WHO EMR agrees regional mechanism to implement International Health Regulations

The World Health Organization Regional Committee for the Eastern Mediterranean concluded its 62nd session on 8 October with the adoption of important resolutions and decisions to advance the health agenda in the Region. The resolutions outline joint work expected from Member States and WHO in the areas of health security, prevention and control of emerging infections, prevention of cardiovascular diseases, diabetes, cancer, medical education, mental health, and assessment and monitoring of the implementation of the International Health Regulations (IHR 2005), among others.

Acknowledging progress made and ongoing challenges and gaps in relation to regional strategic priorities, the Regional Committee adopted the Annual Report of the Regional Director Dr Ala Alwan on the work of WHO in the Eastern Mediterranean during 2014.

Member States agreed on the establishment of a regional mechanism to assess implementation of the International Health Regulations (IHR) and to advise Member States on reinforcement of their national core capacities. This resolution is of major importance as under the obligations of the IHR, countries are collectively accountable for protecting their own populations, as well as global health security.

Noncommunicable diseases, the world’s biggest killers and a leading cause of death in the Region, were high on this year’s agenda. People are dying too young from heart disease, cancers and diabetes.

Participants endorsed a resolution that welcomed the efforts of the Regional Director to raise global and regional awareness of the magnitude of the problem and to strengthen action in the prevention and control of these diseases. The resolution urged Member States to take the necessary actions to reduce premature mortality from Noncommunicable diseases.

For the first time ever, the Regional Committee endorsed a framework for action on strengthening medical education. Health professions education is an important area in promoting public health, strengthening health systems and advancing country progress towards universal health coverage.

The mental health treatment gap in some countries of the Region is as high as 90% in some countries despite the availability of cost-effective and evidence-based interventions. The fact that a large number of countries in the Region are facing complex emergencies is contributing to increasing rates of mental disorders. To address this, Member States agreed to scale up mental health care and implement four strategic interventions related to governance, prevention, health care and surveillance.

Doha’s cancer research centre installs region’s first CyberKnife

The region’s first CyberKnife M6 FIM Suite was officially opened 1 December in the Department of Radiation Oncology at the National Center for Cancer Care and Research (NCCCR) in Doha.

It was opened by HE Abdullah Bin Khalid Al Qahtani, Qatar’s Minister for Public Health, along with HE Sheikh Abdullah Bin Saoud Al Thani, Governor of Qatar Central Bank and Chairman of the Board of Directors of the Sports and Social Activities Support Fund (Daam), Sheikh Faisal Bin Qassim Al Thani, Chairman and CEO of Al Faisal Holdings, Hanan Al Kuwari, PhD, Managing Director of Hamad Medical Corporation and Abdul Aziz Nasser Al Ansari, Secretary and Acting Executive Director of the Fund, Ahmed Salem Al Ali, Director of Programs for the Fund, both from Daam, Sports and Social Activities Support Fund.

CyberKnife is a state-of-the-art, treatment technology for cancer – effectively a compact radiotherapy linear accelerator mounted on a computer-controlled robot that can move in three dimensions around the patient. It is able to treat tumours anywhere in the body more accurately than any other treatment machine so that higher doses can be delivered with less effect on surrounding tissue.

Hanan Al Kuwari, PhD, explained how being the only organization to have this particular piece of equipment very much strengthened the cancer services offered in Qatar.

“We are very proud to have the new CyberKnife Suite at Hamad Medical Corporation. This adds to our already comprehensive range of radiation treatments for cancer and will mean a speedier recovery with fewer side effects for our patients. Our mission is to continually ensure that cancer patients in Qatar have access to the most advanced radiotherapy treatments, in line with those offered within the best cancer centres in the world. The implementation of this new service will have many benefits for patients and is a major boost for the NCCCR as an international centre for medical excellence.”

According to Dr Noora Al Hammadi, Senior Consultant Radiation Oncologist and Chair of Radiation Oncology, the treatment technology gives cancer specialists new options for treating difficult tumours. “CyberKnife allows us to treat tumours that were previously difficult or sometimes dangerous to treat with conventional radiotherapy or surgery, such as tumours close to the spine,” she explained. “By targeting the tumour from many different directions, the correct dose can be delivered without damaging the surrounding organs at risk. This a major advance in cancer treatment and we are pleased to be able to offer the service to our patients.”

CyberKnife will work in conjunction with state-of-the-art CT, MRI and PET machines that provide three dimensional imaging technology and are available at the NCCCR, to accurately map the location and extent of the tumours. This imaging is used by radiation oncologists precisely map the tumour in three dimensions and determine the dose required.

