Jordan Report - Health Tourism



An admirable reputation

With one of the most developed healthcare systems and some of the most advanced
clinical facilities in the region, Jordan attracts its fair share of foreign medical patients.
Middle East Health visited the kingdom and spoke to several of its leading hospitals to
find out the extent of medical travel to the kingdom. How many foreign patients are being treated in the kingdom, where they’re coming from and what treatments are they seeking?

For the past several decades the Hashemite Kingdom of Jordan has maintained a reputation in the Middle East for providing some of the best healthcare available in the region. The country’s doctors are trained to a very high standard with many doing their residencies and specialist training in leading medical schools in the United States and Europe. Several of the kingdom’s hospitals, particularly in Amman, also An admirable reputation operate to the highest standards with a handful of them having achieved the much lauded JCI (Joint Commission International) accreditation status.

Jordan has the highest spend on healthcare in the region – some 10.5% of GDP – putting it on a par with evolved economies such as the US and Western Europe. Oil-rich Saudi Arabia, for example, spends only 3.4% of GDP on healthcare. Germany, on the other hand, spends 10.7% of GDP on healthcare (all figures WHO 2005).

Jordan’s high tech hospitals, such as the King Hussein Cancer Center, the Specialty Hospital, the Arab Medical Centre and Al Khalidi Medical Center, its world class healthcare at costs significantly less than those of Europe and the US, combined with an abundance of easily accessible premier tourist attractions such as Petra, the Dead Sea and Jerash, make this destination an excellent choice for people considering travelling abroad for healthcare.

Whilst in Jordan we spoke to the directors of several leading hospitals in the capital, Amman. Below are excerpts of an interview with Dr Fawzi Al- Hammouri, the CEO and General Manager of the Specialty Hospital and the Chairman of the Private Hospitals Association, a group established to promote Jordan’s healthcare abroad.

Excerpts from an interview with Dr Fawzi Al Hammouri, Chairman of the Jordanian Private Hospitals Association

■ Callan Emery: How many foreign patients visit Jordan each year?
● Fawzi Al Hammouri: In 2006 we received more than 130,000 patients from abroad.

■ CE: From which countries do most of them come?
● FH: It varies according to the political situation in the Middle East. In 2006 the number one nationality was Iraqis, followed by Sudan, the Gulf States, Yemen, Palestine, Syria, Libya and Algeria. Actually, we have seen patients from 48 countries.

We are receiving more patients from African countries such as Chad and Nigeria. We also see patients from Europe and America, as well as from previous Soviet Union countries, such as Uzbekistan and Kazakhstan – we are focusing on attracting patients from these countries at the moment.

■ CE: What are the main treatments that these patients seek in Jordan?
● FH: Most patients visit for treatment for cardiovascular disease, kidney problems, orthopaedic surgery, neurosurgery, plastic surgery, IVF and eye surgery. We have a number of hospitals that are specialised in eye surgery, such as the Eye Hospital in Amman.

■ CE: Why do patients visit Jordan, as opposed to other possible destinations? Is it less expensive for them, or do those specialties not exist in their countries?
● FH: Jordan is now well known as a medical centre of excellence. Jordanian healthcare had several notable achievements in the 1970s and 80s that were firsts in the region, such as the first open heart surgery and first heart transplant in the region.

[Jordan’s first open heart surgery was conducted in the Amman Military Hospital on 17 May 1970, and the first heart transplant was completed on 9 August 1985 at the Queen Alia Centre for Heart Surgery and Treatment.]

This was unique at that time and it is from then that people have been hearing about the medical achievements in Jordan – particularly in cardiovascular and kidney transplants. Over time more good hospitals have been built.

■ CE: And the cost?
● FH: The cost is quite reasonable. For instance if you want to have open heart surgery in the United States you have to pay in the region of US$100,000. You can have open heart surgery in Jordan for $15,000. Even in places like Saudi Arabia, open heart surgery costs in the region of $25,000 to $30,000. In Sudan, which I visited recently, I was surprised at the cost of open heart surgery, which is double what it is in Jordan, even though the level of care is so different.

■ CE: What other attractions does Jordan have?
● FH: Jordan is a peaceful, stable country politically. It is safe to be here. We are proud of our safety, particularly when you compare it to other countries in the region.

■ CE: Do medical visitors need visas?
● FH: Most nationalities don’t need a visa to enter Jordan, which makes it considerably easier to travel here. So taking all this into account we have many advantages over our neighbours. Places like Dubai, Qatar and Saudi Arabia are not competitors as they are trying to attract only the high-end market. We attract the highend, middle income and lowincome groups.

■ CE: What are you doing to promote health tourism?
● FH: As the PHA (Private Hospitals Association, of which Dr Fawzi Al Hammouri is the Chairman) we are doing a lot. We attend exhibitions and participate in conferences across the region and further afield.

For instance we attended the Medical Tourism Association conference in San Francisco in September – a big conference with a global audience of around 1,200 people. We had eight hospitals participating in the exhibition and we were able to tell the Americans that we have hospitals in Jordan that have JCI accreditation.

