|Year : 2012 | Volume
| Issue : 2 | Page : 195-199
Development of anesthesiology and medical service in KSA 1956-2011
Mohamed Abdullah Seraj
Professor of Anesthesia, Chairman of Local Anaesthesia, Post Graduate Committee, Saudi Council of Medical Specialty, Saudi Council, Riyadh, Saudi Arabia
|Date of Web Publication||11-Mar-2013|
Mohamed Abdullah Seraj
Saudi Council Riyadh, P. Box 22422, Riyadh 11495
Source of Support: None, Conflict of Interest: None
| Abstract|| |
In this historical report, a new light is shed on details of the development of anesthesiology and medical service in Kingdom Saudi Arabia 1956-2011. What Dr. Al-khawashki has done between the period of 1956-1980 was commendable. He has found himself and few anesthetists from Egypt and Pakistan in the front of huge task. The shortage of anesthetists worldwide and the increasing surgical specialties in Saudi Arabia, imposed a huge dilemma on the service. In order to face this problem, there was only one way to cover the continuous expanding surgical services by establishing technical institutes to produce anesthesia technicians able to work under supervision of consultants. This was known as the technician's era. It continued for a long period, but the changes were introduced from 1980 onwards by me. This was the era of the development of an up-to-date anesthesia service from 1980-2011. the first, developing the-state-of- the-art anesthesia services in the university hospitals. Second, the Saudi Anaesthetic Association was established under the auspices of the King Saud University. Third, this period culminated by starting the residency training programmes in the country and the Arab world. Moreover the Saudi specialty of anaesthesia and intensive care graduated over 60 specialists and has 98 residents up till now in the programme. Finally three subspecialties fellowships in critical care, cardiac, and pediatric anesthesia were established. The total number of Saudi anaesthetists jumped from one or two anaesthetists in the seventies to almost 300 in 2011. The numbers of consultants or senior registrar are over 160 and the rest are residents in the training program nationally and internationally.
Keywords: Alexandria University, GalalAref, I. Al-Khawashki, Mohammed Abdulla Seraj, development of anesthesia practice, saudi arabia
|How to cite this article:|
Seraj MA. Development of anesthesiology and medical service in KSA 1956-2011. Anesth Essays Res 2012;6:195-9
| Development of Anesthesia Practice, Saudi Arabia|| |
In response to recently published articles on services rendered by two Saudi anesthesiologists in the last century. The senior author of this report proposed to publish a historical paper sent to him by late M. I. Al-Khawashki, as it is a relevant historical document of our departed colleague. So the junior author placed an intellectual effort in translating the Arabic letter and researched the names and data.
We present the personal account of Dr MI Al-Khawashki as it was dated April 25 th 1997. This account has a title published in the 1980s of last century and similar account to the initial published article. This letter was written on the invitation to document the history of anesthesia in Kingdom of Saudi Arabia with names and developing stages of anesthesia. Although professor Seraj did an excellent effort to enlighten the readers about this issue, there are still many loose ends that were not presented. In this letter, the role of WHO in initiation of some training in Denmark for local anesthesiologists, it showed as an effort to propagate anesthesia services mainly in the Ministry of Health. The limitation of posthumously publishing would carry certain defects in pursuing all mentioned data/ but even the late Dr M. I. Al-Khawashki ended his document, hoping that Professor Seraj finish the historical document [Figure 1] and [Figure 2].
We can consider the year 1956 the starting point of anesthesiology and its development as one of the basic supporting medical sciences for the modern medical services in the kingdom of Saudi Arabia. There is no apparent data existing of the aneasthesia specialty before that year. To show the stages of development over the first 30 years, it is appropriate to divide those stages into decade as follow.
Initiation and foundation decade 1956-1965
This started when late Dr. Rachad Faroon was appointed the minister of health. With the debut of the development of anesthesia, the late Dr. Bashir Al Roumy and Dr. Hassan Al Nassif, the director general, who introduced anesthesia service into major healthcare.
