The spectrum of collaborative endeavors is diverse in healthcare and involves international hospitals coming together to improve the culture of health in local communities. There is enough evidence, globally and in the region, that suggests such collaborative partnerships can indeed have a beneficial collective impact.

For instance, Cleveland Clinic Abu Dhabi was developed through a partnership between Mubadala Investment Company and the U.S.-based Cleveland Clinic. The hospital has been open to the public since 2015 and Dr. Madhu Sasidhar, Chief Medical Officer, Cleveland Clinic Abu Dhabi, shares that the vision behind bringing the hospital to the UAE was to deliver world-class standards of treatment to patients in the country as well as in the wider region. Excerpts from the interview. 

How has the response been to Cleveland Clinic Abu Dhabi? What was the idea behind bringing the brand to the UAE?

By combining state-of-the-art amenities with a patient-centered model of care, the UAE’s leadership were confident that they could reduce the need for patients to travel abroad for treatment and improve the overall health of the nation.

The response to the hospital has been very strong. In 2018, we saw more than 508,000 outpatients, an increase of 25 per cent over 2017, and admitted 9,454 inpatients. Beyond this rising demand, Cleveland Clinic Abu Dhabi has earned the trust of the community, with 86 per cent of our inpatients giving our hospital the highest possible ‘likelihood to recommend’.

The hospital has conducted several important clinical firsts in the UAE, including offering the first and only multi-organ transplant program, which conducted the UAE’s first heart transplant as well as multiple lung, liver and kidney transplants over the last two years. These operations give people the confidence of knowing that they have access to a multidisciplinary complex care hospital when they need it most.

How closely do you work with Cleveland Clinic? Do you have visiting doctor programs, or can patients be transferred to the U.S. facility? How well does this partnership work?

We work closely with our colleagues at Cleveland Clinic in the United States. Our physicians consult on cases between both facilities, allowing patients to benefit from coordinated care. Our teams use video technology to discuss complex cases and determine the best treatment path with their colleagues across the global Cleveland Clinic network.

All Cleveland Clinic facilities have a single, integrated medical records system, allowing care teams to gain a clear understanding of a patient’s medical history across all international locations, whether in Abu Dhabi, Florida, Toronto or Ohio. This seamless integration enables the hospital to offer carefully tailored, personalized care, regardless of where the patient is being treated.

Physician recruitment at Cleveland Clinic Abu Dhabi is handled in the same way as in the United States, to support the highest level of expertise and patient care. Approximately a quarter of our staff physicians have a Cleveland Clinic background, including most heads of department.

This seamless integration enables the hospital to offer carefully tailored, personalized care.

How according to you are these international healthcare partnerships beneficial for the local community?

By bringing the Cleveland Clinic model of care to the UAE, we are building on almost 100 years of expertise.

In addition to cutting-edge treatment, the community benefits from our ongoing medical education and research. Cleveland Clinic Abu Dhabi is a designated teaching hospital and research center, supporting caregivers at all stages of their career. We have a ‘Junior Caregiver’ program to introduce high-performing high school students to the healthcare sector. We also enable medical students to complete their internships, residencies and fellowships at the hospital. In 2018, we approved 73 new research projects and published more than 200 academic papers. Many caregivers at the hospital are thought leaders in their fields and known globally for their work.

Could you shed light on any latest developments or plans?

In 2018, we broke ground on our new dedicated oncology center. Modelled on Cleveland Clinic’s Taussig Cancer Center, which is ranked fifth in the United States, it promises to transform cancer care in the UAE.

Cancer is the leading reason patients from the UAE travel abroad for treatment. We hope that the purpose-built center will eliminate that need entirely. Designed to meet the specific needs of cancer patients, it will allow them to receive all their care in one location and expand the range of treatments they will have access to.

As the world becomes more closely connected, and the population ever more global, healthcare provision will continue to change dramatically. Change presents opportunities for high quality, specialized care providers to make a global impact, building the hubs that will deliver a new form of preventative, connected and community-focused care. Cleveland Clinic Abu Dhabi stands ready to work with a broad range of local, regional and international partners to build a truly global healthcare offering.

"In 2018, we broke ground on our new dedicated oncology center. Modelled on Cleveland Clinic’s Taussig Cancer Center, which is ranked fifth in the United States, it promises to transform cancer care in the UAE." - Dr. Madhu Sasidhar

Recently made available to the UAE market, Dr Batra’s Geno Homeopathy is being touted as the world’s first Genetically-Guided Homeopathy treatment method. This innovative and path-breaking gene-targeted homeopathic treatment is scientific, precise and uniquely planned for individuals of all age groups, including children. Arab Health Magazine spoke to Dr. Mukesh Batra, who is the Founder of Dr Batra’s Group of Companies, about the impact of this new treatment method.

How does gene-targeted homeopathic therapy work?

The genes of every person are just as unique as his or her fingerprints or iris. Dr Batra’s Geno Homeopathy is designed where no two patients, even with the same medical condition, will be given the same homeopathic treatment. The homeopathic medicines are both natural and effective, based on a patient’s genetic make-up, and are individualised according to the age, health and lifestyle.

How are the tests carried out?

The genetic test for Dr Batra's Geno Homeopathy consists of a simple saliva test that can assess the severity of a medical problem even years before the disease appears. The results of which are available for the patient within three to four weeks.

In general, genetic tests use up to seven markers. However, Dr Batra’s medical experts in conjunction with specialists in genomics have designed a genetic test which includes an extensive list of 15 markers per test. Ailments covered include hair loss, psoriasis, acne, vitiligo, skin and respiratory allergies, child health, weight management, stress, preventive and women’s health.

These markers are comprehensive and customised and comprise of all related problems to the main condition or complaint including primary and secondary problems. They indicate the gravity of the illness and give an in-depth analysis of the condition. The genetic test also provides patients with a lifestyle chart that incorporates dietary and exercise programmes to compliment the treatment plan.

"Ailments covered include hair loss, psoriasis, acne, vitiligo, skin and respiratory allergies, child health, weight management, stress, preventive and women’s health." - Dr. Mukesh Batra

What is different about this treatment?

Dr Batra's Geno Homeopathy consists of precise gene-targeting for exact diagnostic evaluation. It is a painless and natural, personalised treatment-plan based on unique genetic history of a patient. It predicts the likelihood of genetic ailments well before symptoms appear and also attempts to prevent the risk of any hereditary illnesses through timely treatment.

