Earlier Thoughts

Tuesday, January 4, 2011

Middle East Healthcare Congress of December 2010

“Nothing is more fatal to health than an overcare of it.”
- Benjamin Franklin
This entry was to have been about the Transportation Safety Administration’s (TSA) program to improve aircraft fuel efficiency by asking passengers to fly nude, thereby reducing cargo weight.  But that rant will wait, as I found discussions at a recent meeting of hospital managers, technology salesman, government officials, and care providers at least as stimulating, if not more provocative than TSA. 
I just returned from a week-long meeting in Abu Dhabi called, The World Health Care Congress – Middle East.  Trust me when I tell you that Abu Dhabi is growing.  While the city boasts a few spectacular sites like the Emirates Hotel and Grand Mosque, the noise and disruption from construction-gone-wild disappointed.  The Beach Rotana Hotel hosted the meeting where I stayed, set along a water inlet from the sea and facing the shore of a building site nested with 15 construction cranes busily hoisting materials and workers up 30 and 40 floors of skyscrapers.  If on the hotel-installed beach, a modest expanse of grass, palm trees, and sand, you enjoy all of the noise attending building sites anywhere in the world.  So, while you drink a beer or soda, you also listen to a cachophony of hammers, trucks, and heavy machinery.  (Yes, Abu Dhabi serves alcoholic beverages and pork.  The hotel hosts a rather wonderful German restaurant with more good things.) If you are planning a vacation to this part of the world, visit Turkey, Oman, or Jordon for the entertainment, history and culture.
At the World Health Care Congress, (I thought that we had all agreed to the accepted usage of healthcare vs. health care, but not with the folks who run this for-profit meeting mill.)  I observed a lot of really smart folks talking about how they and their countries and companies were developing care delivery in the region.  Some of the publicly spoken comments are highlighted here for you to digest:
1.       “We are beginning the development of a cost efficient healthcare system by building hospitals…” spoken by the leader of a large for-profit hospital company based in India. 
2.       “…America’s healthcare system is broken,” announced the president of a USA consultant firm.
3.        “We found that providing a network of family care doctors decreased hospital utilization and improved the quality of care…” said a physician working in the Health Authority -Abu Dhabi (HAAD). 
4.       “Doctors are looking for energetic and active nurses instead…” according to a management consultant based in the region.
Is your stomach aching a little?  I know that my public health education and work experience doesn’t support the idea that bricks and sticks investment yields significant gains in health status.  In fact, putting real treasure into building hospital beds makes sense only if you run a hospital and are focused on disease treatment.  Hospitals don’t have much to do with prolonging life or improving the overall health of people.  (More on what does impact health and was visible at this meeting later.)  In fact, isn’t one of the reasons why the USA. health care system takes 17% of the GDP related to the infrastructure costs inherent in buildings and technologies – implants, pharmaceuticals, and diagnostics -- associated with hospitals? 
Given that America’s cost for disease treatment is running wild doesn’t lead to the conclusion that the system is broken.  The use of money in the American system isn’t ideal and likely to not be sustainable. And, the system “fixes” installed by Mr. Obama and Congress contributes to the problems by mostly financing hospitals, technology companies, and doctors.  Politics is playing out on a grand scale to support the disease treatment industry.  The system does a good job of treating illness while not improving the overall health status of Americans and this isn’t likely to get better.  
But, broken?  Let’s limit this assessment to the politics of financing care.  Financing the disease burden is the distinct issue not solved by just moving the cash around.  Supporting the milieu for long, high quality of life requires a community, not institutional, focus.  I do applaud the efforts (and new monies) for community organizations that provide primary health care at lower cost than traditional private practice models or hospitals.  What America does in treating acute disease is good.  What America does in promoting health and managing chronic illness can be improved.   To this point of early and appropriate health relationships, I applaud the young and female Arab doctor’s comment above Abu Dhabi’s success.  What the Middle East learns from the West about disease management and systems is solid.  The challenge is to not replicate the sticks and bricks mania in care delivery such that disease management costs prevent us from funding for adequate food and water, accessible housing, reliable transportation, safe working conditions, and access to education.  All of these things impact quality of life and improve health status.
To the earlier comment by the local expert in manpower development and staffing models,  I don’t think he recognized the ageism or sexism in his statement, but he also didn’t acknowledge this problem when I called it to his attention.  Did it strike you that some men want young and energetic women for all sorts of things, including work?  But the doctors who I know want partners in providing care who, like them, are seasoned professionals with years of experience and thoughtful practice. 
While my stomach hurts a little from the meeting dialogue, soothing relief came not from the lectures or panel discussions hosted at the Congress, but from the poster session in the conference lobby.
About 20 posters were hung in one corner of the large conference center.  These posters were about health promotion, disease avoidance, and early intervention.  I even witnessed a few conference attendees glance at the offerings here.  This small and neglected area offered hope about how the health status of people can truly be improved.  I am truly amazed at the ingenuity of the offerings which included incubators for newborns from used car parts to low-cost applications for disease screening.   Take a look at a few of the innovators at work:
1.       Smart phone ultrasound scanning – www.mobisante.com
2.       Solar powered hearing aids – www.solarear.com.br
4.       Diagnostics-for-all – www.dfa.org
5.       Safe drinking water – www.safewater.org
6.       Point-of-care testing – www.path.org
7.       Diabetes care – www.amcaremobile.com
 I’d like to see conferences that educate professionals about improving the health status of communities by deploying local efforts and low-cost strategies.  Transitioning local innovations into commercial applications without adversely impacting that part of the invention related to its being low-cost will be tricky.
Next time, let’s talk about Saudi Arabian healthcare priorities.


  1. Wow. The view from afar on US healthcare is sharp and clear. These are poignant thoughts stated simply. I have to write a couple reports and I am stealing some of your content. Whatever you ate (and drank) in Abu Dhabi, keep it going. Favorite points: (1) "bricks and sticks investment yields significant gains in health status"; (2) "Given that America’s cost for disease treatment is running wild doesn’t lead to the conclusion that the system is broken;" and (3) "the system “fixes” installed by Mr. Obama and Congress contributes to the problems by mostly financing hospitals, technology companies, and doctors." The question about contributions that might be made by young nurses for aging MDs got me wondering.

  2. Well said Ron. We need you back in America to bring home your points!

  3. Thank you Ron for your blog posts. I enjoy reading about what life is like in the Middle East. It is also interesting to hear that the healthcare conference discussion is not that much different than the USA.

  4. Nothing wrong with wantin' to erect big buildings. It's very American. But let's take a look at some of those innovations that Ronnie-boy recommends. hmmm. Do they work? And why? Smart phone ultrasound - so we can scan our livers while we're riding the bus? TB testing made even simpler. What do we do with peole who test positive? Lock 'em away in the big hospitals. And solar-powered hearing aids. Yeah, that'll work in the heat of the desert! Picture me standing out my front porch in 120-degree weather, trying to boot up my devices.