In October 2015, the World Health Organization Eastern Mediterranean Region (WHO EMRO) organised the third ‘Train the Trainers’ workshop about palliative care. As a special adviser to the WHO EMRO, Prof Sheila Payne met leaders in palliative care from the region and invited them to contribute to this special series on palliative care in North Africa and the Middle East.
Next in the series, we hear from Dr Sami Ayed Alshammary, Consultant in Palliative Care and Family Medicine at the Centre for Postgraduate Education in Family Medicine, Ministry of Health, Saudi Arabia, and a consultant in the Palliative Care Department at King Fahad Medical City, Riyadh.
“Sorry, there is nothing to be done for your father. He has stage four cancer. You may take him home.”
These words used to be so commonly spoken by doctors when breaking bad news during a meeting with a patient’s family. If you were one of the people in the meeting room, you can imagine how upset and helpless you would feel. I have heard these words spoken many times, especially in the early ‘90s before the development of palliative care services in Saudi Arabia.
Increasing life expectancy in Saudi Arabia appears to be similar to that in Western countries because of the changing pattern of disease.1 Currently, a total of 13,300 new cancer cases have been admitted for treatment in the kingdom’s hospitals.2 By 2030, the rate of cases for cancer affliction in Saudi Arabia is expected to increase by five to ten times.3 This prediction is based on the changing demographics and with the range in terms of age of patients mostly affected by cancer – the middle-aged and older people.
In the past, palliative care remained an isolated provision with no integration in the healthcare system. In 1992, King Faisal Hospital made history in Saudi Arabia by establishing a palliative care service. 4
Where are we now?
Currently, there are 12 palliative care centres situated in different areas across the kingdom: six centres in Riyadh, two in Jeddah, two in East Province, one in South Area and one in the North Zone. Of these, six training centres have been accredited by the Saudi Commission for Health Specialties. Furthermore, there are more than 35 qualified physicians who practise palliative care throughout the kingdom. Most undergraduate medical schools now integrate palliative care training in their curriculum. The postgraduate training programmes, such as family and internal medicine, also have palliative care rotations. As well as the physicians, the nurses also undergo training in palliative care, especially in their postgraduate studies. Spiritual care in palliative care was launched as a Master’s programme last year.
It is mandatory in all hospitals that adopt an international accreditation system to have palliative care and pain management services.
Apart from the huge number of cancer patients, a good number of patients with chronic diseases also receive palliative care. For example, in King Fahad Medical City, 20 to 30 % of patients in the Palliative Care Department have chronic, non-cancer diseases. This rate is expected to rise in 2017 as per observation in the current setting.
Palliative care services in Saudi have been available for about two decades and the intensity of demand is continually increasing. This is probably because of cultural and religious acceptance. The greatest recent challenge is to meet the current demand. Presently, there are home care services that incorporate palliative care. Palliative care services are totally free of charge – so there is no financial burden on patients and their families – and this applies to everyone in the kingdom, whether the patient is a Saudi national or not.
In 2013, the Saudi Society of Palliative Care was launched with more than 100 members undertaking various roles in educating and improving the quality of palliative care services.
Though it is not yet reflected in international reports, Saudi Arabia’s morphine consumption in palliative care has rapidly increased.
Where do we want to go?
Research about palliative care is essential to deliver high-quality services. There are good palliative care articles published but we need to do high-quality trials. The issues that can improve palliative care delivery, as well as the areas where evidence of practice is still weak, can be identified by forming networks and collaborative groups for the application of study and research methods in Saudi Arabia. The coordination and partnerships with hospice programmes (that are under development) are a major feature as palliative care continues across the trajectory of disease. Unified palliative care guidelines should be culturally sensitive and relevant to Saudi Arabia’s setting.
We hope that with these continuing developments in palliative care, doctors will do all that they can to enable patients to live with cancer and that families will no longer feel so hopeless about the condition of their loved one. Instead, no matter how severe the case is, there will be an option available to make things go as well as possible – palliative care services.
- Alan Gray, Adnan Ezzat, Palliative Care for Patients with advanced cancer. J Family Community Med. 1997 Jul-Dec; 4(2): 41–46.
- Data from IARC GlobalCan (2008). View a copy here.
- Alsirafy SA, Hassan AA, Al-Shahri MZ (2009) Hospitalization pattern in a hospital-based palliative care program: an example from Saudi Arabia. Am J Hosp Palliat Care 26 (1): 52–6.
- Alshammary SA, Abdullah A, Duraisamy BP, Anbar M. Palliative care in Saudi Arabia: Two decades of progress and going strong. J Health Spec 2014;2:59-60. Download a copy here.
Next week, Dr Fosia Yacin will be sharing her experiences from Djibouti.