Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Evidence based health care in Sudan
- Hayfaa A.A Wahabi (21 October 2006)
-
Diabetes Epidemic & Smoking
- Ihab F Suliman (26 October 2006)
-
What Taboo Research Areas in Middle East Health ?
- Kamal Chaouachi (1 December 2006)
|
|
|||
|
Hayfaa A.A Wahabi, Consultant Obstetrician and Gynaecologist King Abdulaziz Medical City, MC 1216, PO Box 22490, Riyadh 11426, Saudia Arabia
Send response to journal:
|
Low and middle income countries share many problems related to health service provision that centre on inefficiency of the healthcare system and the lack of funding.(1) Sudan is no exception. Healthcare facilities are poor with respect to equipment, drugs, and buildings. The situation is complicated further by the brain drain of skilful health professionals to the West and the Arabian Gulf. Sudan has a limited number of medical schools; none of them teaches evidence based medicine. Good medical practice faces many constraints, such as the lack of infrastructure for support of evidence based healthcare, including absence of informed political decision and ill informed consumers who impose no vigilance on the practice of medical professionals. One of the key elements for implementing evidence based health care is to have national advocates, with an insight about the complexity of the obstacles facing such implementation and who have communication channels with the stakeholders such as politicians, medical licensing bodies, and medical education planners.(2) Sudan Evidence Based Medicine Association (SEBMA), a non-governmental organisation, is one of these groups. Its aim is to establish infrastructure in the health service and medical education for implementing evidence based health care. The association avoids “standalone intervention” because it will be futile without a system to support it. Our proposed system of evidence based health care puts the patient at the centre of care, as the main beneficiary; in addition, consumers should have an active role in overseeing that the right intervention is implemented through health education and a clinical governance system. The strategy of the implementation plan is through establishing centres for evidence based medicine in different institutions, with the true ownership to the hosting institution and technical support of SEBMA. Each centre has a different role, with the final result a complete system of evidence based healthcare infrastructure. Establishing a centre in some institutions such as the Federal Ministry of Health will give it the legislative power for implementation of a national drug policy, the development of national clinical guidelines, and establishment of a quality assurance system. Centres in undergraduate and postgraduate institutions introduce evidence based medicine into medical curriculums. SEBMA has established three centres, in the Federal Ministry of Health, Gezira University, and the Sudanese Medical Specialization Board. These are in their infancy but have a clear plan of action. References: 1. Garner P, Kale R, Dickson R, Dans T, Salinas R. Getting research into practice: implementing research findings in developing countries. BMJ 1998;317:531-5. 2. Aaserud M, Lewin S, Innvaer S, Paulsen EJ, Dahlgren AT, Trommald M, et al. Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia. BMC Health Serv Res 2005;5:68. Competing interests: Hayfaa A A Wahabi is the chair of SEBMA |
|||
|
|
|||
|
Ihab F Suliman, Associate Consultant King Abdulaziz Cardiac Center,National Guard Health Affairs,Riyadh,Saudi Arabia
Send response to journal:
|
Health in the middle east has so many problems,one of these is the emerging epidemic of diabetes & related vascular(both micro and macro)complications. Diabetes Prevalence in middle east has reached alarmingly high levels,due to excessive eating,lack of excercise,eating of unhealthy food high in fat & carbohydrates. Cardiovascular Complications secondary to Diabetes are very frequently encountered even in young people in their thirties or forties years of age. Many people in middle east continue to smoke, including teens, diabetic patients (as if adding petrol to fire) and unfortunately some doctors. If the situation remain unchanged this will lead to a huge financial and economic burden. Prevention & health eduction become a necessity, there is a growing need for an effective primary & community medicine practice, policy & guidelines. Political decisions are very important. A royal decree was issued (in Saudi Arabia) to prevent smoking in hospital premises. Competing interests: None declared |
|||
|
|
|||
|
Kamal Chaouachi, Researcher in Socio-Anthropology and Tobaccology Paris, France
Send response to journal:
|
Comments on: Maziak W. Health in the
Middle East. BMJ 2006;333;815-816. Dear Editor, Dr Maziak pays a tribute to the “Arab-Islamic
civilisation between the 8th and 12th century” whose “scholars
laid the foundation for modern medicine based on observation and reasoning”, recalling
a previous paper he wrote for Science.