Is homeopathy covered under health insurance schemes in the UAE?

Yes, homeopathy is covered under health insurance schemes in the UAE. In fact, the UAE is one of the first countries to include homeopathy within health insurance.

The treatment is a painless and natural, personalised treatment-plan based on unique genetic history of a patient.

The Cooperation Council for the Arab States of the Gulf, colloquially known as the GCC, has experienced unprecedented population growth over the past two decades, with the region’s population nearly doubling between 2000 and 2017. With the exception of Saudi Arabia, countries across the GCC have seen their populations double to quadruple within this time period (Figure). The increase is even more significant when compared to the 12% population growth across all other high-income countries. With the simultaneous addition of 25.7 million residents in the region, life expectancy at birth has increased by between 1.5 years (Kuwait) to 5.1 years (United Arab Emirates), creating a level of increased demand for healthcare that no other geographic region has experienced in recent years.

IIt would be nearly impossible for any country to meet such a dramatic increase in demand by itself. However, targeted infrastructural and human capital investments coupled with strategic collaborations with foreign medical schools and hospitals have helped GCC countries address their immediate healthcare needs while simultaneously creating more sustainable solutions to meet the demands on their healthcare systems. GCC countries have invested heavily in their healthcare infrastructure, with numerous new medical cities and complexes as well as specialty clinics being built over the past two decades. With such a sharp increase in the region’s population, governmental investments have expanded capacity in general acute care hospitals and primary care to address the most prevalent healthcare needs. At the same time, collaborations with foreign providers have begun to help the region address more subspecialty and tertiary care needs. One of the traditional strategies has been to create partnerships with providers in other countries, with patients traveling abroad for complex medical care that may not otherwise be available.

With medical and health sciences education expanding to address the shortage of clinicians and allied health professionals, other collaborations are filling the immediate clinical and management needs within new and existing medical facilities while simultaneously investing in human capital. These solutions have included training clinical professionals on cutting-edge, specialized diagnostics and treatments as well as leadership competencies needed to implement and sustain these new technologies. Collaborations among healthcare providers across borders take many forms, including educational offerings, advisory and consulting services, management services agreements, and capital investments. Each of these collaborations by themselves and in combination with other investments can help to both address short-term needs and increase long-term capacity.

Educational offerings can include both degree and non-degree programs. Degree and continuing education programs may require individuals to travel to the host country or have the training occur in the home country. Both clinical and non-clinical observerships, shadowing experiences for professionals to gain specialized knowledge in a particular area, are a common way to build expertise, particularly for novel treatments and diagnostics. The type of educational offering and whether it is delivered in-country or at the host institution often depends on the depth of knowledge and training required as well as the number of trainees participating at any given time. It may be more efficient and effective for an educational program to be provided within the home country if there is a cohort of trainees to participate; with only one or a few trainees, providing the training at the host organization may be more cost effective. These educational offerings can be sustained by creating capacity via “train-the-trainer” approaches, where the learners are also trained to be the future instructors in their home countries.  

Advisory and consulting services include the provision of expertise about specific service lines as well as in hospital operations and facilities management, talent acquisition and human resource planning, technology and innovation, patient safety and quality, hospital planning and design, and other areas. A third strategy for developing the healthcare systems locally is through management services agreements that help to address the demand for professionally trained healthcare leaders to oversee hospitals, clinics, and individual service lines. Management service agreements bring this in-depth expertise directly into organizations in need, providing patient-centered care and value-based care in addition to clinical specializations. The fourth strategy involves international investment or ownership in healthcare or educational facilities in which a foreign organization either wholly or partially owns a local facility. All of these strategies directly address a near-term shortage or need within the home country while simultaneously providing investments in longer-term capacity building.

In our own research of the types of collaborations U.S. healthcare providers engage in with healthcare organizations abroad, we have found that the most common mode of non-patient international collaboration was via educational programs. Additionally, half of the hospital and health system members of the U.S. Cooperative for International Patient Programs (USCIPP) also engaged in consulting and advisory services with organizations outside of the United States. While addressing an immediate need within the GCC countries, these collaborations also benefit the host organization by enhancing its global reputation and brand. Most U.S. academic medical centers and teaching hospitals have a mission to promote global learning and practice opportunities for students, trainees, fellows, clinicians, and other healthcare professionals, thereby bringing their expertise to communities that need them. These non-patient collaborations are an important means for organizations to fulfill their educational mission of providing care to their communities and creating what are often life-changing experiences for the healthcare professionals themselves.

Examples of collaborations building health system capacity locally

Healthcare providers and governments in the GCC have partnered with USCIPP member health systems to design and implement a variety of initiatives aimed at ensuring access to high-quality specialty care locally, decreasing the number of patients with complex care needs who need to travel abroad.

Mayo Clinic Care Network: A network of more than 42 independent healthcare systems across the world, the Mayo Clinic Care Network includes two members located in the Gulf: the American Hospital Dubai in Dubai, UAE, and the International Medical Center in Jeddah, Saudi Arabia. Internationally, the Network provides local hospitals and physicians with electronic access to Mayo’s clinical specialists and subspecialists, including e-tumor board conferences that allow physicians abroad to discuss complex cancer cases with panels of Mayo Clinic experts and other Network providers. In a recently published analysis of the benefits of Mayo Clinic Care Network’s e-consult and e-tumor board services, second opinions provided through these services improved the final treatment plan in over one-third of challenging cancer cases.

NMC Healthcare and Cincinnati Children’s: The two institutions have an agreement by which specialized pediatric surgeons at Cincinnati Children’s provide lifesaving and life-enhancing surgeries at NMC Royal Hospital in Abu Dhabi through surgical visits. The collaboration is focused on developing pediatric surgical expertise to treat complicated congenital, neurological and musculoskeletal disorders at NMC Royal Hospital.

Al Jalila Children’s Specialty Hospital in Dubai and Children’s Hospital of Philadelphia: The two have a memorandum of understanding to establish a dedicated neurology outreach program that integrates telemedicine consultations into the program, thereby reducing the physical and financial burden of care for children and their families.

The alliance facilitates patients who have sought care for neurology-related disorders at hospitals from across the world to continue their treatment plans at Al Jalila Children’s. Pediatric neurologists from Children’s Hospital of Philadelphia provide consultation, thereby lessening the burden of traveling to and from the United States for patients and their families.

