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Volume 30, Number 4July/August 1979

In This Issue

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Showcase of the Future

"We will not wait...to achieve progress...we will start where human knowledge has ended."

Written by Mary-Jo McConahay
Photographed by Terry Webb
Additional photographs by David Thompson and Dick Massey

By a sere brown escarpment in Saudi Arabia last year, a helicopter clattered to a landing at King Faisal Specialist Hospital, a complex of green gardens and sculptured buildings near Riyadh For a moment, as the pilot cut the engines, and the rotors of the airborne ambulance whistled and slowed, there was silence. Then the hospital's trained staff went into action: doctors, nurses, attendants and - a KFSH feature - computer programmers. Within minutes the new patient had been eased onto a stretcher and started on his way to a cool, clean room while, simultaneously, the staff began the elaborate tests, procedures, medication and treatment that eventually healed the patient and sent him home, his health restored.

The King Faisal Specialist Hospital, which opened in 1975, is among the most modern hospitals in the world. It is a showcase of modern medicine, a model for future health care in Saudi Arabia and a fitting monument to King Faisal, the man who outlined its basic concept in this quotation:

"We will not wait all these innumerable generations, as mankind has had to do, to achieve progress. Very often we will start where human knowledge has ended."

Against a backdrop of desert browns and yellows, the KFSH complex provides a memorable contrast with its buildings of warm native stone and tinted glass and its spectacular grounds, a great green oasis of imported trees and shrubs: Italian cypress, yellow oleander, Indian orchid and Chinese silk trees, roses, rosemary and thyme, California poppies and delicate baby's breath. For patient and visitor, it is a visual delight and a place where nature reigns.

Inside, however, KFSH is a place where technology reigns - medical technology of the highest order. One example is the $60 million Cancer Research Institute which is scheduled to open next year and which will have its own $4.3 million cyclotron (see box). And there are many more examples. Indeed, the entire $250 million hospital is a computerized marvel.

In the "PBX room" near the lobby, for instance, a pink-coated bilingual technician monitors dozens of tiny television screens, their cameras trained on patients in their rooms. If a patient needs a doctor - or just another box of Kleenex - he simply speaks into the communication set at his bedside and the request is transferred by the central console operator to nursing stations or utility points, a process that reduces the need for a large nursing staff. These cameras even "see" in the dark, so sleepers aren't disturbed by routine checks, and in case of emergencies, the technician can turn on a videotape and record the patient's activity during the few moments before help arrives.

The emphasis on technology is not, spokesmen say, an obsession with gadgetry. It is simply a rational response to a fact of life in Saudi Arabia: a decided lack of trained personnel. Despite a massive effort to provide thousands of students with university degrees in all fields of study (See Aramco World, May-June 1979), the kingdom's pool of professionals and technologists is still relatively small. As in early America, therefore, where constant shortages of manpower stimulated mechanization, Saudi Arabia is using technology as an efficient substitute until skilled manpower is more widely available.

At KFSH, for example, vital patient records - which elsewhere may divert precious nursing time from patient-care to record-keeping and require squads of file clerks - are now fed directly into a central computer virtually from the bedside.

The computer is just as important in the laboratory where silent systems, their lights blinking busily, replace medical technicians, who are as scarce as nurses. In the clinical laboratory, for example, automated equipment analyzes body fluids for diagnosis and treatment and transmits the results to a computer which gathers and sorts the information, prints its own special reports and sends the data to the central computer to update patients' files. Another system - the compact Sequential Multiple Analyzer with Computer (SMAC) - can run 20 different tests on 150 samples of blood in one hour with only one operator. As Dr. Nizar Feteih, chief of the cardiology division, says, KFSH laboratories are equipped with "the Rolls-Royce of equipment - the most sophisticated of its kind in the world."

This is particularly true in the heart catheterization lab. According to Dr. Feteih - a Saudi Arab who has spent 17 years studying and practicing in the U.S. - the programs and equipment there measure up to the best in the States.

