Opportunities

Medical travel has grown strongly during the 21st century. Cosmetic, fertility and dental treatments are among the most popular with medical travellers. The factors driving this upsurge in medical travel include the high cost of healthcare in industrialised nations; the ease and affordability of international travel; and improvements in technology and standards of care in many countries around the world.

Challenges

However, the report highlights that it is not a sector without controversy. Ethical issues arise around the sale of organs for donation in poorer countries. Also, there are questions around people returning home with infections or creating burden on their domestic health services owing to complications resulting from surgery overseas.

The annual number of medical travellers worldwide amounts to 5.5 million

Trends

Key medical tourism trends as outlined by LaingBuisson:

• The greater proportion of medical travel is regional or domestic within a country

• Many medical tourists do not seek out the cheapest destination

• The top three European destinations are also the most expensive ones

• Much medical tourism is for cosmetic, fertility or dental treatment

• There are more failed medical tourism projects than successes

• Many countries have stopped promoting medical tourism

• Many trade associations and medical tourism agencies have now disappeared

The study, led by researchers at Weill Cornell Medicine and Hospital for Special Surgery (HSS), was designed to find early molecular predictors of the hypertension syndrome preeclampsia, miscarriage and other adverse pregnancy outcomes in women with the autoimmune disorder lupus, who face a relatively high risk of such outcomes. Over half of the more than 200 women studied were lupus patients. But the results suggest that modulation of the immune system during pregnancy is very similar in women with and without lupus.

Highlights from the study

Commenting on the results of the study, Dr. Amit Majumdar, Consultant Obstetrician and Gynaecologist, and his colleague Dr. Geetanjali Sharma, Specialist Obstetrician and Gynaecologist at King’s College Hospital London in Dubai told Arab Health Magazine: “Understanding early molecular signs, as highlighted within this study, in high-risk pregnancies is very interesting and useful for doctors within our field. We are able to use this study to understand similar risks to low-risk women, the importance of early diagnosis tests and ultimately increase positive outcomes for women.”

In the last decade, there has been a lot of research on the severe complications in pregnancy, including preeclampsia (high blood pressure during pregnancy with protein found in urine), still-births and miscarriages, and it has been well established that alterations and imbalances in immunity during pregnancy can lead to these placental complications. “These issues are routinely faced in practice and with the increased use of the Internet, pregnant women often come with some knowledge of such complications. For us, as healthcare professionals, studies like these are vital to make sure that we have the most up-to-date information on healthcare both in the region and across the world,” says Dr. Majumdar.

The results suggest that modulation of the immune system during pregnancy is very similar in women with and without lupus.

In-depth research

There has been a lot of research in identifying the markers and developing tests that could predict pregnancy related complications, specifically tests related to placental problems such as preeclampsia, foetal growth problems and pre-term still-births. These tests help doctors and patients create an extensive management plan to reduce any complications.

“One test we recommend for high-risk pregnant women, is the ‘Uterine Artery Doppler’, which looks specifically at the blood flow between mother and baby,” Dr. Majumdar explains. “This test is particularly important for women with restricted foetal growth and severe preeclampsia. Other useful tests include ‘Maternal Serum Analytes’ which are an important component of Down’s Syndrome screening. These serum markers are routinely used to identify women who may be at increased risk of having a child with an abnormal chromosomal count, or chromosomal aneuploidy, such as, trisomy 21, 18 and 13. These are also useful in identifying children with structural malformations such as birth defects of the brain, spine or spinal cord.”

“One test we recommend for high-risk pregnant women, is the ‘Uterine Artery Doppler’, which looks specifically at the blood flow between mother and baby,” Dr. Majumdar explains.

"Within the industry there has been a shift towards predicting the development of these potential complications in the first trimester, as opposed to later in the pregnancy," says Dr. Sharma.

Current approach

To make sure that they provide the very best outcomes for patients, Dr. Sharma describes their current approach is to perform a risk assessment in early pregnancy for all women. “We look at the clinical history, demographic profile and examination findings, and high-risk women are then offered various investigations, such as uterine artery doppler with increased surveillance and possible interventions to reduce the risk. However, within the industry there has been a shift towards predicting the development of these potential complications in the first trimester, as opposed to later in the pregnancy. This allows for the appropriate treatment and focus to be provided, ultimately leading to better outcomes for both mother and child.”  

