We always needed a doctor to sit down and talk to us: The growing acceptance of palliative care in the United Arab Emirates

Dr Alia Alawneh, Palliative Medicine Consultant at Tawam Hospital, Al Ain, United Arab Emirates. 

Dr Alia Alawneh

Towards the end of my palliative fellowship training in the US, I wondered if palliative care would be acceptable in Middle Eastern communities. Now, after more than five years practising palliative medicine in the Middle East, I can say that it is well received. Patients and families often say:

“We always needed a doctor to sit down and talk to us,” or “Your team gave us the best experience in the hospital, despite being at a very difficult phase,” complimenting the palliative care team on their thorough and compassionate nursing care, psychological and spiritual support, and holistic approach.

More and more hospitals are nowadays recognizing palliative care in the United Arab Emirates (UAE). The first comprehensive palliative team was founded in 2007 in Tawam Hospital in Al Ain, Abu Dhabi, as part of the oncology department. A specialist palliative unit was designated with a capacity of six beds, later expanding to 10 beds. The multidisciplinary team consists of three palliative medicine physicians, palliative care trained nurses, social workers, a psychologist, clinical pharmacist and a spiritual advisor who provide both outpatient and inpatient care. As part of an integrated oncology-palliative service, palliative care is available to patients receiving active cancer therapy. During the past five years, the palliative team has seen 1,082 outpatients and had 1,129 admissions. Palliative services are growing across the country for both adult and paediatric populations but according to the Global Atlas of Palliative Care at the End of Life, the UAE is still at the isolated provision stage.¹

The palliative care team at Tawam Hospital celebrating the sixth anniversary of the palliative care unit. (Alia is on the left, in the front row)

In the UAE, opioids are available in the injectable, oral, sublingual and topical formulations, including morphine, hydromorphone, oxycodone, fentanyl and methadone. As in nearby countries, consumption levels for opioid analgesics used for the treatment of pain increased significantly from 2000 to 2009, with a more pronounced increase between 2007 and 2009.²

There is increasing awareness of the importance of palliative care in the UAE. The Emirates Oncology Conference, a national conference organised annually by the oncology department at Tawam Hospital, dedicates a complete session to palliative care. Discussion is currently under way to include principles of palliative care in the medical school curriculum. Moreover, this relatively new specialty has been the focus in local conferences and in the local media.

Our challenges are to expand services nationally enabling access for patients who live in small cities and to provide palliative care for both malignant and non-malignant conditions. Despite increased recognition by hospital administration, palliative care must also be recognized at healthcare policymakers’ level.

References

1. Lynch T, Connor S, Clark D. Mapping levels of palliative care development: a global update. J Pain Symptom Manage. June 2013; 45(6): 1094-1106.

2. Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes. (Accessed August 2017).

Further reading
Osman H, Rihan A, Garralda E, Rhee JY, Pons JJ, de Lima L, et al. Atlas of Palliative Care in the Eastern Mediterranean Region. Houston: IAHPC Press; 2017. You can download a copy from the website of the Instituto Cultura y Sociedad Universidad de Navarra (ICS).

Read more about Palliative Care in North Africa and the Middle East on the EAPC Blog.