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.