This information is then fed into the CyberKnife computer to program the robotic arm so that it delivers radiotherapy doses from many directions, always with a laser focus on the tumour site. During the treatment procedure, a separate integrated image guidance system works with the robotic arm so that it moves in synchronization with the patient’s breathing, ensuring submillimetre accuracy of treatment delivery.

“Because the machine is continually recording images throughout the treatment and moves with the patient’s breathing, any movement changes will be recorded and the system can correct itself,” explained Dr Al Hammadi. “This means tumours can be targeted with greater accuracy than was previously possible.”

The CyberKnife M6 FIM system at the NCCCR is the first in the region and one of the few worldwide to be equipped with the M6 Incise Multileaf Collimator – tiny computer-controlled leaves that allow for precise radiation beam shaping, further increasing the ability to target the dose distribution closely to the tumour and spare normal tissue.

Al Zahra Hospital opens waterbirth unit

Al Zahra Hospital has inaugurated of the first water birth department in Dubai. The initiative is part of the hospital’s aim to enhance awareness of healthy lifestyles, including natural birth.

The world is currently experiencing a powerful return of water birth due to its positive healthy impacts on both the mother and the child. As a global medical destination, Dubai has recently witnessed a high turnout for water birth, where a call for using this technique has widely emerged, aiming to reduce caesarean sections and alleviate labour pains. Studies conducted in this field have shown that water birth reduces labour pain by 60%-70%.

Dr Yamini Dhar, Head of Obstetrics and Gynecology department in Al Zahra Hospital, praised this approach where partial anaesthesia will no longer be necessary or might be used in a limited amount, if required. In addition, the mother gets to experience a new way of delivery that psychologically makes her feel better, since water birth provides an easy delivery process.

Dhar also pointed out that the hospital provides state of the art equipment used to perform this procedure as well as employing confident midwifery staff and doctors who can respect women’s choice and allow labour to progress at its own pace without active intervention when all aspects present low risk.

Women choose water birth as it reduces the need for opioid and regional analgesia and gives them the freedom to adopt the birth position of their choice. Water supports 70% of their body weight and therefore provides a natural option for labour. It reduces the pressure on her stomach and back, giving her a sense of relaxation.

The water birth unit at Al Zahra Hospital Dubai provides an excellent environment for the mother and the staff assisting her. Its water pool is equipped with a cutting- edge technology including a built in Bluetooth and lighting system designed to create the ideal mood for a smooth birth. It offers a very calming atmosphere with positive and motivational quotes, stools, ropes and birthing balls to facilitate the entire procedure.

The water birth procedure has preconditions that have to be met before the medical team can agree to go with this option for the delivery. These preconditions state that the mother should be between the ages of 17-35 with a normal full-term pregnancy and she should have no history of gynaecological complications in order to avoid any potential distress to the baby.

Cholera vaccination campaign success in Iraq

In November WHO reported that the the Government of Iraq, with the support of WHO and UNICEF, completed the first round of the oral cholera vaccination (OCV) campaign. The campaign has vaccinated 91% of the targeted population the targeted 255 000 Syrian refugees and internally displaced Iraqis across 62 refugee and IDP camps in 13 governorates. The turnout was very high with no refusals or concerns raised regarding the vaccine. A second round was due to begin in December to administer a second dose to ensure protection against cholera for 5 years or more.

The OCV campaign was discussed and agreed by stakeholders in September 2015. This was followed by planning and training sessions for governorate-level managers of the expanded programme on immunization in Baghdad on 26 and 27 October.

On 28 October, training was provided to 1302 vaccinators and 651 social mobilizers in preparation for the first round of the mass vaccination campaign.

The Shanchol vaccine used in the campaign is a WHO prequalified vaccine. To achieve the required protection among high-risk groups, 2 doses of OCV Shanchol vaccine need to be administered with an interval of 2 to 6 weeks.

The first round of the campaign, lasting an initial 5 days, began on 31 October and the second round was due to take place in early December 2015. The administration of a second dose is needed to extend the duration of protection for 5 years or more. The vaccine was administered to all persons over one year of age living in the target camps.

Cholera vaccination is an additional preventive measure that supplements but does not replace other traditional cholera control measures. “We need to intensify health promotion and education activities to help communities protect themselves and their families from cholera and other communicable diseases,” said acting WHO Representative Altaf Musani.

Medcare opens 10th clinic in Dubai

King’s College Hospital London and Ashmore Group will launch a multi-disciplinary hospital and several day care clinics in Dubai. Al Tayer Group, a diversified regional business, and Dubai Investments PJSC, are local equity partners in the project.

