Middle East Hospital magazine March 2010

The definitive

guide to

Hospitals and

Healthcare

in the

Middle East

THE ARAB HOSPITAL

www.middleeasthospital.com

MIDDLE EAST HOSPITALincluding

Arab Health 2010 Review

Special feature:Women’s health in the Middle East

Osteoporosis: American University of Beirut research paper Breast cancer: mobile screening programmes

Post-show report

UK healthcare excellence at Arab Health

Interview with Diederik Zeven – General Manager Philips ME

Sales Office +44 (0)114 240 4400

Fax +44 (0)114 257 6555

Email [email protected]

www.boltons.co.uk

Bolton Surgical Ltd, Churchill House, 16 Churchill Way, Chapeltown, Sheffield. S35 2PY

March 2010 | 3

Middle East HospitalThe Arab Hospital

In this issue we review Arab Health2010, which took place in Dubaifrom 25-28 January. The MiddleEast’s biggest and most importantmedical technology exhibition cele-brated its 35th year with a recordnumber of exhibitors and atten-dees. The increased of the exhibi-tion reflects the increasingimportance of the Gulf region as anexport market for companiesacross the globe.

Public sector spending on health-care in the Gulf continues to grow,with a recent study indicating that inSaudi Arabia, the region’s largestmarket, government investment inhealthcare-related projects in SaudiArabia is currently running at morethan US$5 billion, compared witharound US$1 billion of private sec-tor investment (figures from Pro-leads). Another report by AlpenCapital forecasts the GCC mayneed in excess of 25,000 additionalbeds by 2020 to address growingdemand for in-patient treatments.The largest share of demand is ac-counted for by Saudi Arabia fol-lowed by the UAE.

With these levels of investmentforecast it is not surprising thatcompanies are increasingly target-ing the Middle Eastern countries forexport growth over the comingyears. UK manufacturers are no ex-ception and we talk to some of thisyear’s exhibitors about the show aswell as the organisers of the UKPavilion (ABHI and UKTI). For theview from one of the industry’sbiggest players we interviewDiederik Zeven, General Managerfor the Middle East at PhilipsHealthcare.

Arab Health 2010 review

Post show reportpg 4-5

UK innovation at Arab Healthpg 7-9

Bolton Surgical featurepg 10-11

Interview with Diederik Zeven-Philips MEpg 12-14

Special feature: Women’s

health in the Middle East

Breast cancer- mobile scan-ning programmespg 16-19

Osteoporosis- Researchpaper: Vitamin D status in theMiddle East and Africapg 20-22

TTC Language Services Ltdpg 23

Healthcare industry newspg 24-25

Country profile: Omanpg 26-27

Editor’s introduction

Our special feature this month is onwomen’s health, and we look at theefforts to tackle breast cancer in theregion, and why the incidence ofosteoporosis is disproportionatelyhigh amongst women in the MiddleEast.

Guy Rowland, Editor

March 2010 contents

The Arab Hospital Middle East Hospital

March 2010 | 4

The Arab Health Exhibition &

Congress, Dubai, UAE, was once

again the focus for the world’s

healthcare sector in January

Now in its 35th year, the showachieved an estimated 20 percent increase in visitor num-bers. Highlighting the increas-ingly important role played bythe Middle East healthcare in-dustry, healthcare authorities,medical device manufacturers,medical supply distributors andhealthcare professionals fromacross the region and theglobe convened in Dubai forArab Health 2010. Held at theDubai International Convention& Exhibition Centre from 25 –28 January, the organiser, IIR

Middle East, was delightedwith the success of the 2010show.

«We are thrilled that the region’shealthcare industry, once again,chose Arab Health as a platformfor seeking regional and interna-tional partners in this burgeoningsector,” said Simon Page, Directorof the Life Sciences Division of IIRMiddle East. “Demand for health-care is growing driven by agingpopulations and life-style relateddiseases such as diabetes, partic-ularly in the UAE and Gulf Region.Governments are being forced totackle this issue head on which ul-timately means a lot more invest-ment in the healthcareinfrastructure in these countries.

He continued, «In spite of signifi-cant project delays in other non-healthcare industry sectors, thepipeline of healthcare projects inthe region remains remarkably ro-bust, particularly for Saudi Arabiaand the United Arab Emirates. Thishas been reflected in the growth inthe exhibitor, visitor and delegatenumbers for this year’s ArabHealth.

«With the opening of the newSheikh Saeed halls providing afurther 20,000 m², as estimated,Arab Health 2010 grew by morethan 20 per cent in size from lastyear,” Page added. “Arab Healthtouches all aspects of the health-care industry in the Middle East.Tens of thousands of medical pro-


Princess Haya visits Touch Bionics’ stand

fessionals, government officials,wholesalers, dealers and distribu-tors converged on the Dubai Inter-national Exhibition Centre for theregion’s main event for the health-care industry.”

There were a number of countrypavilions at the event demonstrat-ing the power of the event to at-tract marketing investment fromaround the globe. Exhibition Direc-tor, Terri D’Elia, from IIR MiddleEast explains: "The healthcare in-dustry is one of the few that is stillshowing buoyancy in these criticaleconomic times. This year ourshowcase featured 30 nationalcountry pavilions and in excess of70 exhibiting countries includingFrance, Germany, United King-dom, China, India, Korea, theUSA, Brazil and Canada, to namea few.”

Research into the healthcare mar-ket in the Middle East indicates

positive growth.Dubai-based re-search firm Proleads’figures show govern-ment investment inhealthcare-relatedprojects in Saudi Ara-bia is currently run-ning at more thanUS$5 billion, com-pared with aroundUS$1 billion of privatesector investment.Another report byAlpen Capital alsoforecasts the GCCmay need in excessof 25,000 additionalbeds by 2020 to ad-dress growing de-mand for in-patienttreatments. Thelargest share of de-mand is accountedfor by Saudi Arabiafollowed by the UAE.

MEH award winners

Lord Darzi at Arab Health

March 2010 | 5

Middle East HospitalThe Arab Hospital

Outstanding Contributionto Healthcare in the

Middle East

March 2010 | 7

Over 192 companies fromacross the UK enjoyed the mostsuccessful Arab Health exhibi-tion on record when they exhib-ited their pioneering products atthe largest and most prestigioustrading platform in the MiddleEast. The UK is a world leader inhealthcare research, develop-ment and innovation and ishome to some of the world’smost distinguished scientistsand innovators.

UK Business Ambassador LordDarzi, a leading figure responsiblefor healthcare innovation and re-form in the UK, attended Arab

Health 2010 to promote the UK’sexcellence in healthcare manufac-ture, services, technology and inno-vation. An eminent British surgeonand former Health Minister, he tookpart in the opening ceremony andgave a keynote address to seniorsurgeons and clinicians.