As the contracted Egyptian anesthesiologist Dr. Saed Al Rays and Dr. Mohamad Rifaat, the first Doctor worked in Bab shareef hospital and the womens hospital then in King Saud hospital. The second doctor worked in Ajeyad hospital along with the women hospital in Makkah. The ministry contracted two anesthesia assistant technicians from the English Hospital in Ghaza, one assigned to work in Riyadh city and the other in Taif. Thus, the ministry of health hospitals had only two anesthesiologist and two anesthesia assistant technicians working. The military hospital in Riyadh had Dr. Fouad Hamdi who worked as an anesthesiologist.
Acknowledging this deficiency the ministry of health requested from the regional offices of (WHO) in the east Mediterranean area to send an expert anaesthesiologist, Dr. Mohamed Kamal Ghalab, was assigned to work in King Saud hospital (Riyadh Central hospital which was opened in 1956) so that he could initiate the technician training program of anesthesia in the anesthesia technician institute. Dr. Ghalab could not attract any Physician to the anesthesia specialty but he laid the foundation of the anesthesia technician training programme.
In October 1957 after my graduation from Qasr Al Aeny Medical School in Cairo University, I was appointed as general practitioner in King Saud Hospital. Then I took the post of anesthesia physician after consultations with Dr. Ghalab and Dr. Roumy. Later on, I was naturalized as Saudi and I was sent to Copenhagen, Denmark to study anaesthesia for two years. I returned back in 1962 to Riyadh, assumed the responsibility in the same department. Later on, the ministry of health contracted many anesthesiologist from Egypt and Britain who participated in the efforts of serving the surgical specialties and establishing the tradition of anesthesia in the ministry hospitals. The ministry of health institute for anesthesia technician qualified six anaesthesia technicians every year those were distributed over the hospitals in kingdom to work under supervision of anaesthesiologists. In the year when the late Dr. Youssef Al Hagery was minister of health, administrative decision was taken to put all anesthesia departments under the command of the department of anesthesia in the central Riyadh hospital to coordinate the services and staff efforts.
The increased number of surgical procedures to be performed under the anaesthesia led to the appearance of a new major problem. When we had complications or a postoperative death, people tended to blame the whole surgical team including an anesthesiologist or blame the anesthesia team alone. Unfortunately, some surgeons put the complications or postoperative death blame on the anesthesiologist. That led to a Royal Decree to form a medical and clerical jury committee to look into any mal practice cases. This was a new advance in the medical environment in the kingdom. It built the trust and the reassurance of the practitioners and the patient relatives of the fair judgment of this legal body.
Settlement and advances decade 1966-1975
In 1966, development and expansions in the field of anesthesiology happened plus the increasing number of anesthesiologist lead to fair distribution of man power in major hospitals in the kingdom. An intensive care unit project was allocated in King Saud Hospital. The project was assigned to a German company to build the unit with eight beds. In 1969, it was operated under directorship of Professor Mohamed Badoor from Alexandria University.
Later on in 1972, the minister of health, Dr. Jameel Al Hujelan, commissioned me to build five units of intensive care in hospitals in Makkah, Jeddah, Taif, Medina Al-Monawarah and Dammam. Under the directorship of Professor Jalal Aaref, Riyadh central Hospital (King Saud Hospital) provided the training for staff such as physicians and nurses to work in these satellite units. In that era Dr. Seraj was sent to Britain by King Saud University, to get the highest qualification of anesthesia and to be the first anesthesia professor in the kingdom. Due to low numbers of physicians working in anesthesia fields, I was unable to follow up with external examination but I was able to get scholarship to Qasr Ayni Medical School, Cairo University in 1973 and to obtained the PHD in anesthesia in 1976.
The growth and spread decades 1976-1985
New blood came to the scene when Professor Hussain Abd Al Razak Al-Jazaery who was the founder dean of the first faculty of medicine in King Saud University with Dr. Amin A. Seraj his deputy who later became the founder of the first dental college. Dr. H. Al-Jazaery became the minister of health assigned me to be the director of Riyadh Center hospital as well as the director of anesthesia department and an advisor for anesthesia affairs in the ministry. After this, I managed to put a development plan for human resources needs for all anaesthesia services in the ministry of health. Also I started working in the college of applied science institute in the late seventies, under the dean Dr. Ibrahim Al Sowayegh. I was appointed as member on the board. The college board approved that anesthesia will be one of its science majors.