Memorial Sloan Kettering Cancer Center and the Kuwait National Mammography Screening Program: The institutions have collaborated to implement a national mammographic screening program in Kuwait. Physicians are trained in both the United States and Kuwait, and Memorial Sloan Kettering physicians provide follow-up to assess image quality, screen program results, and provide continuing education in Kuwait for Middle Eastern radiologists and technologists. Five Kuwaiti radiologists participated in a six-month breast imaging program in the United States under the instruction of a Memorial Sloan Kettering radiologist. Similarly, six Kuwaiti technologists observed nearly 600 cases over a three-month teaching period. The educational training program occurred from 2014 to 2016.

King Faisal Specialist Hospital and Research Center (KFSHRC) in Saudi Arabia and Houston Methodist: The two have cooperated since 2009. Through their latest agreement, KFSHRC and Houston Methodist explore the advancement of various projects, including providing staff with clinical and leadership training programs in Houston. The agreement also provides KFSHRC’s physicians with access to world-class experts at Houston Methodist who will offer second opinions for patient diagnoses as part of the hospital’s second opinion program.

Healthcare providers from across Europe, Asia, and beyond are also actively collaborating with providers in the GCC to help build capacity. For example, King’s College Hospital London opened a medical center in Dubai in 2017.

In many cases, these international collaborations focus on specific service lines through which partners bring their expertise to the region to address a healthcare need. University Hospital Sharjah has partnered with Himchan Hospital in Seoul, South Korea, to provide advanced spine and joint medical services locally. At the same time, Canadian institutions have helped to grow capacity for cancer care in Kuwait through clinical specialization, knowledge transfer, and education and training.

With the continued demand for complex, cutting-edge medical care, strategic collaborations between GCC providers and foreign medical schools and hospitals help to address evolving human capital and infrastructural needs. At the same time, these collaborations create longer-term capacity necessary to address the region’s healthcare demands locally.

References available on request.

International collaborations focus on specific service lines through which partners bring their expertise to the region to address a healthcare need.

Though we are in an era when the U.S. government may seem to be pulling back from global engagements – political, social and even commercial – this may be an opportunity rather than a hurdle for the private sector. We must keep in mind that the government and the marketplace are two quite different spheres. America has vibrant, leading private sectors, quite simply offering the best available resources and output: defense, aerospace, education, energy, and perhaps most of all, healthcare. We in the U.S. – that is, academic and research institutions, providers, clinicians, practitioners, and administrators – are the worldwide leaders in healthcare. There is an increasing need and as importantly, demand, for the very best healthcare from every corner of the globe. We have it, and quite literally, the world wants it. Markets seek products. Need means opportunity.

“…development assistance for health, if suitably targeted and managed, has the potential of drastically reducing inequality in health outcomes: the robust empirically observed relationship between health outcomes and healthcare spending is indicative of large returns to healthcare investments…” – Financing Healthcare by Esteban Ortiz-Ospina and Max Roser.

Turning trade around

In healthcare, as in many industry sectors, until now, we have been good at sharing our best practices, ideas and innovations with people and enterprises around the world by having open channels to our knowledge and experience, by having others come to us. In many areas of manufacturing, we have been quite proficient at creating flow in the opposite direction, taking our goods to others. But in human services such as healthcare, while we have done an outstanding job of caring for the sick from around the world when they come to our land, we have yet to fully realize the potential impact of our asset and its value on a global scale by taking it to the world instead of only inviting the world to us. We have said, in effect, “We are the experts. You’re welcome to come and see our doctors and nurses and stay in our hospitals.” The result is that at best, we “export” healthcare one patient at a time. Of course, this is to some extent, an exaggeration since there are global health initiatives. One could argue that we have been prolific in some research and education collaborations, expansive in our reach with technology and business ventures, and generous in our funding of global health initiatives (in addition to private support and philanthropy, the U.S. government Global Health Funding in 2019 totaled US$11 billion). But, in order for all of these advancements to impact the center of it all – the patient – we need to develop, deploy and adapt the operational systems that make this complex healthcare machine work around the world, not just in the U.S. To play off of the aspirational words of Steve Jobs, we have hardly made a dent in the universe…yet.

Trade and aid converge in healthcare

“Private enterprise is the single most powerful force for lifting lives, strengthening communities, and accelerating self-reliance.” – USAID Administrator Mark Green.

In December of 2018, the United States Agency for International Development (USAID) marked the formal launch of its new Private Sector Engagement Policy (PSE) unveiling an “intentional shift” to market-based approaches to development. It defines the private sector as “for-profit commercial entities and their affiliated foundations; financial institutions, investors and intermediaries and for-profit approaches that generate sustainable income” such as venture and investment funds run by non-governmental organizations. The policy directs the agency to collaborate with the private sector across all areas of its work – including economic growth, education, healthcare, and crisis and conflict. By doing so, USAID and the private sector can accelerate progress and achieve outcomes of shared interest and value.

Demand, demand, demand

In a world where things no longer happen slowly or incrementally over time – but rather knowledge travels at the speed of a click – people, countries, governments, enterprises everywhere, no matter how remote, know what is possible, what they want, what they do not have but desperately need, instantaneously. And at the top of that list of needs is health. Of course, as countries step up efforts to build healthcare infrastructure and services to meet the needs of their increasingly educated consumers, those countries seek to adopt best practices, modeled after what is believed to be the best healthcare in the world, that of the U.S.

The inquiries and proposals coming from public and private investors on every continent, calling for U.S. partnerships, through formal and informal channels, are currently a virtual onslaught and continue to escalate. The frequency of delegations visiting AMC’s (Academic Medical Centers) is overwhelming. And this is frankly, in spite of the reality that most if not all of these medical centers are at best ambiguous about their global healthcare objectives. They all know there is a need, and they each know they possess some of the wherewithal to meet that need, and that doing so may represent a future growth path…but they almost all lack a strategy or plan on how to get there. The lack of knowledge, and the dearth of definitive strategies or plans for global engagement, leaves them unprepared to proactively address the opportunities and leverage for economic benefit and competitive advantage. A priceless asset sits without a path to market.

Emerging wealth and wellness

In a worldwide marketplace, there are few unexploited sectors.  Healthcare is one…at least for the moment, a moment to be seized. It meets all the criteria of financial gain, reasonable risk, and sustained growth. And this is not only in the opinion of those who stand to participate, but rather from those who dispassionately study markets and invest for a living.

