Regional profile - Jordan

Ancient land – modern medicine

Jordan sees many visitors who come to savour the country’s historical sites such as the ancient city of Petra, but it is not only for the history that they come. More and more are visiting the county to make use of its first class healthcare facilities. Middle East Health visited some of the country’s leading hospitals to find out why.

The Hashemite Kingdom of Jordan has a wealth of history with many ancient and well preserved historical sites. It is a relatively small country (population 5.6 million) with a good road network making it easy to get around.

By far its most wellknown attraction is the World Heritage Site of Petra. This ancient Nabataean caravan-city was an important crossroads between Arabia, Egypt and Syria- Phoenicia. Petra is halfbuilt, half-carved into the rock and is considered one of the world's most famous archaeological sites, where ancient Eastern traditions blend with Hellenistic architecture. However, there is much more to Jordan – from the well preserved Roman ruins at Jerash in the north to the spectacular diving at the Gulf of Aqaba on the Red Sea in the south. The country is dotted with Crusader castles and Arabic forts, the mesmerising desert landscape at Wadi Rum and the rejuvenating saltwater of the Dead Sea.

But the country does not attract visitors exclusively to its cultural and historical sites. Increasingly visitors, particularly from the Arab world, but also as far away as South Africa, are travelling to the country to make use of its first class healthcare facilities. These are largely based in Amman, the ancient capital. Middle East Health visited some of these hospitals and clinics to find out more.

The development of Jordan’s healthcare infrastructure has essentially taken place over the past 40 years following independence from Britain in 1946 and the establishment of the Hashemite Kingdom of Jordan. In the following years the Ministry of Health established many of the important pillars of the country’s healthcare infrastructure, including a nursing college in 1953, the establishment a central laboratory for medical tests in 1955; the implementation of the country’s first health insurance system for the Armed Forces in 1963 and for civilians in 1965.

During these years various laws were implemented to protect public health. According to 2001 statistics from the Ministry of Health infant mortality is 23.8 infant deaths per 1,000 live births; life expectancy at birth for the kingdom's population is 68 years for males and 71 for females; population growth was estimated at 2.78%, and the fertility rate at three children per woman.

The leading causes of death according to Dr Abdallah Bashir, Chairman Board of Directors, Jordan Hospital, are, as it is in other developed countries, cardiac-related diseases and cancer. Doctors with whom Middle East Health spoke said there were no diseases peculiar to Jordan. They said there was relatively good health education through-out the country and noted that the incidence of AIDS was low. However, Dr Najeeb Layyous, a well respected gynaecologist and obstetrician and IVF specialist based in Amman, told Middle East Health that in the rural areas there is a high incidence of genetic problems, largely due to intermarriage or consanguinity.

“There is a lack of genetic counselling,” Dr Layyous pointed out, “and although the Government has made progress in pre-marital genetic testing, it is only for Thalassaemia. “This creates a false sense of security,” he emphasised, “as there are many other genetic diseases.” Related couples are being screened for Thalassaemia and being cleared and then think they have nothing to be concerned about regarding genetic abnormalities, he said. “Even families who have had genetic problems don’t talk about.

They hide it from other family members because of the stigmas attached to such diseases. “There needs to be more government education about the issue.” Dr Layyous did, however, remark that the situation had improved considerably over the past 15 to 20 years. “The media has had a large effect. More patients are seeking help although they want to keep it quiet.”

Health insurance

According to a report in the Jordan Times in January regarding health insurance, within two years 95% of Jordanians will be covered by the national health insurance scheme. Health minister Saeed Darwazeh, said currently 80% of the population are covered by national health insurance. The Ministry of Health (MoH) is planning to upgrade the agreement with private hospitals whereby patients will be referred for treatment by the MoH and public hospitals.

According to the newspaper such patients pay 20% of private healthcare costs and this was expected to increase under the new scheme. The health minister said the new scheme will enable patients to choose from 56 private hospitals compared to only three under the present scheme. Dawazeh said that beneficiaries of the current scheme were largely government employees and their dependants and called on citizens not covered by any health insurance to apply for coverage in the new scheme in the second half of this year.