In the field of cosmetic dentistry, we are witnessing an exciting period of advancements with progress in several areas mainly due to the introduction of new technologies and revolutionary materials. 

What are the latest technology trends in cosmetic dentistry?

Without a doubt, laser dentistry and 3D dentistry are the most exciting trends in cosmetic dentistry right now, and with the advances in the materials used in restorations, patients now also get quality aesthetic dentistry resulting in teeth looking more natural than ever before.

For example, digital dentistry helps in creating Clear Aligners, which allow teeth straightening without having to wear traditional metal braces. Not only does it assist in precision and efficiency, but it also makes the dentist’s job easier and ensures the ultimate results for the patient.

Lasers have been significant in making dentistry less invasive, more comfortable and are extremely effective in enhancing cosmetic treatments such as gum recontouring for patients with a “gummy smile” as well as lip and gum depigmentation (or bleaching).

Another popular treatment delivered with laser is intraoral skin tightening, which involves the laser applied to the inside of the mouth stimulating collagen. As a result of this stimulation, there is an immediate reduction in the nasolabial folds along with a plumping effect.

How do you see the cosmetic dentistry industry evolving in the UAE?

Dentistry in the UAE has changed dramatically in the last 20 years. While there were only a few cosmetic dentists in those early days, we currently have approximately 5000 dentists who are licensed and practising in the UAE.

However, the supply of dentists per capita is higher in Dubai than in most developed countries, making running a successful business difficult for dentists practising here. Hi-tech quality dentistry and laser dentistry, as well as keeping up with the latest techniques and technology needs to be a priority for quality practices to improve and enhance the services and treatment we give to patients.

With the continued growth and popularity of social media, patients have higher aesthetic expectations, which will keep motivating practising dentists in keeping up with the advances and continuing to evolve their practices, techniques and materials.

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Recently, Geltec Group celebrated the opening of its new US$ 30 million manufacturing plant at National Industries Park (NIP). This plant will be used to manufacture dietary supplements and pharmaceutical formulations in soft-gelatine capsules and gelatine-enrobed tablet forms.

NIP is a part of DP World, UAE, falling under the global trade enabler’s Parks and Zones portfolio, which includes Jebel Ali Free Zone and Dubai Auto Zone. It covers an area of 21 square kilometres. While Geltec is an Indian company with a global presence, specialising in the manufacturing of softgel capsules and gelatine enrobed tablet products comprising of nutraceuticals and pharmaceuticals. 

Rewarding Relationship

Their association began in 2000, when Geltec first set up shop in the UAE at NIP’s sister concern, Jafza. This initial venture served as a marketing and distribution arm of the group that sought to expand Geltec products in the region.

“Through this entity, we managed to establish several mutually rewarding business relationships in this market,” said Vikram Tannan, Director, Geltec Group. “With the continuously emerging opportunities here, we were motivated to have a manufacturing base in the UAE, which is why we built the Geltec Healthcare FZE facility.”

Key Objectives

The new facility’s opening also serves to further the goals of the Dubai government. The pharmaceutical segment is one of the key objectives of 2030 Dubai Industrial Strategy, which was launched in June 2016 by His Highness Sheikh Mohammed bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai.

The strategy will have a significant impact on Dubai’s economy by 2030, leading to an expected AED 160 billion increase forecast in Dubai’s total GDP, an AED 18 billion increase in GDP for the industrial sector, creating more than 27,000 jobs, and boosting research and development expenditures by about AED 700 million.

“We are a global trade enabler, and that means our goal is to provide support to our customers all across the supply chain,” said Mohammed Al Muallem, CEO and Managing Director of DP World, UAE Region. “Through this holistic solution, we are able to mitigate many issues that businesses face when entering the GCC market, such as high start-up costs or – in the case of manufacturing – availability or accessibility to raw materials.”