Equipment, of course, is only part of the KFSH story. In the end it is people, not machinery, that make a hospital work. And in the intensive care unit, a highly mechanized area, Dr. Feteih himself gave an example during recent rounds. Although he carefully checked the computer screen by the bed of a sleeping patient, he also had a word with the nurse. Next he tousled a child's hair-raising a wan smile - and conferred with a young physician from Georgia on temporary assignment at KFSH. His bedside manner comes from the heart - and from the efficient support and spare time granted by the computerized systems.

Like Dr. Feteih, Mrs. Afaf al-Blaihed, a KFSH administrator, is also strong on the personal touch. The director of a staff of 110 in the outpatient clinic, Mrs. al-Blaihed finds that some patients temporarily forget their own concerns in their curiosity about her job: she is the first Saudi woman to receive a master's degree in hospital administration. (See Aramco World, May-June 1979.)

"Sometimes the women don't believe I'm Saudi," she grins. "Then I start speaking in slang and they know for sure. They are happy to meet someone who shares their way of life."

This is particularly true of patients from outlying regions of the kingdom, some of whom have never seen a modern urban hospital. During Dr. Feteih's rounds, for example, his patients included a Bedouin shepherd from the Empty Quarter, a 50-year-old truck driver from Hail and an 18-month-old boy from the south. For them, the extraordinary technology of KFSH - along with the thick carpeting, plush sofas and twinkling chandeliers in the waiting room - may be an unsettling experience. Designers, with just that in mind, made a special effort to "plan away trepidation" by substituting walls painted a soft yellow, or covered in fabric, for the more traditional stark white, and by substituting discreet individual beepers for a p.a. system.

Unlike other hospitals in Saudi Arabia, KFSH does not admit all patients. As its name suggests, it is a referral hospital - a hospital that only accepts those patients who cannot be treated anywhere else in the kingdom. To be admitted, patients must be referred by provincial medical committees to which their own physicians have first referred them.

If their physicians and the medical committees agree, however, patients will find an assortment of international specialists on tap to diagnose and treat them: dental surgeons, plastic surgeons and neurosurgeons; endocrinologists and otolaryngologists, experts in blood and tumors, and psychiatrists. Altogether there are more than 30 specialists on call at KFSH, enough to cope with the rarest or the most difficult condition.

And they do cope. In the four years since KFSH opened its sliding glass doors its experts have treated up to 10,000 out-patients per month and admitted 600 to 700 patients a month - many of whom might not have survived without referral to KFSH.

A case in point is Muhammad Z. - a frail and wide-eyed little boy from Taif, whose parents brought him to the capital last year. Although he was eight years old, Muhammad looked more like five and, his mother said, turned blue whenever he ran or exerted himself - a symptom, perhaps, of congenital heart disease. Fortunately, the famed American cardiovascular surgeon Dr. Michael DeBakey (See Aramco World, March-April 1975) and a team from Baylor College Medical Hospital in Houston were just then inaugurating the hospital's own permanent open-heart surgery program. Muhammad Z. was to benefit.

The operation on Muhammad Z. - the first of its kind at KFSH - showed the hospital's facilities at their best. It was, simultaneously, televised to personnel in the hospital's medical library, still-photographed on the spot by hospital audiovisual staff - to be filed in the archives for future training - and videotaped for showing on public television.

It was also fine theater that, at KFSH and in Riyadh, got high ratings. In one scene, as DeBakey worked in the boy's open chest under the operating theater's bright lights, the cameras zoomed in to fill the television screen with the boy's pulsing heart and the master surgeon's deft fingers. In another, someone drawled, "O.K. now, turn on the bubble machine," and the bypass pump took over the boy's vital functions, as DeBakey went in for the delicate surgery on the suddenly motionless heart.

The operation got a high rating from Muhammad Z., too. Less than 90 minutes after he went under the first anesthesia, doctors could say of him, "He can look forward to leading a normal life now."

For KFSH, however, Muhammad's operation was just a beginning. Because there is a relatively high incidence of rheumatic fever - which damages the valves of the heart - in the kingdom, the addition of open-heart surgery to the list of KFSH specialized treatments has been invaluable to patients and has also expanded the capabilities of the cardiovascular department as a whole. Today about seven open-heart operations a week are being performed by KFSH's permanent team from Baylor and there are plans to integrate Saudi surgeons into the team soon. As DeBakey said, after launching the program, "All the facilities are here for any kind of cardiovascular surgery we want to perform."