Lord Darzi presented MEH’s Healthand Innovation awards to the UK-based winners at a ceremony dur-ing Arab Health. Receiving MEHawards from Lord Darzi were Kimal,Adam,Rouilly, Mirage HealthGroup, NuTec Medical, Downs Sur-gical, Medibord, Bolton Surgical,Malem Medical, Surgins, BedfontScientific, and Sanitas.

Lord Darzi said, “The UK medicaltechnology sector has 2,771 com-panies generating £10.6 billion ofturnover. It has a large proportion ofthe world’s most innovative medicaltechnology SMEs, multinationalsand leading R&D centres. It is at theforefront of healthcare innovation,and it gives me great pleasure to beable to promote such innovativetechnologies and solutions at ArabHealth 2010.“We already have excellent tradingrelationships with countries acrossthe Middle East, with sustained in-vestment in health delivery reformsleading to demand for the latesttechnologies and medicines. Weare looking forward to developingnew trading collaborations in the fu-ture.”

The UK had its largest presence atthe show this year and with contin-ued support from UK Trade & In-vestment (UKTI), the UKGovernment’s international busi-ness development body, compa-nies highlighted exactly why theyare world leaders in healthcare in-novation and excellence.

Head of Life Sciences at UKTI,Jane Grady, said: “UK Trade & In-vestment is at Arab Health to show-case the UK Life Sciences sector.The UK is a world leader in innova-tion with its supportive regulatoryenvironment, outstanding R&D andacademic excellence. Our pres-ence here is increased this yeardue to additional Government fund-ing and support, which means weare able to do even more to pro-mote UK companies and promoteUK innovation and expertise.”

Arab Health 2010 review: focus on UK innovation

Record success for UK companies at Arab Health


Jane added, “It has been a greatyear for UK companies and we aredelighted with vast amount of busi-ness opportunities that have beengenerated between the Middle Eastand the UK. The UK is a worldleader in innovation and ArabHealth offers a perfect opportunityto share these pioneering productswith the rest of the world. “

The Association of British Health-care Industries, who jointly organisethe UK Pavilion with UKTI believethat early reports indicate thatBritish companies have had theirmost successful year ever. PaulBenton, Director, Commercial andInternational, said, “Arab Health isa key event in our international cal-endar, and its popularity is growing.2010 saw ABHI taking its largestever pavilion at the show. Spaceon the ABHI pavilion for 2011 will goon sale at the end of March, and isexpected to sell quickly. Exhibitorsinterested in the Middle East realisethe importance of having a pres-ence there. Importantly, for manynewcomers to the market it is a firststep to doing business in region.”

Charlotte Fraser, International Man-ager at Medilink Y&H, regional sec-

tor specialistfor UKTI, andorganiser theYo r k s h i r ePavilion atthe show,said: “TheUK enjoys ane x c e l l e n ttrading rela-tionship withc o u n t r i e sacross theMiddle East,with sus-tained investment in health deliveryreforms leading to the demand forthe latest technologies and medi-cines. This year in a bid to furtherdevelop new trading collaborations,there are a wide range of pioneer-ing companies at the exhibitionshowcasing the latest in cuttingedge products and innovations.”

IInnovative UK products on dis-

play at Arab Health

NuTec Medical, a Southend basedcompany, showcased their awardwinning Paraskate range at theshow. The ParaSkate has beenspecifically designed to assist in thehandling of gas cylinders, and theproduct picked up an MEH awardfor most innovative piece of hospitalequipment for export to the MiddleEast.

Rob Moore, Managing Director ofNuTec, said, “Gas bottles are inwidespread use in the healthcareindustry and they are tall, thin andheavy. The dangers their instabilityposes while they are being movedand in use are considerable, andthis is a worldwide problem. Previ-

ous systems to keep gas bottles inplace simply do not work effectively.But by using Paragrip and its coun-terpart Paraskate, a simple mini-trolley, stability of bottles is greatlyincreased both in use and in transit.To win this award is a fantasticachievement for the company andit is a tremendous honour for us tobe recognised by the Arabic health-care world. This award will help usexpand our business and opera-tions both in the UK and internation-ally.”

Adam, Rouilly are one of the fore-most names in healthcare educa-tion and produce a range of medicaltraining tools from brain models andheart models to venipuncture train-ing tools and instruments, and re-suscitation simulators. Thesetraining aids help healthcare profes-sionals perfect all manner of essen-tial clinical and nursing skills fromsuturing and injection techniquesthrough to resuscitation and airwaymanagement. One of the most pop-ular products manufactured is theVenepuncture and Infusion Arm.Cast from life, the moulding of the

March 2010 | 8


Lord Darzi demonstrates to HH Sheikh Mohammed binRashid Al Maktoum the world’s first fully articulating bionichand developed by Touch Bionics


The Arab Hospital

March 2010 | 9

Graham Fowler of Adam, Rouilly

Infusion Arm Trainer has been im-proved and incorporates many newfeatures resulting in an extremelyrealistic finish which shows a welldeveloped male left arm in fine de-tail. The product features a closedblood system which is clean to usewith reduced risk of leakage.

Graham Fowler, Sales and Market-ing Manager, told MEH, “The suc-cess of Adam,Rouilly’s ExportSales is due to the hard work of ourdedicated sales team. In 2009 weachieved 50% of our total sales inexport markets with significantsales in the Middle East. The ad-vent of Clinical Skills Training inHospitals in the Middle East is amajor factor in these achievements. Attending Arab Health since 2004has enabled us to regularly meetmany of our customers, and thesales reflect the confidence ourdealers have in the products, qual-ity and service that Adam,Rouilly of-fers to Healthcare Education.”

Sanitas’s swine flu hygene packswere a huge success this year. RobGros, CEO, Sanitas Healthcare Plc

said: “Building on our recent suc-cess in the UK we are increasingour efforts in the Middle East wherethe response from Saudi Arabian,Libyan and Kuwaiti distributors inparticular has been highly encour-aging. At Arab Health we will belaunching a new addition to the Flu-Pak family - TravelPak the hygienekit which has been developed forpeople on the move by air, by seaor on land.

“The complete range of Sanitasproducts empowers people to ac-tively protect themselves againstviruses such as swine flu and avianflu, and pathogens such as MRSA,Norvirus and E.coli etc by sanitisingtheir environment and reducing therisk of infection. This way we can allhelp protect ourselves. The formulacontained in FluPak is currentlyused by the NHS Hospitals in over160 UK Hospital Trusts.”

Middle East Hospital

The Sanitas team

Medibord Ltd, from Nottingham inthe UK, have launched the world’sfirst fully x-ray translucent and non-conductive material for a range ofcouch tops and patient positioningdevices. Their innovative new prod-uct picked up an MEH award in thediagnostic innovation category.

