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

Other dysfunctional foundations of our health care system need attention. A primary care system should consist of a physician, internist or family practitioner, assigned to or chosen by the patient to follow his or her care, schedule routine follow-up visits, recommend screening tests in due time, and, when indicated, provide referrals to either a specialist or a medical center for further care. In our reality, matters are quite different. Due to an excessive workload and time constraints, our clinic practitioners rarely follow their patients and are often unable to request certain basic diagnostic tests typically part of the armamentarium of such providers. Backed by the flagrant inequalities between Kuwaiti and non-Kuwaiti patients, this results in a generalized loss of confidence in the primary care system, inappropriate referrals to emergency departments, either by the patient’s request or the inaptitude of providers, and mismanagement of illnesses. This in turn creates a bottleneck effect in our hospitals where absurd numbers of patients present unnecessarily to our emergency departments requesting primary care services thereby diluting the true emergencies. Combined with inappropriate staffing, lack of specific expertise and a rigid administration, this creates a detrimental effect on patient care.

This brings us to another major malfunction: public health, or the lack thereof. This is the area that focuses on educational programs, disease prevention, risk factor analysis, and determination of disease prevalence within a population. As highlighted in previous articles, public campaigns are rare and in many cases have not captured sufficient public attention to bring about change. Road traffic injury-related mortality and disability is on the rise in spite of attempts at sensitizing our people. While we hold the sad record of having the fifth highest prevalence of diabetes in the world (International Diabetes Federation, 2007), our nation has not been engaging in large-scale campaigns to educate our communities on the major preventable risk factors such as obesity, poor diet and sedentary lifestyles. Adult onset diabetes (or type II diabetes) is now becoming apparent in our youth largely due to these factors. The same applies to coronary artery disease which, due to poor diabetes control, unhealthy dietary habits, tobacco abuse and the lack of early diagnosis and proper management, is expected to remain at the top of the list of causes of death in our region. Finally, cancer will continue to kill thousands because of the laxity in our screening practices. Those must be rigorous, performed within the recommended timeframe by diligent practitioners with the continued education of the patient in the detection of early warning symptoms.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
World Health Organization (1946), Constitution. Geneva (WHO)

Stay tuned for the conclusion to the “Health of Kuwait” series.