Such extraordinary facilities, it is true, have led to criticism from some observers who feel that the glamor of KFSH's high technology diverts attention from such basic medical needs as health education.

"Sometimes," says one KFSH administrator, "we get people who look around at the comfortable surroundings and high-powered machines, and say we are starting at the wrong end of the wood pile."

In fact, say hospital personnel, these high-technology processes and computerization are already effective tools for health education. Ushered into ultra-clean rooms, shown the modern facilities and given simple, straightforward and complete information about their illnesses and treatment, the patients themselves begin, back home, to spread the word about the quality of medical care they can expect in the future.

KFSH, however, does not leave it at that. Every month its personnel mail 2,000 detailed medical reports to the community doctors who originally referred the individual patients to the hospital. "Whether he ever sees the returning patient again or not," says Peggy Meeker, head of the medical records department, "the local doctor reading the report is himself exposed to the latest medical regimen."

Upstairs, above the quiet bustle of the hospital streets, the KFSH public relations department also does its bit for health education. Its staff prepares programs for a local "Radio Doctor" show and produces a weekly full-page feature for a Riyadh newspaper written, in Arabic, with the assistance of staff doctors.

These articles, which are illustrated, cover a wide variety of subjects: advice on diet and nutrition, explanations of psychological problems, warnings on the hazards of smoking or suggestions on treatment of snake bites or scorpion stings.

In other articles staff writers have focused on modern medical technique, highlighting X-rays in one and, in a feature on amniocentesis, showing the womb being punctured and explaining how doctors use the extracted fluid to diagnose the condition of an unborn baby. The PR writers also produce little books with layman's texts and lively but precise colored drawings to instruct patients in caring for themselves after they leave the hospital.

Television is equally valuable in health education, said Dr. Alvin Merendino, director of medical affairs. Dr. Merendino, in fact, would "love to have a public educational television station" to reach those who do not or cannot read, and thinks that the hospital's closed-circuit television system could provide enough medical material to justify it.

Located on the hospital's second floor, channel KFSH, operated by the audiovisual department, already transmits on two closed-circuit channels to every hospital room and to the hospital community, often running its own shows about medical topics and even printing a weekly TV guide. In a sense, it's entertainment, but it is also a substitute for the years of quasi-educational programs such as Dr. Kildare, Ben Casey and Marcus Welby, which, says Bill Jarr, acting head of the audiovisual department, may not have been good medicine, but did give people a familiarity with hospitals and medical practice. "Here," he says, "we have to do part of that job too."

Jarr's staff, for example, noticed that the Arabic terms for peptic ulcer (qarha) and a simple gas pain (harqa) were similar and wondered if some people might, therefore, worry unnecessarily. So the audiovisual department created a ten-minute film explaining the difference, and showed it recently between a rerun of "How to Lose a Million" and a show on traditional Kuwaiti dancing. During the same week, patients viewed television films made in the hospital on asthma, vaccination and infections.

Such films, Jarr says, are made "with patients' fears in mind," but more direct material is also broadcast on a special channel to 11 locations exclusively for medical staff. "The Surgical Removal of Liver Cysts" may not appeal to the average viewer, but it is shown on the "professional" channel as part of the hospital staff's continual process of teaching each other.

This, at KFSH, is important and the hospital's provisons for it are, like its technology, elaborate. Its quiet wood-and-gold-leaf medical library is stocked with 5,000 books, 300 medical journals, plus cassettes and microfilms.

Another example of cross-staff teaching is in the medical records department where about half the 43 employees are receiving training as they work- part of a special effort to teach the vital arts of medical transcription and record-keeping to local personnel and thus, eventually, upgrade record systems in hospitals across the kingdom.

Even for veterans, however, KFSH is a continuous learning experience. When DeBakey's open-heart team came, for example, records department employees were called to a meeting at which a surgeon demonstrated the micro-valve replacement and then translated the operation into layman's terms. "When something like this happens," says Meeker, "it's like learning a whole new language for everybody."