The strategy will have a significant impact on Dubai’s economy by 2030, leading to an expected AED 160 billion increase forecast in Dubai’s total GDP, an AED 18 billion increase in GDP for the industrial sector

RAK Hospital has won the prestigious Sheikh Khalifa Excellence Award (SKEA) for Business Excellence at the 17th edition of SKEA awards in Abu Dhabi, UAE, gaining recognition as the only healthcare institution in private sector to receive the honour. The healthcare institution is also the first hospital in the northern emirates to have won the award, selected from more than 50 companies representing all economic sectors in the UAE and abroad.  

Secret to success

Following the win, Arab Health Magazine spoke to CEO of Arabian Healthcare Group and Executive Director - RAK Hospital, Dr. Raza Siddiqui about how RAK Hospital remains competitive in today’s healthcare landscape and continues to enhance its service delivery.

Discussing the healthcare facility’s business model and its secret to success, Dr. Siddiqui says, “At RAK Hospital, we adopt the European Foundation for Quality Management (EFQM) Business Excellence Model which addresses all stakeholders’ needs and expectations with customer satisfaction being the prime focus.  

“The EFQM model is designed to assess the current performance, focusing on areas that need improvement and identifying the strengths. The excellence model further helps people to understand the impact of the organisation’s actions and the results it can achieve. Moreover, Joint Commission International (JCI) accreditation ensures that we provide international standard health care,” he adds.

Innovation is at the forefront

One of the primary focuses for RAK Hospital is utilising innovative technology and digitisation to enhance efficiencies in the hospital. As Dr. Siddiqui explains: “The innovation management structure at the organisation is through planned projects and innovation is focused on customer service to enhance experience and clinical excellence. Digitisation is incorporated to deliver efficient care. Incorporation of technology in our processes has enhanced customer satisfaction.”

RAK Hospital is always looking to introduce innovative technology, and have brought several new procedures that have added value not just to the hospital, but the UAE healthcare sector in general.

These include the opening of the first Cardiac Catheterisation Laboratory in the northern emirates, establishing the first Cardiac Intervention and Cardio-Thoracic Surgery Centre, launching the first-ever Neurosurgery and Spine Centre in the emirate and the introduction of a new and revolutionary Stem Cell Therapy for the treatment of arthritis and other joint related issues.

The hospital also became the first to perform a successful Artificial Cervical Disc Replacement surgery in the UAE, it launched gyroscope-based technology for more accurate alignment in knee replacement surgeries, and it also offers life-saving and non-surgical balloon dilation procedure, among many others.

Blending hospitality with healing

Over the years, RAK Hospital has demonstrated that it has been able to blend hospitality with healing successfully. The hospital has been recognised on several platforms for the physical design elements while providing optimum patient healing is the governing philosophy of RAK Hospital.

“The hospital is built with a stringent belief in the subliminal effect of the environment in the entire healing process,” Dr Siddiqui explains. “Clearly defined processes and markers ensure that patients are given the highest quality care and sent back home within record time. Our average length of stay (LOS) over the past four years is two days further emphasising our effective patient management and speedy recoveries.”

An article submitted to the American Journal of Hospital Pharmacy long ago in 1967 identified how ‘outpatient visits are increasing at a rapid rate and administrative adjustments will be needed to handle larger outpatient prescription volumes. The author laid out how, ‘new methods and procedures must be developed to reduce patient waiting time, provide the physician and the pharmacist with information pertinent to drug therapy and increase productivity through the elimination of administrative detail, which can be handled better through automation’.

The situation remains not dissimilar in 2019, some 52 years later. Outpatient visits continue to rise year-on-year, with increasingly complex patients being handled by these departments. Globally there has been a drive towards automation in healthcare to help handle the constantly increasing workload, and to allow for the redeployment of our limited numbers of highly qualified staff away from routine tasks and towards more constructive engagement with patients.

There is also considerable political and financial pressure on healthcare decision-makers to optimise the utilisation of resources and to improve services for patients, whilst ensuring that any automation and technology that is deployed definitively adds quantifiable health-economic value. The size of any initial investment in health technology and automation is inevitably significant and requires substantial decisions to be taken about funding, the need for change, and required re-engineering of a facility’s infrastructure and established a hospital and department procedures, policies and workflows.