Then the practical and academic activity augmented in the kingdom either in government hospitals or in private hospitals. In this era, the Saudi anesthetic association was founded under Professor M. Seraj's presidency who also created the anesthesia club of Riyadh. The monthly meeting rotated between hospitals in Riyadh and each department of anesthesia selected an important topic for presentation. In this time period, an explosion in the development of anesthesia happened within new modern hospitals furnished with sophisticated and highly advanced equipment
| The Era of Professor Seraj (The Academic And Scientific Advances of Anesthesia in Ksa During 1985-2011)|| |
As Dr. I. Khawashki explains that there were several major problems
- Minimal service with low image of the specialty.
- Few numbers of working anesthetists.
- Lack of standard of care and monitoring and no policy and procedures.
- Influence of administrative and surgical department.
As anesthesia was a forgotten entity in KSA. Many problems existed; this reflected on the quality and quantity of work. People at large still have no direct contact with the anesthetists; this continued for long time. In 1977, I returned as first Saudi qualified anesthetist with fellowship from Ireland. I started work in the 30 bedded small hospitals, later it was known as King Abdul-Aziz University Hospital (KAAH). The department started recruiting professional manpower. It begun first by Drs. Ameer Channa, Mohamed Al-Nakeeb, Moukhtar Astafan and Fayez Khan. The small department started to exhibit its own personality in the specialty. Recommendations put forward to administration with plans and strategies laid down for the future. None of these were able to be implemented at KAAH. These plans and strategies were carried forward where they have been implemented in the newly opened 400 bedded King Khalid University Hospital (KKUH). Later, more qualified Saudi anesthetists followed. They are Drs. Sami al-Marzoki, Dhafer Al-khedairy, Hussain Darweesh, Adnan Al-Mazroa, and Walid Al-Yafy. The new era of the specialty begun. I started as the fighting force and the defender of the specialty. I was working in the medical college of King Saud university. Several articles were published tackling the difficulty of establishing modern anesthesia services including the dilemma facing the specialty. The main objectives were to have future plans composed of several targets.
- The first target was to present the new image of the specialty by first having a top-class department in the KKU hospital capable of providing state-of-the-art services based on applying
- The standard of care and monitoring;
- applying and enforcing the policies and procedures;
- holding regular mortality and morbidity meetings;
- I was able to defend, protect and change the old image of the specialty in the country.
- The second target establishing the Saudi Anaesthetic Association (SAA). The main objective being to care and improve the practice of anaesthesia specialty all over Saudi Arabia. We planned
- organizing and conducting regular annual scientific meetings in all regions;
- holding monthly club anesthesia meetings that started in Riyadh, later in other regions;
- producing outreach program that were able to be held anywhere in the kingdom;
- update, improve the services of the new image of the specialty and able to furnish the hospitals with the standard of care and monitoring;
- actively participate in international conferences;
- be a member of the world federation of societies of anesthesiologists;
- to launch and produce a regular issue of the SAA newsletter, widely distributed;
- to initiate a new and genuine idea of malpractice insurance known as Takaful Ejtemaei Each member deposit once S.R. 2000 to have the blood money in case of litigation. The member can take his/her money or donate when leaving the department to the SAA. They all felt legally protected.
- The third target was to start the residency training programs in the Kingdom exactly to the western standard. Mainly to produce future Saudi qualified staff. Earlier we were able to recruit one of the leading researchers on Muscle relaxant Professor Viby-Mogenson from Denmark, Dr. Trevor Dobinson a cardiac anesthetist from New Zealand and Professor P. Bromage from USA and Professor Mohamed Naguib from Egypt.