After the successful launch of King’s College Hospital’s flagship Abu Dhabi clinic, which recently celebrated its first anniversary, Dubai is set to become home to an 80-100 bed world-class hospital facility and several clinics which will all be fully integrated with King’s College Hospital’s facilities in London. King’s College Hospital Dubai will be located in ‘Dubai Hills’ (being developed by Emaar and Meraas) UK-based Ashmore Group will act as the investment manager for the project.

The first facilities – a number of clinics – are expected to open their doors towards the end of 2016 and in 2017, in locations across Dubai. This will be followed by the 80-100-bed multi-specialty King’s College Hospital Dubai scheduled to open in 2018. The hospital will offer four specialties – Paediatrics, Endocrinology, Orthopaedics and Obstetrics & Gynaecology – as well as other acute and general medical services. In line with the existing operating model of the Abu Dhabi clinic, all staff and services will be fully integrated with King’s College Hospital London to ensure provision of quality, evidence-based healthcare to UAE and regional consumers, with a significant proportion of experienced clinicians joining Kings College Hospital Dubai from the UK.

Commenting on the announcement HE Humaid Al Qutami, Chairman of the Board and Director-General of the Dubai Health Authority said: “The UAE’s relationship with King’s College Hospital London has been strong for more than 30 years and we welcome the addition of this world class brand to our ever-expanding offering of healthcare providers in line with the UAE’s 2021 vision of achieving a world-class healthcare system.”

AUBMC’s Dr Nagi El Saghir wins award for breast cancer research

Dr Nagi El Saghir, professor of clinical medicine and hematology-oncology at the American University of Beirut Medical Center (AUBMC), has been awarded the 2015 CNRS Research Excellence Award for “his outstanding contribution to the understanding of breast cancer in young women, genetic mutations, downstaging and improving outcome of breast cancer patients in Lebanon.” The award ceremony was held at the Grand Serail in Beirut in November.

The annual award by the Centre National de Recherche Scientifique (National Center for Scientific Research) recognizes scientists who excel in conducting research in different scientific disciplines in Lebanon. The award is meant to reinforce scientific research and innovation and to direct research to respond to national needs. “It is a great honour for me to be recognized by the CNRS for the cancer research I am doing in Lebanon,” said Dr El Saghir.

“Such recognition is a great stimulus for me and our group to continue our research and to advance it further. Without research, we could not have documented nor known that half of breast cancer cases in Lebanon occur in women below the age of 50 and that most women in Lebanon and Arab countries with breast cancer were diagnosed at an advanced stage; and we would not have known what to do to lower these rates. It is because of such research data that we have embarked on studies to learn of the causes of cancer in young women, and we have launched large-scale awareness campaigns that helped reduce the number of cases of advanced breast cancer by detecting the disease at early stages.

“Our 2014 study showed that there is a recent decrease in advanced breast cancer, with more than 60% of patients now diagnosed as early stage I and stage II. We showed that we are performing less total mastectomies and more partial mastectomies that conserve women’s breasts; and more than 90% of women with stage I, and more than 80% of women with stage II are alive and free of disease after 10 years. Those are excellent results and show that we have changed the face and outcome of breast cancer in Lebanon,” said Dr El Saghir.

Spreading the word that early breast cancer has become curable, have reduced the fear of cancer and more women are enrolling in screening and early detection campaigns. However, Dr El Saghir notes that there is still lots of work to do to reach all women. He also organizes fundraising campaigns throughout the year to help breast cancer patients in need for financial support at AUBMC, and started breast cancer patient support groups at the Naef K. Basile Cancer Institute at AUBMC.

Qatar’s organ donors honoured

Qatar’s Hamad Medical Corporation’s (HMC) Organ Donation Center (Hiba) in November honoured 41 organ donors and their families for giving the gift of life at the annual “Celebration of Life” event, held at Sharq Village and Spa.

The event was attended by His Excellency Abdullah bin Khalid al Qahtani, Minister for Public Health and Hanan Al Kuwari Phd, HMC’s Managing Director and honoured 33 living organ donors and the families of the eight deceased donors, for their contribution to the health of the nation and the organ donation program.

Seven Qatari organ transplant recipients who chose to have their transplant surgery in Qatar rather than going abroad during 2015 were also honoured. Supporters of the program were also thanked for their contribution including Qatar Red Crescent and representatives of the 12 shopping malls who donated space for the organ donation campaign to share their message with the public.

Dr Yousef Al Maslamani, Director of HMC’s Qatar Center for Organ Transplantation said the organ donation program has seen remarkable success in the past few years. “Through awareness programs, especially the ongoing public awareness campaign about organ donation has managed to bring about a large shift in public understanding and perspective of this important topic,” he said.

“It is important to thank those who contributed to the program, especially our living donors and deceased donors and their families. They have truly given the gift of life.

