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Thu 1 Feb 2007 12:00 AM

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Specialist care at home

Why patients with complex musculoskeletal conditions don't have to travel to Europe or the US for specialist care.

Residents and nationals of the UAE have typically had a preference for having specialist treatment carried out abroad. Whether the problem is real or perceived, healthcare institutions in the country have tended not to be trusted by its public.

The Dubai Bone & Joint Centre (DBAJ) was established as part of a government effort to reverse this trend. The choice of a centre focusing on orthopaedics and musculoskeletal conditions was a reflection of the requirements of the local market.

“It’s because we found there is a huge need and a market gap. Most of the patients that got approval to be referred abroad were in two specialities, one of them is cardiology and the other is musculoskeletal care,” says Suzanne Al Houby, CEO of the DBAJ.

Musculoskeletal conditions, although not always immediately life threatening, can require often lengthy physiotherapy and rehabilitation. That means patients either have to continuously travel overseas, which is costly and impractical, or relocate for the entire length of their treatment.

Responding to what it felt was a clear need, Tatweer, an arm of Dubai Holding, went ahead and established Dubai Bone & Joint Centre in 2004. Al Houby, a veteran of the healthcare business who is a bio-med engineer by training, was headhunted to head up the centre and helped draw up the initial business plan.

Up and running for just over two years, the Dubai Bone & Joint Centre is currently focusing on four key areas, listed as: Joint Replacement, Back & Neck Surgery, Rheumatology and Paediatric Orthopaedics.

The last of these specialities is one that Al Houby feels is particularly important to have. The UAE, she explains, sees a relatively large number of often rare deformities amongst newborns. “Paediatric orthopaedics is one of the recently added programmes that we feel very strongly about moving forward because there are almost no orthopaedic surgeons that specialise in paediatric care,” Al Houby says. “For example, club foot [is a condition] for which you fly abroad and stay for months and months for treatment; now we’ve brought this home.”

A rheumatology department is essential because the DBAJ feels that patients with the condition locally are not being correctly diagnosed. “One in a hundred in this region has rheumatoid arthritis and studies on our patients in the [DBAJ] have shown that diagnosis of the disease is coming eleven months late,” the CEO explains. “When you put the patient on the right treatment at the right time, you improve their life and their chances of not going down the route of drastic degeneration of their condition.”

The DBAJ’s vision of providing specialist care at home in the UAE has been clearly set out. If it is to succeed, however, building up credibility and overcoming negative perceptions about the quality of local healthcare provision are key.

One key factor in attaining credibility is to recruit the best and the DBAJ is very specific about what skills it is looking for. “For us to sell ourselves as a specialist centre, it means not just a specialist in orthopaedics or rheumatology,” explains Al Houby. “So I recruit for an orthopaedic surgeon, who’s sub-specialised in either the spine, the joint or paediatric surgery. That’s really the key to success.

“You don’t want someone touching your spine who’s doing 50 spines a year or 50 knees a year. You want someone who’s only doing 400 or 500 spines per year.”

So far, the DBAJ appears to have been successful in attracting the kind of people it wants. Dr. Chris Whately, M.D., senior orthopaedic surgeon, specialises in total joint replacement (including revisions and infections), limb lengthening, and deformity correction.

Dr. Desmond Kwok, M.D., senior orthopaedic surgeon, specialises in the spine, including trauma and degenerative conditions such as disc herniations and spinal stenosis. He also has experience and expertise in the management and reconstruction of fractures of the pelvis and acetabulum.

In the field of pediatric orthopaedics, Dr. Marc F. Sinclair has focused on the correction of limb deformities, especially by usage of external fixation such as the Ilizarov and Taylor Spatial Frame System. According to his profile, he also has a strong interest in the correction of pediatric foot deformities.

Prof. Paul Peter Tak, MD, PhD is registered as an internist and rheumatologist. He has extensive experience treating rheumatologic and immune-mediated conditions.

Dr. Humeira Badsha has been the principal investigator in various clinical trials of medications for rheumatoid arthritis. She has conducted research studies on Lupus and autoimmune diseases and has published several papers in leading journals.