CEO Jonathan Richards told MEH,“For such a new business such asMedibord, it is a great honour to beacknowledged for our innovativerange of products and we are de-lighted to receive such a prestigiousaward. The Arab Health exhibitionwas a fantastic success for us withsome exciting meetings and poten-tial partners being identified. It isour aim to set up a group of highcalibre distribution partners in theregion as it is clear that the Medi-bord can offer significant improve-ment in radiology and radiotherapyapplications and flat patient posi-tioning boards. Medibord is yet an-other step closer to developing asignificant market share in theMRI/CT scanner accessory field.”

Jonathan Richards of Medibord

Bolton Surgical Ltd is a manu-facturer and supplier of the fi-nest quality SurgicalInstruments and accessoriesfor use within the modern thea-tre environment. The companyhas a large customer base ofboth NHS and private sectorhospitals, clinics, and Deconta-mination Units throughout theUK.

Bolton bring together traditionalmanufacturing methods with thetechnology you would expect froma market leader in Surgical Instru-ment supply, enabling them to pro-vide a totally flexible servicetailored to meet the differing anddemanding needs of modernTheatre/Decontamination Depart-ments.

It is no coincidence Bolton Surgicalare based in Sheffield, with a steelmaking pedigree second to none,it was the ideal place for Sheffieldborn William Henry Bolton to setup the business in the early1900’s. Manufacturing SurgicalInstruments and Scissors from hisworkshop in the Centre of Shef-field, he supplied hospitals and ex-ported throughout the BritishEmpire.

The skills and dedication of theworkforce, ensure that the nameBolton Surgical is synonymouswith quality products and BritishManufacturing, and the companyhas been a member of the Guild ofMaster Craftsmen for over a de-cade. Products manufactured byBolton Surgical are currently ondisplay at The Royal College ofSurgeons, The Pelican Centre andSt. Marks Hospital in London.

The company is proud to be inde-pendent, and is still owned and runby the Bolton family, continuing atradition of manufacturing span-ning many decades.

Targeting new markets in the

Middle East

Bolton did in excess of £ 3 millionin terms of business at the showand appointed 8 new distributorsin the region. From a solid base inthe UK Bolton are increasingly loo-king to expand their overeas pre-sence in key markets such as theGulf. George Constantinou joinedthe organisation in 2006 as Inter-national Export Director.

CEO Judy Roberts explains,“George has a wealth of expe-rience in Middle Eastern Exportand his skills and expertise havehelped the company become amajor supplier in a global market. Commenting on this year’s Arab

March 2010 | 10


Exhibitor focus: Bolton Surgical

Health show Mrs Roberts toldMEH, “I thought it to be a verygood platform for Bolton Surgical.The enquiries this year were betterquality than previous years. Thisis our 4th consecutive year so weare still effectively a new businessin the Middle East. Although weare approaching our Millennium in2012 our markets have previouslycentred around the NHS and pri-vate sector in the UK, trade manu-facture and Europe.

“We have over the last decadedesigned and developed an exten-sive range of instruments for theColo-rectal surgeon. Our ColoKraft range is now recognisedworldwide and to receive an MEHaward for this product range whileat Arab Health was a wonderful ac-colade. We look forward to 2011and the next event.”

Finest quality surgical instru-

ments

The company manufactures thea-tre quality surgical instruments co-vering all disciplines of surgery,and are the market leaders in thedevelopment of instruments forColo-rectal surgery. This rangehas been developed in conjunctionwith Europe’s leading Colo-rectalsurgeons over the last 10 years.

Judy Roberts told MEH, “In the UKthe organisation still manufacturesfor trade but also supply the majo-rity of the NHS and private Health-care groups. We have been apreferred supplier for over 5 de-cades. Customers choose BoltonSurgical as we have a reputationfor quality, price and strict deliverydeadlines. Traditionally the com-pany offered a ‘one off’ manufac-turing service and today thetradition continues as we have a

specialist department offering abespoke service to surgeons forspecialist instruments.”

Bolton Surgical run a strict qualitymanagement system. All productsmanufactured and supplied byBolton Surgical comply in everyrespect with current quality stan-dards, including compliance withthe European Directive for MedicalDevices, therefore we have been

awarded the CE mark.

March 2010 | 11


MEH Interview with Diederik ZevenSenior Director and General Manager of Philips Healthcare ME

MEH: How big is the healthcare

industry in the region?

Diederik Zeven (DZ): Accordingto the World Health Organization,Healthcare spending as percent-age of GDP in the GCC historicallyhas lagged behind that of OECDaverages. As a consequence, re-cent reports suggest there is up to$14b being made in infrastructureinvestment in the region and ana-lysts have indicated that we canexpect the total market size togrow to between US$ 47b toUS$55b by 2020. In terms ofgrowth, that represents a sus-tained 9% CAGR for the nextdecade.

MEH: Does Philips still look at

the healthcare market in the

Middle East the same way it did

a few years ago?

DZ: Definitely not, the healthcare

market is going through a transfor-mation. One example is the rise ofaging population hence the risingimportance of Home Healthcare. Advancements in technology andmedicine are not only enablingpeople to live longer lives, they areenabling people to do so while re-maining healthier. The aging of thepopulation—older people repre-sent approximately 15 percent ofthe population in the developedworld today, with this figure set todouble over the next 25 years—provides strong potential marketgrowth for home healthcare solu-tions.

Older people are also becomingincreasingly more active in manag-ing their own health and wellness.Looking forward, seniors of the fu-ture will be empowered, techno-logically-savvy healthcare

consumers playing an active rolein the management of their health-care. They will increasingly wantand expect their doctor’s care athome and on the go.

MEH: What was your main clini-

cal focus during this year’s Arab

Health?

DZ: During Arab Health, Philips

Respiratory Therapy System

March 2010 | 12


demonstrated awide range of itshealthcare solu-tions designed todirectly addressthe needs ofh e a l t h c a r eproviders in car-ing for their pa-tients. This year, Philipsshowcased itssolutions forthree clinical seg-ments: Cardiol-ogy, Women’sHealth and HomeHealthcare.

In cardiology wefocused on fourimportant areasthat helps us im-prove healthcaredelivery for pa-tients with car-diac diseases:timely triage (so-lutions for fast,n o n - i n v a s i v eevaluation of highrisk cardiac pa-tients) discovery to treatment (so-lutions that reduce door to balloontimes for acute cardiac patients byclearing a path from discovery totreatment), minimally invasive in-terventions and connected health-care solutions in the home forchronic heart patients.

In women’s health, breast canceris the leading cause of cancerdeath amongst women. Philips of-fers leading-edge imaging and in-formation management tools tohelp detect breast cancer, en-hance clinical decisions andstreamline workflow. Philips also

has a complete portfolio of leadingedge cardiology products, includ-ing non-invasive solutions to helpdetect heart disease symptoms inwomen.

Finally in Home healthcare, ouraim is to improve comfort andcompliance for those who suf-fer from sleep disorderedbreathing and chronic respira-tory diseases. We are trans-forming home healthcarethrough innovative thinking—pioneering new solutions andimproving the quality of life forpatients in the home.