Jordan hospital

Jordan Hospital in Amman is a fully comprehensive medical facility offering expert medical and multispecialty care. “The hospital receives referrals for tertiary care from all Arab countries,” Dr Abdallah Bashir, consultant surgeon and chairman of the Board of Directors, Jordan Hospital, told Middle East Health.

He pointed out that the hospital’s rates are approved by the Jordanian Ministry of Health and the Jordanian Medical Association.

The hospital has ISO 9002:2000 certification. It is also well-recognised for its post-graduate medical education and training. “Each specialty is a medical centre,” Dr Bashir said.

For example the endocrinology and diabetes medical centre was setup in 1998 when two well-known specialists in the field of endocrinology and diabetes in Jordan, Dr Mohamed El-Zaheri, (a diplomate of the American Board of Internal Medicine and the American Board of Endocrinology and Metabolism) and Dr Omar Abu- Hijleh (Member of the Royal Colleges of United Kingdom and Masters Degree in Endocrinology and Diabetes [UK]) combined their private practices and efforts to establish the Jordan Center for Diabetes & Endocrinology (JCDE).

The centre treats all types of diabetes and is equipped to carry out the following procedures: Thyroid Ultrasound and fine needle aspiration (FNA); Dynamic testing of various endocrine functions; Assessment of diabetes control by blood and urine testing; Electrocardiogram and Peripheral Vascular Doppler.

Dr Bashir said that the hospital was renown for a number of specialties, in particular, neurosurgery with robotic surgery, cardiology and transplantation including liver and bone marrow. The 300-bed hospital is equipped with modern technology for conventional radiology, interventional radiology and digital angiography and fluoroscopy. Among its range of modern equipment is a 16-slice CT scanner, 1.5T MRI and ultrasound with colour Doppler. Jordan hospital has four intensive care units – neonatal, paediatric, adult and neuro.

“Our coronary care unit comprisses four beds for angina, myocardial infarction and post cardiac catheterization and angioplasty,” Dr Bashir noted. Its medical centres include the JCDE; the International Medical Center – affiliated with the Boston University Medical Center – specialising in sexual dysfunction and prostate diseases; the Obesity Center for morbid obesity treatment; and the Jordan Osteoporosis Diagnostic and Therapeutic Center with DEXA (the hitech bone densitometer).

The hospital has its own laboratory and pathology labs, including those for haematology, genetics, microbiology and histopathology among others. The hospital is kept busy particularly with a 24-hour ER. “We received 22,680 ER cases in 2004,” Dr Bashir pointed out. “In 2003 in-patient admissions numbered 14,604, however, in 2004 the hospital put in 66 extra beds and admissions increased to 17,500.”

Asked why Jordan is a popular destination for patients from Arab countries Dr Bashir said: “Visitors come here because they have confidence in the doctors, all of whom are Jordanian and either US, UK or West German board certified.”

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Jordan University Hospital

Jordan University Hospital (JUH) in Amman is big. It covers the whole gamut from family medicine to open heart surgery and everything in between. The 540-bed hospital is the main teaching hospital in Jordan.

It was established in 1971 by the Ministry of Health to serve as a referral hospital and was called Amman Grand Hospital. In 1975 the hospital was transferred to the University of Jordan and was affiliated with the Faculty of Medicine. The hospital serves three core functions – a teaching facility for the Faculty of Medicine at the University of Jordan Medical School, a research facility and as a healthcare facility. As a healthcare facility “it serves as a referral centre for the Ministry of Health, the Royal Corps and the private sector”, professor, Dr Mahmoud Abu-Khalaf, director general JUH, told Middle East Health.

“As such we try to keep costs down and make it affordable. In-patients pay around JD100 (about US$140) a day.” Regarding its role as the main teaching hospital in the country, Prof Abu- Khalaf commented: “Currently we have about 300 under-graduate students and about 200 post-graduate residents.”

“The students are mostly Jordanian, although among the undergraduates there are a number of other nationalities studying here through various exchange programmes. “The hospital covers all departments of medicine from family medicine to cardiology, although the emphasis is on critical care. A quarter of the hospital’s beds are for this.” The hospital has 18 operating rooms.

The out patients clinics (OPD) were built in 1987 to provide the necessary space for teaching and for all the specialised clinics and other complete services. The OPD complex contains the dentistry clinics with 85 dental chairs, the renal dialysis units with 16 machines, the blood and the eye bank, as well as the medical labs.