Healthcare investment in emerging economies has significant upside. Acquisitions, mergers and healthcare private equity investments are growing by size and profitability. And they are outperforming other industries. The Emerging Market Private Equity Association (EMPEA) representing more than 300 institutional investors, fund managers and industry advisors who manage more than US$5 trillion in assets across 130 countries, conducts an annual survey of members and reports on industry performance and outlook. Healthcare is ranked as the most attractive sector for exposure to emerging markets in recent years. At the same time, these financial experts recognize the complexity, challenges of the sector and their lack of experience. In addition, the majority of the association’s commercial investors “explicitly acknowledged the importance of social and environmental factors in their investment decision-making,” thus elevating the opportunity for collaboration to balance financial and social impact.

Healthcare diplomacy

International healthcare, or “healthcare diplomacy” exports wellness and makes people well. It exports diagnoses, prevention, treatments, cures, and health habits to patients and potential patients of all ages, in all conditions, in all levels of need, from those fetuses who might otherwise not be born, to infants born but struggling, to those that might not survive, or may survive only to suffer debilitating disease, or shortened lifespans, or population-ending epidemics. It is literally a healthy business. There are fewer still where one profits and does good.

Emerging opportunity

The high value of U.S. assets – including AMCs and their powerful brands built on knowledge, experience and healthcare outcomes – will prompt more investors, including U.S.-based firms, to look overseas.

Individually and in collaboration, international investors are looking to U.S. partnerships to build healthcare resources around the world to meet the needs, country-by-country and region-by-region. Naturally, they are attracted to internationally recognized “brands” or centers where the expertise is already acknowledged and recognized, where the brand equates to medical superiority. (Many of these international investors have personal experience, often first-hand or via a family member, with U.S. based medical centers and have felt the impact of advanced medical treatment). But beyond the obvious brand names that come to mind, the U.S. has an even larger collection of accomplished centers of excellence, often every bit as good as the “famous” ones, that possess expertise in critical treatments and specialties that would be ideal and enthusiastic partners for investors. The U.S. medical resource is vast and as yet, largely untapped in the global market.

Patient perception

The U.S. leadership and continual advances in medicine – prevention, drugs, procedures – and in medical operating systems, and most importantly, quality outcomes are known by not only experts or investors, but most importantly by patients or potential patients around the world. While the nearby treatment may not be available globally, the news of medical advancements is well known. It is perceived, and therefore wanted, even where it isn’t yet available. In fact, knowing life-altering treatment exists and not being able to access it not only creates greater demand, it creates a human obligation to meet that need. Healthcare at its best is valued by patients and by providers alike, as well as the countries in which those patients live, the municipalities, the employers, and everyone who relies on good health for their existence.

This intersection of AMCs’ opportunity to expand their footprint, for investors and partners to realize gain, and for the increase of worldwide wellness is uncommon. It is no wonder that the export of healthcare – or healthcare diplomacy – represents an inflection point to invest, succeed, and impact lives at once.

Proof of concept – healthcare benchmarks

It is an acknowledged reality that American benchmarks and quality are sought after both as the mark of standards and as a competitive advantage in the market.
For investor comfort, optimizing return requires operational and clinical expertise and management. In addition, there is a need for implementation systems that are locally viable and sustainable. That is, it is not enough to have an “American brand name” grafted onto a facility. There must be a partnership – a solid, locally-based entity, with a plan for future training and growth in order to be both a top-level healthcare provider and a long-term investment.

Global partnerships should have a structure and maintain a process-oriented framework for the long-term collaboration. Most importantly, notes Dr. Heitham Hassoun, VP and Medical Director at Cedars-Sinai Health System, it should have defined Clinical Requirements that allow for the monitoring of the quality of care delivered at the collaborating site and to ensure the quality is consistent with standards and reputation of the partners. The areas of focus are 1) clinical quality, 2) risk management, 3) patient safety, 4) international accreditation and 5) patient experience. A well-developed process also allows for collaborative development of key performance indicators with benchmarking across a network of facilities at home and abroad.

International funds (that is, global alliances as well as local and regional investors) are highly motivated to invest in emerging markets...but often lack the depth of experience and expertise needed for complete due diligence. In other words, even if they want to invest, they may not be equipped to evaluate opportunities in sectors where they do not have prior experience. They need to understand what constitutes a strong healthcare facility in terms of human capital, physical plant and proven management. Further, they must become more informed of the cost base required to operate facilities at our standards.  

Healthcare – a positive opportunity to connect with the world

There are many good reasons why we should organize ourselves and respond to this demand – economic, scientific, academic and humanitarian – as well as a rare opportunity to enhance and advance the standing, individually and collectively, of AMCs in the world. Healthcare is more than a national or international trade or business engagement; it is deeply personal – literally life altering, often life-saving – and as such, bears lasting impact. Leading AMCs can and must seize the opportunity to relate to people around the world on the platform where all parties can see eye to eye, where they are actively seeking our presence, our guidance, our business, and our citizens. It is a healthcare platform of shared values and goals providing the best possible care to individual citizens. The role of the private sector is making that happen. Third world and emerging economies, and the international corporations that do business in those parts of the world need improved prevention and healthcare for their survival and success. It is critical to their economic, political and social survival and growth to have healthy people to become healthy employees to build healthy, stronger and more viable economies. They need the instant credibility that U.S. AMCs bring on day one, in partnership with locally-based facilities. They need the longer-term impact and outcomes that they bring over time – healthier citizens. Those AMCs, their corporate partners and investors, that are part of the solution will be viewed as the leaders around the world. Those investments will pay dividends monetarily and reputationally. It is not just policy or political; it is a business with unique potential in international relations – it is healthcare diplomacy.  

Reluctance: The reasons more AMC’s haven’t engaged

If the opportunity is so compelling, if the returns are potentially so substantial, why has there not been a greater rush to engage and invest?

First is readiness or the structure to commit fast and fully. It is generally not in the nature of academic institutions, often for good reasons, to act or react so quickly. They are, after all, academic first, not economic. But they also must survive and thrive.

Advanced medical care is inherently complex and requires the interaction and coordination of multiple areas, from infrastructure, to financing to human capital (doctors, nurses, researchers). Advanced care is dynamic, that is, it is in constant motion and change, and as a consequence, the timely adoption and implementation of innovations and discoveries can be challenging.

Second is interest or priority. As U.S. health systems have faced challenges at home, there was little bandwidth to develop expertise and practical models for the expansion of services beyond our borders and service areas.

