The rising global threat of ransomware has become a grim reality. “WannaCry” virus, over a year ago, unleashed one of the worst and most widespread cybersecurity attacks ever seen that crippled business operations across the world including hospitals, government offices, telecommunications, banks and other industries critical to national infrastructure. One of the most seriously impacted victims of the WannaCry ransomware attack was the National Health Service (NHS) in the UK where some hospitals were forced to cancel outpatient appointments.

If any positives can be said to have come out of the situation, it is that WannaCry has served as a wake-up call for IT departments supporting the healthcare sector globally, as the devastating impact of an advanced and sustained cyber security attack has been made crystal clear to all concerned. It cannot be allowed to be repeated.

Cyber security and healthcare
At a time when other industries have become more sophisticated in detecting and blocking cyberattacks, criminals have begun actively hunting for new sources of valuable data and have realised there are potentially rich pickings to be found in the healthcare sector. Healthcare institutions collectively hold huge amounts of highly sensitive information on the vast majority of the population and, in some cases, their IT systems will also have links to financial services data.

When it comes to IT security, healthcare organisations have been slow to adopt the kind of preventative practices that have worked for other industries. Many medical personnel are unaware of the risks to data security (notwithstanding the traditionally strong emphasis on patient privacy in the sector). Healthcare organisations also tend to have smaller security budgets and teams than organisations operating in other sectors which brings obvious additional challenges.

As organisations in the Middle East embrace new technology to drive flexibility, cost-efficiencies and growth, it is important for Chief Information Officers (CIOs) to build secure IT infrastructures that not only withhold attack, but have backup processes in place to ensure data remains available for all who need it.

The need for prevention
The axiom “prevention is better than cure” is as true for the field of IT security as it is for healthcare and the effectiveness that preventive action has against cyber security threats cannot be overstated. Offsite and offline backups not only mitigate the effects of ransomware, but when combined with the right security suite and employee awareness training, can help prevent the problem altogether. When it comes to security and data backups, however, the reality between what should be done, and what is happening is startling.

Veeam research suggests that only just under half of IT decision-makers test their backups on a monthly basis. Long gaps between testing can increase the chances of issues being found when data needs to be recovered. For those that do test their backups, a mere 26% test more than 5% of their backups.

There are a number of ways to externally backup data, from system disks and removable hard drives, to offline tape devices and cloud backups. Whichever option an organisation chooses, the backup repository itself must be protected against attack.

Mitigating the impact of ransomware
There are some obvious steps that all organisations need to take to avoid ransomware attacks. Keeping all software up to date and performing a threat analysis with the security team (including penetrating testing to find any vulnerabilities) is vital.

With ransomware threats becoming more frequent and complex, organisations also need to ensure that they mitigate the impact of ransomware by adopting common best practices for intelligent data management. Once attacked, there are two courses of action; pay the ransom (with no guarantee of the recovery of the encrypted files or that a reinfection won’t occur) or restore data as quickly and reliably as possible.

One of the best tried-and-trusted data protection rules that can effectively mitigate a ransomware attack is called the 3-2-1 rule which prescribes organisations should:

Have at least three copies of their data-the primary data and two copies-to avoid losing data to a faulty backup.

Store the copies on two different types of media-such as tape, disk, secondary storage, or cloud.

Keep one backup copy offsite-either on tape or in the cloud-in the event of local hazards or ransomware infections within the network.

Following the 3-2-1 rule will mean organisations always have an available and useable backup of your data and systems, and in a world where ransomware can instantly take you offline, that is a vital precaution.

Raising awareness
Human error is the leading cause of major security breaches today. All organisations must prioritise compulsory training for all their staff and this is particularly true of the healthcare sector, where staff sometimes faced with life or death decisions may, understandably, not focus on cyber security best practices.

With the impact of high profile cyber security breaches and attacks still being keenly felt, now is the time to seize the opportunity and ensure staff are equipped with the best levels of knowledge of the most effective preventative processes and practices.

A holistic approach
Protecting patients’ health information in the wake of attacks like WannaCry will take a highly coordinated effort among global healthcare organisations, as well as significant investments in new tools and process implementation. But the basics I have outlined above can help make a big difference in a short space of time.

Furthermore, for intelligent data management to be realised in the healthcare sector, CIOs within it will need to address the cyber risks across their organisation, not simply in one niche area (e.g., access to patient records), and be prepared to share these learnings with peers.

Today, hospitals must approach the risk of IT infections with the same level of seriousness as medical ones. Through intelligent data management, healthcare organisations can ensure the necessary processes are in place to ensure malware-based IT data infections can be surgically removed, before ever affecting a patient’s life.

 

El-khani said: “While it is true that with advancements in technology we have been able to meet the growing demand for faster turnaround times in every laboratory discipline, it has been quite challenging to achieve similar progress in the microbiology laboratory.”

Traditionally, microbiology testing is a labour intensive and lengthy testing process, requiring microbiologists to wait patiently while the microbial cultures grow enough to be identified. Once grown, the processes that follow - Kit for direct  identification of bacteria and yeast specifically staining, microscopic examination and identification of the resulting growth - each add approximately 12-24 hours to the time needed to report the result growth - collectively reaching a total turnaround time of 48-72 hours.

El-khani highlighted: “Although the traditional process continues to be important today, we are fortunate to live in an era of development where technologies such as the MALDI-TOF MS allow us to significantly improve the turnaround time of microbial identification.”

Evolving Identification Methods

There are various methods used to identify microbes, including: phenotypic, immunologic, genotypic, and proteomic.

• Traditional phenotypic methods are lengthy and labour intensive, and are dependent on the physiological and/or biochemical characteristics of the microbe.

• Immunological methods are based on the interaction between a microbial antigen and a known antibody.

• Genotypic methods are molecular diagnostic techniques that require the examination of the genetic material of the microorganism. The genotypic methods include the use of nucleic acid probes; for example, Real Time Polymerase Chain Reaction (Real Time PCR) sequence analysis and Restriction Fragment Length Polymorphism (RFLP).
  
  El-khani said: “The genotypic or molecular methodologies used for microbial identification today are increasingly becoming the preferred means of identifying microorganisms due to their speed and accuracy. Nevertheless, the disadvantage of the molecular methodologies is that you have to know the exact type of microorganism that you are looking for in the sample, in order to be able to identify it.”

• Proteomics is the study of proteins in an organism. This method offers an excellent complement to the aforementioned techniques, and includes the following: MALDI-TOF MS; Electro spray ionization mass spectrometry (ESI-MS); Surface enhanced laser desorption/ionization (SELDI), and Fourier-transform infrared spectroscopy (FT-IR).

Insight into MALDI-TOF MS

Mass spectrometry (MS) is an analytical technique in which chemical compounds are ionized into charged molecules (ions), following which the components are separated by their mass-to-charge ratio. Although MS was developed in the early 1900s, its scope and application was limited to the chemical sciences. However, the development of electro spray ionization (ESI) and MALDI-TOF MS, as advanced types of MS methods in the 1980s, increased the applicability of MS to large biological molecules such as proteins.

El-khani explained: “The MALDI-TOF MS technology was developed in the 1960s; however, growth in the number of publications related to the use of MALDI-TOF MS for bacterial identification occurred only in the past 10 years. The publications and the visibility they provided led to MALDI-TOF MS becoming a mainstream technology and a major breakthrough within the microbiology diagnostic laboratory.”