MEH: During the last few years,

Philips offered revolutionary so-

lutions in combining healthcare

with an attractive lifestyle, tar-

geting different community seg-

ments such as children through

“Kitten scanner experience” or

and the adults through “Ambi-

ent Experience.” Are there any

new launches in that area?

DZ: Philips will continue to simplifyhealthcare by introducing mean-ingful innovations and solutions.We focus on both patients andcaretakers alike. Instead of focus-ing on technology alone, we have

HFO MR and ambient experience

March 2010 | 13


Kitten scanner experience

differentiated ourselves through in-novations designed around peo-ple.

At Arab Health 2010, Royal PhilipsElectronics demonstrated itsunique solution to create a patient-friendly environment by presentingits state-of-the art high field openMR system, the Philips Panorama1.0T, with the Ambient Experience.

Not only does this MR system offerphysicians high-field image qualityfor advanced applications, it alsooffers a completely open designthat makes getting an MR scan amore positive experience, as manypatients suffer from feelings ofclaustrophobia in a closed MR

system. The Panorama 1.0T fea-tures the widest open patientspace of any high-field MR sys-tem. The Philips Ambient Experi-ence solution integratesarchitecture and design such aslighting, sound and projection. Thiswill allow patients to personalizetheir environment and wrap them-selves in a relaxing positive ambi-ence.

Feedback from clinicians whohave used Ambient Experiencesolutions indicates that providing arelaxing environment makes a realdifference for the patients. Itspeeds up the procedure, as pa-tients are more comfortable andrelaxed, and in some cases it re-

duces the need for sedation partic-ularly among children.

MEH: What other innovations or

solutions did Philips reveal dur-

ing the show?

DZ: Philips and SMIT Mobile Equip-ment partnered to introduce a mobilebreast cancer screening vehicle,specifically adapted to the Middle Eastrequirements. It is designed to reachremote areas in the region and takinginto account privacy and weather con-ditions. The vehicle contains state-of-the-art screening equipment such asthe Mammo Diagnost DR, Philips’ dig-ital solution for mammography, de-signed for efficient high-volumescreening.

March 2010 | 14


medibord.com

World First Technology Medibord™

The Medibord™ has been designed to enable the development of innovativesolutions for radiotherapy and MRI compatible medical devices and clinical use.

• Lightweight – less than 4.5kg/m²

• Rigid – impressive strength to weight ratio

• Robust – high impact resistance offers superb durability

• Ecological – 100% recyclable

• MRI Compatible – uniquely magneto-radio translucent

• Modular – ability to form and offer 2D for shaping cost effective ancillaries

Successful clinical trials carried out by Nottingham University Hospitals have provedthe Medibord™ to be a revolutionary material for the use in radiotherapy and MRI scans

eliminating heat and the resultant image artefacts.

• Oncology couch tops

• Patient positioning boards and devices

• Patient transfer systems

• Emergency and temporary partitioning

• Clinical waste applications

For more information and to arrange for a clinical trial please contact us.

• • [email protected]

Most InnovativeProduct for Export

Breast cancer is the most com-mon cancer in women world-wide, comprising 16% of allfemale cancers. It is estimatedthat 519 000 women died in2004 due to breast cancer, andalthough breast cancer isthought to be a disease of thedeveloped world, a majority(69%) of all breast cancerdeaths occurs in developingcountries (WHO Global Burdenof Disease, 2004).

Incidence rates vary greatly world-wide, with age standardized ratesas high as 99.4 per 100 000 inNorth America. Eastern Europe,South America, Southern Africa,and western Asia have moderateincidence rates, but these are in-creasing. The lowest incidencerates are found in most Africancountries but here breast cancerincidence rates are also increas-ing.

Breast cancer survival rates varygreatly worldwide, ranging from80% or over in North America,Sweden and Japan to around 60%in middle-income countries andbelow 40% in low-income coun-tries. The low survival rates in lessdeveloped countries can be ex-plained mainly by the lack of earlydetection programmes, resulting ina high proportion of women pre-senting with late-stage disease, as

well as by the lack of adequate di-agnosis and treatment facilities.

Middle East women more likely

to suffer from advanced stage

breast cancer

Breast cancer remains the most feareddisease of women around the world.Heightened awareness of breast can-cer risk in the past decades has led toan increase in the number of womenundergoing mammography for earlydetection with a resultant improvement

in survival rates. Still, breast cancer isthe most common cause of death inwomen between the ages of 45 and55.

“80 per cent of women who de-velop breast cancer in the MiddleEast are found to be at an ad-vanced stage where treatment ismuch more difficult and the chanceof cure is very low”, says Dr NagiF. Khouri, MD, Associate Professorof Radiology and Oncology and

Breast cancer in theMiddle East


March 2010 | 16

Special feature: Women’s health

Director of the Division of BreastImaging at Johns Hopkins Medi-cine in Baltimore, USA (who spokeat the "Current Concepts in Mod-ern Breast Healthcare " Confer-ence being held during the MiddleEast Obs-Gyne Congress held inDubai last month).

“Through a series of measuresconsisting of increasing breastcancer awareness in the generalpopulation and among health careprofessionals, focusing on early

detection through high-qualityscreening mammography with theproper centers for diagnosis andtreatment, the percentage ofwomen developing breast cancerfound to be at an advanced stagecan drop to 20% as has been seenin many countries in the world”,says Dr Khouri. “In addition, breastcancer in the Middle East showssome additional different featuresfrom breast cancer in the Westernworld, such as a significant higher

incidence in women under the ageof 40 that is not explained and re-quires further research.”“This is the challenge that thewomen of the Middle East face,”continues Dr Khouri. “The oppor-tunity is here now, to help reducethe burden of breast canceramong these women through amultidisciplinary approach to pa-tient education, screening, diagno-sis and treatment.”

Over the past few years severalinitiatives have been taken in theregion to enhance the awarenessabout breast cancer. This includesdeveloping the centers for diagno-sis and treatment, building grass-roots advocacy support, improvingthe training of the health care pro-fessionals and enhancingwomen's empowerment.

Partnerships have been set up be-tween various countries from theMiddle East such as Jordan, SaudiArabia and the United Arab Emi-rates and outside institutions lead-ing the fight against breast cancersuch as the Susan G. Komen forthe Cure breast cancer movement,The Johns Hopkins Medical Insti-tutions, and the University of TexasM.D. Anderson Cancer Center.

Tawam Hospital’s mobile

screening programme

In 2009 Tawam Hospital launcheda mobile screening programmewhich has had remarkable suc-cess in encouraging women to bescreened for breast cancer. A vitalfirst step in tackling the problem inthe region. Awareness of the needfor preventative screening is grow-ing and medical professionals inthe Middle East are searching fornew ways to cope with the increas-


March 2010 | 17

ing need for early diagnosis of thedisease.