Third is a model or rather the lack of an evidence-based model. There have been few prescriptions for global engagements that have proven effective and sustainable. But we now have a collection of documented experiences that emerged out of experimental engagements by those who have ventured into world markets. We now have concrete, positive, learnings and results to share with others. We have the raw data for a model but now we need to utilize it to build repeatable, replicable, cases in point from which we can say, “let’s do more of those.”

Where to start – immediate regional relevance

The Arab world with its various healthcare constituents – patients, providers, educators, investors and governments – has played major role in the development of international healthcare programs with major medical centers in the United States. Many of the first ventures of US AMC’s abroad were to the region, enabled by the resources and local drive for healthcare excellence, and not to be underestimated, the welcoming environment. Whether by refining current models or by innovative approaches, the bilateral experience will shape future collaborations and cross border transactions. The region will continue to play a major role. There is literally – and geographically – no better place to develop, nurture, and reap the rewards for all parties of healthcare diplomacy than the Middle East. There is need and demand; willingness, experience, and resources; a history of joint success; a knowledgeable population, interested governments and global businesses – only upside. What better place to do well by doing good?

Cases in Point – West Coast medical centers

Numerous prominent U.S.-based medical centers and medical educational institutions – the famed east coast medical “brands” – are already visible in the Arab World, through affiliates, branches and in-country projects. But, because of the attractiveness and timeliness of the opportunity, many other institutions – big brands in their own right, often on the “other coast” – have also pursued a wide range of collaborations and exchanges that have generated attention and gained positive impact. These recent initiatives have gone beyond international patient care in the United States and include medical education and training, public health initiatives, and research. Notably Stanford Medicine and UCLA have undertaken ambitious, high-results, high-return ventures.

Combined with significant experience under their belt from Asia markets, they are moving aggressively, with intent, and seek to be part of the transformative healthcare efforts in the Arab World, expanding their relationships and creating programs outside the classrooms and training labs.

Let’s start with Stanford, based in Northern California, as prestigious an institution as any on either coast, or in the world. “At Stanford Medicine, we recognize that the health organizations leading tomorrow will look very different from those we see today,” said Priya Singh, Chief Strategy Officer at Stanford Medicine. “They will rival retail companies in consumer experience, have international reach through digital services and platforms and, most importantly, they will collaborate across institutions and borders to innovate. As an organization, we are aligned toward this future. And we view the region as a key partner in our global strategy. We are actively seeking to foster clinical and scientific exchange in the region and collaborate on efforts to enhance local capacity for delivering what we at Stanford Medicine call Precision Health. It is our vision for the future: to harness the latest advances in biomedicine and informatics to predict, prevent, and cure disease — precisely. Only by working together can we realize the true potential of Precision Health.”

Just down the coast is UCLA, a public institution that has gained regional, national and international prominence. Highlighting the depth and breadth of their activities in the Arab world and beyond, Dr. Maie St John, Professor and Chair of Head and Neck Surgery at UCLA Health states, “We are very excited at the prospect of developing relationships internationally to further the reach of cutting-edge clinical discoveries and new models of patient care.”

“This opportunity is one that can’t be missed,” adds Dr. St John, referring to the unique science and population health models from UCLA being shared in global communities, and fueling teaching, capacity building and research initiatives abroad.

These two cases are indicative of the appetite, interest, and opportunities in the Arab World for high level American medical institutions from across the U.S., partnering with governments and business interests. In a market region as challenging and rewarding as it gets, more institutions may indeed bring unique perspective and learnings from their healthcare ventures throughout the Asia-Pacific. It will be interesting – and likely good health and good business – to follow and observe how things play out in this part of the world.

Polycystic ovarian syndrome, or PCOS, is reportedly one of the most common endocrine hormonal disorders affecting women in the Middle East. One study found prevalence of the syndrome to be as high as 27.6 per cent among women in the UAE and is a leading cause of infertility.

Raising awareness

Doctors warn that despite the rise in prevalence, women still remain unaware of the serious implications of the disease. The close link with the sedentary Dubai-lifestyle calls for raised awareness on the importance of a healthy lifestyle – which also happens to be the main way to treat the disorder.

“Polycystic ovarian syndrome is one of the most common endocrinopathies amongst women and is very commonly seen in Dubai,” explains Dr. Shiva Harikrishnan, Consultant Obstetrics & Gynaecology, Medcare Women & Children Hospital.

“It is characterised by high levels of male hormones, cysts on the ovaries which is detected by ultrasound scan, and irregular or skipped menstrual periods. We don’t know exactly what causes PCOS – it may be that the high levels of male hormones prevent the patient’s ovaries from producing regular hormones and making eggs. However, genes, insulin resistance, and inflammation have all been linked to excess androgen production.”

Symptoms

Women diagnosed with PCOS commonly display abnormalities in insulin regulation. Excess insulin might increase androgen production, causing difficulty with ovulation. These women also exhibit a type of low-grade inflammation, which also stimulates androgen production and can also lead to heart and blood vessel problems. This excess androgen production common to PCOS cases can result in hirsutism and acne. There may also be a hereditary link to PCOS as it is commonly seen in family groups.

"We don’t know exactly what causes PCOS – it may be that the high levels of male hormones prevent the patient’s ovaries from producing regular hormones and making eggs. However, genes, insulin resistance, and inflammation have all been linked to excess androgen production.” - Dr. Shiva Harikrishna

Treatment

“Some women start seeing symptoms around the time of their first period. Others only discover they have PCOS after they’ve gained a lot of weight or they’ve had trouble getting pregnant. Patients should see a healthcare professional as soon as they suspect symptoms to ensure the best overall outcome. There are numerous treatment options, including medication and surgery,” Dr Harikrishnan adds.

The main avenues of treatment revolve around weight loss and the implementation of a healthy lifestyle. Nutrition advice, a carb-controlled diet and adequate physical exercise are all first line treatment options for PCOS. Even a modest reduction in weight can improve hormonal imbalance. Doctors can also prescribe medication to regulate menstrual cycles and encourage ovulation.

References available on request.

The main avenues of treatment revolve around weight loss and the implementation of a healthy lifestyle.

Hospitals and health networks have spent the past several years adjusting to the introduction and proliferation of electronic health records (EHR) and building up their IT infrastructure to support and leverage EHR use. There are however other parts of the hospital IT network that are often also overlooked.

