Female first: women's healthcare in the Arab world

How do you convince doctor-shy women to get their check-ups? The usual response is to launch a cautionary public health campaign. But perhaps there’s a kinder route – make the hospital somewhere women want to be.

Arab women are prone to developing more aggressive breast cancer at a younger age than those in the West; obesity rates in the region are skyrocketing, bringing diabetes, hypertension and heart disease with them. However, preventive medical care has yet to widely catch on. Check-ups and screenings are dismissed as ‘looking for trouble’ and there may be cultural expectations that women place more importance on their family’s health than their own. For Muslim women in particular, the idea of seeing a male doctor can be deeply uncomfortable. Although separate sections for female patients are common in most hospitals, a 2005 study in the journal Acta Obstetricia Et Gynecologica Scandinavica found that over 86% of Middle Eastern obstetric and gynaecological patients would be happier being treated by a woman.

In October 2016, the opening of Medcare Women and Children’s Hospital in Dubai was hailed as a major step forward for UAE women’s healthcare because of its unusual staffing policy: 90% of its 400 employees are female, from doctors and pharmacists to security guards. While Abu Dhabi’s Brightpoint Royal Women’s Hospital, which opened in June last year, was the UAE’s first hospital to accept only female patients, Medcare Women and Children was the country’s first tertiary hospital to have such a high proportion of women on staff. Alisha Moopen, the CEO and executive director of Aster DM Healthcare Group, says the aim was to provide a “comfort zone” for women who “always put themselves last”.

Women for women

Dr Shamsa Abdullah Ali bin Hammad, chief operating officer of Medcare Women and Children’s Hospital, says the hospital is most importantly “by women for women” but one of the biggest challenges has been to market the facility as a one-stop shop. “Everybody thought that the Women and Children’s Hospital is only for pregnancy and deliveries – no. We are a multispeciality hospital,” she says. “We always try to touch and heal every aspect of women’s health.”

The facility currently has 84 beds over 132,500ft² with the capacity to treat 1,000 outpatients a day. While the obstetrics and gynaecology departments see the most traffic, the hospital also offers paediatric cardiology, dermatology, plastic surgery, dentistry, urology, gastroenterology, general surgery and a 13-bed NICU, the smallest success story of which was born at just 24 weeks.

Much of the staff’s work is in guiding women to appreciate the importance of their own healthcare outside pregnancy and childbirth. That means changing their understanding of a hospital to a place that is more than just a nursery. “All these women are ignoring their health while they are taking care of their families, kids and the work they have at home,” Hammad explains. “A healthy woman has the power to create healthy societies, so it’s really important to take care of her and her family.”

Luxury look

The private, premium Medcare brand is designed to remove the dread of a hospital stay with a philosophy of creating ‘hospitals that don’t look like hospitals’. The front entrance opens into a lobby with polished marble floors, carved railings and a chandelier. Patient rooms look more like stylish hotel suites, with tasteful chaise longues and ornate cabinets, balconies hidden by embroidered curtains, and elegant pendant lights. The bed and its curtain rail are the only clues to where a patient really is. There are VIP wings, a terrace swimming pool and plans for a wellness centre with fitness classes, a spa and a beauty salon. Evie Boustantzi is general manager of Al Shirawi Interiors, the company that designed the fit-out of the hospital. She says the quality of the finishes “resembles that of a seven-star hotel”.

The luxury feel helps to reimagine a hospital visit as more like to a trip to the spa, at a time when the UAE Government is eager to promote medical tourism and there is still high demand for obstetric and gynaecological services. In combination with the all-female atmosphere, this makes the hospital appealing to obstetrics patients, who are the most likely to travel for treatment.

However, the other big draw for visiting patients is non-surgical: they come for comprehensive check-ups and wellness packages tailored according to a woman’s age. Starting from AED1,575 ($428), a basic women’s screening includes a gynaecological consultation, pap smear, ECG, abdominal ultrasound, and blood and urine tests, including fasting blood sugar.