The MALDI-TOF MS method uses a laser to ionize the sample consisting of proteins and polymers, where the analyte is embedded in a crystal aromatic matrix. The presence of the matrix causes the large molecules to ionize, instead of decompose or fragment, when absorbing the laser energy. As a result, the analyte ionizes into a gas phase and a “cloud” of proteins is released into a flight-tube in the mass spectrometer. The proteins are accelerated by an electric charge, and after passing through the tube, their “Time of Flight” is recorded. The proteins are then detected with a sensor that creates a spectrum which represents the protein makeup of each sample.

Finally, the spectrum is compared to a known database of proteins, and according to the match, the microbial identification is completed.

Currently, many laboratories are using MALDI-TOF MS technology to replace selected steps from the conventional microbial identification process; for example, confirming the genotype samples for isolated cultures. Such process enhancements significantly reduce the turnaround time of bacterial identification by at least 12-24 hours. As a result, the time to report antibiotic susceptibility is also shortened.

Improving Patient Outcomes and Healthcare Efficiencies

Septic Shock a Priority

One of the most important applications of the MALDI-TOF MS technology is the identification of microbes from samples for blood cultures, which represent approximately 10% of the samples received by microbiology laboratories. Bloodstream infections are associated with high rates of morbidity and mortality among hospitalized patients. The risk of death from septic shock increases by 7% with every hour that passes, and the mortality rate in severe sepsis is reported as high as 35%. Therefore, the time required to complete the identification of microbes in sepsis, and to establish their antibiotic sensitivity in order to administer appropriate antibiotic treatment, is crucial for the clinical outcome of patients.

A study conducted on 501 patients found that MALDI-TOF MS based identification in comparison to conventional identification, resulted in the following:

• Reduction in mortality by 5.8%
• Reduction in length of hospitalization (ICU) from 14.9 to 8.3 days (≈ 7 days or 44%)
• Reduction in time to effective therapy from 30.1 to 20.4 hours (≈10 hours or 32%)
• Reduction in hospital costs per patient from US$45,709 to US$26,126 (≈US$20,000, or 43%)  

El-khani continued: “The application of MALDI-TOF MS technology in the microbiology laboratory greatly improves clinical outcomes by reducing morbidity and mortality, guiding more appropriate antibiotic selection and initiating appropriate infection control measures. The positive impact of this technology becomes evident as it improves patient care and reduces financial costs for the patients, providers, payers and the healthcare system in general.”

The Future for MALDI-TOF MS and Automation in the Microbiology Laboratory

El-khani concluded: “Currently, we are able to use MALDI-TOF MS for bacterial identification of several types of primary samples including blood, urine and cerebrospinal fluid. It will not be long before MALDI-TOF MS will be used to directly analyse other samples, such as stool and sputum, and thus reduce the time to diagnosis for a wider variety of diseases. The next development that is expected to bring pivotal change to the microbiology laboratory is the full automation of the testing process. Full automation will further improve laboratory efficiencies and enhance the quality of the microbiology testing process through increased reproducibility and productivity which will reduce contamination and time to result. With the many advancements in technology in the microbiology laboratory, physicians will be able to provide appropriate therapy for their patients earlier than ever before.”

MALDI-TOF workflow for multiple primary samples

Arab Health Magazine sat down with King’s College Hospital (KCH) UAE Chief Operating Officer Neil Buckley to get an update on the UK-based hospital group’s plans for expansion into the UAE and his views on the increasing cost of medical care in the country.

• King’s is expanding its footprint within the UAE. Can you give us a progress update?
  We are delighted to be delivering on our promise of bringing the best of British evidence-based healthcare to the UAE and enhancing patient journeys across more than 10 specialties, including paediatrics, foetal medicine, diabetes, and endocrinology. We’ve been in Abu Dhabi since 2014, with our flagship medical and surgical centre based in the capital. We also launched our second medical centre in September last year, this time in Dubai, specifically in Jumeirah. We are full steam ahead and on track to introduce two additional facilities in Dubai — another medical centre in Dubai Marina this year, plus our highly anticipated 100-bed hospital in Dubai Hills in Q1 2019.
  
  All our facilities are directly connected to King’s College Hospital in London and we are committed to delivering and transferring its 175 years of world-leading expertise to the UAE and enhancing patient journeys so people don’t have to travel overseas, even for the most complex procedures.
  
  Once all facilities are operational, come 2019, King’s will be serving a catchment area of hundreds of thousands of patients every year. In addition, we will be creating jobs for UAE-based healthcare professionals as well as for international doctors wishing to come to the UAE and be part of King’s expanding footprint.
  
  We already have a stellar line up of world leading experts from King’s in London and its partner hospitals, who will visit patients in the UAE every four to six weeks as part of our unique ‘London Faculty Programme’. During the intervening period, their day-to-day involvement with our UAE-based doctors and patients is maintained through telemedicine and through our local clinicians.

• King’s is really championing primary healthcare in the UAE and the role of the Family Medicine Consultant. Why is this?
  We believe that primary healthcare is the answer to some central problems that affect the UAE healthcare industry. Family Medicine Consultants can significantly help improve patient care outcomes and reduce medical inflation.
  
  Often, when UAE residents have common medical ailments, they prefer to visit a specialist, rather than first visit a Family Medicine Consultant, also known as a general practitioner (GP). The common misconception is that by going to a specialist first, people will save themselves the time and money of an extra visit paid to the Family Medicine Consultant, and will get to the treatment quicker. However, in order to determine which specialist to visit, people self diagnose themselves.
  
  Research shows that 72% of people self-diagnose, yet the chances of getting the diagnosis right are fairly low. In the eventuality of a misdiagnosis, patients don’t get the right treatment as early as possible, delaying recovery. Also, a patient’s condition could worsen, and their recovery may be slower, making the patient experience complicated and unpleasant.
  
  An extra visit is, after all, not all that time-consuming; especially as the Family Medicine Consultant is the most qualified clinician within a clinical setting, fit to triage and refer the concerned patient to the right specialist, making a patient’s journey to better health much quicker and smoother. People should think of their Family Medicine Consultant as their health champion. Not only will he or she be able to coordinate the care the patient needs across specialists and help them make the right decisions following specialist visits, but he or she will also help manage their condition from a holistic point of view.
  
  A Family Medicine Consultant will also educate patients about prevention and remind them of important health screenings and vaccinations. He or she is also the clinician who will know a patient’s full medical history (and his or her family’s history if they also visit them), and will help them make better informed decisions when prescribing a treatment.
  
  Last but not least, patients’ medical choices affect the whole health ecosystem. Visiting multiple specialists for the same medical ailment leads to unnecessary costs for insurance companies, who find themselves having to increase medical premiums and decrease benefits. According to the Health Authority Abu Dhabi (HAAD), in Abu Dhabi people undertake - on average - 14 visits to solve a common health problem. We estimate that if this number was reduced by one visit, it could save insurance companies AED600 million.

• What is driving up medical inflation?
  The UAE’s medical inflation rate generally ranges between 13% - 20%. There are many contributing factors, such as science and innovation, as ground-breaking developments come at a high price due to the investment needed in research, development and training. You also have a soaring prevalence of lifestyle diseases – diabetes, cardiovascular diseases, obesity and so on – the burden of which add enormously to medical expenditures.
  
  Then you have over-utilisation. There is a tendency for some UAE providers to over treat and over prescribe, with a massive impact on inflation. On the other side of the coin, there is often a patient mind-set that, unless you walk out of a doctor’s appointment with a big bag of medication, then you have not been treated properly. Often, quite the contrary is true.
  