KFSH is also involved in other aspects of medicine, seeking to draw national medical profiles for the first time and to discover the special health needs of the Saudi population. What, for instance, are the "normal" levels of hemoglobin and cholesterol among the Saudi population? Why does there appear to be more cancer of the throat and esophagus than of the lung? KFSH finds the answers by measuring, examining and treating Saudis within the kingdom and by assigning medical specialists and scientists who know what the correct queries are, and how to use the latest support equipment to tabulate and analyze results.

Another aspect is research in such fields as nutrition. Dr. Fredrik Serenius, for example, a pediatrician and head of the Neonatal Service, is working with the Saudi Arabian Food Establishment to improve the health of Saudi children by supplying them with nutritious school lunches. As part of this project he - with Dr. Dominique Fougerouse and nurse Farida Foula - trekked far afield to conduct surveys, to talk extensively to sometimes willing, sometimes shy families, and to examine children. The team traversed the stone desert north of Riyadh - where villages are sometimes an hour apart - to the Nafud and the region of al-Qasim. Enroute they slept in village schools and provided ad hoc health education in their mobile clinic.

As the survey results are still being analyzed, the researchers have yet to come up with specific results on nutrition. But they have already concluded that there is a great need for general preventive medicine.

As preventive medicine does not necessarily demand fully qualified doctors - who are still in short supply - Dr. Serenius suggested that selected villagers be given a six-month course in community hygiene and health care and basic first aid. He also noted that pregnant mothers needed more check-ups and KFSH has approved a study to identify local high-risk factors in pregnancy which might endanger a child's future health. The hospital, in cooperation with a government project, is also pushing polio inoculation as well as providing orthopedic rehabilitation.

Yet it is as a referral center that KFSH has won its reputation. And although some observers do question the need for the apparent luxury and what seems to be an excess of medical technology, even critics admit that KFSH is invaluable. One, a surgeon himself, said: "I wish every city could have the same services."

Some other areas, in fact, are beginning to provide similar care (see box) but in the meantime KFSH, like a healthy plant, continues to grow. Although it is already a virtually self-sufficient city - with its own power station and a five-million-gallon underground reservoir - KFSH has continued to build new facilities. Under construction, for instance, are a corneal transplant unit and a new 150-bed minimal-care facility "like a hotel cum hospital," where out-of-town patients who need only basic treatment can stay close by and avoid traffic and hotel bills. Plans are in hand to add 250 beds, new housing for nurses and to expand the outpatient clinics. KFSH is also developing facilities that may establish it as a central blood bank for the kingdom. Supplies of blood are frozen so they last for years instead of weeks - an important consideration in a region where the public is still not fully accustomed to the idea of "giving blood."

Blood freezing, brain scanners, SMAC, sensors and cyclotrons, heart-lung bypass machines - it's an impressive inventory. But what is more impressive is the care KFSH provides and the hope it offers to the patients. They may not understand high technology but they do understand that however rare, or advanced, or complicated their cases may be, KFSH is offering the best care possible. And in the end, that is probably all that matters.

Mary-Jo McConahay, a reporter for The Arab News, an English-language daily in Jiddah, has done free-lance writing for Ms. and New Times from Mexico and has lived in Saudi Arabia since 1976.

KFSH: A Cyclotron in Riyadh

Because King Khalid has declared that any person with cancer can be admitted, KFSH next year will open a $60 million cancer research center—with its own cyclotron, or atom-smasher, one of medicine's more effective anti-cancer weapons.

In simple terms, a cyclotron breaks atoms down into even smaller particles—electrons, protons, etc.—and then propels them like bullets into other atoms, a process which changes the nature of the target atoms. Some iodine atoms, for example, become radioactive and these atoms, now called isotopes, are extremely useful in detecting, locating and treating cancer. Taken into the body of a patient—perhaps in a glass of water or even inhaled—the isotopes can be traced with a special camera to detect the tiniest, most hidden tumors; they cause the image of the diseased area to turn brighter than that of the surrounding normal cells. They can also be used to treat the cancerous cells once they have been confirmed and located.

For any cancer treatment center the advantage of having its own cyclotron is rooted in the "half-life" of the radioactive isotopes—i.e. the span of time over which the isotope is still effective. If the "half-life" is too short, the isotopes will be ineffective, but if it is too long the radioactivity may itself be dangerous when ingested. By having its own cyclotron, therefore, KFSH can produce isotopes suited to the needs of particular cases.

