Palliative Care Fellow Mohammad Al Ghamdi on the need to establish palliative care services in Saudi Arabia so patients at the end of life can receive appropriate, humane care
“The caring part of palliative care is part of who we are, and we take that with us wherever we go.”
By Devon Phillips. Mohammad came to McGill to do his Fellowship in palliative care with a specific goal in mind ̶ to go back to Saudi Arabia with the skillset to establish palliative care services in the Johns Hopkins Saudi Aramco Healthcare Network, which has several hospital and clinics in the Saudi Kingdom. With his Fellowship almost complete, Mohammad feels confident that this intensive year of training will serve him and his native country well in terms of clinical skills, psychosocial expertise, and the know-how to set up multidisciplinary inpatient and outpatient teams based on the Palliative Care McGill model.
Q: Tell me about your background as a physician and how you came to McGill.
A: I was born and raised in Saudi Arabia and I finished medical school in the capitol, Riyadh. I did pediatrics from 1997-1998 and then I was sponsored by my company, Johns Hopkins Saudi Aramco, to go for family medicine at the University of Toronto from 1999-2001. After that, I did around 14 years of family medicine in Saudi, emergency as well. I did my MBA as well and I am also a certified physician in healthcare quality.
Q: So you were doing several jobs and you have children! How did you manage all this?
A: Yes, I have three children. To tell you the truth, work is demanding and at times, there is little time for the children but you have to create the time. My daughter is now 19, I have a son 15, and a younger son who is 8 years old. My family drives me to achieve and they drive me crazy sometimes!
Q: So when you came to do your Fellowship in palliative care at McGill after 14 years of practicing medicine in Saudi Arabia, was there any culture shock?
A: I think that because I was trained at U of T a long time ago, and in the hospital that I work at in Saudi Arabia, there are at least 70 nationalities ̶ Canadian, American, people from Asia and Latin America, lots of Europeans like Italians, Spaniards, it’s really multicultural, I am used to other cultures. Toronto was more challenging than Montreal because it’s a bigger city and people are less friendly than Montreal. The team here at McGill is very supportive and friendly. I think that’s part of the palliative care culture; people are very caring and receptive to others.
Q: What motivated you to come to McGill and do this Fellowship?
A: In 2010, I was working as Chief Physician in a healthcare network. Aramco has only acute care hospitals; there is no capacity for end-of-life care so patients had to be admitted to other hospitals that we work with called “network hospitals”. At any given time, we have over 320 patients who are at the end of their lives. Some patients have end-stage dementia, end-stage neurologic disease, stroke, or they have terminal cancer. A good percentage are pediatric patients.
So we have no palliative service in the hospital whatsoever so this was the driving force for me to say, “That’s enough. This is not appropriate. We have to do something about this.” And my whole organization in Saudi supported me by sponsoring me to come here for this Fellowship, to learn palliative care and do something good by setting up palliative care services in Saudi Arabia.
I am proud to be here and thankful to all the people who have supported me. It’s a debt on my part that I cannot pay back to McGill but if I am successful in establishing palliative care in Saudi Arabia, that will show my thanks to the people at McGill.
Q: In your heathcare network in Saudi Arabia, where are people dying?
A: None of the centres are providing palliative care, so people end up dying in ICU with a lot of tubes and pain and very frustrated families because the assumption is that the patient will receive active, acute care, which is not appropriate. In a way, these patients are not treated as human beings. In addition, the utilization of resources is inappropriate because a lot of resources are dedicated to people who will not benefit from them, and at the same time, you have young patients dying in emergency without access to an ICU bed. We have kids who at 15, 16 years old are ventilated and intubated for around five, six years. You can imagine how much burden this for the family who comes every day to see their child like this − they have been treated for infection, bed sores, everything, and none of this benefits the child because it will not bring them back, it only prolongs their suffering.
Q: Tell me about the McGill Palliative Care Fellowship. How is it structured?