“When we introduced our mobilemammogram van in June 2009,the response was very encourag-ing. Over a hundred women inUAE’s Western region came for-ward to be screened in just fourdays.” said Michael E. Heindel,CEO of Tawam Hospital, “Whilethis is a positive sign that indicatesthat women are becoming moreproactive towards their health, italso demonstrates the importanceof reaching out to.”

Dr Ghowaya Mohammed Al-Neyadi, Family & CommunityMedicine Specialist and Coordina-

tor for the mobile unit at TawamHospital said the statistics indi-cated a momentous step forwardon the road to breast cancer edu-cation and awareness. “With theresources we have now and the in-creasing understanding thatwomen in the UAE have aboutbreast cancer, the figures areenormously encouraging. Not onlyis it a success for each womanwho comes for a screening, butshe will have friends and familywho will become more aware andmore confident about the mammo-grams.”

Dr. Shamsa Al Awar, Chairpersonof Tawam Breast Cancer Aware-ness Committee said that the cam-

paign was all about information,understanding and education.“With the mobile unit, there are farmore opportunities for women tobe screened, but it is their attitudeand perspective that has reallymade the difference. To have gonefrom 188 mobile screenings innine months last year to 1,126screenings so far this year is agreat credit to the women whohave come forward and to themedical workers and campaignsupporters who have encouragedthem.”

This campaign was organized byTawam Hospital and supported bythe Health Authority of Abu Dhabi(HAAD), and SEHA, the Abu

Special feature: Women’s health

Interior of the Philips/Smit Mobile Mammography Screening Unit


March 2010 | 18

Dhabi Health Services Company,which is responsible for the cura-tive activities of all the public hos-pitals in the Emirate of Abu Dhabi.

Philips launches mobile screen-

ing unit at Arab Health 2010

Royal Philips Electronics in part-nership with Smit Mobile Equip-ment, introduced a mobile breastcancer screening vehicle specifi-cally adapted to the requirementsof patients and healthcareproviders in the Middle East. Thevehicle (Mobile MammographyScreening Unit) was showcased atArab Health 2010.

“This innovative mobile screeningvehicle is specifically designed toreach remote areas in the MiddleEast and is built to take into ac-count the desired level of privacyand the often severe weather con-ditions in the region,” said DiederikZeven, General Manager of PhilipsHealthcare for the Middle East.

“This is yet another example ofPhilips’ commitment to patient-fo-cused healthcare solutions, im-proving the accessibility ofprofessional screening facilities inthe region.”

Philips and Smit Mobile Equipmentpartnered closely with breast screeningprogram operators to translate their ex-perience into a solution designed tomeet the specific needs of patients andcare providers in the Middle East.

The design of the Mobile Mam-mography Screening Unit thus in-cludes dressing facilities, a staffroom and an examination room, aswell as a self supporting air condi-tioning system. The vehicle alsoincludes a built-in Philips AmbientExperience lighting system thatcontributes to a more pleasant pa-tient experience and significantlyreduces anxiety levels.

In addition to providing a high levelof patient comfort, the vehicle con-tains state-of-the-art screeningequipment such as the MammoDiagnost DR, Philips’ digital solu-tion for mammography, designedfor efficient high-volume screen-ing. It provides excellent imagequality and the streamlined intu-itive user interface at the consolemakes working with the systemcomfortable and efficient for the ra-diographer and allows for a quickand easy examination for the pa-tient.

The Mobile MammographyScreening Unit takes into consid-eration the care cycle from thescreening of patients to transmis-sion of data to medical centers, re-porting and immediate follow-up.This could include making furtherappointments at hospitals wheretreatment may be provided.

March 2010 | 19


Vitamin D Deficiency

and Insufficiency

Vitamin D deficiency has beenlinked to the pathogenesis of osteo-porosis and hip fractures as well asother skeletal and non-skeletal dis-orders. Although there is ongoingdebate as to the exact definition ofvitamin D insufficiency, a new reportfrom the IOF CSA Nutrition WorkingGroup shows that regardless ofwhether it is defined at 50nmol/L or75nmol/L, vitamin D status is seri-ously inadequate in large propor-tions of the population across theglobe.

The review, published in Osteo-porosis International, provides aglobal perspective of vitamin D sta-tus across different regions of theworld and identifies common andsignificant determinants of hypovit-aminosis D. Six regions of the worldwere reviewed—Asia, Europe, Mid-dle East and Africa, Latin America,North America, and Oceania—through a survey of published liter-ature.

The main risk factors for low vitaminD levels include older age, femalesex, higher latitudes, winter season,darker skin pigmentation, less sun-light exposure, dietary habits, andthe absence of vitamin D fortifica-tion in common foods. Further fac-tors include the increase inurbanization, where people tend tolive and work indoors, as well ascultural practices that tend towardssun avoidance and the wearing oftraditional clothing that covers theskin. The severity of the problem in

Middle East and South Asia arisesfrom the combination of several ofthese risk factors.

These findings suggest that preven-tion strategies must be initiated atthe national level - especially giventhe increasing ageing of popula-

Women’s health: Osteoporosis

tions in many regions of theworld. National plans of actionshould encourage safe, limitedexposure to sunlight and im-proved dietary intake of vitaminD, whilst considering fortifica-tion of foods as well.


March 2010 | 20

Despite ample sunshine, the MiddleEast (15°-36°N) and Africa (35°S-37°N), register the highest rates ofrickets worldwide. This is in largepart explained by limited sun expo-sure due to cultural practices andprolonged breast feeding without vi-tamin D supplementation in theMiddle East [1], and by dark skincolour and calcium deficiency,rather than vitamin D deficiency, inseveral countries in Africa [2]. Bothregions also have a high preva-lence for hypovitaminosis D, the la-tency disease for osteoporosis, andthe main focus of this discussion.

Hypovitaminosis D is very commonin this region and does not sparethe paediatric age [3, 4] (see Table1). A large proportion of adolescentgirls, up to 70% in Iran [5] and 80%in Saudi Arabia [6] had 25(OH)Dlevels below 25nmol/L. The re-ported proportions were 32% inLebanese girls and between 9-12%in Lebanese adolescent boys [7, 8].Diarrhoea and maternal vitamin Dstatus in infants [9, 10] and gender,clothing style, season, and socioe-conomic status in older childrenwere independent risk factors for

25(OH)D levels [5-7, 11]. Severalwere also predictors for calciumand vitamin D intake [12].

The first study in adults from the regionwas conducted in university studentsand elderly from Saudi Arabia, and re-vealed a mean 25(OH)D level rangingbetween 10-30nmol/L [13]. The mean25(OH)D level was near 25nmol/L inLebanese, Saudi, Emirati and Iranianwomen [14-17]. A similar mean wasrecorded in elderly Lebanese [18].

