotherapy helps individuals to understand how they have related themselves to significant others and how this may have affected them. It also helps to understand people’s concerns that are caused by avoiding or suppressing emotions rather than having their emotional needs met.

Common therapies to treat mental illnesses are Cognitive behavioural therapy, Exposure therapy, Dialectical behaviour therapy, Gestalt therapy and other forms of therapies.

Untreated mental health problems can have serious impacts both in individual’s life and across the community. Awareness about the development of early warning signs, differentiating between different sets of symptoms, and taking proper actions towards them with early mental care interventions, may prevent or delay major mental illness and may reduce the intensity of their severity.

Cultural competence in mental health field needs to be expanded so that individuals with mental health problems are provided with effective and respectful quality of mental healthcare. Promoting wellness, implementing health strategies and planning social campaigns on mental health is imperative in targeting a healthy and prosperous community. The sense of belonging to a community is able to support individuals with mental health problems, has priceless value and it is not a fact of private interest. Mental health belongs to community of which members are psychologically empowered to overcome their mental health conditions, achieving their personal goals and live a fulfilling life.

The current state of affairs

The MENA region boasts six of the top 10 countries in terms of diabetes levels according to the International Diabetes Foundation – Saudi Arabia (23.9 per cent), Kuwait (23.1 per cent), Bahrain (21.9 per cent), Lebanon (19.8 per cent), and the UAE (19 per cent).

Throughout the world diabetes is an increasing concern, but nowhere matches the speed and volume of the rise of diabetes in the MENA region, China and India.

Conventional treatment is becoming financially crippling, not producing encouraging results and certainly not reducing these alarming numbers. The time has come to look elsewhere.

How did we get here?

Type 2 diabetes (T2D) is essentially insulin resistance run riot. Insulin is spiked most by carbohydrates, especially high glycemic index carbohydrates, and even more by processed, white carbohydrates such as white bread and rice where all the fibre, which technically should slow this glycemic response, has been removed.  

As Gary Taubes outlines in his book Good Calories, Bad Calories, we can draw a clear correlation between the rise of processed carbohydrates (which were scarce in previous times) eaten in conjunction with high levels of unhealthy fats, and the rise of Metabolic Syndrome, which includes obesity and T2D.

As we have continued to eat these hyper-palatable foods, insulin responses have been forced higher and higher, eventually making the insulin receptors in the body unable to respond, and as these responders lose their functionality, more insulin is needed to clear excess glucose from the blood. This signals the brain to eat more of the foods, which spike insulin the most, and so the cycle continues until an individual can no longer effectively remove glucose from the blood themselves.

Our response? Give them more insulin! When excess insulin was the thing that caused this illness in the first place!

Dr. Jason Fung, a renowned endocrinologist, had this exact realisation after treating thousands of patients with T2D; that the treatment he was offering his patients was entirely counter-intuitive.

So what’s the alternative?

Fung then began using fasting as a tool to treat T2D and obesity in his clinic, and as his research continued he realised that any state in which the body is not continually spiking insulin and glucose has the potential to heal metabolic syndrome, and reverse, yes reverse T2D.

The state of ketosis, attainable by eating a very low carb ketogenic diet (VLCKD), is one such state. Not to be confused with diabetic ketoacidosis where the liver begins producing ketones in an uncontrolled and dangerous manner, ketosis occurs when the body has become depleted of carbohydrates and the liver begins producing what is increasingly being recognised to be a therapeutic fuel for the body, ketones.

Vanessa Emslie, a licensed nutritionist based in the UAE says: “The real origin of the Keto or Low Carb diet is the Banting diet, after William Banting, a formerly obese English undertaker who published a book in 1863 on his weight-loss success. Under the recommendation of his physician Dr. William Harvey, he limited his intake of carbohydrates, especially those of a starchy or sugary nature. He was so successful in this (Keto) approach, he self-published a book on the diet.”

The diet was then found to be an effective intervention for epilepsy in the early 1900s, but only in the 1970s did it rise to fame again with Dr. Robert Atkins’ diet book publication. Many people lost weight on the Atkins Diet, which was considered a fad, and whilst not low enough in carbs to be truly ketogenic, it was certainly low enough to induce the fat loss effects of carbohydrate restriction. Since then ketosis has been researched as therapeutic for everything from autism to Alzheimer’s, but its most compelling use for which we have the most undeniable data is as a treatment for type 2 diabetes and obesity.

Research into the ketogenic diet as a treatment for T2D began to mount in the early 2000’s amidst strong push-back from the medical community about the safety of the diet model, which was in such direct opposition to the long held dietary guidelines.

Six studies on humans with T2D from 2005 through 2016 consistently found that VLCKDs, under supervision of a medical practitioner, improved HBA1C, waist circumference, fasting blood glucose and a variety of other blood markers over simply reducing calories in the control groups. Many subjects in these studies were able to either reduce their medication or stop taking it completely.

But what about cholesterol?

