Tunnel vision

In 2001, a Pakistani woman was publicly gang-raped and later forced to walk the streets of her village unclothed, exposed to the rest of the villagers.  This atrocity was perpetrated by individuals who claim to be faithful Muslims and who begin their sermons with the mention of God and our prophet Mohammad, PBUH.  The first question that jumped to mind was how a group of people could approve of such a horrendous crime.  You would assume that your social network would guide you back in track when deviating from a righteous path.  However, the reality is that it is easier to commit an immoral act collectively where the responsibility is diluted in the masses and the appearance of diminished individual accountability often prevails.

In Kuwait, expatriates make up almost two thirds of the entire population and constitute most of the nation’s labor force. 

Priority Check

Budget allocated to the improvement of Kuwait’s health services (2007): USD 181 million (KWD 51 million)

Kuwait’s contribution to the Katrina disaster: USD 500 million (KWD 141 million)

Go figure.

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policy-makers have adopted the “band-aid” technique to solve conflicts whereby essential rights are consistently being withdrawn when complaints are filed by both laypeople and uninformed politicians instead of engaging in educational campaigns.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.

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,

Little Children

The investigation and prosecution of crimes perpetrated by the mentally ill is an excessively sensitive issue. As you will come to understand, legal systems throughout the world have struggled with the determination of one’s guilt in the face of a coexisting psychotic disorder. One controversial case recently tried in Texas is that of Andrea Yates, an American woman who drowned her five children while suffering from postpartum psychosis. In 2002, she was sentenced to life imprisonment for first degree murder. The jury at her second trial in 2006 found her to be not guilty by reason of insanity. Such a ruling remains an extremely rare one in most nations. In a 1991 study of eight U.S. states, the National Institute of Mental Health found that less than 1% of felony cases involved this mental disorder defense and only a fraction of those were successful.

In Kuwait, the man responsible for slaughtering his fourteen-year-old daughter in front of her siblings, after accusing her of no longer being a virgin, was found not guilty by reason of insanity (irresponsible for his actions). According to the Arab Times article, the man was subsequently referred (they likely meant committed) to the Psychological Medicine Hospital for treatment of schizophrenia (???). More recently, a man who attempted to poison eight of his children, successfully killing five, and then trying to commit suicide, was also found not guilty and was committed to the psychiatric facility until deemed fit for discharge.

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

Many of you have noticed a number of newly refurbished departments in our hospitals. Their new design may be appealing in some ways but, in most instances, are not in-line with basic patient safety standards. It does not take a health care architect to tell you that slippery marble or granite flooring is hazardous, it is intuitive. When looking more closely at critical areas of a hospital such as emergency departments, where design can dramatically improve or, conversely impede, patient care, we notice that in most of our public facilities patient flow and access to life-saving equipment and medications are hindered by inappropriate architecture thereby defying their purpose. Despite being obvious even to the layperson, hospital administrators, departmental chairpersons and government officials seem to disregard major safety issues when addressing renovations or new constructions. It would only seem natural to involve experts in health care design when engaging in such activities. Furthermore, it is a well-established fact that ergonomics, cost-effectiveness and safety are not priorities when construction contracts are negotiated. Delegated contractors aim at maximizing their commissions by reducing the overall costs.

Foreign Medical Treatment - Health Care Sidetracked

The recent disputes over the responsibilities of the Foreign Medical Treatment Department at the Ministry of Health are further highlighting the misguidance of our health care system. While we focus on getting our patients out of the country to more capable providers, time has deepened our homeland’s health care crisis. Indeed, misinformed decision-makers and erroneous popular belief have shifted resources away from many of the basic foundations of a sound health care system. The solution is not to “outsource” health care but to establish our very own state-of-the-art system by training and recruiting leaders, launching nationwide prevention programs, building quality hospitals, reinforcing medical education and rendering the workplace safe for both providers and patients alike. We must set aside our pride, accept the harsh reality of the declining quality of care, and reallocate resources to reverse this. We cannot bow to misinformation that attributes our low death rates to a flawless health care system in a nation with a pyramidal population structure. Our neighbors have understood this and have now outpaced us owing to their forward-thinking and risk-taking behavior.

Let us analyze the shortcomings of our decision-making.

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

Health is neither a luxury nor a commodity; it is an unquestionable right of every human being. Governments must strive to provide the best possible care to their people. The public must be informed of advances in health care and have access to a scope of quality services. In an altruistic realm this could probably stand as a moral statement. Truth be told, health must also be looked upon as an investment as a healthier population is a more productive one. Illness impedes on the socioeconomic progress of our nation by reducing productivity through the lack of manpower. This may seem to be a moot point knowing that Kuwait’s economic expansion has been unprecedented in the last couple of years. Thanks to our desirable resource, we have achieved a growth of close to 20% in 2004 alone, continuing to fair well to this day. So, what is the point you may wonder? Well, with health being the third largest budget, you would expect our health services to flourish accordingly. They do not. People in the business will tell you that, in the recent decades, the quality of services has been steadily declining. Can we objectify this? Standard markers of a population’s health such as infant and maternal mortality rates or life expectancy can be deceiving as they do not adequately highlight certain deficiencies in primary, secondary or tertiary prevention throughout life creating a false sense of well-being despite a high prevalence of chronic diseases with worsening courses and trauma-related injuries in the country. The reasonable life expectancy underscores a trend in our disease profile, also seen in the rest of the industrialized world, towards more chronic conditions such as heart disease or diabetes from the more acute, life-limiting infections previously observed in our young and middle-aged populations. A caveat to keep in mind is that devastating infectious disease crises remain plausible if entities such as HIV continue to be neglected and prevention programs for threats like the Avian Flu or, worse, the deadly XDR-TB