We can also tell them that patients will be treated by US-graduate physicians and they will have insurance against liability. We invite delegations from many countries. Every year we have 4 or 5 groups visiting Jordan to see the hospitals and level of care that we provide. We also hold several medical conferences throughout the year and invite physicians from the region.

And we carry out marketing campaigns in the various media. All this increases our exposure to the health travel market.

■ CE: Is health tourism growing in Jordan?
● FH: Yes. Over the last three or four years the number of non- Jordanian patients has increased between 5% and 8%, but it varies from one hospital to another.

■ CE: Are you concerned that patients from Saudi, UAE and Qatar will stop travelling to Jordan as their healthcare facilities improve in those countries?
● FH: Actually what we have noticed is that the number of visiting Saudi patients is increasing.

It appears patients in northern Saudi Arabia prefer treatment in Jordan for a number of reasons – it is cheaper than going to Jeddah or Riyadh and it is closer. They also have confidence in the Jordanian doctors. So we expect to keep seeing patients from this region in Saudi. Even though patients should be starting to take advantage of the new hospitals being built in Saudi Arabia, we realise that building hospitals is not enough – they must have human expertise and this is where we are at an advantage.

● For a complete list of all hospitals which are members of the Private Hospitals Association of Jordan, including details of their specialties and their contact details, visit: www.pha-jo.com

Top treatment:
The following is a brief review of select hospitals in the Private Hospitals Association of Jordan

King Hussein Cancer Center

When King Hussein Cancer Center (KHCC) was establishing itself, it initially partnered with the US National Cancer Institute in Bethesda, Maryland, which offered guidance and training.



KHCC is a very comprehensive cancer centre offering everything required for cancer diagnosis, treatment, management and social care, including surgery, radiotherapy, chemotherapy, paediatrics, psychooncology, palliative care, pain management, child play, back to school programmes with inhouse teachers and more.

The hospital has two JCI accreditations – a general one and most recently an oncologyspecific accreditation. It is the only centre in the world outside the United States to have this specialist award.

“This specialist JCI accreditation looks at protocols and how we deliver care to the patient, what kind of therapy we give and how we use the data from the therapy to improve patient outcomes. It requires more physician involvement than the general JCI, which looks at systems, safety regulations and administration,” explains Marmoud M. Sarhan, MD, CPE, Director General and CEO of KHCC, and Professor and Director of the Bone Marrow and Stem Cell Transplantation Programme.

KHCC was awarded the oncology specific accreditation in December 2007 and it lasts for three years.

Dr Sarhan said that KHCC uses clinical pathway guidelines (CPG), a system that ensures treatment is consistent. “If you have a stage 2 breast cancer patient, for example, this ensures the way you treat them is the same each time – it is consistent.

Each disease has a CPG – breast cancer, brain cancer, infant leukemia, chronic leukemia and so on. The clinical team follows these guidelines which minimises variation and ensures consistent quality.

“After a year or so we look at the results and compare them to the West and then see where we can improve it. Initially these guidelines are taken from the US of Western Europe, but whether they are appropriate or not, you cannot know without looking at the outcome,” Dr Sarhan says. Following this analysis the protocols can be adjusted to better suit the local population and environment. There are many factors that can influence the different outcomes on different population groups using the same treatment protocol, such as genetics and nutrition, says Dr Sarhan.

KHCC is a 180-bed hospital. “Everything that is needed for cancer treatment is available,” says Dr Sarhan. This includes CT, CT-PET, MRI, dual head gamma cameras, linear accelerators and so on. The hospital has large outpatient facility and sees around 80,000 outpatients a year.

“We have multi-disciplinary teams,” he added. “So a patient with cancer will be treated by a medical oncologist, a radiologist, a pathologist, a surgeon. He will be seen by all the subspecialties related to his disease at the same time to device a plan of care according to the CPG. We spoke to Dr Sarhan before the expansion of the hospital to the current 180 beds. At that point he said KHCC was full to capacity with only 12% of patients from outside Jordan and 88% Jordanian.

“With the new expansion we’re hoping we can accomodate 20-25% of patients from outside Jordan in the following couple of years.”

Most foreign patients at KHCC were from Iraq and the rest evenly distributed between UAE, Kuwait, Bahrain Libya, Sudan and Palestine.

The Specialty Hospital

The Specialty Hospital is a 250- bed multispecialty equipped with some of the latest technology, such as Open MRI, a 3T MRI and 64-slice CT. The hospital has 10 theatres with state of the art technology and telemedicine facilities.

The hospital serves as a teaching hospital in six specialties – general surgery, gynaecology, paediatrics, general medicine, radiology and anaesthesia. Hospital services include all the general services in medicine, surgery and gynaecology as well as specialist services for laparoscopic surgery, cardiac surgery, joint replacement and transplant surgery – such as kidney and corneal transplants.

There is also a fertility centre offering IVF treatment and the hospital was expected to have completed building a second Cath Lab by the end of 2008 to cater to the high demand for interventional cardiology.

Regarding foreign patients, the Specialty Hospital sees patients mainly from Sudan, Libya, Yemen, Palestine and Iraq.

