1. Cancer care Abroad National look Ahmed I Al-Sagheir Hematologist and medical oncologist KFSH-Dammam King Saud University Saudi Arabia

2. Fatimah A 55 yrs old, new seisures, and breast mass –Mammogram: suspecious, FNA: cancer –CT: confirms metastases, to CNS, bone and liver. –Family meeting Need to start palliative radiotherapy and chemotherapy, both are available Poor prognosis A week later the family wants a medical report, pathology slides and want advise about going to US, Germany or UK and may be Thiland.

3. Introduction Cancer care…definition What do patients want? What does the society want? What does the health of the society need?

4. No good Data What is the magnitude of the problem?

5. Introduction Cancer care…definition What do patients want? What does the society want? What does the health of the society need? Cancer care –Not only therapeutic intervention –Screening programs –Early detection –Palliative care

6. Patients need Best possible care Access to health care Support –Education –Communication –Family support –Financial support Why do patients choose to go abroad ?

7. Patients need Best possible care Access to health care Support –Education –Communication –Family support –Financial support Pros –Confidence in health care –Lack of confidence in local services –Assumption that medical errors are less frequent –Availability of the option –Culture and expectation

8. Patients need Second opinion Tourism –Summer vs winter Political gains Pros –Confidence in health care –Lack of confidence in local services –Assumption that medical errors are less frequent –Availability of the option –Culture and expectation

9. Patients need Cons –Illness and homesickness –Unnecessary delays –Un-necessary diagnostic procedures –Lack of familiarity with local diseases G6PD –Lack of support Societal religious –Financial costs Pros –Confidence in health care –Lack of confidence in local services –Assumption that medical errors are less frequent –Availability of the option –Culture and expectation

10. Society prospective History –Generations of patients going to Iraq, lebanon and Egypt Culture Inferiority complex Value system –Guilt feelings Health sector is a major financial drive Jobs Opportunity to support loved ones during illness Companions –Vacation –Family disturbance Charity

11. Public health prespective Establishing national registry Building on experience –Training Long-term care –Cancer survivors Costs

12. Cost of lost opportunities Building on experience –Developing training for doctors, nurses, pharmacists, etc National registry –Which ultimately will help identifying pattern of disease –Help in prevention and planning Jobs Social impacts

13. No good Data What is the magnitude of the problem?

14. Health system in SA Ministry of Health (MOH) –KFMC –KFSH-D King Faisal Hospital and Research system (KFSH&RC) Security forces health system National Guard Hospitals (NGH) Military hospitals (MH) University hospitals Private sector

15. New cancer cases Saudi Arabia experience Population 26 M KFSH&RCNGHKFMCKFSH-DAbroad 2005~3000-- 20072500950800660-- 2008~23001000 900100 Budget 2008 3.2 Billion SAR ---1.6 Billion SAR 1 Billion SAR 1 Billion SAR 1 SAR = 0.266 US $

16. Contributing Factors Way the media deals with the medical errors –Exaggeration of medical errors How do health care providers act? –Public awareness –Sharing experience

17. Solutions Targetting Patient satisfaction Satisfied patients are more likely to accept therapy  compliance  outcomes High impact easy gains –Nursing quality and courtesy –Cleanliness of the hospital

18. Some suggestions How would we act as role models? What massage does our own actions give.. –Story of AbdulRahman Al-Sagheir…my son..

19. Case AbdulRahman Al-Sagheir

20. Some suggestions Starting research on identifying predictors of good health care at national level Monitoring referrals abroad –Indications –Monitor outcomes Quality intiatives –Private –Government sectors Involving media in talking about achievements Providing second opinion thought telemedicine

21. Conclusion Cancer care…definition What do patients want? What does the society want? What does the health of the society need? Cancer care –Not only therapeutic intervention –Screening programs –Early detection –Palliative care

22. Case AbdulRahman Al-Sagheir Thank You