This has long been the medical community’s standard comeback. Centrepoint to this apprehension is the widely accepted association between heart disease and dietary fat, in particular saturated fat, which formed the basis of the diet-heart hypothesis proposed by Ancel Keys in the 1960s.

Fast forward to 2018 and there is mounting evidence that the link between dietary fat and heart disease is at best exaggerated and at worst potentially one of the most damaging pieces of information to become firmly embedded in society.

As research on the connection between cholesterol and heart health mounts, it is being noted that although “required” for the development of atherosclerosis, LDL is not “sufficient” as numerous other factors are required. Of particular interest at the cutting-edge of lipidology is the role of inflammation and the different types of LDL, in particular particle size and particle number as opposed to the molecular weight, which is the measure provided through the standard cholesterol test.

In fact, all six studies did take lipid markers into consideration while assessing the overall effect of the diet on their subjects. All saw an almost uniform decrease in triglycerides in the VLCKD compared to the control group. Most noted very little change in HDL or LDL.

A 2006 study compared a VLCKD to a low fat diet and monitored lipoprotein subclasses and noted a shift in LDL particle size. Small, dense (suggested to be most damaging) particles decreased while large particles increased.

The virta study

Perhaps the most compelling and encouraging VLCKD dietary intervention and study on humans yet is still underway in the U.S. 349 adults with T2D enrolled, 92 per cent obese and 88 per cent on medication. Patients were supported by a physician, as a VLCKD can dramatically lower blood glucose, and so medications must be closely monitored. Patients wore continuous glucose monitors, which fed data back to an application, which the physician had access to and could be immediately alerted if glucose levels sift dangerously.

Patients were also assigned a health coach who supported them to continuously make the correct diet and lifestyle choices to keep them on track. Patients were able to watch their own glucose spikes in real time in response to eating high carbohydrate food. This dramatically improved compliance. The health coach was able to educate the patients in real time on which foods were surprisingly high in carbohydrates (like onions and bell peppers for example) and show them where hidden carbs were sneaking in, as well as provide emotional support and strategies for staying on track and driving change.

This study published a paper at the end of its first year in October 2018. This is what it said about T2D markers, “After one year, patients in the CCI, on average, lowered HbA1c from 7.6 to 6.3 per cent, lost 12 per cent of their body weight, and reduced diabetes medicine use. 94 per cent of patients who were prescribed insulin reduced or stopped their insulin use, and sulfonylureas were eliminated in all patients.”

In terms of cholesterol, HDL increased, triglycerides decreased, and Apolipoprotein 4 (a proxy for LDL particle size) was unchanged. The study is ongoing and more personal triumphs are being achieved for these patients daily.

The question we have to ask ourselves in this region, where nothing we do seems to curb the uncontrolled increase in diabetes and obesity, is when are we going to wake up? When are we going to realise that these diseases do not develop unaided by the chronic overeating of highly processed foods, sugars and starches, but in perfect unison with their appearance?

The examples of tribes who had lived on their natural diets until the introduction of western processed foods are many, and the rise in heart disease, diabetes and obesity can virtually be drawn in perfect parallel to the increase in consumption of these foods. The UAE itself being one such example.

When are we going to give our patients the information that they deserve, that their pre-diabetes or diabetes cure is completely in their own hands, and as practitioners, pair up with coaches to heal this epidemic?The data is here, the solution is in our hands, all we need to do is act.

The Al Jalila Foundation Research Centre, opened in 2018 in Dubai Healthcare City, is set to become a beacon for regionally-relevant medical innovation produced by home-grown biomedical researchers. It will focus on the five most pressing regional health challenges: cancer, cardiovascular diseases, diabetes, obesity and mental health.

Al Jalila Foundation is a global donor-funded philanthropic organisation dedicated to transforming lives through medical education and research, founded to position Dubai and the UAE at the forefront of medical innovation.

Visioning the project

With the construction of the Al Jalila Children’s Hospital fully funded and well under construction, the board at Al Jalila Foundation focussed attention on the next challenge; the establishment of a local research centre, and their ambition for the project was clear.

It would become the premier scientific research facility in the UAE, designed to nurture a home-grown generation of medical professionals working on ground-breaking research that addresses health challenges prevalent in the region.

Within Al Jalila Foundation, both Professor Galadari and Dr. Abdulkareem Al Solama have been instrumental in championing this project and bringing it to fruition.

Professor Sehamuddin Galadari, Al Jalila Board Member, Chair of the Scientific Advisory Committee, and Professor of Biochemistry & Molecular Cell Biology – College of Medicine & Health Sciences at UAE University, Al Ain, articulated the high-level science and research requirements for the new facility.

Professor Galadari worked closely with Dr. Abdulkareem Al Solama, CEO of Al Jalila Foundation to create a project brief that added commercial space, educational facilities and new HQ facilities for Al Jalila Foundation itself to the science requirements to round out the functions that the new facility would provide.

Situated in the heart of Dubai Healthcare City, the Al Jalila Foundation was endowed a parcel of land specifically to accommodate the new research centre and allowed the establishment of the vision for the project to proceed.