The proportion of subjects with vita-min D levels below specific cut-offsvaried. It was 35% for a vitamin Dlevel below 25nmol/L in a study ofelderly subjects from a geriatrichospital in Israel [19] and between60-65% in Lebanon, Jordan andIran [14, 20, 21]; and was 48% fora cut-off less than 37.5nmol/L insubjects from Tunisia [22]. In theelderly Lebanese, 37% of men and56% of women had vitamin D levelsbelow 25nmol/L; the correspondingproportions were 8% for men and14% for elderly subjects participat-ing in the Longitudinal Aging StudyAmsterdam [23].

IIn the similar international studyconducted in women with osteo-porosis, the highest proportion ofhypovitaminosis D was noted in theMiddle East [24]. In a study of hipfracture patients and elderly fromIsrael, up to 80% of subjects hadhypovitaminosis D [25, 26]. Inade-quate vitamin D intake, urbandwelling, female gender, wearingthe veil, winter season, age andhigh parity were independent pre-

dictors of low vitamin D levels [15,20-22, 27, 28].

Neonates born to mothers with lowD levels have lower cord vitamin Dlevels, and may be at risk for ricketsand other complications [3, 29].Studies from Saudi Arabia, Kuweit,United Arab Emirates and Iran re-veal that 10-60% of mothers and40-80% of their neonates had un-detectable to low vitamin D levels(0-25nmol/L) at delivery [30-33](see Table 3). Neonatal outcomeswere not detailed in most studies.Higher socioeconomic status, ante-

Vitamin D status in Middle East and Africa

BY Rola El-Rassi, Ghassan Baliki and Ghada El-Hajj Fulheihan American University of BeirutMedical Center, Department of Internal Medicine, Beirut, Lebanon

The International Osteoporo-

sis Foundation (IOF)

Registered as a not-for-profit,non-governmental foundation inSwitzerland, the IOF functionsas a global alliance of patient,medical and research societies,scientists, health care profes-sionals, and international com-panies concerned about bonehealth.

IOF headquarters are in Nyon,Switzerland, with regional repre-sentations established in Ar-gentina, Hong Kong-China, andJordan

The Foundation was establishedin 1998, when the EuropeanFoundation for Osteoporosis(EFFO), founded in 1987, joinedwith the International Federationof Societies on Skeletal Dis-eases (IFSSD, established1995) .


March 2010 | 21

For further information, thereader is referred to:

A. Mithal, D.A. Wahl, J-P. Bon-jour et al. on behalf of the IOFCommittee of Scientific Advisors(CSA) Nutrition Working Group.Global vitamin D status and de-terminants of hypovitaminosis D(2009) Osteoporosis Interna-tional, in press

natal care, and vitamin D intakewere associated with higher vitaminD levels [33].

The negative impact of low vitaminD on mineral metabolism is illus-trated in the inverse relationship be-tween vitamin D and PTH levelsnoted in Lebanese of all agegroups, and in Emirati and Iranianwomen (R= -0.2-0.25) [17, 34, 35].A positive correlation between25(OH)D and spine, but not hipBMD (Z-score) was noted in post-menopausal Iranian women [36].Similar correlations were noted inelderly Lebanese with spine, hip,and forearm BMD (R=0.13-0.3), butwere not present after adjustmentfor age, height, lean mass and PTHlevels [18]; consistent with findingsin Iranian women [34]. Neonatal

size or bone mass may be affectedby maternal vitamin D status [3]. Noeffect of maternal vitamin D levelson neonatal birth weight was de-tected in a sample of 50 mothers-neonates from Iran after adjustingfor maternal height, age, and parity[30]. Conversely, in a larger sampleof 449 women and their newbornsfrom Tehran, neonates of motherswith adequate calcium and vitaminD intake, were 0.9 cm taller andhad a better Apgar at birth [37]. Vi-tamin D supplementation for oneyear increased lean mass, bonearea, and bone mass in a ran-domised controlled trial inLebanese adolescent girls [8].

In summary, vitamin D levels arequite low across age groups in thisregion. Consistent predictors of lowlevels are older age, female gender,

multi-parity, the winter season, con-servative clothing style, low socioe-conomic status and urban living.The negative impact of low vitaminD levels on indices of mineral bonemetabolism and the positive effectof replacement in adolescents isconsistent with observations world-wide and supports recommenda-tions to optimise vitamin D status.


March 2010 | 22

TTC provides pharmaceuticaltranslations by specialised transla-tors who have experience workingwith the pharmaceutical industry.Currently, TTC provides translationservices for suppliers of turnkeypharmaceutical plants; machineryand equipment for the treatment ofpharmaceutical raw materials; ana-lytical instruments and labreagents; testing instruments; ac-tive pharmaceutical ingredients;tableting and capsulation unit.

Director of TTC, Levent Yildizgoren,told MEH, “I co-founded TTC to-gether with Banu Yildizgoren. Wewere passionate about languagesand communications and wanted todo what we like most: communica-tions. At TTC we are helping ourclients to be at the leading edge ofrevolutionary changes in languagecommunications. Since the industry

is so complex with many differenttypes of drugs (brand name andgeneric medications) and there areso many strict laws and regulationsregarding the patenting, testing andmarketing of drugs in the pharma-ceutical industry, it is important thatyou choose the appropriate transla-tor for your documents. Afterall,pharmaceutical documents havethe potential to change lives.

“We are equipped with 16 years ofexperience in the fields of transla-tion and localisation, a solid infra-structure of providing comprehensivelanguage services and most impor-tantly a clear vision. We have nowproved ourselves as a leading lan-guage services provider for bothonline and offline media and forlocal and global requirements.”

Formed in 1992, the company hascatered for the communicationneeds of businesses around theglobe. Faced with the ever growingand changing demands of commu-nications technology, TTC’s strate-gic focus has shifted towards anincreasingly client-driven model inthe last 16 years. The result is flex-ible and value-added partnershipswith clients, of which they are justi-fiably proud.

Mr Yildizgoren explains, “Comingfrom different backgrounds andfrom all parts of the world, our keyteam is our greatest asset. They in-clude permanent and freelancetranslators, proofreaders, linguisticand technical experts, DTP special-ists, software engineers andtesters. Over the last 16 years, to-gether we have completed thetranslation and localisation of mil-

lions of words into over 100 lan-guages and it is their knowledge,commitment and passion thatmakes TTC what it is today.

“Our mission is to make a world ofdifference to our clients. We areproud to have a wide variety ofclients in our portfolio, ranging fromglobal blue-chip companies to indi-vidual Local Authorities and Chari-ties. It is our goal to help enablethem to communicate their mes-sage across international borders.”

www.ttcltd.com

Company profile: TTC Language Services Ltd Pharmaceutical translation services

TTC Directors Levent and Banu Yildizgoren


March 2010 | 23


March 2010 | 24

Siemens seal record deal for

Middle East region

Siemens Healthcare have an-nounced a contract win of US$69million to supply diagnostic imagingequipment to all Ministry of Healthhospitals across Iraq. The recentlysigned contract will provide the IraqiMinistry of Health with unrivalled di-agnostic imaging equipment, fullyserviced over a period of 5 years.Maurice Faber, Vice PresidentSiemens Healthcare Sector MiddleEast said, “We are very proud toannounce this agreement as it

means we are playing an active rolein the helping to rebuild healthcareservices in Iraq. One major result ofthis contract will be improvedhealthcare for all Iraqi people, andadvanced breast cancer screeningfacilities for women in Iraq.”

