The Health of Kuwait – Awake Yet?

Certain generalizations can be made from the analysis of our system. There seems to be a trend towards an ultraconservative approach to decision-making. Risk taking is discouraged and our policy-makers have adopted the “band-aid” technique to solve conflicts whereby essential rights are consistently being withdrawn when complaints are filed by both laypeople and uninformed politicians instead of engaging in educational campaigns. Dramatic examples include the withdrawal of the rights of emergency physicians to order important diagnostic tests such as CT scans or ultrasounds due to some past excesses and to unwarranted resistance exhibited by our more established radiologists. Paramedics, who in other nations perform life-saving procedures and provide critical medications, have seen their responsibilities downgraded following complaints by family members of transported patients. More recently, a new computer system introduced to a major teaching hospital to facilitate patient care was rapidly dismantled after components were stolen. This habit of bypassing core problems and placing a band-aid on a hemorrhaging wound is an example of passivism and poor judgment from the part of our leadership. The outcome is a system in failure due to repeated mistakes resulting from the lack of awareness.

So what solutions can we bring to this crisis? Well, to begin with, we should change our mindsets and refocus our efforts on finding solutions instead of lament over the problems. This is the quality that we should all strive to emulate. Taking a problem-solving approach instead of being inhibited by the challenges and obstacles will only impress positivism onto our system and promote creativity in this conservative environment. We should not fear taking risks as risk taking will lead to faster change. The sitting and waiting approach will only further widen the divide between us and the rest of the industrialized world.

More concrete solutions include recruiting renowned experts by offering attractive contracts to develop our deficient specialties while we train larger numbers of our young physicians overseas. Our neighbors have now consolidated lasting partnerships with North American universities through donations or collaborative endeavors and have subsequently secured an unprecedented number of positions for their trainees. As a result, many of our qualified doctors have suffered from the unavailability of training opportunities finding themselves spending unnecessary time practicing in Kuwait with little added value to their clinical training. Our foreign bureaus must aggressively network with the major universities and medical centers to promote an exchange of knowledge. Our medical, dental, and allied health students need to be informed of emerging specialties and of the opportunities to achieve highly desirable positions in those areas of deficit.

To ensure the return of our trainees and their job satisfaction, we must facilitate their incorporation into the health care system by establishing a smoother and more effective promotion scheme. This should include reducing the number of hierarchical levels to a bare minimum (please refer to the “Health Policy” section) and reforming it in such a way to disperse the responsibility throughout all levels of trained physicians. Our policy-makers should build on the example our Canadian counterparts have set by simplifying the British graduate medical education system and its numerous clinical layers. Continuous quality assurance measures will allow for closer monitoring of job satisfaction and early detection of non-standard practices. The evaluation process for medical professionals needs rethinking. The current system does not highlight many important aspects of an individual’s function in the system. Key components such as work ethics, personality, personal clinical and research interests, achievements in medical education or evaluations from the nursing staff or the student body are not being captured.

As the bulk of our health care workforce is an expatriate one, we must conceive ingenuous means of creating incentive. Due to the vaste differences between Kuwaiti and non-Kuwaiti workers many of our foreign employees see no benefit in risking a change in their practice or adding tasks to their current job description in view of improving their own work environment. This has largely contributed to the stagnation and deterioration of our health care. To overcome this, we must involve external experts as our bias as individual Kuwaitis and members of various political and religious groups prohibits us from viewing the problem in its entirety and conceiving selfless solutions. With the support of an effective evaluation process and a simple promotion scheme, we should focus on eliminating those differences.

With regards to our institutions, we must view our major general hospitals as providers of the most comprehensive health care. This means that they must be restructured to include all the necessary services tertiary care facilities typically provide including the full array of trauma and critical care-related services. We cannot accept the continued lack of 24-hour coverage of many of our essential specialists. We must have access to neurologists and neurosurgeons when dealing with time-sensitive, treatable central nervous system catastrophes, hand surgeons to manage potentially disabling hand trauma or infections, nephrologists when the need for emergent dialysis arises, trauma surgeons for the rapid management and disposition of our numerous polytrauma victims, radiologists when needing an immediate report on various imaging studies, among many others. Many will rightfully say that those regulations are in place at the Ministry of Health. However, more frequently than not, they are not enforced. Examples range from the recently publicized emergency department staff absences to the refusal of certain radiologists and house staff from other services to remain in the hospital overnight. Let’s all keep in mind that critical illness does not pick a time or place to strike and will certainly not wait for our dear consultants to show up. Also, transferring patients will only worsen their outcomes as it lengthens the time to definitive care. Finally, there is no place for short-term solutions such as the creation of “geriatric” or “expatriate” medical centers as these are not cost-effective enteprises. Either we decide to undertake large-scale upgrades of our facilities and provide state-of-the-art, consolidated care to all the residents of our nation or we don’t and risk further deteriorating our services.

We must commit to computerizing our health care system in a lasting and upgradeable way. Again, there is no need to reinvent the wheel as there are numerous applications out there that, with the appropriate help, could be translated into our current system and could dramatically facilitate patient care by connecting our hospitals, research facilities, laboratories and clinics while reducing medical errors. Reliable data collection will result from this and help us gauge the health of our nation via public health studies.

Our leadership must take an ardent stance in uniting all major policy-makers by encouraging regular roundtable talks to identify critical issues before they actually become a problem. The Ministry of Health must be open to non-clinical training programs in health policy, management, public health, epidemiology as well as business administration as they are fundamental in defining a more efficient work environment. Indeed, how can our nation set up appropriate health planning with data that remains unreliable due to this paucity of expertise? It is necessary to promote degrees that produce quality researchers to quantify the burden of disease in Kuwait. As a side note, the Kuwait Foundation for the Advancement of Science (KFAS), the Kuwait University’s Faculty of Medicine, the Public Authority for the Assessment of Compensation (PAAC), and the Harvard School of Public Health are currently collaborating on a large-scale study looking at the general health of the Kuwaiti population. It is important for our clinicians to know that many of these degrees may be undertaken simultaneously with or following their clinical training. Physicians who graduate from these programs will optimize the structure and function of health care institutions by merging different perspectives, educating our future decision-makers, and forming a research environment necessary for continued improvement.

Ultimately, by uniting various experts, we should aim at creating health care research institutions such as a school of public health or dedicated foundations that focus on finding efficient means of upgrading our systems, ensuring lasting collection of reliable epidemiologic data, developing local educational curricula, and producing nationwide public campaigns and prevention programs. To leap forward, we cannot omit the assistance of renowned foreign institutions and, for this, we must also agree to increase our budget in the short-term to ultimately develop a more cost-effective and, potentially, cash generating future practice.

Why is it that we pride ourselves with our high standards of living epitomized by fancy cars, brand names, designer garments, or the food galore we indulge in but accept the lowest standards when it comes to our health? This contradiction perfectly illustrates the Kuwaiti persona. Our materialism has overshadowed the most basic of necessities. To paraphrase a cult French movie, a man, who has just jumped out of a window, repeatedly reassures himself throughout his fall: “all is well until now, all is well until now” before his fatal crash. The moral being that what matters is not the fall but the landing. So, do we continue to disregard our health and that of our children hoping for a better tomorrow or do we decide to take a stand now to prevent aggravating the crisis?

Kuwait, great things are at hand, open your eyes and reach out.