Recruiting is, of course, an ongoing process. Amongst the centre’s future plans is the development a sports medicine competency. A key challenge for 2007 is finding the person that can champion and kickstart a sports medicine programme at the centre.

The DBAJ says it is prepared to invest the money required to land the right people, but believes there are other factors that make it an attractive place to work. Being part of a pioneering new centre in an emerging area of the world is one element, along with a freedom to practice that is restricted elsewhere by the constant threat of litigation.

“DBAJ is really exciting for surgeons that want another challenge and there is a large element of that physician wanting to contribute to a new community,” says Al Houby. “Another factor is the strict conditions they face elsewhere. Lots of physicians practising in the West don’t have the freedom or authority to do what they feel is suitable for the patient because the whole legal system is working against them.”

Having the right medical experts in place is one aspect of building credibility. Other key factors are creating awareness of the DBAJ’s existence and overcoming public apathy towards local healthcare providers.

In an effort to create awareness, the DBAJ has worked hard to build relationships with potential referral sources, which include local health authorities, the armed forces and embassies. One source of business so far has been Kuwaiti nationals who would otherwise have to travelled to Europe or North America for specialist treatment. “I’m not saying we have filled this gap [for specialist treatment], but we are in the process of filling the gap,” the CEO says.

Building awareness and referral relationships amongst individual physicians is the next stage in the development of the DBAJ’s referral network. “You have patients being treated for rheumatoid arthritis by generalists and they should not be treated by generalists; they should see a specialist,” argues Al Houby. “The physician has traditionally been reluctant to refer to a patient elsewhere because specialist care hasn’t been there — yet.”

Although business is coming in, the DBAJ says it is more focused at this early stage on building patient trust. Physicians are therefore encouraged to spend considerable time talking to patients about their condition and explaining possible courses of treatment. According to the CEO, this communication with patients is something that has long been lacking in the regional healthcare business.

“For a long time, people have mistrusted the healthcare system here and our physicians spend a lot of time educating the patient,” explains Al Houby. “Patients, unfortunately, have not even had their condition explained to them. We explain to the patient in a non-technical way what they need to have done to become better and we always respect the patient’s decision. We’re not hungry for business, we’re hungry for credibility.”

To do its job, a specialist centre like the DBAJ needs to be able to source sophisticated equipment and technology. This is something that the centre has found to be a challenge here in the Middle East.

“We are often meeting vendors and reps that don’t know the product,” says Al Houby. “The service level and the commitment to time and commitment to delivery, the whole vendor-physician relationship really needs to go to a totally new level. We find it one of the biggest challenges we have. They need to look at this like they are part of the overall improvement of care and they are still not getting this.”

In an effort to improve the situation, DBAJ tries to run regular CME sessions to which vendors and fellow medical professionals are invited. CME is obviously essential for the centre’s staff and the DBAJ helps them clock up their hours by giving them paid CME leave and assistance with the cost of education and travel.

Just over two years into its existence, DBAJ continues to build up its reputation and competencies. Al Houby’s ongoing challenge is to ensure that patient care is of the highest standard whilst the goals of the business plan are being achieved. “Our philosophy as an organisation is that care comes first because the money is going to come later,” she explains. “It might come in three years or five years, but we want our clinical outcomes to be the best of the best worldwide.”

Amongst the DBAJ’s concrete plans for 2007 are the development of a sports medicine competency and the establishment of an outpatient capability. All this helps in achieving the DBAJ’s vision, which is to, “raise the bar and start having practices that are comparable with, if not better than, best practices elsewhere.”

What:

The Dubai Bone & Joint centre: (DBAJ)

When:

Began operations in late 2004

Objective:

To establish a local centre of excellence for orthopaedics and treatment of musculoskeletal conditions. This will reduce the need for citizens and residents to go abroad for care.

Specialities:

Joint Replacement, Back & Neck Surgery, Rheumatology and Paediatric Orthopaedics.

Future plans:

To establish a sports medicine competency and an outpatient capability.

‘‘People have mistrusted the healthcare system here and our physicians spend a lot of time educating the patient.”

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