Some radioactive isotopes of iodine, for example, have a life span long enough so that KFSH will be able to manufacture them and ship them to the growing number of hospitals in the kingdom with facilities to use them. But KFSH can also manufacture isotopes for use at KFSH, with a life span long enough for diagnosis, but short enough to reduce the danger of giving the patient too high a dose of radiation while trying to diagnose the complaint. If, for example, a patient comes to KFSH and doctors suspect thyroid cancer, they might, without a cyclotron, use the iodine isotope "I-131" for diagnosis; because "I-131" has a long half-life it is stored and available at many hospitals. But as "I-131"and other long-lived isotopes can give a relatively high dose of potentially dangerous radiation to the patient, doctors prefer to use isotopes with a shorter life span. While using "I-131" is an acceptable risk in therapy if existence of a cancer has been proven, isotopes with equal effectiveness, but less hazard are obviously preferable.

"Here's where the cyclotron shines," says Raymond Barrall, director of the Cancer Research Institute. With a cyclotron, for example, scientists can make "I-123,"an isotope which does the job but subjects thepatient to30 times less radiation than the long-lasting type; it has a half-life of only 13 hours. And that is not the minimum; still another important radioactive isotope made with the cyclotron—carbon-11—has a half-life of only 20.4 minutes.

Besides radioactive isotopes, the cyclotron also can produce a neutron beam which can be used like a knife in pinpointing and destroying malignant cancers. As with all treatments of cancer, it is by no means a certain cure, but one hospital, the prestigious Hammersmith in London, has published clinical evidence that cancer patients treated with the neutron beam have a dramatically higher recovery rate than those who receive the more common cobalt treatment.

A cyclotron, obviously, is a costly facility for any hospital—the one at KFSH will cost about $4.3 million—but as safety is vital, the hospital has invested heavily in two-meter-thick shields and walls, and in complex devices to monitor the air and the tanks where the wastes are held. In addition, the institute recruited 120 high-caliber specialists and Barrall—at the recommendation of the U.S. Atomic Energy Commission—to be head of the project. As in all departments, the institute knows that it is the combination of top people and high technology that will provide the quality of care KFSH hopes to give.

KFSH: A Swing Of The Pendulum
Written by Caroline Stone
Illustrated by Neville Mardell

The opening of the ultramodern, high-technology KFSH created a considerable stir. In one dramatic move, Saudi Arabia had established in the Arab East a hospital to rival many of the great medical centers of the West.

In a sense, however, the establishment of KFSH was a case of history repeating itself. For the Arab East, centuries ago, had pioneered many of the advances in hospital care that subsequently evolved into the modern, scientific care represented by KFSH and hospitals like it around the world.

The precise beginnings of medicine are difficult to trace. Some evidence suggests that medicine as a science goes back to Babylon some 6,000 years ago—long before Greece emerged as a center of philosophy and science—and was flourishing in both India and Iran in very ancient times.

History is also vague on the origins of hospitals. The word "hospital" comes from the Latin hospitium, a place where hospites, or guests, were made welcome—and hence is linked to such words as "hostel," "hotel" and "hospice." But hospitals themselves probably go back to a time when the sick gathered at the temples of gods, hoping for relief, and by the fourth century were fairly common. Christians in the Roman Empire, for example, had established hospitals for lepers, cripples and the blind, and religious communities existed which cared for the sick.

The fourth century also saw a great advance in medicine. Because of an upheaval at the University of Edessa—present-day Urfa in Turkey—scholars fled to Jundishapur in Iran, bringing with them many precious medical textbooks. As so often happened when East met West, the emigration of the scholars initiated a flowering of scholarship. By about AD. 500 Jundishapur had established a medical academy and a hospital, and had become a center for the translation of medical texts by Greek and Indian authors, first into Persian, later into Arabic. After the Muslim conquest, Jundishapur also provided doctors for many of the new Islamic cities, particularly Damascus and Baghdad—where, in the Golden Age of Islam, medical science moved dramatically forward.

One element in this surge was the establishment by the Caliph al-Ma'mun of the Bait al-Hikmah, the "House of Wisdom" in the year 830. Primarily a research institute, the Bait al-Hikmah rescued and preserved the treasures of Greek learning from oblivion and provided Arab scientists with the foundation for their own spectacular advances in medicine.

