The Health of Kuwait – A Wake up Call (Part II)

Following the 2000 WHO report and to respond to the needs of their population, our neighbors have engaged in large scale upgrades of their systems. Increasing financial prosperity allowed for the creation of new, state-of-the-art health care facilities thereby increasing the availability of care. Qualified professionals were recruited from Western nations to spearhead the advancement of several deficient specialties. Attractive, tax-free packages were offered to promote incentive. More importantly, collaborations with leading institutions were initiated to help uphold self-sustainable developments. Examples, discussed previously, include Weill Cornell Medical College in Qatar, the world-renowned Joslin Diabetes Center of Boston in Bahrain, attracting much-needed expertise in diabetes treatment to the area, the Clemenceau Medical Center in Beirut and the Tawam Hospital in Abu Dhabi, the new affiliates of Johns Hopkins Medicine International, or the collossal King Fahd Medical City in Saudi Arabia and the Harvard-affiliated Dubai Healthcare City. Such ventures not only introduce healthy competition to the region but also provide the work environment needed to motivate health care professionals. These projects will help avert reinventing the wheel by introducing approved standards and protocols, implementing a modern clinical practice, and enhancing medical education in the region.

So why does Kuwait lag behind? The reasons are many. For one, there is an ongoing paradox in our health expenditure. The budget’s size has not increased proportionally with the rising cost of health care. Lack of confidence and concerns of criticism by high level government officials are behind this. Shortsightedness is the rule prohibiting any form of long-term planning. Indeed, instead of taking the proactive route and engaging in exchanges with experts in health care management, the decision-makers have opted for the more conservative approach of reducing expenditure by recruiting cheap, incompetent labor, sacrificing patient safety measures, or findings the lowest priced deals on vital equipment, comparable to, say, the textile industry. On the other hand, there seems to be a total disregard for cost-effective measures within individual institutions. Lengthy hospital stays, improper utilization of diagnostic and therapeutic tools, inconsistent practices, and unsatisfactory post-hospitalization rehabilitation are few obvious examples leading to inappropriate expenses. When practitioners or administrators are confronted with such issues, they are quick to dismiss them by stressing the concept of “free health care” within our fortunate nation.

To give you a classic example, a few years ago, while presenting a well-designed study from the Children’s Hospital in Boston on the use of an anti-emetic (anti-nausea medication) in children presenting to the emergency department with gastroenteritis (vomiting & diarrhea) to the Department of Pediatrics at Mubarak Al-Kabeer Hospital, I encountered a great deal of resistance from most of the pediatricians present who were skeptical of using an “experimental drug” when it was so much easier to admit these patients for intravenous hydration. They added that cost is not an issue that needs consideration in our system. Well, this so called “experimental drug” has now been part of the standard treatment of these children for years at many leading pediatric emergency departments and has helped significantly reduce costs by preventing unnecessary admissions to the hospital.

Another point highlighting the ill health of our system is the current relationship between the public and private sectors. A fact known to most of us, many private practitioners hold appointments at public institutions and have been utilizing these resources for the benefit of their private patients. The abuse is notable in surgical and obstetrical cases where facilities, equipment and staff at public hospitals are mobilized for the physician who in turn bills his or her patient for the entire cost incurred. Not only is this unethical practice but, as highlighted in the WHO’s report, is a major cause of systems failure through the added burden on the health care budget.