The remit of the Health Technology Assessment Office to the UAE Ministry of Health and Prevention (MOHAP) is to act as a guide on the introduction of new Health Technology to MOHAP in an efficient, equitable, transparent and explicit manner. The priority of the office is the welfare of the UAE’s population and to act always with the highest economic, ethical, legal, social and organisational standards regarding patient care.

With the above in mind, the Health Technology Assessment Office embarked on a two-site head-to-head comparison between an automated and a ‘traditional’ outpatient pharmacy to assess possible cost-benefits of extending pharmacy automation across multiple MOHAP outpatient facilities in the UAE. The output from an automated outpatient pharmacy and a conventionally managed outpatient pharmacy was collected over 12 months. During this period 11,646 patients were served by the traditional pharmacy with 33,782 prescriptions and 12,739 patients were served by the automated pharmacy with 37,754 prescriptions (Table 1).

Metrics collected from both pharmacies were average time from prescription order to dispensing, completeness of medications dispensed versus prescriptions, expired inventory, average inventory stock levels, turnaround of unused or uncollected medications into circulation, number of mislabelling or prescription discrepancy events caught, time taken in completing regular inventory, and percentage of missing medications identified.

The study took place over 12 months in 2018. The automated pharmacy served 9.4 per cent more patients than the traditional pharmacy in this period and dispensed 11.8 per cent more prescriptions. Overall the automated pharmacy showed a 28.8 per cent lead over the traditional unit in correctly dispensed prescriptions. The time to fill a received prescription was also an impressive 95.7 per cent less than in the traditional pharmacy. Maximum turnaround times for dispensed complete prescriptions was also reduced by 81.4 per cent.

The improvement in the number of completely filled prescriptions was perhaps partly due to the increased numbers of individual medication types that the automated pharmacy can store. These increased to 114,262 individual medication types, up 1.3 per cent from the 112,814 held in the traditional pharmacy’s storage. This is not an uncommon finding in automated pharmacies; robots are simply better than humans at mundane tasks like constantly calculating the optimum way of stacking and placing medications on shelves, this ensures that more items can be stored without increasing the overall volume of stock. Up to 4,000 medication packs/metre of shelving can be stored by advanced robotic systems.

Pharmacy robots even use ‘down-time’, when they are not dispensing or adding the stock, making minute adjustments to existing stock on shelves and cleaning the storage area. An increase in line-item storage without a concurrent growth in stock level overall would generally be responsible for less bound capital, the reduction of expired stock loss, and a higher value to the organisation in the stock held as more prescriptions could be serviced and completed.

When adding stock pharmacy robots can also read expiry dates on drug packages, and thereby reduce waste from out of date medications, and also automatically recognise medications that require refrigeration. Some automated pharmacies have internal refrigerated storage units within them and their entire stock area is temperature-controlled.

The large increase in speed of dispensing by the automated pharmacy seen in the head-to-head study is probably due to the nature of ‘picking’ by the pharmacy robot; rapid barcode identification of ordered medications and multi-picking of up to 8 medication packages per move makes for a speedy pick-up and conveyor belts and automated gates leading to spiral chutes can deliver these picked medications directly to the patient service point.

Regular inventory is a labour-heavy task in a manual pharmacy. Automated pharmacies can maintain a consistent inventory count as each of the actions, direct loading into the robotic-managed storage with barcode reading for medication stock-up and automatic item deduction from stock level upon dispensing is under its control. This means that the inventory balance is a constant and dynamic process.

From what has been seen in this head-to-head study, the time savings and accuracy of automated dispensing for outpatients are both impressive. Further efficiencies are perhaps also possible if workflow bottlenecks, such as that between prescription and the commencement of dispensing can be resolved. Studies generally seem to indicate that the fuller the integration between systems such as Computerised Practitioner Order Entry, Electronic Medication Administration Record, and the patient’s Electronic Medical Record and automated dispensing systems, the greater the gains for the organisation.

AD is a chronic skin condition most commonly known as eczema, by driving key conversations among various communities.

#LivingWithEczema

The #LivingWithEczema network and campaign has been established to give members of the community suffering from AD the knowledge and confidence to tackle their condition.

“It also encourages them to have more open conversations about their struggles with AD in order to inspire other patients,” explains Dr. Anwar Al Hammadi, Consultant Dermatologist and President of the Emirates Dermatology Society, who leads the #LivingWithEczema coalition network.  

