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Cancer care AbroadNational look
Ahmed I Al-SagheirHematologist and medical oncologist
KFSH-DammamKing Saud University
Saudi Arabia
Fatimah A
• 55 yrs old, new seisures, and breast mass– Mammogram: suspecious, FNA: cancer– CT: confirms metastases, to CNS, bone and liver.– Family meeting
• Need to start palliative radiotherapy and chemotherapy, both are available
• Poor prognosis
• A week later the family wants a medical report, pathology slides and want advise about going to US, Germany or UK and may be Thiland.
Introduction
• Cancer care…definition• What do patients want?
• What does the society want?
• What does the health of the society need?
No good Data
What is the magnitude of the problem?
Introduction
• Cancer care…definition• What do patients want?
• What does the society want?
• What does the health of the society need?
Cancer care– Not only therapeutic
intervention– Screening programs– Early detection– Palliative care
Patients need
• Best possible care
• Access to health care
• Support– Education– Communication– Family support– Financial support
Why do patients choose to go
abroad ?
Patients need
• Best possible care
• Access to health care
• Support– Education– Communication– Family support– Financial support
• Pros– Confidence in health
care– Lack of confidence in
local services– Assumption that
medical errors are less frequent
– Availability of the option– Culture and expectation
Patients need
• Second opinion• Tourism
– Summer vs winter
• Political gains
• Pros– Confidence in health
care– Lack of confidence in
local services– Assumption that
medical errors are less frequent
– Availability of the option– Culture and expectation
Patients need
• Cons– Illness and homesickness– Unnecessary delays– Un-necessary diagnostic
procedures– Lack of familiarity with local
diseases• G6PD
– Lack of support• Societal
• religious
– Financial costs
• Pros– Confidence in health
care– Lack of confidence in
local services– Assumption that
medical errors are less frequent
– Availability of the option– Culture and expectation
Society prospective
• History – Generations of
patients going to Iraq, lebanon and Egypt
• Culture• Inferiority complex• Value system
– Guilt feelings
• Health sector is a major financial drive
• Jobs• Opportunity to
support loved ones during illness
• Companions– Vacation– Family disturbance
• Charity
Public health prespective
• Establishing national registry
• Building on experience– Training
• Long-term care– Cancer survivors
• Costs
Cost of lost opportunities
• Building on experience– Developing training for doctors, nurses, pharmacists,
etc
• National registry– Which ultimately will help identifying pattern of
disease– Help in prevention and planning
• Jobs• Social impacts
No good Data
What is the magnitude of the problem?
Health system in SA
• Ministry of Health (MOH)– KFMC– KFSH-D
• King Faisal Hospital and Research system (KFSH&RC)
• Security forces health system• National Guard Hospitals (NGH)• Military hospitals (MH)• University hospitals• Private sector
New cancer casesSaudi Arabia experience
Population 26 MKFSH&RC NGH KFMC KFSH-D Abroad
2005 ~3000 -- -- -- --
2007 2500 950 800 660 --
2008 ~2300 1000 1000 900 100
Budget
2008
3.2 Billion
SAR
--- 1.6 Billion SAR
1 Billion
SAR
1 Billion
SAR
1 SAR = 0.266 US $
Contributing Factors
• Way the media deals with the medical errors– Exaggeration of medical errors
• How do health care providers act?– Public awareness– Sharing experience
SolutionsTargetting Patient satisfaction
• Satisfied patients are more likely to accept therapy compliance outcomes
• High impact easy gains– Nursing quality and courtesy– Cleanliness of the hospital
Some suggestions
• How would we act as role models?
• What massage does our own actions give..– Story of AbdulRahman Al-Sagheir…my son..
Case AbdulRahman Al-Sagheir
Some suggestions
• Starting research on identifying predictors of good health care at national level
• Monitoring referrals abroad– Indications– Monitor outcomes
• Quality intiatives– Private– Government sectors
• Involving media in talking about achievements• Providing second opinion thought telemedicine
Conclusion
• Cancer care…definition• What do patients want?
• What does the society want?
• What does the health of the society need?
Cancer care– Not only therapeutic
intervention– Screening programs– Early detection– Palliative care
Case AbdulRahman Al-Sagheir
Thank
You