A: It is a one-year Fellowship. We work with inpatients and outpatients throughout. I did my first rotation here at the Glen site of the MUHC. Initially it was difficult to go back after 14 years of practice. So in those first few months I felt like I was learning to walk again. People held my hand to get me up and running for the inpatient part and it made a big difference to me throughout my rotations. I did rotations in four centres ̶ the Glen MUHC, the Jewish General, Mt. Sinai, and St. Mary’s hospitals, and I received great support from the staff that I worked with at all the sites. We did home care, inpatient care, and two months of outpatient clinics.
Q: Do you feel that you have acquired the skills you need to establish palliative care services in Saudi?
A: Yes I do. I came here for a couple of reasons. I wanted to know the clinical part, the psychosocial part, and how the set-up is done, all of which I learned in this program. This Fellowship program is well structured. I not only learned the clinical aspects but there was longitudinal psychosocial training throughout the Fellowship year which contributed to my overall medical expertise. In addition, I got to see how the multidisciplinary team works with both inpatients and outpatients, and how the teams are integrated. This is so important because I need to know how to set up palliative care back home in Saudi.
Q: What is your plan once you are back in Saudi Arabia?
A: I have already started organizing things. For the last six months we have had conference calls back and forth where I have been part of setting up a team similar to the multidisciplinary team here. I already have a couple of nurses trained in palliative care through the End-of-Life Care (EOLC) program, a social worker and a part-time psychologist, and I am looking to attract more people.
We are in the process of developing policies and procedures, and we have secured some inpatient beds to start a unit, so hopefully the only missing part is me! I will work as the palliative care physician.
Q: Will palliative care be set up at Aramco Saudi or a different site?
A: The good thing about Armaco Saudi is that we have a relationship and contracts with 85 hospitals in the Kingdom. Whenever a specialty is established in Saudi Armaco, we encourage the 85 facilities to start a similar service. For example, I worked with a team that took that a primary care program implemented in Armaco Saudi to all the affiliated hospitals and they in turn established primary care clinics, and we incentivized those hospitals. I believe that if we establish a good palliative care service, this will drive the establishment in multiple facilities in the Kingdom, not just tertiary care hospitals, but also in community hospitals, so people can have early access to palliative care, including pain and symptom control.
Q: Do you anticipate that palliative care will be embraced in Saudi Arabia?
A: In the entire Kingdom we have only two or three palliative care units with very limited capacity and you can imagine the need with 2.2 million Saudis, this is apart from the other nationalities, so altogether there are approximately 30 million people. There is a huge need for inpatient, outpatient and homecare services so we have a long way to go. I have been lucky enough to work with some of the people who have established palliative care here and have been practicing for years ̶ Dr. Towers, Dr. Borod, Dr. Lapointe, Dr. Dworkind, and many others. I am in about the same place as when they started, where the services need to be started. You start slow and grow.
Q: Sounds like there will be an ongoing Saudi-Canada connection.
A: McGill has sent back a lot of people to Saudi Arabia who are well trained and this has led to an improvement of services that could not have been achieved otherwise. When people go back to Saudi Arabia they always say, “I have been trained at McGill and I am proud of that.” The relationship always goes beyond residency, beyond fellowship. We share presentations and literature and the positive connection continues.
A lot of people at McGill have been helpful. I have asked a couple of them to be my mentors during the start-up period and they are more than happy to do that.
Q: Would you recommend this Fellowship program to your colleagues?
A: Yes. This program is unique to Canada and in fact, unique in North America. I have met colleagues from the US and I think there is an opportunity here that doesn’t exist there because the psychosocial aspect is stronger here than in any other program. The exposure to different services is probably more diverse than anywhere else as well and you have very strong leadership in this program. True, I am biased because I went through it, but the McGill Palliative Care Fellowship is special and you won’t find it anywhere else.
Q: Will give us an update on how things are progressing once you are back in Saudi Arabia?
A: You bet! This is a journey I would like to document and publish. It will be helpful for other places that do not have palliative care. I would love to create a “how to” on how to set up palliative care services, how to train people, and all of this is important to share.