“In order to execute this vision, we have set-up the #LivingWithEczema network which will bring together thought leaders, policy makers, healthcare professionals and media to raise awareness around Atopic Dermatitis in the UAE. I am currently leading the network, with the support of Sanofi, and we are in the process of inviting more members to join the team and will keep you posted on our course of action,” Dr. Al Hammadi tells Arab Health Magazine.

What is AD?

AD is a chronic, immune-mediated disease that is systemic and visible on the skin. In moderate-to-severe cases, its symptoms can include an intense, relentless itch, skin dryness, cracking, redness, crusting and oozing.

“AD affects 10 to 25 per cent of children, around 10 to 20 per cent of adults globally. These individuals are not only battling physical symptoms but are also dealing with its impact on their mental wellbeing and quality of life, which is an important aspect to address,” says Dr. Al Hammadi.

References available on request.

These emerging countries not only offer cost advantages but also a large patient pool and an overall faster process.

Amongst these emerging countries are the META countries (a group of nine countries including Egypt, Lebanon, Saudi Arabia, UAE, Jordan, Tunisia, Algeria, Morocco and Turkey) that offer potential to become the future hubs of clinical trials, the report says.

Industry Growth

Globally, the pharmaceutical industry spent more than US$60 billion on clinical development in 2016 alone.

In terms of the number of CTs, ICH countries (U.S., EU, Japan), which make up 14 per cent of the total world population, have hosted around 61 per cent of all trials registered with clinicaltrials.gov until the end of 2013.  

On the other hand, the BRIC countries and MENA, with a combined population of more than 3 billion, (nearly half of the world’s population), have collectively hosted less than 7 per cent of the clinical trials.

While Turkey and Egypt together account for 90 per cent of all the clinical trials hosted within META, Egypt alone has exhibited a growth rate of ~27 per cent, in increase in number of clinical trials hosted, over the last one decade. Jordan and Saudi Arabia with a well-defined regulatory infrastructure are well positioned to grow over the coming years.

Strategic Factors

The authors of the report note that there are many strategic factors that determine the location of conducting trials, such as, location of key partners, healthcare infrastructure, future launches besides the obvious factors like patient population, regulatory policies etc., and like various other industries, offshoring clinical trials to developing markets is becoming a viable option for pharma companies to better control the exorbitant development costs.

As per industry reports, it is expected that depending on the choice of location, cost savings can range from 30 per cent to 65 per cent compared to trials conducted within the U.S. or Western Europe.

Recent trends indicate that the META governments have realised the increasing importance of clinical trials and are taking active steps to drive investment and innovation in the country.

The report concludes that hosting clinical trials is advantageous to overall society and improves access and helps to build a strong talent pool for local industry advancement. It also found that META governments have also realised the huge impact that clinical trials would potentially have on their economies and have hence started taking steps to drive investment and innovation in their countries.  

Taking Care of Blue-Collar Workers

Encouragingly, this doom-and-gloom scenario does not apply in the UAE. Over the past decade, a series of reforms has led to steadily improving conditions for the region’s blue-collar workers.

The UAE has approximately 5.5 million workers at the base of the pyramid, earning less than AED9,500 a year. The federal government and the Ministry of Health have long recognised the importance of this workforce to the growth and prosperity of the country.

Mandatory health insurance with the intention of providing even blue-collar workers with access to quality healthcare in a timely manner has been a landmark initiative. Underlying this regulation is the hypothesis that a healthy working population results in a healthy and productive business environment and a robust economy.

As primary breadwinners, blue-collar workers remit most of their earnings back to their home countries to pay for their families’ living expenses, education and healthcare. Therefore, mandatory healthcare offers invaluable support to these workers, who are already stressed about job security.

Common Health Issues

Advances in healthcare and technology are enabling healthcare professionals to proactively work on preventative measures that reduce the burden of disease as well as deliver an uptick in cost savings and employee productivity.

The data that has emerged on the sector over the last few months offers the potential to identify more efficient ways of safeguarding the health and well-being of blue-collar workers. The data points to a few common ailments affecting this segment of the community.  