The hospital has 18 royal luxury suites (18 more were due to be completed by end 2008) and a concierge service (a non-Jordanian Patients Office) to arrange airport transfers, tours of Jordan, Syria, and other foreign patient travel services.

Al Amal Hospital


We also spoke to Dr Raja al Karaki, the scientific director of the IVF Unit at the Al Amal Hospital established in 1994 in Amman.

Al Amal is highly regarded as a maternity hospital and for it obs/gyn and fertility treatments.

Dr Karaki said about 50-60% of their patients are non- Jordanian. She said most were from Libya and Iraq, but they also see many patients from the Gulf countries and Palestine and Syria.

“We have also had couples from Canada, USA and Venezuela”.

“They visit because of our good reputation and we’re less costly. “Most come for IVF treatment after years of infertility,” she explained.

Al Rashid Hospital

Al Rashid Hospital is the only private psychiatry and drugaddiction centre in the Middle East.

The 120-bed hospital has 50% of its patients from Jordan, 30-40% from Arabic countries and the balance from Europe “who are mostly tourists in Jordan who fall ill with a psychiatric episode while on vacation and are sent here”, says Rifat al Masri, the director of Al Rashid Hospital The hospital also serves as a teaching hospital and is recognised by the Arab Board of Psychiatry and the Jordan Board of Psychiatry.

The hospital treats and rehabilitates patients for drug addiction, easting disorders and psychiatric disorders.

Arab Medical Center


The Arab Medical Center is an upmarket, prestigious multispecialty hospital, which focuses largely on the Jordanian market, although up to 20% of it patents are foreign coming mostly from Saudi Arabia, Sudan and Palestine.

The 142-bed hospital was established in 1994, originally as a cardiac and specialist surgery centre, but within a few years developed into a multi-specialty centre. It has a consultant set up, whereby consultants in private practice use the hospital for surgery, radiology and so on.

The hospital is used by the UK and US embassies and they take referrals from the government and the Palace. 


Pain management specialist joins
Al Khalidi Med Centre

Al Khalidi Medical Center, Amman, Jordan, has proven over the 30 years of its history to have its patients’ best interests at heart and has manifested that in its relentless pursuit of the latest medical technologies and techniques, in addition to its passion for employing unique medical talents and worldclass specialist doctors. The latest specialist doctor to join Al Khalidi medical staff is Dr Sadik Nezar Haba. He comes to KMC after training and working as a staff physician from the world-renowned Harvard Medical School. Dr Sadik is an Anesthesiologist and an Interventional Pain Management physician – Jordan’s first and only bona fide specialist on pain management, a specialty that is rare even in the United States. He is bi-boarded by the American Board of Anesthesiology and the American Board of Pain Medicine. His major clinical interests include treating chronic pain disorders originating from the spine.

“We’re proud to welcome Dr Sadik, who brings unique, extensive experience in the specialty of pain management to our medical staff,” said Dr Ibrahim Al Khalidi, KMC Managing Director. This initiative is another example of KMC’s continued commitment to increase access to physicians in much-needed medical specialties while enhancing facilities, programmes and services.

The breadth of chronic pain management has grown tremendously ever since its formal inception in the early 1990’s when it was recognised by the American Board of Medical Specialties. The emphasis on minimally invasive techniques in medicine has made major advancements, especially in the field of pain medicine. It used to be that if one had any treatable disease originating from the spine, then most likely their only option of treating the problem was traditional open surgery of the spine, which is a major surgery involving general anaesthesia that does not always “cure” the patient of his/her symptoms.

Nowadays, the reasons for electing to have a traditional open spine surgery are becoming fewer and fewer with the armamentarium of the latest Interventional Pain techniques being available. The idea of Interventional Pain Medicine is that after a consultation takes place, a plan is devised to try to uncover the source or sources of the patient’s pain. This is done by minimally invasive procedures using real time X-ray guidance and local anaesthesia. The initial procedures are both diagnostic, as well as therapeutic. It may take the patient a few rounds of therapy before un-roofing the exact pain generator; this is because it can be very difficult to elucidate a pain generator from the spine, unlike other areas of the body plagued by pain. Patients usually respond very well to these initial forms of treatment and do not require any other type of treatment. However, sometimes it is necessary to undergo maintenance procedures over a longer length of time to keep the pain at bay. If more definitive treatment is needed, there are other procedures that can be done, which again are all done using X-ray guidance and occasionally a small amount of sedation. All types of spinal pain can be treated using these methods. It doesn’t matter if the pain originates in the neck or the back, there are many treatment options. The idea is that you start from the least invasive treatment option and only progress to other more invasive methods if need be. This scientific algorithmic approach spares the patient unnecessary risk and suffering of the older techniques unless its absolutely necessary. The most common forms of spinal pain, whether they come from the neck or back, are disc herniations, spinal stenosis and arthritis, all of which can be treated by minimally invasive therapies.

Dr Sadik also treats chronic pain originating from cancer, headaches/facial pain, diabetes, osteoarthritis, post-herpetic neuralgia, vascular disease and all forms of chronic pain resulting from any previous surgery, especially failed back surgery.


● For more information visit: www.kmc.jo    


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ate of upload: 25th January 2009

                                  
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