“Ladies are requesting packages for nutrition, skincare or how to live a healthy lifestyle,” Hammad says. “A lot of awareness is happening, and they are really taking care of themselves and their health.” The hospital has used this as a springboard into community outreach, with campaigns for healthy eating, breast cancer screening, skin diseases and dental care. The marketing is often framed as a woman’s duty to her family, but Hammad says it also pushes the message that “you are important, so you have to take care of your life”. Campaigns target nurseries, mosques and professional societies to reach working women, including a recent talk for employees at the Dubai Customs Centre on how diabetics should handle fasting during Ramadan. One direct, but discreet, campaign in March placed specially-made pebbles into women’s shoes while they were at prayers. When they went to remove the lump they felt in their shoes, they found the pebble printed with a message: “Some lumps are not visible. Breast check tips at 800 Medcare.”

At the hospital itself, there are sessions for first-time parents – dads included – and sexual health open days where women can pick up information in a safe environment. This is vital in a country where sex education isn’t taught in schools. “We are doing woman-to-woman campaigns, where they can talk freely and comfortably with us,” Hammad says. “We have feedback from our patients about how it’s easier for them to talk to the [female] doctor… we are relating to the patient, and that’s emotional defence also.”

Hammad believes employment, education and Dubai’s multicultural atmosphere have contributed to the growing awareness among Emirati women of the need to take care of their personal health. The rising employment rate for women has also meant that the hospital has had few staffing issues despite the gender emphasis. “I think maybe in the previous 20 years you would have had difficulty finding females who could work at this place, but now, in 2017, we have a lot of ladies who would like to join us,” Hammad says.

Hammad is one of only two Dubai women on staff, a fact she says is by design rather than a product of a country with a shortage of medical graduates. “Dubai is a multicultural place, so we need different people so they know how to deal with different nationalities,” she says. Filipino, Asian, Australian, Czech and UK expats all feature on the staff roster.

Patient care staff who treat women and baby girls wear pink scrubs, while those treating baby boys wear blue. However, in practice, hospital life is not entirely segregated. Aside from the few male staff members and the occasional man admitted to the emergency department, the hospital embraces a holistic philosophy of caring for not just the patient but her family too. “Women are coming with their husbands, with their families, so actually you are dealing with everybody,” she explains. “If a patient delivers, you also have to take care of the father, because the mother is in the delivery room and the father is maybe anxious or exhausted.”

Support networks

Hammad previously spent 14 years at the Dubai Health Authority as a family physician and administrator for its women’s clinic and community health department. Apart from the support of a bigger and more comprehensive team, the major difference she sees is in the attitude of her staff. “We are treating patients how we would want to treat our families,” she says. “It’s a really friendly environment here; if you create a family environment, you get an excellent result for your clients. We are doing a lot of communication skills courses for our staff and they were really a success. We got a lot of positive feedback from our clients saying thank you, they loved it.”

Anything that the Women and Children’s Hospital is unable to deal with can be referred to Medcare’s Multi Speciality Hospital or Orthopaedics and Spine Hospital, which are just a few blocks away along Sheikh Zayed Road. Demand is high – deliveries in May 2017 reached a peak of 214 – and Medcare already has big plans for expansion. As well as the women’s wellness centre, the hospital plans to add up to 100 more beds, including increased capacity in the NICU. A dedicated breast surgery unit is set to open in September 2017 and will increase surgical capacity while the hospital’s gastroenterological department is also tipped for growth. Hammad says she aims to increase demand for general surgery and plastic surgery – although obstetrics and gynaecology remain the clear leaders.

NMC Healthcare, owner of Brightpoint Royal Women’s Hospital, is also seeing high demand and plans to turn its success into a chain of similar facilities. Whether it’s the luxury touches or the ability to fully relax out of sight of men, the female-led model is clearly striking a chord. Every patient benefits when a key source of stress is removed and women-only hospitals offer a rare opportunity to reach women who sorely need education on sensitive health topics. Ultimately, for Emirati women to begin taking charge of their day-to-day health, they must be able to see a hospital as a place of understanding and comfort.