1) Viral infections, such as chickenpox that starts much like the flu with fever, fatigue, loss of appetite, aches and pains, and headaches, commonly make an appearance. Chickenpox, like all infections, is contagious, and therefore proactive measures to spot, isolate and treat cases are critical to prevent the virus from spreading.

2) Eye infections and irritations are another regular complaint among labourers working in dusty and sandy environments that can severely affect the eyes. Infections can easily be transferred through rubbing the eyes and contact via machines and tools. Using protective eyewear, washing eyes periodically, as well as applying eye lubricants can reduce the incidence of such conditions.

3) Pre-diabetes glucose intolerance tends to be high among the working population, including the younger workforce. This can be attributed to the quality of the food the workers consume and the lack of exercise owing to their long work days.

4) Issues like high cholesterol, which can cause blockages in arteries, can also be mitigated through proper diet and exercise. Workers from Asian countries have narrower arteries, and the situation is compounded by the cultural diet and lifestyle choices that put this population at great risk of health complications.

Increasing Awareness

Employers can play a key role in improving employee health through providing access to sports facilities in residential labour camps. In the long run, this will significantly enhance the workers’ quality of life while reducing the cost burden on the healthcare system – benefiting the insurer, the employer and the workers themselves.

Organising health talks and video screenings, creating green spaces, facilitating access to exercise equipment in community areas, and reaching out to the workers through WhatsApp and SMS are prime examples of low-cost interventions that can help bring about lasting behavioural change with a positive impact on worker health while drastically cutting healthcare expenses.

Role of Private Sector

The private sector can play an important role in delivering preventive healthcare. Understanding the unique challenges and complexities facing blue-collar workers in the UAE and the wider region makes it possible to deliver innovative solutions. Recognising the potential, the government, employers, insurers and healthcare providers can collaborate on implementing cost-effective preventative measures.

Prevention leads to fewer hospital visits, better attendance records at work, managed insurance cost burden and improved ability of the workers to support themselves and their loved ones. Collectively, these interventions translate into a healthier, happier, more productive workforce and bring manifold benefits to businesses, insurers and the government.

Expansion Plans

Addressing the gap in medical and surgical needs in the emirates, the 41,000 square meter SGH-Ajman is the largest hospital in Ajman and offers high- tertiary, primary and critical care with new and revolutionary technologies and facilities.

The hospital is the first phase of expansion, and will later include Centres of Excellence, medical colleges and staff accommodation to become a part of Batterjee Medical City.

Speaking during the official launch press conference, Engr. Sobhi A Batterjee, President and Founder of Saudi German Hospitals Group said: “This is just the beginning, and in the next few years we plan to develop the Batterjee Medical City. This will add further value to Ajman in terms of creating job opportunities and providing the UAE health sector with qualified and highly efficient medical staff.”

Hospital Facilities
SGH-Ajman has 200 inpatient beds, 25 ICU beds, a state-of-the-art Cath Lab – which covers vascular, cerebral and cardiac intervention – 46 OPD clinics, seven CCU units, 12 PICU and nine NICU units and a 24/7 Emergency Department. The Operation Theatre comprises four operations rooms, six recovery units, nine ICU units and two isolation rooms. The hospital also offers a wide range of speciality facilities including, Open Heart, Oncology, Neurosurgery, ENT, Maxillo-facial surgery, Obs/Gyn and IVF centers, Laparoscopic and Laser surgeries and trauma management, among others.

The hospital will also offer Cardiac-electrophysiology to diagnose and treat electrical activities of the heart. Moreover, it is one of the only few hospitals in the UAE to have the capacity to convert private rooms into shared rooms in case of emergencies and with a view of disaster management.

State-of-the-art Healthcare
Also commenting during the opening ceremony, Dr Reem Osman, CEO of Saudi German Hospitals (SGH) Group – UAE, added: “Over the years Saudi German Hospitals Group has developed a reputation of offering state-of-the-art and the best possible healthcare experience to the people across the MENA region. Today, we bring the same international standards to Ajman, particularly in the area of critical care. With SGH-Ajman, we have further strengthened our position as a key player in the UAE’s growing healthcare sector catering to both local as well as foreign patients.”