The Minister of Health, Iraq, His Ex-cellency Ali Saleh Al Hasnawi, com-ments, “We have been a regularcustomer of Siemens for more than30 years and are confident of thequality of their products, innovativesolutions and excellent service his-tory.”

Healthcare Industry NewsStem cell breakthrough at

Children’s Hospital Boston

In a study that ties stem cell re-search together with research onaging and cancer, investigators atChildren's Hospital Boston haveused genetic reprogramming to cre-ate cells from patients with a rarepremature-aging disorder that areable to rebuild their telomeres--thetips of chromosomes that must bemaintained to prevent a cell from"aging" and enabling it to divide andmake copies of itsel.

Publishing in Nature on February17, researchers in the laboratory ofGeorge Q. Daley, MD, PhD, Direc-tor of the Stem Cell TransplantationProgram at Children's, report suc-cessfully reactivating the cellularenzyme telomerase, which main-tains the telomeres, in patients withdyskeratosis congenita.

In this rare genetic disorder, geneticmutations cause telomerase to bedefective, leaving the chromo-somes without protection fromdamage and unable to compensatefor the natural shortening of telom-eres that occurs when a cell di-vides. As a result, a patient's cells"age" more quickly, leading to bone-marrow failure (an inability to makeenough blood cells), degradation ofmultiple tissues, premature aging-like symptoms and a much-short-ened lifespan.

The findings suggest the possibilityof developing drugs to help patientswith dyskeratosis congenita main-tain their telomeres, prolongingtheir lives. But the study also hasbroad implications for stem-cell re-search, as well as research onaging and even cancer.

70% of Dubai hospitals to

be private

Qadhi Al Murooshid, director gen-eral of Dubai Health Authority, saidjust 30 percent of Dubai’s hospitalswill be public sector within fiveyears, as private players arepushed to shoulder more of theemirate’s healthcare burden.“Our aim is by 2015 that DHAshould own and operate only 30percent of the hospitals and that theprivate sector will operate the re-maining 70 percent,” he said,speaking at the relaunch of RashidHospital’s psychiatric ward. Around57 percent of Dubai’s hospitals and54 percent of its outpatient facilitiesare privately owned, he added.The DHA currently has three hospi-tals and a string of outpatient carecentres under construction, part ofan AED3.67bn upgrade of medicalservices in Dubai. The projects,which include a 200-bed paediatrichospital, an emergency hospitaland a rehabilitation centre for theelderly, will bolster bed space by

around a third, adding 600 beds inthe next two years. Private sectorprojects are expected to add an-other 500, Al Murooshid said.

“The DHA will focus on specialisedhealthcare services such as devel-oping trauma and emergency care[and] specialised healthcare serv-ices and will work with the privatesector to support them in caseswhere the investment they need toundertake is huge,” he said.

Qadhi Al Murooshid

The agreement allows the signato-ries to share medical resources inorder to provide patients high stan-dard of healthcare services and isaimed to further improve the qualityof gynaecologic care that patientsreceive in the Emirate of Dubai.

Mr. Khalid Al-Shaikh Mubarak, CEOof Shared Support Services at theDHA signed the agreement with DrTarek Fathey, Hospital Director, TheCity Hospital, on Thursday markingthe first -of -its -kind public privatepartnership in the Emirate of Dubai.

Mr. Khalid Al-Shaikh Mubarak, CEOof Shared Support Services at theDHA said, “At the DHA, it is ourconstant endeavour to further im-prove the quality of health andhealthcare services in the Emirate

of Dubai. We consider the privatesector to be our key stakeholderand this agreement is a reflection ofthe relationship we share with theprivate sector whereby we are will-ing and keen to work with them inorder to provide patients with ut-most level of quality healthcare.”

Dr Mohammad Al Olama, CEO ofHospital Services Sector at theDHA said, “The agreement is thefirst-of-its-kind agreement betweenthe government and the privatesector especially since it entailssharing medical resources. Thecontract enables specialists fromthe Dubai Gynaecology and FertilityCentre to use the resources of theCity Hospital to conduct surgeries.”

GE Healthcare Introduces

Vscan™ Pocket-sized Vi-

sualization Tool for Point-of-

care Imaging

GE Healthcare have announcedthe availability of Vscan, a new,pocket-sized visualization tool de-veloped to provide physicians withimaging capabilities at the point-of-care. Roughly the size of a smartphone, Vscan houses powerful,ultra-smart ultrasound technologythat provides clinicians with an im-mediate, non-invasive method tohelp secure visual informationabout what is happening inside thebody.

Vscan is portable and can easily betaken from room to room to be usedin many clinical, hospital or primarycare settings. The Vscan imagingdevice received 510(k) clearance inthe U.S. by the Food and Drug Ad-

ministration (FDA), the CE Mark bythe European Union, as well as theMedical Device License fromHealth Canada and is now com-mercially available in the U.S., Eu-rope, India and Canada.

"Having Vscan at my disposal at alltimes has allowed me to use ultra-sound in a number of settings andwith patients that I wouldn't haveanticipated before – from the ICU,to the outpatient clinic as well aswith ambulatory patients," said An-thony N. DeMaria, MD, Professor ofMedicine at University of California.

The ability to take a quick look inside thebody using Vscan may help cliniciansdetect disease earlier. This may proveinvaluable in today’s busy practice envi-ronment including primary care physi-cians and those specializing incardiology, critical and emergency careand women’s health, as well as hospi-talists.

Philips opens new head

office in Riyadh

Royal Philips Electronics, whichhas been present in Saudi Arabiafor more than 50 years and has es-tablished representative offices inJeddah and Dammam, has openeda new head office (HO) in Riyadh.The new HO will serve as the cen-tre of the company’s operations forSaudi Arabia, which will support thecompany’s continuous growth andto better serve current and futurecustomers, a statement said.

“Our expansion and continuedgrowth in Saudi Arabia is a testa-ment to our unwavering commit-ment to the region, and is part of astrategic vision that has long recog-nized the Middle East as an impor-tant part of the global economy,”said Louis Hakim, vice president ofRoyal Philips Electronics and CEOof Philips Middle East. “In 2009,Philips registered a sales growth of50 per cent in Saudi Arabia,” headded.