  This is where evidence-based medicine can help. King’s is a fantastic example of placing evidence-based medicine at the core of its business model. We follow strict governance guidelines working closely with King’s in London, adhering to evidence based NICE (National Institute for Health and Care Excellence) treatment protocols that form the framework of our patient care. That means that we only treat patients using best practice for what is presented in front of us and nothing more. We refuse to over prescribe, which seems to be the fashion of the day. According to our research, 32% of UAE residents feel their doctors over prescribe. At King’s, only one in four patients will be prescribed medication compared to the industry average of four in four, and what’s more interesting is that over 50% of what we prescribe are generics.
  
  We take all measures to maximise the chances of successful outcomes, fewer complications and fewer corrective procedures, and this practice is being extremely well received by insurers, brokers and most importantly, patients. What’s best is that by the efficient use of healthcare providers that practice evidence-based healthcare, individuals, companies and the government can and are taking control of their medical costs.
  
  Without this, we need to recognise that ultimately, there is only one loser in the end and unfortunately, that is the patient. Medical inflation comes at the price of higher renewal rates and often employers find themselves having to downgrade their employees’ health coverage, or even changing insurance providers, often resulting in stripped out health benefits for employees.
  
  In order to stop this, we need change on many levels: regulator, provider, corporate and the patients themselves. By doing this, the end result is enhanced patient care and a more effective and efficient system with the flexibility to redirect funding towards other public health priorities, such as cancer treatment and research, awareness campaigns for obesity or diabetes, upskilling local talent or more medical infrastructure.

• With rising medical inflation costs, how can providers, like yourselves, help control costs?
  
  Again, this is where evidence-based healthcare really comes to the fore. More importance needs to be placed on practicing evidence-based healthcare across the UAE. I’d like to give you a few examples of how evidence-based healthcare can help with cost containment and combating medical inflation.
  
  Let’s start with upper respiratory tract treatment protocols. King’s estimates that if all uncomplicated upper respiratory tract infections are treated using the same protocol guidelines that we use, then the savings to the economy could be above AED1 billion given the prevalence of these conditions.
  
  I’d like to give an example of how reducing elective procedures can help. King’s encourages natural births. King’s in London has a 17% elective C-section rate compared to the current industry average rate of 25% in the UAE; our target is 18-20%. The expectation is that there will be approximately 77,000 babies born in the UAE in the year 2020. If all providers took the same approach to reduce their percentage of C-sections to 18-20% while considering the wishes of the mother, this would represent an estimated cost saving to the economy of AED 305 million in 2020 alone.
  
  Aside from evidence-based healthcare, there are many ways providers can help. Advocating for better use of primary care systems and educating patients on the importance of the Family Medicine Consultant as your ‘health champion’ are key changes I’d like to see across the industry. Ultimately, if we all do our part, when extrapolated out, these changes can make a big difference and add up to great wins for the UAE’s health and economy.

The Dubai Health Authority (DHA) has announced that an Emirati double amputee has become the first in the region to receive 3D printed transtibial prosthetics.

25-year-old Fahad Mohammed Ali, a Paralympic champion from Dubai, who had been wearing wooden prosthetic legs for over 15 years will now walk in his customised orange 3D prosthetics.

The initiative to provide Ali with 3D prosthetics was undertaken by the Dubai Health Authority (DHA) in partnership with Mediclinic, Mercuris, a German company specialised in enabling digital prosthetics and orthotics, and Immensa Technology Labs, a Dubai-based privately-owned company specialising in the development and advancement of 3D printing.

The department of humanitarian services at the DHA fully supported and funded the initiative.

Fahad Mohammed Ali, a champion wheelchair racer and an engineer with Dubai Electricity and Water Authority (DEWA), can now walk with the maximum feeling of anatomical function due to his 3D prosthetics. “My life has been transformed,” he said.

3D printing has brought a new level of personalised patient care to the healthcare sector in the UAE. According to His Excellency Humaid Al Qutami, Director-General of the Dubai Health Authority, said, “In line with the vision of His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai, the DHA has prioritised fostering the development of future technologies such as 3D printing in healthcare to provide high-quality patient-centric care.”

He added, “We are keen to use this technology in the health sector to improve efficiencies, enhance healthcare management, improve overall workflows and most importantly further improve patient care. This is truly heartening as it is an example of how healthcare technology directly improves the patient’s quality of life. We aim to continue harnessing manpower, collaborating and investing in future health technologies to serve our community.”

Dr Mohammad Al Redha, the Director of the Executive Office for Organisational Transformation at DHA, said, “This is a unique collaboration that allows us to see the most modern technology develop and become a reality. Our aim at the DHA is to provide patients with the best possible care and thus we are happy to bring together international and local stakeholders to work jointly on future technologies. The work we have done so far is part of the foundation of future 3D printing research and development work in the UAE.”

Ali, who received the 3D prosthetics, said, “For the past 15 years I have been using regular prosthetics until I received the 3D prosthetics. My life has been transformed for the better. The 3D prosthetics make me feel like I got my legs back and it is simply incredible. I am very thankful to the leaders of the UAE and the DHA.”

With more than 25 years of experience in the field, Sebastian Giede, Certified Orthopaedic Prosthetist with Mediclinic, said, “The potential of 3D printing in the field of prosthetic devices is huge. It allows for faster turnaround times; we can get a foot customised within two to three weeks. It also provides more personalisation in terms of both design and functionality as these are designed using lightweight and strong materials. It also provides greater flexibility when it comes to replacement. The functionality of 3D printed prosthetics is superior as it allows us to design completely individualised models as compared to mass manufactured prosthetics.”

Giede added that every aspect including the colour can be individualised.

Ali said, “I chose orange prosthetics as it is an attractive and positive colour. I even wear shorts now as I am confident and can show off my prosthetics.”

In terms of the process of designing the 3D prosthetics, Giede, said, “We conducted several 3D scans of the patient’s amputated legs. After that, we used a CAD software programme to design and modify the inner shape of the prosthesis. Then the test socket was 3D printed so that we could use it on the patient to control the size and make changes that will help provide the patient with maximum comfort and functional alignment.”

Dubai-based Immensa Technology Labs, the UAE’s leading Additive Manufacturing (AM or 3D printing) company, provided the test socket and final socket, which is about 40 per cent of the 3D prosthetics.

Fahmi Al Shawwa, CEO of Immensa Technology Labs, said, “3D printing technology provides a massive opportunity for Dubai to become competitive across various sectors including medical and we are proud to be working with the DHA and Sebastian Giede to realise this potential. Immensa is investing heavily in developing 3D printing capabilities and knowledge in line with the ‘Dubai 3D Printing Strategy’ and we believe that we need to see more private sector participation and involvement to fully capitalise on this technology on a wider UAE scale.”

The rest of the 3D prosthetics were provided by Mecuris, a German company that combines existing industrial 3D technologies like 3D scanning, 3D data processing and 3D printing into an innovative process of digital tailoring for orthopaedics.

Manuel Opitz, CEO of Mecuris GmbH Germany said he is delighted about the professional and visionary collaboration between Mecuris, Mediclinic and DHA. “We team up with medical professionals to co-create - with users and wearers - customised O&P products. This now is the second time we have worked together. With partners like this, boundaries are non-existent and the patient’s needs and preferences are at the centre of a truly individual care, enabling us to enrich the wearer’s life.”