Arab scientists, for example, discovered the circulation of the blood in veins centuries before Harvey did, worked out the principles of infectious disease, discovered a vaccination against smallpox and could perform eye operations with a skill subsequently lost until our own century.

Hospitals in the Arab East were not, at first, popular. Because of strong family attachments Arabs preferred treatment at home—a preference that endures to this day. But with the gradual urbanization that followed the spread of Islam, hospitals became essential and by the 12th century had spread throughout the Islamic world.

The organization of these hospitals was very similar to that of today's hospitals. In 1183, for example, Ibn Jubair (See Aramco World, November-December 1978) visited the great hospital of Cairo built by Saladtn, and described it in detail:

It is a palace, goodly for its beauty and spaciousness... In the rooms of this palace were placed beds, fully appointed, for lying patients. At the disposal of the intendent are servants whose duty it is, morning and evening, to examine the conditions of the sick, and to bring them the potions and food that benefit them.

Facing this establishment is another especially for women, and they also have persons to attend them... who examine their condition and give them what is fitting for them. All these matters the Sultan oversees, examining and questioning and demanding the greatest attention and care to them. In Misr (another part of Cairo) there is another hospital of precisely the same model.

Ibn Jubair also provided a description of "the well-known hospital of Baghdad" after a visit there in 1184:

It is visited by physicians every Monday and Thursday, who examine the patients, prescribe for them the proper treatment and order them the food that they require. These physicians have under them nurses whose duty it is to prepare the medicines and food. This hospital was once a large palace and consists of a number of halls and rooms. It is provided with every comfort, such as is found in the royal establishments. The water supply is from the Tigris.

Great cities such as Cairo and Baghdad were not the only ones to provide medical care for their inhabitants. Shiraz, Tabriz, Samarkand and Jurjan, for example, all had their hospitals, but so did such small townships as Biriz, outside Shiraz, and provincial centers as far away as Marrakesh in North Africa. The Marrakesh hospital, in fact, was described by one 13th-century visitor as "unequaled in the world." It was, the visitor continued,

embellished... with a beauty of sculpture and ornamentation... All sorts of suitable trees and fruit trees were planted there. Water there was in abundance, flowing through all the rooms. In addition there were four large pools in the center of the building, one of which was lined with white marble. The hospital was furnished with valuable carpets of wool, cotton, silk and leather, so wonderful that I cannot even describe them.

On the Arabian Peninsula, Mecca and Medina also built noteworthy hospitals and Taif—not surprisingly—was recommended as a place for convalescence because of its healthy climate.

Arab travelers like Von Jubair were not the only visitors to be impressed by the Islamic hospital system. Rahere, court jester to King Henry I of England, founded the famous St. Bartholomew's, or "Bart's" Hospital, in London, apparently because he admired the hospitals he saw in Syria, Lebanon, Egypt and Palestine during the Crusades.

Nor was he the only Crusader to be impressed. The Knights Hospitalers—also known as the Knights of Rhodes and the Knights of Malta—based their hospitals on one founded by their chief foe, Saladin. Such hospitals, established by the Knights, set new standards for medical care in the West. Airy, clean and stocked with medicines, they aroused admiration for centuries.

Such interaction between East and West runs through the entire history of medicine and hospitals. What one area developed the other learned, preserved and improved—and then returned. In the past few centuries the West has forged far ahead but possibly, the establishment of KFSH suggests, the pendulum may one day begin to swing again.

Caroline Stone writes regularly for Aramco World.

KSFH: Model For Many

KFSH is unique, but it is not an island. Its high-technology medicine is a preview of the modernization and extension of medical care that the Saudi government is pushing in most areas of the kingdom. To modernize and improve the kingdom's entire system of medical care is, of course, an enormous undertaking that will require time and money. But the undertaking is well underway. Saudi Arabia today has 67 hospitals and numerous clinics both public and private, all of which are being - or will be - upgraded and provided with new equipment. In addition, Saudi Arabia, under its current Five Year Development Plan, is hoping to provide 11,500 hospital beds by 1980.