King Saud fellowship in anesthesia and intensive care
We were asked to start a Master Degree. The team, Drs. Channa, Mogenson, Dobinson, and I accepted the challenge. We have established the programme and two candidates were enrolled. Later we were requested to change the master degree to a fellowship. We started gathering and reviewing all materials for the international fellowships. We selected the Canadian training program for its collectiveness and simplicity. We prepared the final program. It is 4-year program. The program is composed of two junior years and two senior years. The residents must rotate in all specialties, produce a log-book containing 2000 cases, and successfully passyearly examinations plus the final exam. The program started in 1989. The coordinator was Dr. Ameer Channa, then Prof. Mohamed Naguib then back to Prof. Channa. The first graduate was Dr. A. Sammerkandi in 1993. The program is still active, but recently changed to be 5-year program.
Arab board in anesthesia and intensive care
In November 1991, I prepared the statutes of the programme. It was presented to the Arab Council for medical specialties in Damascus and approved in November 1993. The Board started slowly, enrolment kept increasing and reached over 1400. The graduates have exceeded 160. Several Arab countries joined the scientific board of the specialty of anesthesia and intensive care. It is still four years programme. It has only part I and II examinations.
Saudi specialty of anesthesia and intensive care
An Ad-hoc committee composed of Drs. Sami Al-Marzoki (KAU), A. Janfi (KFU), I (KSU), and Dr. Al-Khedairy from Prince Sultan cardiac centre. We prepared the document for the specialty of anesthesia and intensive care. The task was completed in 1998. The Saudi Commission for Health Specialties (SCFHS) accepted and approved it. The scientific council for the specialty of anaesthesia and intensive care was formed in the same year. I was the chairman and member for three successful periods. The program started slow, but the number of candidates enrolled in the programme has increased to 98 Saudi and expatriate residents. The numbers of graduates are exceeding 60, some are expatriates. Four years ago the council of the specialty altered the program to 5 years in order to accommodate the new services and able to accept up to 40 candidates per year that can be increased by 1020% up to 44-48 candidates.
Subspecialties postanesthesia fellowships
The members of the Saudi scientific council for anesthesia and intensive care decided to create postgraduate specialty fellowships. Four Ad-hoc committees were selected to develop state-of-the-art training program of 2 years in the following subspecialties. Three fellowships started mainly in cardiac anesthesia, critical care, and paediatric anaesthesia. The forth is pain management in progress.
Fellowship of king faisal university
The programme started in 1984. It was 4-year program. It started successfully, but unfortunately it only lasted for a few years and graduated only three fellows. The reason for its cessation is unknown.
| Further Readings|| |
- Al-Khawashki MI, Ghaleb HA, El-Gawhary N, Madkour MK, Radwan AM, El-Sherbiny AM. Pharmacological effects of althesin and its steroidal components on the cardiovascular system. Middle East J Anaesthesiol 1980;5:457-69.
- Al-Khawashki MI. Anaesthesia in KSA development, problems, present status. Middle East J Anaesthesio l1979;5:149-54.
- Al-Khawashki MI, Ghaleb HA, el-Gawhary N, Madkour MK, Radwan AM, el-SherbinyAM. Effects of althesinand its steroidal components on a variety of excised smooth muscle preparations. J Egypt Med Assoc 1979;62:209-23
- Al-Khawashki MI, Ghaleb HA, el-Gawhary N, Madkour MK, Radwan AM, el-Sherbiny AM. Pharmacological assessment of the anaesthetic potency and acute toxicity of althesin and its steroidal components in laboratory animals. J Egypt Med Assoc 1979;62:191-208.
- Seraj MA. Difficulties of establishing modern anaesthesia in a developing country. Middle East J Anaesthesiol 1979;5:155-61.
- Seraj MA. Two Saudi anesthesiologists who served anesthesia in KSA in the last century. Anesth Essays Res [serial online] 2011;5:3-4. Available from: https://www.aeronline.org/text.asp? 2011/5/1/3/84170 [Last cited on 2011 Nov 11].
- Sthesia Servicesning Programmes In Saudi Arabia: Facts And Personal Prospective. The internet of anesthesiology.2007;15:
- Seraj MA. Update in anaesthesia service and residency training programme in KSA "how far from the target?" review article year. Saudi J Anaesth 2009;3:29.
[Figure 1], [Figure 2]