“The introduction of electronic health records (EHR) still remains at an infancy level globally given the extent of work that needs to be completed in closing existing IT infrastructure gaps within hospitals,” said Pierre Havenga, managing director MEA at Vertiv. “Our experts have identified key solutions that build stronger, more resilient hospital IT networks to streamline processes and optimise power and cooling systems to ensure fast, safe and efficient record keeping for both patients and doctors in the region.”

Vertiv experts identified three such areas – imaging suite, nursing stations and billing – where today’s hospitals can benefit from increased attention to and investment in their IT infrastructure.

Imaging suite

Medical scans and images are benefitting from technology advancements such as 4K resolution that provide stunning, revealing detail. But these improvements also require high data transfer and low latency to operate as intended. Some legacy infrastructure equipment, such as KVM switches that enable easy access to numerous files and servers across multiple workstations, aren’t equipped to work with today’s high-resolution images and video. Newer KVM switches enable higher resolution imaging. Doctors and surgeons should have access to the same high-definition images and videos as those used in the broadcast industry.

Nursing stations

Many hospitals rely on building UPS systems and generators to provide backup power throughout the facility. That’s fine in theory, but if that centralised UPS system fails, it can be crippling to the routine – and often urgent – work that occurs throughout the hospital. Nursing stations are especially vulnerable, because they rely heavily on IT systems for patient status updates, medication management, and treatment schedules.

A local UPS system with extended battery time can deliver redundancy and ensure availability of those critical IT systems. Nurse’s stations frequently rely on a remote desktop or KVM switch to access and manage data, but too often those tools are rendered useless in the event of a loss of network connectivity. For this reason, a KVM switch capable of out-of-band management is a smart choice. In fact, out-of-band remote management is critical across the hospital. Too often today, system maintenance needlessly disrupts life-critical activities when a simple serial console server can allow IT staff to perform routine maintenance remotely without disrupting the more important, patient-focused work of doctors and nurses.

Billing department

Billing personnel switch frequently between sensitive private patient data and non-sensitive applications. For example, while accessing a patient’s file, they may open an Internet browser to search for information about an insurance provider. Without the right equipment, that can create a vulnerability a skilled hacker could exploit. Secure switches traditionally used in government applications allow safe switching between sensitive and non-sensitive platforms, and they are finding new uses in health systems and wherever privacy concerns exist.  

System maintenance needlessly disrupts life critical activities when a simple serial console server can allow IT staff to perform routine maintenance remotely without disrupting the more important, patient-focused work of doctors and nurses.

Some of the biggest global healthcare challenges are the collection of non-communicable diseases such as cancer, diabetes and heart disease. Sedentary lifestyles and unhealthy eating habits, particularly in certain regions such as the Middle East – alongside risk factors such as high blood pressure and obesity – mean that these affect a worryingly high percentage of the population.

As consumers become more health literate, it’s somewhat frustrating that in the face of myriad awareness campaigns around nutrition, smoking and exercise, there doesn’t appear to be a huge shift in changing behaviours.

When we are looking specifically at health disease awareness campaigns, we need to think carefully about what we want the outcome to be. Do we want to merely raise awareness, or do we actually want to influence and change behaviours? Is it enough for people just to know they are at risk of heart disease if they make certain lifestyle choices, or can we do more to persuade them to make better choices?

Communities are bombarded with facts and figures, such as recommended calories and minutes per day of exercise, as well as ideal BMI and weights. But with this cold and objective information, are we actually missing the key to capturing attention and addressing behaviour?  Do people not remember the information or are they wilfully – or even subconsciously – ignoring it?

Biases

Those of us working in marketing and communications often use market research to help us to build informed strategies to address the needs of consumers. However, this type of data, which gives a picture of conscious decision-making, only tells half a story. It is tainted by cognitive bias – that is, it fails to uncover – or even recognise – those less tangible factors that subconsciously influence the decisions we make and reflect our nature as emotional, impulsive and irrational beings. It answers the ‘what’ and the ‘how’ for consumers, but it cannot really address the ‘why’. Understanding non-conscious decision making is emerging as a real area of importance for communicators because psychologically, bias trumps logic, so finding the right motivators is essential to drive behavioural change.

Of the different biases that affect our healthcare decision making, two stand out that we must counter when thinking about educational campaigns. The first is present bias, which reflects our desire for instant gratification, and challenges our ability to act now for a future benefit. Present bias makes it much harder to make positive decisions that we know will benefit our health long term but might be harder in the moment (think the gym on the one hand, or Netflix and sofa on the other).

The second is our limited attention, which considers the functional decisions we have to make to stay alive – the financial, familial and other pressures. Positive healthcare decisions and changes require mind space that may not exist in the face of everything else – particularly for low income, time-poor individuals. Habits, mental shortcuts and reminders help us to navigate our choices moment to moment and reduce the number of conscious decisions we have to make.

Within any specific healthcare context, be it screening, diagnosis, treatment adherence, or follow up, specific biases will influence patients in their decision making. Psychological testing is potentially an effective way to uncover some of the non-conscious influences of behaviour. This could identify fear, societal or familial pressure, presumed knowledge, desire to follow the crowd, desire to stand out – the list goes on.

Non-conscious testing can uncover behavioural patterns and prioritise them in order of importance in a way that traditional research simply cannot. And the kicker is this: once we know and understand these biases, we can use psychological tools and ‘nudges’ to design strategies that address them. We need to find ways to make choices appeal in the moment and we need to help people form new habits and mental shortcuts. It needs to be easier or more rewarding to make a good health decision than a poor one.

Applying creativity

But, how do we incentivise people to make a good choice? How do we help people make small commitments to build new habits? From a communications perspective, this is where creativity comes into play. In advance of the 2014 Winter Olympics, Olympic Change, the group in charge of ticketing, wanted to get Russians active and amped up for the games, so they offered a free subway ride in Moscow in exchange for 30 squats. The financial reward may have been small, but it was immediate and real, and it got people moving. Ok, this won’t necessarily build a long-term habit, but it’s easy to see how this simple yet creative idea could be applied elsewhere.

On a more strategic level, there are health insurers in the UK and elsewhere slashing insurance premiums for those who allow their exercise and nutrition to be monitored. This has been in place for more than 10 years. Organ donation is also a great example. How do you get people to register as an organ donor? You make it the default option. You make it easier for someone to be a donor than not to be one. In an analysis of government registries across Europe, the effective consent rate for organ donation was between 86 and 99 per cent in opt out countries, vs a maximum of 28 per cent in opt in countries. When people don’t have strong preferences, the use of defaults can have a significant impact.