Giede constructed the prosthetics in Dubai. He said, “We are proud that we were able to provide Fahad with 100 per cent customised 3D printed prosthetics that provides a natural feeling of anatomical movement to the maximum extent possible.”

This is the second time the DHA has collaborated with Mediclinic and Mecuris for 3D prosthetics. In 2017, the Authority and Informa Life Sciences collaborated with them and with Prosfit to provide a Dubai resident with a 3D prosthesis.

The 3D printed prosthetic leg was donated to Belinda Gatland, a British expat who had been an amputee for more than 10 years – following a life-changing event after a horse riding accident at the age of 22. With subsequent necrosis (premature death of tissue or bone cells) leaving her in immense pain, she ultimately had to have her left leg amputated. Belinda become the first amputee in the region to wear a completely 3D printed prosthetic leg as part of the Dubai Health Authority’s Year of Giving initiative in 2017.

Salim Bin Lahej, Director of Humanitarian Services Department at the DHA said that the department was proud that they were able to provide Fahad Ali with prosthetics using the most modern technology.

“Sleep hygiene is a term used to include just about anything related to your sleep habits,” says Dr Hassan Al Hariri, Head of Sleep Medicine at Rashid Hospital. “It includes practices and habits that influence good sleep quality at night and full daytime alertness.”

Light is the most powerful influencer of the body’s circadian clock, he says. “Bright lights in the evening hours can confuse your brain into thinking it is still daytime. Artificial blue light [the type that laptops, tablets and mobile phones emit] is the worst culprit, so get rid of these devices at least two hours before bedtime.”

He adds: “Consistency is also key for sound and regular sleep. Try sleeping and waking up at the same time on most days including weekends if possible.”

Experts estimate almost 30 per cent of the UAE population experiences insomnia for a certain period in their life. While in most cases, insomnia fades away on its own once the person’s stress levels reduce, there are cases where medical intervention is needed.

The trouble with prolonged sleeping problems is that it is a risk factor for chronic health problems such as high blood pressure, heart disease, diabetes and stroke.

Sleep deprivation should not be taken lightly as it can affect everything from your memory to your immune system, heart and metabolism, says Dr Al Hariri.

“Sleep deprivation due to medical conditions such as obesity and arthritic pain needs immediate medical intervention,” adds Dr Al Hariri. “The patient should visit a primary healthcare physician who may recommend specialised treatment.

“If the person is unable to sleep for three weeks in a row and continues, it becomes chronic insomnia and treatment can be very challenging.”

A study by the University of Surrey in England revealed that the quality of sleep can even have an impact on a genetic level. It found that getting less than six hours a night affected the activity of more than 700 genes associated with controlling responses to stress, immunity and inflammation.

At Rashid Hospital’s sleep clinic, doctors see more than 500 new patients a year.

Given the high obesity rates in the country, about 70 per cent of the patients are affected by obstructive sleep apnea due to obesity. About 20 per cent are cases of sleep deprivation due to stress and other medical-related issues and the remaining 10 per cent are due to insomnia.

“These figures do not reflect overall emirate-wide statistics,” says Dr Al Hariri. “At Rashid Hospital, we pay particular emphasis to obesity-related sleep problems and work with doctors from other departments to ensure obese patients receive early and comprehensive intervention to prevent further complications.

“Snoring is one of the first signs of sleep apnea and should not be taken lightly. The problem is usually first noticed by the patient’s spouse who is disturbed by the patient’s loud snoring.”

He said that sleep apnea is a disorder in which one’s airway becomes obstructed while asleep, causing loud snoring to a complete cessation of breathing, cardiac arrhythmias and low blood oxygen levels at its worst. “The airway of the obese individual becomes obstructed by large tonsils, enlarged tongue and increased fat in the neck, all pressing on the airway when the throat muscles are relaxed during sleep. Sleep apnea is a major risk factor for heart disease and stroke. It can be dangerous for the person and those around him as patients with sleep apnea can fall asleep anywhere, even while driving.”

Earlier people didn’t seek medical intervention for sleep problems, but with greater awareness they are slowing realising the importance of early intervention.

“It is important to discuss your sleep patterns with your primary healthcare physician as sleep is one of the fundamental pillars of good health,” says Dr Al Hariri.

“Early intervention is always advisable.”

In today’s world, where we try to squeeze time for everything, maybe we need to wake up to the importance of sleep.

Ways to get a restful sleep
How much sleep do you need? This could vary depending on your age and is also impacted by your lifestyle and health. In general, some of the good sleep hygiene practices to incorporate in your daily life include:

Establish a regular routine: Maintain a regular sleep and wake-up schedule, and try to stick to it even during weekends.

Create a sleep-inducing environment: Light is the most powerful influencer of the body’s circadian clock and it will negatively affect your body’s ability to sleep. So, keep the bedroom dark, opt for heavy or blackout curtains and wear an eye mask if needed.

Keep digital devices away: Do not bring papers or a laptop to bed, keep your phones away and avoid watching TV. Screen time disrupts your sleep routine.

Avoid stimulants: Avoid smoking close to bedtime because nicotine is a stimulant and can keep you awake.

Restrict heavy food at dinnertime:  Steer clear of heavy, fatty or fried dishes at night as these can cause indigestion and affect your sleep quality. 

Avoid excessive sleep: Although obtaining healthy sleep is important for both physical and mental health, it is best to avoid sleeping more than 8 hours a day.

Limit daytime naps: It is best to do away with afternoon naps. If you need a nap, it should be early afternoon and not more than 30 minutes.

Restrict consumption of caffeine: Avoid caffeine-containing beverages and foods such as teas, sodas and chocolate six to eight hours before bedtime.

Source: Rashid Hospital Sleep Clinic

Restful sleep for kids:

• Children need much more sleep than adults; number of hours of sleep depends on the age of the child.
• Keep external stimulants such as TV and all tech devices at bay two hours prior to bed time
• Avoid installing a TV in your children’s bedroom
• If your child has regular trouble sleeping, keep a sleep chart and jot down your observations, present the details to a doctor if the problem is persistent
• Do not let weekends mess up your child’s biological clock. Try to keep the bedtime and wake-up time as close to the weekdays as possible for consistency.
• During holidays, ensure that children go back to their regular sleep schedule at least one week prior to the school commencing date.
• Exercise, particularly in the day helps induce sleep
• Provide the right nutrition support: No sugar four to six hours before bedtime is ideal
• A warm bath before bedtime relaxes the muscles and helps provide a restful sleep
• Do not give chocolate/sugars to children who have restless leg syndrome, especially few hours prior to bedtime
• If your child sleepwalks, put your child back in his/her bed.

Informa Life Sciences Exhibitions, the world’s leading publishing and exhibitions company, has announced that the FIME Exhibition & Congress will be making a return to its original host location – the Miami Beach Convention Centre in Florida - in 2019. The show, which is the largest health expo in Americas, will be relocating back to its permanent home in Miami as the venue is expected to complete a $620-million state-of-the-art renovation project by the end of 2018.

Due to the ongoing refurbishment project, FIME Show was temporarily held at the Orange County Convention Centre in Orlando in Florida in 2016, 2017, and for the final time from July 17-19, 2018. Attracting more than 1,200 medical device manufactures from 42 countries, FIME 2018 welcomed more than 24,200 healthcare trade professionals looking to source products and medical services from across the continent.