Al Jalila Foundation selected IBI Group and GHD as architects and engineers respectively, to design the project, commencing with a rapid architectural visioning exercise to breathe an air of reality into the aspiration and become a focus for fundraising efforts.

Tony Burley, Project and Design Director for IBI Group developed a strong relationship with the Al Jalila Foundation client team from the outset, quickly becoming a trusted partner to deliver a design, which would meet their high aspirations for this significant project. Dr. Abdulkareem Al Solama and Professor Sehamuddin Galadari, would remain hands-on stewards, and active supporters of the project throughout the development of the design and construction.

Designing for the science of the future with the knowledge of today

Dubai Healthcare City – home to many world leading healthcare focussed tenants – was an ideal location for a new facility focussing on this type of research, but the site itself was unusual and brought specific challenges that required careful study of multiple options and a unique approach to unlock the true value of the site.The site was occupied by the partially completed concrete frame of the administration building for the former Dubai University Hospital. The client’s vision for the new research centre was to incorporate and adapt the existing structure rather than demolish, which meant working with the curved façades and unusual tapering structural grid defined by the crescent shaped building form of the administration building.

Building the vision, enabling the future

The rapid visioning developed options ranging from designs that would complement and be contextual with neighbouring properties, to have a bold iconic approach, which would set it apart as something different at the heart of the DHC campus. Seeing the potential of this facility as a beacon within the district, the client boldly selected the most iconic visual approach. With this approach having buy in at such a senior level, the challenge to the design team became developing the complex programme of functions that the project contained, without straying outside of the expectations already set.

Although the distressed project site added considerable challenges to the planning of the development, the Foundation was committed to achieving ‘sustainable innovation’ across the project.

The high-level brief and project vision were matured into the current design through a comprehensive testing and consultation process, which remained faithful to the key elements of the original vision. The different functions of the diverse ‘vertical villages’ of the buildings were each driving different circulation patterns around the floorplate, with separate access requirements depending on the function, which the original design for a simple office building had not considered. In our test fitting phase, a change on one floorplate type would have negative effects on all other floor-plate types, so we had to work through multiple iterations with the client to find the sweet-spot of maximum utility to the function with minimum compromise.

The building form and appearance is intended as iconic but timeless, with a minimal palette of materials and repeated rectangular curtain wall panelling providing a distinctive mega-grid diamond pattern. The building is topped by back-lit glass panels following the crescent profile, which shroud the plant level and contribute to the varied Dubai roofscape.

The new research centre has three basement levels and 10 floors of above ground accommodation in a crescent-shaped plan defined by the previous building’s structural grid. It has been designed to accommodate biohazard containment Level 2 research laboratories to international best practice standards with specialist secondary laboratory functions varying per floor. The facility also provides underground car parking, building services plant and laboratory technical areas, and office accommodation as well as serving as the Al Jalila Foundation Headquarters. The latter will include hosting facilities for symposia, training events and forums associated with the Foundation’s royal patronage.

The key to unlocking the final planning arrangement came from an ‘architour’ of four similarly sized research facilities at Oxford University, which IBI had programmed and designed. This tour afforded the client first-hand experience of different spatial arrangements and opportunities to discuss the benefits of planning approaches with the building users. During the tours we were able to highlight the critical findings of our “4 Labs – 4 Cities” research project in developing successful research environments. The tour informed the development of the project brief and introduced a number of innovations including:

– The inclusion of social / lounge areas on each laboratory floor to encourage ad hoc discussion and interaction between researchers away from formal laboratory or write up areas.

– The primary laboratory spaces are counter-intuitively located at the heart of the building, away from the external facade

– an arrangement which allows a direct physical link to the supporting specialist laboratories, visual connection to adjacent write up areas, and the transmission of abundant natural light to the primary laboratory via fully glazed division walls. Although we had promoted this approach early in the design process, it was only from the Oxford architour where the client saw a successful example of this type of implementation that they had the confidence to place the lab spaces at the centre of the plan.– A modular façade design of glazed and insulated panels with a palette of just three panels in three widths, which has moved away from the fully glazed building originally anticipated, providing 50 per cent glazed area to significantly reduce the cooling load and environmental impact.

– The addition of a new vertical core providing connectivity between laboratory levels within the containment zone, at the same time as providing discrete and secure laboratory flows for delivery and waste removal.

The building’s distinctive appearance, which bucks the trend from the Mediterranean themed Dubai Healthcare City zoning, was personally endorsed by His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai. It provides the Al Jalila Foundation headquarters with a distinctive identity and accommodation that enjoys commanding views towards the Dubai Creek.

Burley said: “It was a great honour to work with such committed and appreciative clients as Dr. Adbulkareem Al Solama, and Professor Sehumaddin Galadari. Their unfailing faith that we would achieve a building that not only met all their functional requirements but be of exceptional quality, leaving a lasting legacy within Dubai Healthcare City was a key element of the successful outcome.”