Diabetes epidemic in the UAE

According to the Imperial College London Diabetes Centre, diabetes rates in the UAE are rising faster than anywhere else in the world, driven by limited exercise and unhealthy diets. We need to think differently to make change. Encouraging good health decisions is not just about educating people, it’s about understanding their motivations and changing the environment around them to make the default choices the right one. In this region, and particularly in young countries such as the UAE where socioeconomic development continues at an astronomical rate, rather than look at targeting the people, the question we should be asking is this: how can organisations and companies help create an environment in which the better decision for individuals is the easier and more obvious one? If we succeed, a healthy community becomes the default rather than the aspiration.

References available on request.

When people don’t have strong preferences, the use of defaults can have a significant impact.

September 29 is recognised the world over as World Heart Day. No one needs to be told how important their heart is, but many of us could do with some help looking after ours. Heart disease is a catch-all for a catalogue of health concerns and, according to a recent survey, cardiovascular disease (CVD) remains the number one cause of death in the UAE, accounting for over two-thirds of all deaths.

Risk of heart disease is dependent on several factors such as age, smoking habits, diabetes, weight and stress, family history and genetics. The good news is that even small lifestyle changes can lower your risk of heart disease by as much as 83 per cent. The key is to act now.

So, what can you do to build a healthy heart and avoid heart disease?

Don’t stress it

Stress itself is a risk factor in cardiovascular disease and it's one that disproportionately affects expatriate employees. We understand the pressures of living and working abroad, often in demanding roles. Then, there is the added challenge of settling families in a new culture and living without the support of a domestic network, such as friends and extended family.

Many expats find it hard to talk about anxiety, depression, stress and mental health, or simply don’t have anyone to support them.

Your insurance will most likely include an Employee Assistance Programme (EAP). The programme provides a confidential counselling service from behavioural health experts around the world to help keep you healthy and happy while you’re living abroad. Find out if you have access to our EAP through your plan and get the support you need today.

Know your numbers

There are ways to calculate and monitor your risk of heart disease and it’s important to keep up-to-date with your health status.

One method is to use the American College of Cardiology’s ASCVD Risk Estimator Plus tool, which gives you a percentage likelihood of developing atherosclerosis (clogged arteries) in the next 10 years. The tool uses your age, sex and ethnicity as well as vital statistics such as your cholesterol level (HDL and LDL) and blood pressure. Most of us won’t know these latter statistics so it’s important to get a check-up with your primary doctor, who will also recommend you have blood tests at least every four to six years.

Optimise your intake

Diet is a key factor in maintaining a healthy heart. Studies consistently link high-quality, healthy food to a lower risk of coronary-artery disease.

Ignore the latest diet fad and focus on building a healthy and balanced diet that you will stick to. The key is to gradually remove bad things and replace them with good things to build healthier habits that you can sustain. Inject more vegetables, fruits, whole grains, nuts, legumes and yoghurt into your meals. Remove or cut down food such as red and processed meats, refined grains, sweets and fried food.

Think about this when you make or choose your next meal — what would a healthier option be?

Get moving

Making time to exercise can be hard when you have a job, family and other demands — let alone when you’re trying to do it all in a new country — but increasing your aerobic fitness is an essential part of building a healthy heart.

If you don’t have time to go to the gym or play a sport, try to fit brisk walking or desk exercises into your daily routine. Even these small lifestyle changes can help you to reach the Centers for Disease Control and Prevention-recommended 150 minutes of moderate cardio every week.

A balance of strength and cardio work is ideal and many time-poor individuals have found HIIT (High-Intensity Interval Training) a great way to workout. HIIT involves ‘micro workouts’ of as little as 10-minutes, to be done every day. Done over many weeks, the results can double your stamina, increase metabolism and burn fat — and there’s no equipment necessary!

Centers for Disease Control and Prevention recommended 150 minutes of moderate cardio every week

Tackle cholesterol

The body makes its own cholesterol, but certain foods — those high in saturated or trans fats such as fatty cuts of meat and dairy products — allow additional cholesterol to build up in your arteries. This build up prevents blood flow around the body and, if it isn’t addressed, can result in heart attack.

Without having a blood test, many people are unaware that their cholesterol levels are too high. As such it is important to find out what your cholesterol numbers are by visiting your primary doctor.

If, after assessing you, your doctor discovers that you are at high risk of cardiovascular disease or have high cholesterol, they may prescribe you statin ― a drug that helps to lower cholesterol in the blood.

Build your support network

Mental health is an often-overlooked factor in heart health. However, it can impact the body directly — blood pressure, cholesterol — as well as indirectly by driving unhealthy behaviours such as drugs, drink, smoking and other psychological crutches that people rely on to get through a difficult or vulnerable time.

It’s important to manage your mental health to avoid the impact on the heart, and the support of friends and/or family is essential. This is particularly pertinent for expats, many of whom move for demanding jobs on their own — although even relocating with a family can bring its own set of stresses and pressures.

This makes it essential to build and maintain a support network while living away from home and there are many ways to do it. The easiest thing is often staying in touch with family at home by booking in set times for when you will call or chat with them.

Another good approach is to proactively build relationships with your work colleagues. Many international workplaces have a ‘buddy’ system to support new arrivals and facilitates work social events. Particularly in the UAE we are blessed that we have vibrant expat communities who can offer support and they’re often easy to find and connect with online.

There is a famous Chinese proverb that says, ‘A journey of a thousand miles begins with a single step.’ Making small everyday changes — whether it’s reducing your stress levels, making health food choices, exercising regularly, going for regular health checks, or taking care of your mental health ― will go a long way to strengthen your heart health and avoid heart disease.

References available on request.

Social media has emerged as a platform for individuals to lead the way in bringing conversations about mental health into public online spaces. While the more negative affordances of social media are often emphasised, Arab Health Magazine spoke to Dr. Saliha Afridi, Clinical Psychologist and Co-Founder of The LightHouse Arabia – Center for Wellbeing in Dubai, to find out about her thoughts on social media as a method for challenging mental health stigma in the region.

What role does social media play in destigmatising mental health issues in the Middle East?

Our region has a high number of social media users so using this platform to destigmatise mental health issues has been a key strategy of mine, as well as of the The LightHouse.

Educating people on symptoms of depression and anxiety and other disorders, demystifying what it looks like because people have an idea that depressed and anxious people hide under the covers all day, when in fact they are high functioning men and women and suffering in silence, and normalising seeking therapy or medication as treatment has been very important in the last few years.