According to Gil Alejo, Exhibition Manager, FIME: “Under Informa’s stewardship and strategic direction, FIME has continued to witness a 25% year-on-year growth in visitor numbers, and, with exhibitors already looking to secure their booths for the 2019 edition, our move back to Miami is vital in order to accommodate the increasing scope of the show. It was always the intention to bring FIME back to Miami in 2019 and we look forward to fully utilising the 500,000 sq ft of exhibition space at the Miami Beach Convention Centre to the benefit of our strategic partners, exhibitors and visitors.”

As the “gateway to the Americas”, Miami continues to serve the world’s healthcare business community due to its strategic geographic location and its fast airway connections to Latin America. The city also benefits from a rich social makeup with more than 70% of its inhabitants from multicultural backgrounds. The network of professional contacts that Miami facilitates is geared towards a fruitful business relationship between the Americas. As the 18th largest economy in the world, and with an extensive transpiration system and flourishing trade ecosystem, Florida is the ideal place to reach customers and suppliers anywhere, fast.
For FIME 2019, the primary focus of the show will remain across four industry sectors: medical technology, medical products & supplies, medical services, and medical equipment. Informa also remains committed to expanding the clinical education offering proving industry workshops, conferences and seminars to attending healthcare trade professionals from across the continent.
Informa Life Sciences Exhibitions, in charge of the healthcare portfolio within Informa's Global Exhibitions division, organises 26 exhibitions yearly covering the Middle East, Africa, Asia, Europe and US market, connecting more than 150,000 healthcare professionals worldwide and offering a range of marketing solutions for companies involved with the healthcare sector. Over 100 congresses take place in parallel with the exhibitions.

Affordable Healthcare Solutions Showcased at FIME 2018
The 28th edition of the FIME Exhibition & Congress, held from July 17 – 19, 2018, at the Orange County Convention Centre in Orlando, Florida, U.S., welcomed more than 1,200 medical device manufactures from 42 countries showcasing new and refurbished medical and hospital equipment, technology, products and supplies. The show also attracted more than 24,000 healthcare trade professionals looking to source products and medical services from across Latin and North America.

According to estimates by the Centers for Medicare & Medicaid Services (CMS), U.S. healthcare spend is projected to reach nearly US$5.5 trillion by 2025, and the Latin American medical device industry is expected to reach US$ 18.4 billion by 2020. This market growth is expected to attract a huge amount of interest from overseas medical device manufacturers, suppliers, service providers looking to capitalise on the expanding market.

Gil Alejo, Exhibition Manager, FIME, says: “FIME continues to be one of the most important events to do business in the healthcare market in Latin and North America. It is truly the optimal platform to source cutting-edge medical equipment and technology on a global level, ensuring that attendees have access to the largest range of affordable new and refurbished medical devices, products and supplies, at the best possible prices.”

Featuring 16 dedicated country pavilions as well as the popular Dealers & Distributors Wall offering dealers/distributors and agents the opportunity to post their business requirements live for exhibitors to review and connect directly to do business, FIME 2018 featured an array of national and international companies looking to promote their affordable healthcare solutions.

Exhibiting for the 6th year at FIME was Florida-based Vertisa Medical Waste Technology who promoted and showcased their medical waste technology compact systems for clinics and hospitals - in particular, models AXL 150/100/150 L that are cooled with air generating 20-40-80 kl/per hour systems.​

Axel Lopez, Business and Marketing Director, Vertisa, said: “We look to FIME each year to establish new distributorships and clients and to catch up with our clients and existing distributors.​ The show is very productive for our company as it generates great traffic and new business.”

Medical solutions provider Strena Medical was also at FIME to announce the acquisition of a set of companies, including Medimar Corp., that support a stronger strategic initiative into the health technologies market. According to Strena Medical CEO Mario Labella: “FIME is one of the most important tradeshows in the U.S. for medical equipment and we attend every year to be able to reach our target market and customers that are looking for the solutions we offer. That's why we decided to announce the acquisition at this special event.”

Los Angeles-Based Carley Lamps showcased their Carley Manufacture Line of products compatible with Riester, Hiene, Welch Allyn, Neitz, Rusch, as well as hard to find obsoleted examination lamps and batteries at FIME this year. Carley has also added a new to portable handheld LED light source ROVER IV to their endoscopic illumination line.

Educational Agenda at FIME Show 2018
Visitors to FIME 2018 were also able to attend a series of insightful accredited conferences that focused on infection control, digital healthcare and healthcare supply chain and procurement, whilst the trade seminar discussed investment opportunities in North America, and provided market insights, trade prospects and regulatory affairs for market entry to the US, Latin America, China, Asia, APAC and Europe.

According to Gil Alejo, Exhibition Manager, FIME: “Informa’s motto of ‘Exhibition with Education” has been well received at the FIME show in previous years and this year too, thousands of delegates attended the multi-specialty three-day conference and seminar programme. We welcomed some of the most respected and knowledgeable experts from various medical specialities who shared their insights on the challenges and opportunities the future of the industry.”

One of the key themes discussed at this year’s meeting was patient safety and quality control; in particular, the fresh perspectives on healthcare imperatives relating to infection prevention, infectious diseases, public health and healthcare epidemiology. Chairing the Patient Safety & Quality Congress for 2018 was Kelly Pyrek, Editor in Chief of Infection Control Today Magazine from Phoenix, Arizona, alongside activity director Anthony Warmuth, who is the Enterprise Quality Administrator at Cleveland Clinic in Cleveland, Ohio.

“Cyber security was another major conversation focus at FIME 2018,” said Alejo. “Delegates at the Digital Healthcare Conference were offered practical advice on assessing how disruptive technologies and innovations can impact the healthcare ecosystem, and discussions were held on how connected health technologies can support delivery of new models of care, as well as the implementation of practical strategies to protect patient data and facilities from growing cyber security threats, among other topics.”

Meanwhile, key topics at the Healthcare Supply Chain and Procurement Conference held under the theme ‘New frontiers in supply chain management’, included clinically integrated networks: challenges and opportunities, value chain transformation and patient engagement, investment protection, device tracking, contract compliance and quality control, as well as supply chain importance to patient care.

The free-to-attend Medical Devices International Trade Seminar took the approach of exploring opportunities in an evolving market. Delegates got the chance to understand the trends in the US health devices market, capture new markets by understanding the global opportunities available and review trade regulations in emerging markets, among other new trends.

This year, FIME was co-located with MEDLAB Americas, a dedicated area for medical laboratories, which brought together leaders in the IVD, diagnostics and laboratory management industry to exchange ideas and discover the latest testing techniques and solutions available to the market.

Examining the GCC’s evolving multi-billion-dollar healthcare industry, Investcorp, a leading global provider and manager of alternative investments, has offered several recommendations in its recently launched white paper on improving the operating environment, reducing costs and increasing opportunities across the industry’s value chain.

Titled, “A Health Prescription for the GCC”, the white paper identifies four areas of weakness in the region’s healthcare industry, namely, insufficient access and quality of care, the high cost of treatment of a relatively young population and the increasing burden of funding on GCC governments - the current primary spenders on healthcare in the region. These gaps must be bridged, and several weaknesses need to be addressed for the industry to reach global standards.

Based on tried and tested models, global best practices and deep knowledge of the GCC’s healthcare industry, the paper offers six vital remedies and highlights key priorities to help improve it.

Rabih Khouri, Managing Director, Corporate Investment MENA at Investcorp

The paper recommends that the Gulf countries improve their wellness and prevention measures, for example, by promoting a healthy food and exercise regimen for their citizens and encouraging screening and health checks. It says that prevention and early diagnosis are widely recognised as effective levers to reduce healthcare costs and improve clinical outcomes.