“The greater number of organ donors has led to an increase in kidney transplant procedures as well as enabling new procedures to take place, such as liver transplants and paediatric kidney transplants.” Mohammad Saad Al Rumaihi, a kidney transplant patient who received care at HGH, commended HMC’s efforts in the area of organ donation.

He said HMC has succeeded in changing the views and perceptions of many Qatari patients who previously opted to travel overseas for their treatment and transplants.

Qatar Organ Donation Center (Hiba) Director Dr Riadh Fadhil said the Center had achieved its goal of doubling donor registrations to 100,000 in 2015. “Organ donation saves lives and enables opportunities to develop the organ transplantation program,” Dr Fadhil said. “HMC’s full commitment to the Doha Donation Accord has seen the number of registered donors increase significantly over the last four years from 2000 to more than 100,000.”

“These advances have been achieved through strict implementation of the ethical principles of the Doha Donation Accord, excellent infrastructure, and the unwavering support of HMC’s leadership, especially our Managing Director, Hanan Al Kuwari PhD and the highly motivated and dedicated medical, nursing and support staff of Qatar Organ Donation Center and Qatar Center for Organ Transplantation.”

Polio outbreak stopped in Middle East, but experts remain cautious

Despite continuing conflict, declining immunization rates in conflict-affected areas and mass population displacement, no new polio cases have been reported in the Middle East for over 18 months, and experts believe the extensive multi-country outbreak response has been effective in stopping the outbreak.

The outbreak, which was detected when a case of polio was confirmed in northern Syria, paralysed 36 children in Syria and 2 in Iraq between October 2013 and April 2014, prompting fears of a major epidemic. In what has become the largest ever immunization response in the history of the Middle East, more than 70 mass immunization campaigns were implemented in 8 countries, aimed at reaching 27 million children with vaccine multiple times, and more than 200 million doses of vaccine were given.

“The response in the Middle East is one of the most well-coordinated and intensely focused outbreak response efforts we’ve seen in the history of eradication programmes,” said Chris Maher, Manager Polio Eradication and Emergency, WHO. “We congratulate governments, health partners and communities around the Region for the role they’ve played in preventing a major epidemic.”

The swift and collaborative intervention and effective partnerships between the governments of countries dealing with the outbreak, World Health Organization (WHO), UNICEF, other global Polio Eradication Initiative partners, international organizations and nongovernmental organizations has been given credit for the successes of the response and the lessons learned have been shared globally. “In such a complex environment, teams were working round the clock to reach missed children and engage in social mobilization with communities and raise awareness about the vaccination” says SM Moazzem Hossain, regional Chief of Child Survival for UNICEF.

Representatives from governments and the Global Polio Eradication Initiative met in Beirut late October to review the outbreak response and discuss next steps to maintain the gains made. Experts strongly encouraged governments to continue working with partners to strengthen the basic delivery of routine immunization and focus on further strengthening surveillance so that the virus will be detected should it reappear. Despite the positive news for the Region, the risks and factors that led to the outbreak remain and complacency at this time could be disastrous. In the Region, up to 700,000 children under the age of 5 are not reached on a regular basis by polio vaccinators.

“Across a number of countries in the Region, insecurity and displacement of communities is making it difficult to reach all children with vaccines,” WHO’s Maher said, “the job of our partnership is far from done, over the coming months we will continue to work together to reach children to be able to sustain the achievements and keep the Region polio free.”

Meanwhile in Yemen, Inactivated Polio Vaccine (IPV) was formally introduced into the routine immunization programme in November in Sana’a, Yemen for all children under the age of one. The introduction, which is supported by GAVI - the Vaccine Alliance, WHO and UNICEF, came as a significant step towards eradicating polio and enhancing Yemen’s immunization programme. Currently, there are no cases of polio in Yemen.

“This is a significant step in eradicating polio as part of the Global Polio Endgame strategic Plan,” says Dr Ahmed Shadoul, WHO Representative for Yemen. “It’s a huge achievement to introduce this vaccine, given the major security, political and economic challenges facing Yemen today.” The planned introduction of IPV for polio eradication represents the fastest global introduction of any new vaccine in low- and middle-income countries in recent history. Yemen is one of 126 countries that are introducing the vaccine in 2014–2015.

“Yemen is committed to eradicating polio so the national immunization programme has made every effort to introduce the vaccine,” said Dr Ghada Al-Haboob, Director of the Expanded Programme on Immunization. “We are doing our best to ensure that every child receives this vaccine in order to maintain the advances made in the field of immunization.”

The new vaccine does not replace oral polio vaccine (OPV) doses. The IPV and OPV doses will together further boost the immunity of children against polio. The formal introduction of IPV was preceded by intensive training for health workers and vaccinators in all governorates in Yemen.


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