We also have social media influencers who have been diagnosed and been in therapy also document their experience, which has helped to destigmatise mental health issues in the Middle East. However, we still have a long way to go.

Are there any risks associated with looking for mental health advice/ online?

The more anxious a person is and the more lost and confused they feel, the more literal and concrete they will become. This is why online advice can sometimes do harm because we have to see a problem and a person in context.

We have to be able to do a full biopsychosocial history of the person’s presenting problem to give them the most considered and thought-through treatment. To have the most accurate treatment, you need the most accurate diagnosis, and self-diagnosis is definitely not that.

Is it recommended that patients use online communication tools such as Skype to speak to their clinical psychologists?

Clinical psychologists will work with those who need counsel on life difficulties but also individuals who are presenting with moderate to severe symptoms of mental health difficulties such as depression, anxiety, suicidality, eating disorders, psychosis, to name a few.

If the person is not presenting with any clinical symptoms such as depression and anxiety, then it is okay to use Skype because there is no risk involved with the person becoming unstable or unravelled. If the person is presenting with clinical symptoms, and they are using Skype or Facetime with a psychologist who is not in the same city as them and their symptoms deteriorate over the course of therapy, the client is at risk of becoming destabilised without the care of a psychologist nearby to handle their care.  

"We have to be able to do a full biopsychosocial history of the person’s presenting problem to give them the most considered and thought through treatment. To have the most accurate treatment, you need the most accurate diagnosis, and self-diagnosis is definitely not that." - Dr. Saliha Afridi

Have you seen an increase in patients reaching out to you online rather than making an appointment to see you in person?

Yes, we have had an increase in people requesting to do online sessions. Some people request online appointments due to the fact that they have a medical condition that limits them from coming into the clinic (e.g. bed rest, inability to travel), or because they live in another country.

However, we always request that they come in to meet us in person before we can have an online relationship with them. If they cannot come into the clinic, we may do a home visit to have the in-person contact. This is done to assess risk, as well as establish rapport.

We have social media influencers who have been diagnosed and been in therapy document their experience, which has helped to destigmatise mental health issues in the Middle East. However, we still have a long way to go.

Science discoveries and drug development are the cornerstones of modern medicine. Providing information about diseases trends and risk factors, as well as new treatment options and diagnostics procedures, R&D will lead to increased knowledge and ultimately, better patient care. In an interview with Arab Health Magazine, Mazen Altaruti, AVP Managing Director GCC at MSD, explains how R&D goes beyond simply investing in the invention of new medicines and vaccines and requires significant investment in the resources and human capital involved in the R&D process.

How important is invention and innovation for your field?

Throughout the past century, scientific and medical inventions have revolutionised the lives we lead. Any attempt to pinpoint the most important inventions of this era would certainly be debatable, but we believe our company has been at the forefront of scientific innovation.

At MSD, we’re inventing medicines and vaccines for the most serious illnesses in our region. And while our commitment to lifesaving science is at the heart of our business, our scientists are not the only people at MSD who are inspired to invent. Every day, in every part of our company, our colleagues are finding new ways to bring our medicines and vaccines to more people than ever before both in the region and around the world.

It may take years of investment and hard work, but we believe and invest in our team to change the course of disease.

"Every day, in every part of our company, our colleagues are finding new ways to bring our medicines and vaccines to more people than ever before both in the region and around the world." - Mazen Altaruti

How important is it to foster employee diversity and inclusion to improve the health sector?

We’re inventing to change the lives of our people; our employees are our most valuable resource and work daily to fulfil our mission to help improve health around the world. We are constantly seeking to make our workplace an environment that allows our employees to reach their full potential, but also one in which they feel their skills and creativity are valued.

Diversity and inclusion are essential parts of our business, in line with government strategy. We aim to create a unique environment where each employee can demonstrate their talent and capabilities to the fullest. Our differences are our source of strength that allow us to appreciate nuances, develop respect, and ensure stronger business results. Hence, our company fosters over 500 employees within the region from 36 nationalities, including 31 per cent female representation, which is growing each year, and we are continually striving to become even more diverse.

What initiatives do you apply to support employees in the work place?

Our employees are among the industry’s most sought-after talent, and we rank in amongst the top three employer categories for the “Most Friendly Women Employer" and “Best Diversity & Inclusion Initiative in the Workplace” awarded by the Global Women in Leadership Economic Forum and endorsed by the UAE Ministry of Economy.

We have several initiatives focused on supporting females in building more professional confidence to enable their career development. MSD Women’s Network Academy is an educational programme, which provides female employees with skills and knowledge to prepare them for taking higher roles within the organisation. The GROW programme was built by MSD Women’s Network to expand the diversity principles to our external stakeholders through a series of events for physicians where we combine medical educational information with female empowerment topics. We also seek to empower the millennial generation through our Next Gen Network, which exists to optimise their success and we now boast a 78 per cent millennial workforce.  

What is the key driver behind driving invention and diversity amongst employees?

Empowering and celebrating women and millennials in our field is imperative to drive our ability to invent and has proven our diversity makes us stronger as we draw on the different experiences and cultures residing within our region. To celebrate our diverse community of cultures and backgrounds, MSD celebrated Intercultural Day in honor of the World Day of Cultural Diversity for Dialogue and Development led by the MSD Interfaith Organization (MIO). Our team also recently set a record and entered the Guinness World Records for initiatives showcasing our commitment to patients and partners.

Our talent management processes are built in a way to enable fair assessment of employees’ performance and potential and focused on boosting their development: from building individual development plans, sharing available career paths, working with managers to make them strong coaches and career advisors to mentorship and developmental moves across the region.

MSD's Next Gen Network boasts a 78 per cent millennial workforce. 

CSR is a fundamental pillar to large organisations, could you tell us more?

We are strong advocates of corporate social responsibility, and have numerous region-specific initiatives for our employees to get involved in. Our Ramadan fridge campaign in the UAE saw MSD employees’ stock over eight fridges to feed for those in need during the Holy Month, while our Stay Warm campaign in the Kingdom of Saudi Arabia saw employees donate warm clothes for people in need. Being a major contributor to the field of medicine, we know the crucial importance of blood donation, so we held a blood donation drive in Jeddah and Khobar for employees to make an invaluable contribution to local blood banks. All these activities are employee-created and employee-driven to uphold our company vision.