Second, to help fill supply gaps with adequate care, there needs to be a focus on increasing the number of specialised facilities and improving the quality of services, by, for instance, partnering with experienced Western institutions.

Third, as the private sector remains somewhat fragmented in the GCC, healthcare providers, such as hospitals and clinics, need to consolidate to benefit from economies of scale. The top five private hospital groups in the KSA, for example, account for just one-fourth of all private beds, and the top five in the UAE make up 40%, while similarly sized Western markets are much more consolidated.

Fourth, the paper stresses the importance of privatisation to improve the overall healthcare system and infrastructure. Private players, for instance, can help public providers and the overall system become more efficient, using techniques already proven in many parts of the world.

Fifth, it recommends that governments try value-based care systems to incentivise good behaviour and reduce costs. Finally, the paper emphasises the need for greater cooperation between GCC nations and pooling of purchasing power and infrastructure.
Commenting on the white paper, Tristan de Boysson, Co-Head of Corporate Investment for MENA at Investcorp, said: “The GCC healthcare industry is undergoing a much-needed transformation, mainly driven by the pressure on governments to shift the burden of funding to the private sector and the rise of the patient as a ‘consumer’ of healthcare services. The change is creating plenty of opportunities, and the buildup of a more complete eco-system.”

According to Rabih Khouri, Managing Director, Corporate Investment MENA at Investcorp, “Encouraging steps have already been taking place to help take the GCC healthcare industry to global standards. The magnitude of the transformation is highest in Saudi Arabia, where new regulations are being prepared as well as a substantial privatisation programme. I believe the transformation will considerably raise the standards of healthcare and better meet the population’s expectations.”

Over the last twenty years, major social and industrial growth unfolding in the Gulf region has had a significant impact on social norm, lifestyle commonalities and personal daily activities. The rapid expansion and urbanisation driven by economic prosperity and strengthening in technology, telecommunication and globalisation of services in the Gulf region have been associated with higher life expectancy and reduced infant mortality.

The United Arab Emirates in particular, has seen significant economic growth and prosperity and highly stable political arena, with strengthening global recognition, broadening of public services and empowered individual productivity. Unfavourable outcomes have been a dramatic increase in incidence of diabetes, with the International Diabetes Federation revealing that around 20 per cent of the population aged 20-80 have diabetes, mainly Type 2 diabetes, with many patients remain undiagnosed. This means that more than a million people in the UAE have diabetes, with many more being prediabetic. This has led to significant global increase in ranking in diabetes prevalence making the UAE in the top 20 countries worst affected by diabetes.

This has led to an astonishing increase in health expenditure for treating diabetes, which exceeds $3 billion annually. Since 2015, general trends in diabetes prevalence in the UAE have shown faster than expected increase, which has been directly linked to sedentary lifestyle and higher life expectancy. Subsequently, diabetes prevalence in the UAE is expected to increase 100 per cent by 2040, with diabetes treatment costs exceeding $6 billion annually. This increase in prevalence and associated health costs are anticipated to have a major impact on the social fabric of the country and future prospective and economic growth.

Diabetes mellitus is a life-long chronic disorder which is divided into three types: Type 1 diabetes, gestational diabetes and Type 2 diabetes.

Type 1 diabetes affects 10 per cent of diabetics and is caused by the immune system destroying cells of the pancreas responsible for insulin section. This results in partial or complete cessation of insulin production and the need of diabetic patients to inject exogenous insulin.

Gestational diabetes affects less than 1 per cent of diabetics and develops in pregnant women. Gestational diabetes results in loss of tissue sensitivity to insulin and subsequent raise in blood glucose levels despite availability of endogenous insulin. Gestational diabetes is not chronic as the majority of pregnant women will not have the disease after giving birth. They are though more likely to develop diabetes at a later stage.

Type 2 diabetes is a chronic disease and the most dominant type of diabetes mellitus, affecting 90 per cent of diabetics. It is caused by loss of tissues to insulin stimulation and glucose uptake, and results from insulin-resistance. Type 2 diabetes has been strongly associated with sedentary lifestyle, poor diet and obesity, and lack of physical activity.

All types of diabetes are believed to have genetic and hereditary components. They share main features such as loss of glycaemia control, chronic inflammation and disturbances of insulin release and effects. Prevalence of diabetes mellitus is around 7 per cent globally and this is rising by about 1 per cent every year. The health cost of diabetes is increasing every year, and this includes direct costs of treating diabetics and indirect costs of increased rate of hospitalisation, reduced work performance, increased time off work and low life expectancy as the result of diabetes and its complications.

In addition to making significant and better lifestyle changes, common treatments for diabetic patients include insulin injections, and antidiabetic drugs which stimulate insulin secretion and improve tissue sensitivity to insulin. Insulin was discovered in 1921 and since then has been a life saver and widely used by diabetics. All Type 1 diabetics, 30 per cent of Type 2 diabetics and the majority of gestational diabetes sufferers use insulin. However, current insulin therapy has many limitations including patient compliance, adverse effects such as hypoglycaemic episodes and the lack of appropriate glycaemic control, despite strict adherence to therapy.

Diabetes mellitus has been associated with pancreatic damage, and failure of pancreatic cells to produce sufficient insulin or body inability to utilise insulin efficiently. Recent research in the area of diabetes treatments have focused on the possibility of replacing injectable insulin, with a more permanent and consistent delivery system which ensures insulin-tailored release, based on body requirements.

One research area is using nano and micro bioencapsulation technology in order to produce capsules which can be loaded with healthy pancreatic cells, mimicking an artificial organ. The artificial organ will be implanted into the body, and the encapsulated healthy cells will produce insulin, based on body requirements and sugar concentrations. The aim of the research is to have a new artificial pancreas which will replace the body’s damaged one, and thereby serve as a healthy new source of insulin capable of synthesising and producing enough inulin to cure the disease.

In order to design new capsules with healthy cells capable of producing a new organ and curing diabetes, there is a need to be able to produce the microcapsules and fill them up with viable living healthy cells. In order to produce capsules containing cells, there is a need to use the microencapsulation technology, which is responsible for fabrication and manufacturing of the new microcapsules.

The microencapsulation technology was pioneered by Professor Thomas Chang at McGill University (Canada) in the 1960s, and this technology has been used globally by many researchers, scientists, industrial partners, and translational entrepreneurs. Artificial cells are engineered capsules that mimic our own biological cells in terms of shape and ability to carry out biological entities. They are novel delivery systems for cells and biologically active compounds and have been used significantly in the delivery of various cells and therapeutics. When using the microencapsulation technology, the polymeric semi-permeable membrane encapsulates biotherapeutics (such as cells) and biologically active compounds (such as bile acids), and allows the diffusion of small molecules such as nutrients, oxygen and metabolic biowastes, while preventing metabolising and degradation of enzymes, antibodies, complements factors and active biomarkers and cytokines, from entering the microcapsule.

There are several labs in the world that carry out artificial pancreas research, and as a leading researcher in the area of pharmaceutical science and biotechnology, I am using my research training in New Zealand, Canada and Australia, to apply the use of cutting-edge biotechnologies to design new breed of capsules, which can grow new and functional organs. As the founder of a highly productive research lab at Curtin University in Australia, the Biotechnology and Drug Development Research Laboratory, the focus of my research has been to design, develop, refine and establish new types of capable, robust, competent and industrious capsules for tissue engineering, biomaterials and production of matrices suitable for growing and implantation of healthy organs.