One major effort, a five-hospital turnkey project by a single European firm, will provide a total of 2,113 beds at facilities in al-Khobar, Hofuf Jiddah, Jizan and Medina; nearly completed, the hospitals are scheduled to open this summer. Another - launched last May when Saudi health minister Dr. Hussain al-Jazairi signed close to $300 million worth of contracts - will provide hospitals in Hail, Najran and Tabuk, and a health institute in Dammam.

In addition, King Khalid recently opened a 330-bed, $46.2 million armed forces medical facility to serve Riyadh and the military industries in al-Kharj. The first stage in the construction of a comprehensive center with medical installations worth some $300 million, its equipment includes a network of computerized data banks and a system of constant contact with international medical centers.

There are, it is true, no other specialist hospitals in the kingdom like KFSH. But there are individual specialized centers, such as the new Maternity and Children's Hospital in Jiddah, a mental hospital in Taif, and a fever hospital in Abha. And most of the new hospitals being built include at least some of the medical technology and computerization that is the hallmark of KFSH.

Last year, furthermore, the Ministry of Health - recognizing that personnel are as important as technology in medical care - opened a massive campaign to recruit some 5,000 physicians, nurses and medical technicians to man the five new hospitals in Jiddah, Medina, al-Khobar, Hofuf and Jizan. To launch the campaign the government sent a recruiting committee to South Korea, the Philippines and Bangladesh.

Such recruitment is essential, says Dr. al-Jazairi, because Saudi Arabia is "crucially short" of trained medical manpower. Only eight percent of the Ministry's doctors, for example, are Saudi Arabs. Thus health officials think that medical care will have to include foreign medical staff for some time to come.

On the other hand, the ratio of Saudi Arab physicians and nurses is expected to increase once the kingdom's new programs of medical training get into high gear. The University of Riyadh Medical School has already graduated its first class of physicians and other students are studying at medical schools at King Abdulaziz University in Jiddah, King Faisal University in Dammam, and abroad. In addition there are now four nursing schools in the kingdom.

Saudi women are especially enthusiastic about medical studies. Some 200 Saudi girls are enrolled in the medical school in Dammam alone, all of whom look forward to careers as sorely needed doctors for other women and for children. Nevertheless, with the competition for talent in the booming kingdom, medicine as a career still attracts fewer candidates than, for example, engineering.

Medical care in the kingdom is complicated by one situation unique to Saudi Arabia: the annual influx of 800,000 to a million or more pilgrims, most from abroad, who come by air, sea and road during theHajj, the Muslim pilgrimage to Mecca. Because these visitors may introduce communicable diseases to the kingdom, an immense preventive effort is required which, of course, temporarily diverts many of the kingdom's already strained resources.

Yet health care of pilgrims is also a demonstration of how well public health teams in the kingdom can function. The entire Ministry of Health, for example, moves for the time of the Hajj from Riyadh to Jiddah - the main port of entry - to mobilize the personnel necessary to enforce the kingdom's strict vaccination requirements and supervise sanitation programs for the huge crowds of pilgrims.

Public health programs, however, are not limited to pilgrims. According to Dr. al-Jazairi, the kingdom is also mounting a campaign to eradicate malaria and bilharzia and expects to have those diseases under control within four years. In an even more ambitious effort, health authorities say the kingdom hopes to have eliminated all communicable diseases by the end of the third Five Year Development Plan in 1985.

Meanwhile, other programs continue quietly and steadily. At Khamis Mushait's military hospital, a team of doctors from Loma Linda, California, periodically perform open-heart surgery on selected patients from across the kingdom. In the Eastern Province, Aramco, in cooperation with the Ministry of Health, continues its study of sickle-cell anemia. The study has already determined that the course of the hereditary disease, found locally in a few areas, is generally more benign than in the U.S. and elsewhere. If the project team can determine exactly why that is so, then here and throughout the world victims of the more severe type of sickle-cell disease can look forward to more effective treatment.

By such programs of research, buttressed by construction of new hospitals, modernization of older hospitals and continued developmen t of the KFSH referral facilities, Saudi Arabia hopes to provide tomorrow's medicine today.

This article appeared on pages 14-29 of the July/August 1979 print edition of Saudi Aramco World.


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