Philips has chosen the CanaryCentre to accommodate the new of-fice as a result of its unique environ-mental system and ecologicallyfriendly premises. “With health andwellbeing in the forefront of Philips’business strategy, the Canary Cen-ter provides us with an ideal work-ing environment. Energy efficiencyis a topic on everyone’s mind whichis why we are setting an exampleand contributing towards a greenerenvironment,” Hakim concluded.

The Dubai Gynaecology and Fertility Centre signs

agreement with the City Hospital


March 2010 | 25

Country overviewThe Sultanate of Oman is located inthe southeastern corner of the Ara-bian Peninsula. It has a coastal lineextending almost 1,700 kilometersfrom the Strait of Hormuz in theNorth to the borders of the Republicof Yemen, overlooking three seas;the Arabian Gulf, Gulf of Oman andthe Arabian Sea. The Sultanate ofOman borders Saudi Arabia andUnited Arab Emirates (U.A.E.) inthe West, the Republic of Yemen inthe South, the Strait of Hormuz inthe North and the Arabian Sea inthe East. Besides, there are a num-ber of scattered Omani islands inthe Arabian Sea; the most impor-tant are Masirah and Al-Halaniyat. The Sultanate of Oman is approxi-mately 309,500 square kilometersand has a population of 3,311,640,including 577,293 non-nationals.Oman is dependent on oil exports,but is actively pursuing a develop-ment plan that focuses on diversifi-cation, industrialization, andprivatization, with the objective ofreducing the oil sector's contributionto GDP to 9 percent by 2020. GDPper capita is $19,000 (2007 est.)which is made up of the agricultural(2.2%), industrial (38.2%), andservices (59.6) sectors.

Healthcare system

Oman’s health system is dominatedby the public sector (accounting formore than 98% of the hospitalbeds). The Government covers allOmanis and expatriates working inthe public sector. Expatriates work-ing in the private sector are by lawcovered by their sponsors/employ-

ers. The WHO and the World Bankhave noted that Oman’s health sys-tem performs well, providing nearuniversal access, without excessivespending. Ministry of Health expen-diture for 2006 was RO210.6 mil-lion, representing 4.7% ofgovernment spending.

The Ministry of Health (MOH) is theSultanate's main agency responsi-ble for provision, coordination andstewardship of the health sector.MOH is required to ensure overalldevelopment of the health sectorper se and in relation to other keysocial sectors. In keeping with thisrole, MoH acts as the principal ar-chitect of health system design andtakes responsibility for achievinginter-sectoral coordination. It devel-ops policies and programmes forthe health sector. It implementsthese in coordination with all otherrelated ministries, health servicesinstitutions under the governmentas well as in the private sector.MOH employs 4,579 doctors intotal, 17.8 doctors per 10,000 peo-ple in the Sultanate.

Country profile:

Oman

MOH serves as the main agency ofthe government for providing cura-tive care to the people of Oman. Itruns hospitals and health centres atnational, regional, sub-regional andlocal levels, which are integrated ina referral chain. There are 59 MOHhospitals in the country with a ca-pacity of 5,319 beds, and 194 gov-ernment health centres . Thecurative care services provided inMOH hospitals is supplemented byother government hospitals/clinicssuch as those run by the Sultan Qa-boos University, Ministry of De-fence, Royal Oman Police and thePetroleum Development Oman.There are also several private hos-pitals/clinics, which are playing anincreasingly important role in pro-viding care. All these establish-ments are linked with the MOHsystem through a referral chain.

MOH undertakes drug controlthrough its Directorate General ofPharmaceutical Affairs (DGPA &DC) and drug procurement and dis-tribution through its DirectorateGeneral of Stores (DGS). MOH isresponsible for the registration of


March 2010 | 26

drug manufacturers and products,control of narcotics and other con-trolled drugs, issuance of the nec-essary customs clearances forimport and re-export of drugs. Asper the new drug policy, MOHshoulders the responsibility forprice control in the retail market.MOH is responsible for privatepharmacy licensing, and the licens-ing of pharmacists employed in pri-vate pharmacies.

The private sector is encouraged toplay a significant role in a largespectrum of activities ranging frominvestment in Primary, Secondaryand Tertiary health care to HumanResources and Health Educationand Training. At present there are 3private hospitals and 491 clinics op-erating in Oman. The policy of MOHis to encourage investment by pri-vate sector in the health sector andto that extent even partially fi-nanced projects extending to 10million ranging from private hospi-tals to pharmaceuticals. There are732 private health clinics in Oman.

State of Health

The infant and under five mortalityrates were 10.25 and 11.02 per1000 live births respectively in2006. This represents a dramaticfall in infant and child mortality fig-ures over the last decade, which isdue to rapid socioeconomic devel-opment, the successful immuniza-tion programme, and improvementin water and sanitation. The immu-nization coverage currently standsat 98% for all the vaccine-pre-ventable diseases. Oman has beenpolio-free since 1993.

Cardiovascular disease

Diseases of the circulatory systemcause almost a third of adult hospi-tal deaths (1223 out of a 4259 total

deaths in 2006 )and are graduallyincreasing inpa-tient morbidityfrom 5.1% of totalpatient dischargesin 1990 to 6.6% in2003. Ischaemicheart disease is aparticular problemfor adults aged 45years and above.

Hypertension isalso a major killerand the WorldHealth Organiza-tion reported in2005 that, “preva-lence of high sys-tolic or diastolicblood pressureduring the Na-tional Health Sur-vey 2000 was33% for adultsage 20 years and older (35.2% formen and 30.9% for women) andwas especially high in Muscat Re-gion (49.7% for men and 37.6% forwomen). Ad-Dakhliyah Region hadcomparatively lower rates, 22.9%for men and 25.4% for women. TheNational Health Survey found alarge percentage was undiagnosed.A sedentary lifestyle and the lack ofphysical activity contribute to car-diovascular disease in Oman.”

Cancer

Although Oman currently has a lowincidence of cancer, Neoplasms areof increasing concern, accountingfor around 10% of adult deaths,with 404 deaths in 2006. The WHOreported that in 2003 the top fivecancers for men were leukaemia(11.8% of all cases), non-Hodgkin’slymphoma (10.6%), prostate(6.9%), stomach (6.5%) and lung

(6.2%). For women it was breast(15.3%), leukaemia (9.4%), cervix(8.8%), thyroid (8.1%) and non-Hodgkin’s lymphoma (6.8%). How-ever, with aging of the populationand changes in lifestyle it is ex-pected that the incidence of cancerbe higher in the future.

Diabetes

As Oman continues through theepidemiological transition and so-cioeconomic development, the bur-den of diabetes will increase. Justas serious as the known cases of(an estimated 11% of the adult pop-ulation), are the high percentage ofdiabetes cases that remain undiag-nosed; 66% compared to 50% in-ternationally with a range from12.3% in Musandam to 86.5% inMuscat Region. One study foundthat 60% of all people with diabeteswere found to be undiagnosedcases.


March 2010 | 27

Documents

Middle East Hospital magazine March 2010