This new breed of capsules I have pioneered has special properties which address two major challenges of current tissue engineering and diabetes treatment. The first challenge is the lack of ability to control inflammation, with the need to administer anti-inflammatory treatments. The second challenge is the ability to design a capsule or implantable matrix which can house and promote survival, growth and functions of different types of cells.

With the continuous interests in the applications of microencapsulation biotechnology, many labs are aiming to produce more complex, sophisticated and multilayered systems that are capable of maintaining viable mammalian cells that can perform normal physiological functions once implanted in the body.

Such aim can have great future implications as the fields of artificial organs and stem cell continue to grow including undifferentiated and differentiated mammalian cells, and pluripotent and multipotent stem cells. Stem cells can be extracted from diabetic patients, and ideally be differentiated into new healthy pancreatic cells capable of producing insulin.

This is particularly interesting as this technology offers many advantages, compared with other formulation methods that have been used in the past. Such advantages include forming new body-own functional cells, formulation process that is gentle and does not need heating or significant pressure and the use of biodegradable and biocompatible polymers that can accommodate the new cells and form a new healthy and functional organ. In addition, aiming for least immune-response associated with stem cell implantation is another area of great interest. Characterising of such microcapsules can be easily performed.

As prevalence of diabetes mellitus is increasing annually in the UAE, so do diabetes-associated complications such as bad blood circulation, rate of amputations, kidney failure, eye damage, and heart disorders. Current research in artificial organs is likely to have huge positive impact on wellbeing of diabetics in the UAE and the rest of the world.

Meanwhile, significant lifestyle changes can contribute significantly to reduction in diabetes-associated complications and improve long-term prognosis. Increase in daily physical activities, diet control and strict adherence to diabetes medicaments are all important in improving diabetes prevention, enhancing diabetes therapy and improving the long-term effects of the disease and its complications.

References available on request.

The Dubai Health Authority (DHA) has announced that an Emirati double amputee has become the first in the region to receive 3D printed transtibial prosthetics.

25-year-old Fahad Mohammed Ali, a Paralympic champion from Dubai, who had been wearing wooden prosthetic legs for over 15 years will now walk in his customised orange 3D prosthetics.

The initiative to provide Ali with 3D prosthetics was undertaken by the Dubai Health Authority (DHA) in partnership with Mediclinic, Mercuris, a German company specialised in enabling digital prosthetics and orthotics, and Immensa Technology Labs, a Dubai-based privately-owned company specialising in the development and advancement of 3D printing.

The department of humanitarian services at the DHA fully supported and funded the initiative.

Fahad Mohammed Ali, a champion wheelchair racer and an engineer with Dubai Electricity and Water Authority (DEWA), can now walk with the maximum feeling of anatomical function due to his 3D prosthetics. “My life has been transformed,” he said.

3D printing has brought a new level of personalised patient care to the healthcare sector in the UAE. According to His Excellency Humaid Al Qutami, Director-General of the Dubai Health Authority, said, “In line with the vision of His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai, the DHA has prioritised fostering the development of future technologies such as 3D printing in healthcare to provide high-quality patient-centric care.”

He added, “We are keen to use this technology in the health sector to improve efficiencies, enhance healthcare management, improve overall workflows and most importantly further improve patient care. This is truly heartening as it is an example of how healthcare technology directly improves the patient’s quality of life. We aim to continue harnessing manpower, collaborating and investing in future health technologies to serve our community.”

Dr Mohammad Al Redha, the Director of the Executive Office for Organisational Transformation at DHA, said, “This is a unique collaboration that allows us to see the most modern technology develop and become a reality. Our aim at the DHA is to provide patients with the best possible care and thus we are happy to bring together international and local stakeholders to work jointly on future technologies. The work we have done so far is part of the foundation of future 3D printing research and development work in the UAE.”

Ali, who received the 3D prosthetics, said, “For the past 15 years I have been using regular prosthetics until I received the 3D prosthetics. My life has been transformed for the better. The 3D prosthetics make me feel like I got my legs back and it is simply incredible. I am very thankful to the leaders of the UAE and the DHA.”

With more than 25 years of experience in the field, Sebastian Giede, Certified Orthopaedic Prosthetist with Mediclinic, said, “The potential of 3D printing in the field of prosthetic devices is huge. It allows for faster turnaround times; we can get a foot customised within two to three weeks. It also provides more personalisation in terms of both design and functionality as these are designed using lightweight and strong materials. It also provides greater flexibility when it comes to replacement. The functionality of 3D printed prosthetics is superior as it allows us to design completely individualised models as compared to mass manufactured prosthetics.”

Giede added that every aspect including the colour can be individualised.

Ali said, “I chose orange prosthetics as it is an attractive and positive colour. I even wear shorts now as I am confident and can show off my prosthetics.”

In terms of the process of designing the 3D prosthetics, Giede, said, “We conducted several 3D scans of the patient’s amputated legs. After that, we used a CAD software programme to design and modify the inner shape of the prosthesis. Then the test socket was 3D printed so that we could use it on the patient to control the size and make changes that will help provide the patient with maximum comfort and functional alignment.”

Dubai-based Immensa Technology Labs, the UAE’s leading Additive Manufacturing (AM or 3D printing) company, provided the test socket and final socket, which is about 40 per cent of the 3D prosthetics.

Fahmi Al Shawwa, CEO of Immensa Technology Labs, said, “3D printing technology provides a massive opportunity for Dubai to become competitive across various sectors including medical and we are proud to be working with the DHA and Sebastian Giede to realise this potential. Immensa is investing heavily in developing 3D printing capabilities and knowledge in line with the ‘Dubai 3D Printing Strategy’ and we believe that we need to see more private sector participation and involvement to fully capitalise on this technology on a wider UAE scale.”

The rest of the 3D prosthetics were provided by Mecuris, a German company that combines existing industrial 3D technologies like 3D scanning, 3D data processing and 3D printing into an innovative process of digital tailoring for orthopaedics.

Manuel Opitz, CEO of Mecuris GmbH Germany said he is delighted about the professional and visionary collaboration between Mecuris, Mediclinic and DHA. “We team up with medical professionals to co-create - with users and wearers - customised O&P products. This now is the second time we have worked together. With partners like this, boundaries are non-existent and the patient’s needs and preferences are at the centre of a truly individual care, enabling us to enrich the wearer’s life.”

Giede constructed the prosthetics in Dubai. He said, “We are proud that we were able to provide Fahad with 100 per cent customised 3D printed prosthetics that provides a natural feeling of anatomical movement to the maximum extent possible.”

This is the second time the DHA has collaborated with Mediclinic and Mecuris for 3D prosthetics. In 2017, the Authority and Informa Life Sciences collaborated with them and with Prosfit to provide a Dubai resident with a 3D prosthesis.

The 3D printed prosthetic leg was donated to Belinda Gatland, a British expat who had been an amputee for more than 10 years – following a life-changing event after a horse riding accident at the age of 22. With subsequent necrosis (premature death of tissue or bone cells) leaving her in immense pain, she ultimately had to have her left leg amputated. Belinda become the first amputee in the region to wear a completely 3D printed prosthetic leg as part of the Dubai Health Authority’s Year of Giving initiative in 2017.

Salim Bin Lahej, Director of Humanitarian Services Department at the DHA said that the department was proud that they were able to provide Fahad Ali with prosthetics using the most modern technology.