The diagnostic imaging facilities include: spiral CT scanners (Somotom plus 4); MRI – Magnotom Vision plus 1.5 tesla; Echocardiography; Sonography; Mammography; Coloured Doppler Ultrasound; Interventional radiology services. These facilities and the hospital’s nuclear medicine department, provide comprehensive diagnostic services.

The hospital had 56,000 ER patients last year. Inpatients numbered 27,376 and out-patients 292,000. At the community level, the hospital plays a pioneering role in educating the local community. This is in addition to its wellacknowledged voluntary and benevolent services it gives to the underprivileged elderly, women and children in remote areas of the kingdom.

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Amman Surgical Hospital

Amman Surgical Hospital (ASH) is a leading Jordanian hospital specialising in aesthetic plastic and reconstructive surgery, otolaryngology, ophthalmology, paediatric and general surgery. The hospital opened in 1993 with a capacity of 24 beds as a private hospital designed and equipped for a few specialist services such as aesthetic plastic and reconstructive surgery and paediatric surgery. In 1997, ASH expanded into a comprehensive medical centre with a capacity of 95 beds. The hospital now has the following departments:

- gastroenterology – comprising a fully equipped endoscopy unit;
- cardiology with the catheterisation lab, cardiac theatres. The Intensive Care Unit and Cardiac Care Unit are on the same floor for patient comfort. Organ transplants can also be carried out here;
- NNICU (Neonatal Intensive Care Unit);
- internal medicine;
- general surgery including laparoscopic surgery;
- A renal unit with seven of the most advanced dialysis machines in the kingdom;
- urology and nephrology;
- plastic surgery and reconstructive surgery;
- ENT (Ear-Nose and Throat Surgery);
- ophthalmology;
- orthopaedic surgery;
- obstetrics and gynaecology comprising fully equipped delivery suite and private theatre;
- anaesthesia;
- diagnostic radiology including general radiography, digital fluoroscopy, doppler ultrasound and spiral CT-scanning; laboratory medicine;
- 24-hour fully equipped ER.

“The hospital is most well known for its cardiology services,” Rasha Taher, director of patient services told Middle East Health. “We have all the latest equipment and can treat all cardiac problems,” she said.

Taher said the hospital had a telemedicine facility offering a direct satellite link with the Mayo clinic in the US for patient consultations and video-conferencing. Other disciplines for which the hospital is recognised include plastic surgery and obs-gyn. Taher said they have many patients and VIPs visiting from the Arab countries.

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Other top healthcare facilities in Amman include the Al Khalidi Medical Centre and the Specialty Hospital.

Speciality Hospital

The Speciality Hospital is a 200-bed private facility specialising in cardiology, neonatal intensive care, nuclear medicine and a wide range of other specialties. The hospital has 14 Royal Suites and has a dedicated patient services department where medical records can be sent to be analysed before a foreign patient makes the trip to Jordan and the hospital. The department takes care of all visitor formalities and will meet patients at the airport.

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Al Khalidi Medical Centre

The Al Khalidi Medical Centre is an Amman-based upmarket private medical centre with 243 affiliated doctors.

Established in 1978 as a maternity hospital in Amman, Al Khalidi Medical Center (KMC) is now a first class heart and comprehensive specialty hospital with more then 15 clinical departments.

It houses some of the latest medical technology including a 32-slice CT scanner, MRI, 4D ultrasound and an advanced lithotripsy unit, among others. Walid Maaytah, the director of marketing, told Middle East Health that KMC would soon be opening a nuclear medicine centre with a PET scanner and other hitech equipment including a gamma knife.

He said the centre was most recognised for openheart surgery; its ICU which is used by VIPs; IVF; bonemarrow transplants; radiology; and its labs. “Our labs are highly respected. In fact, several foreign hospitals send their samples here to be tested.” He said that about 40% of the KMC’s patients were foreign, “mostly from the Gulf”. “As we say here: we offer 1st class medicine and 5-star service.”

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Dead Sea Medical Centre

The Dead Sea Medical Centre situated on the Dead Sea about 45 minutes drive from Amman is worldrenown for its treatment of psoriasis and arthritis.

(Look out for an in depth report on the Dead Sea and the Dead Sea Medical Centre in the September issue of Middle East Health.)

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