In a response to the latter, I insisted that what the Middle East is
missing, from the research point of view, is surely not a supposedly lost sense
of “observation” and “reasoning”. It is definitely still present and lively in
the above region. There is absolutely no need there for a new “scientific
revolution” in this field (1). We are afraid the author of this tribune shirks
the true and well known issues at stake: chiefly how research is funded and by
whom and how its quality output is evaluated and by whom, again. For instance,
is there really, in the Middle East, a qualitative difference in research
production when the funds come from abroad or when it is locally financed ? Unfortunately, I can only answer in the very
field I am specialising in. However and by some coincidence, it is also that of
the author of the paper discussed here: namely tobacco smoking, and
particularly research on the “waterpipe” (shisha, hookah, narghile) smoking
world epidemic “exported”, for two decades now, by the Middle East to the whole
world. Just to take one example related to public health, I realised that
Jordanian researchers funded by local national grants were capable of carrying
on the best studies –on cotinine and nicotine levels and CO intake in realistic
conditions- ever done in this field while other local Middle Eastern teams,
funded by Western institutions did not reach the same quality and by far (2).
In these conditions, relying on external funding, supposed to be a source of
independence and methodological efficiency, is not true. Besides, if solutions
for “smoking, obesity and hypertension” “cannot necessarily be imported”,
why do we see that models –particularly concerning dependence patterns-
designed for “Western” cigarette smoking have been applied almost blindly to
treat the “Oriental” hookah smoking epidemic ? (2). Indeed, what the Middle
East does not need for its health systems is the importation of models that are
not adapted to the local socio-cultural context, a complex one indeed. This is
a second taboo issue. Certainly, we are all against authoritarian
regimes. We all want women to have the choice to work where and when they want.
However, another important question deals with the parties directly responsible
for the gloomy situation in the Middle East. What about the destruction of
dozens of thousands of lives in the name of freedom and democracy ? Some researchers,
not necessarily native of the region we are talking about, while sitting
comfortably in front of our computers, have recently acted with moral gumption
to tackle this taboo issue, the third one (3). Finally, we are afraid that the following statement:
“the failure of governments to provide comprehensive healthcare services has
led to health care being taken over by market forces” is not but a mere
truism in today’s global capitalistic world. Besides, the problem is absolutely
not specific of the Middle East. Kamal Chaouachi
(kamchaAgmail.com) Researcher in
Socio-Anthropology and Tobaccology (Paris) (1) Chaouachi K. E-Letter to the Editor: Arabs Neither Need a Scientific Revolution Nor Are They a Cultural
Exception. Science 2006 (7 March). A critical analysis of the following study: MAZIAK
W. Global voices of science. Science in the Arab world: vision of glories
beyond. Science.
2005 (3 June);308(5727):1416-8. http://www.sciencemag.org/cgi/eletters/308/5727/1416#3253 (2) Chaouachi K. E-Letter to the Editor: Syria, Lebanon,
Tobacco Research in General and Narghile (Hookah, Shisha) Smoking in Particular.
Tobacco Control 2006 (8 June). A critical analysis of
the following study: Ward KD, Eissenberg T, Rastam S, Asfar T,Mzayek
F, Fouad MF, Hammal F,Mock J, Maziak W. The tobacco epidemic in Syria.
Tobacco Control 2006;15;24-29. http://tc.bmjjournals.com/cgi/eletters/15/suppl_1/i24 (3) Roberts L, Lafta R, Garfield R, Khudhairi
J, Burnham G. Mortality before and after the 2003 invasion of Iraq:
cluster sample survey. Lancet. 2004 Nov 20-26;364(9448):1857-64. Competing interests: None declared |
|||