A demographic shift where population above the age of 60 are expected to rise considerably in the next decade, increased private sector participation and increase in health insurance coverage are amongst some of the chief factors raising the stakes for high growth opportunities in the healthcare sector landscape of the Kingdom of Saudi Arabia. In addition, the country’s ambitious Saudi Vision 2030 and National Transformation Program 2020 (NTP) seek to improve the quality of healthcare services and facilities while optimising available resources thereby boosting opportunities for increased private sector participation.

Alaa Adel, senior director and general manager in Cerner Middle East, who focuses on client satisfaction and organisational growth in Africa and Saudi Arabia, opines that despite the inherent challenges in the system, government initiatives are changing the dynamics of the healthcare sector in Saudi Arabia. Effective regulatory frameworks will help facilitate the flow of private investment, he says, and the encouragement of public-private partnerships will sustain growth even in the face of long-term challenges.

In an interview with Arab Health Magazine, Alaa Adel says that as the government switches over from its role as that of a service provider to a regulator, competitiveness and quality care services will be given a boost leading to increased efficiency and improved outcomes.

“A sweeping change in imminent and on the horizon,” he adds, “and this change needs to be embraced. Ultimately, a healthier population leads to enhanced productivity for the national economy.”

• What, according to you, are the major healthcare challenges in Saudi Arabia today? Can the existing model of healthcare delivery meet the future needs of a growing and ageing population in the country?
  
  I have seen over the last couple of years the advancement of healthcare services in Saudi Arabia and how that has influenced life in the Kingdom and the health map of the country in a very positive way. I believe the current 2030 healthcare vision will provide the Kingdom with efficient healthcare services. However, with every nationwide programme and new developments, there are a few challenges that need to be addressed. These include:
  • Rapid increase in expenditure: Healthcare services are free for all Saudis. In a rapidly growing and ageing population, this tends to be a costly model.
  • Waiting time: This is another challenge as we see waiting time of several months in certain cases for patients to get surgery or procedures done.
  • Shortage of qualified healthcare resources: This is true not only for Saudi Arabia, but other GCC countries too. Relying on expatriates to make up for this shortage may lead to other impediments like language barriers between care providers and patients.
  • Digital transformation: Adoption of modern technology in combination with healthcare best practices is required to enhance patient care and deliver the highest quality of service. 
  • Restructuring: The public sector will need to undergo a transformational shift from its status as a cost centre to a revenue centre in alignment with Vision 2030, and this could lead to several hurdles in the initial stages of implementation.
  • Insurance sector: The insurance market in Saudi Arabia is maturing fast in expectation that moving forward, healthcare organisations will do more to improve health with less resources and improve health outcomes. This is a double-edged sword as with the little resources they have, organisations are now in the position of having to decide where they get the most bang for their buck and also show the best outcomes. Insurance companies will have a big role here and need to keep up with this shift.
  • Public health management: Around 5 million pilgrims visit Saudi Arabia every year, which provides a major challenge in providing health services and containing infectious diseases arising from such a large mass gathering.
  
  That said, I believe the competent and able teams in the Kingdom responsible for the delivery of the 2030 healthcare vision are hugely talented and have thoughtfully strategised innovative ways and measures to achieve this vision.

• What are the main drivers of new demand for quality healthcare in Saudi Arabia in the medium to long term? What is the outlook for the sector in the medium to long-term?
  
  The current leadership in Saudi Arabia has given a thrust to improve healthcare quality in the country for two main reasons: improving the welfare of the citizens and higher efficiency compared to the current model. These are in line with Saudi Vision 2030 and one of the main changes it will bring about lies in the financing of healthcare. The government is encouraging private investments in the healthcare sector and is preparing to switch its role over the long term from that of a service provider to a regulator. This will create competitiveness in service quality amongst all service providers and stakeholders, including the current government-run hospitals, which will lead to service improvement and increased efficiency.

• What are some of the operational challenges that Saudi Arabia has to contend with? How can a more effective integrated continuum of care be brought about to overcome these challenges?
  
  Several operational challenges including long waiting times, high appointment no show rates, underutilisation of resources, and tight controls may limit the agility of the leaders and block or delay some of the creative changes required to solve the current problems. Technology now offers many solutions to address some of these challenges. The direction should be to have better visibility to manage the available resources and better engage the patient for better results. If we can increase the percentage of care delivered outside the four walls of the hospital using the available technology and by relying more on primary healthcare centres, we should see natural improvement in the above-mentioned challenges.
  
  We also need to keep in mind that lifelong learning and continuing education of healthcare professionals are critical to improving healthcare, patient outcomes and population health. This by itself will largely address the continuum of healthcare.
  
  In addition, operational changes should also be reviewed regularly between both the public and private sectors to achieve the best synergy between the two entities.

• Obesity is a growing concern in Saudi Arabia. What are the specific healthcare challenges that lifestyle habits and rising incidence of non-communicable diseases are causing in the region? How can these be addressed?
  Obesity is an increasing challenge in many countries especially with the onset of the modern life style. Several noteworthy campaigns have been launched in Saudi to raise awareness on these issues. However, the impact has been minimal to lead to a big shift in results. The problem is that fast food is quick, unhealthy options are tasty, and hectic work schedules or sedentary lifestyles - even with entertainment - does not leave much time for exercising. While people know that these are bad choices and will have a negative effect on their health in the future, what is required is a direct and timely incentive for individuals to make the change.
  
  At Cerner, our experience in addressing this issue with the introduction of a programme linking one’s activity level and BMI with the discounts one can get from health insurance and a few other similar incentives has shown promising results. We need to look at new methods of enhancing obesity assessment and management programmes if we need to have a healthier and happier population.
  
  I believe, we should maintain an attitude that more can be done from adopting a preventative approach rather than looking at it from a curative perspective. It is imperative to address this challenge and encourage people to make healthy lifestyle choices through raising awareness amongst the public and design efforts and strategies to combat obesity so that the consequences brought on by the rising incidence of non-communicable diseases such as cardiovascular diseases, diabetes, etc are greatly reduced.

• How has the rapid pace of technological innovation and digital disruption affected the healthcare delivery system in Saudi Arabia?
  Technology is playing a big role in our lives across all industries and healthcare is no exception. In Saudi Arabia, healthcare stakeholders are welcoming digital disruption to transform the sector in the coming years. For example, in many cases where the need for physician opinion or consultation is urgent but does not require a personal meeting, physician e-visits can be done over the phone or through video conferencing. This will be much more efficient and convenient for both the patient and the physician and will lead to better results as opportunities for complications are reduced (if the patient waits or took wrong medication on his own). In addition, a virtual waiting room is better than the physical one to help prevent infection between patients.
  
  The availability of multiple devices and solutions which can track our health (activity, vital signs, sleep, sugar levels) can provide a much more comprehensive picture about our condition to our healthcare providers and allow for early warnings and proactive engagement.
  
  Also, the sharing of data across facilities and the possibility of having a single patient file across providers is a game changer as it negates the need for unnecessary examinations and conflict of treatments which arise from fragmented care.

• In your opinion , what would be some of the ideas or solutions for a nationwide healthcare programme ?
  • Use technology to aggregate patient data and have national registries; modernise primary care centres
  • Increase collaboration between different facilities and organisations (including private sector) to efficiently utilise existing resources.
  • Switch the focus from sick care (treating illness) to preventive care (avoid illness and staying healthy); create public awareness of adopting healthier lifestyle habits
  • Attract qualified clinicians and offer continuous professional development to improve quality of care
  • Implement best practices and innovative strategies to improve care coordination and manage multiple chronic conditions.