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EF: Looking at 2022 in the context of the last two years, 2020 was the year of diagnostics, 2021 the year of vaccines; what do you think 2022 will bring?

EA: We hope to return to normality in 2022; there is Covid fatigue generally setting in, and hopefully, we are past the worse of it. There may still be a minor Covid wave, but there is huge healthcare catchup in the backlog of other diseases. People are returning to treatment for their chronic conditions neglected over the past two years. Many patients have not accessed treatments using technology, whether in-home care or telemedicine. We see the consequences at the facility and the long-term effects of Covid. My 2022 forecast is that it will be a good year in terms of health provision. We are projecting a good run for the year financially as many elective surgeries were postponed, and there has been a huge push to get them done before the next wave and the cold winter months when Covid might be worse. We are all suffering from Covid fatigue and are trying to get our lives back.

EF: Could you elaborate on the hospital's role during the pandemic?  

EA: We were primarily responsible for ensuring Covid-care for the community. We had a detailed and structured system to manage patients at home or outpatients. We sent out nursing teams to patients' homes, and we set up an emergency station at the facility, installing an additional separate structure centre for patients. We had three sessions a day, morning, mid-morning, and afternoon to treat patients. Through partnerships with charitable organizations and foundations, we went to outlying areas to offer the provision of care, trying to assist as many people as possible by creating satellite services. We collaborated using every possible avenue of help going to the patients rather than the patient coming to the facility because it created better patient experiences and clinical outcomes. It also meant getting to the patients earlier before the complications of Covid set in. Between waves, we set up post-Covid recovery structures, a kind of Covid rehab centre, to get patients to exercise their lungs. We made available oxygenation centres for those who had difficulty breathing and provided oxygen to patients' homes. Our service was complete and holistic.  

EF: Could you elaborate on the lessons learned –here to stay-and experiences from the pandemic?  

EA: Judging from what we saw during the Covid waves, a lesson learned was the at-home-care, a pivotal point for us and the patients because it worked very well, as it didn't block up the hospital, and we could still collectively manage the patient. Home care is a key priority for us; post-covid, we have set up an in-home care department. Patients either have a teleconference with a doctor or come in once to the doctor and then we provide nurse services. The nurse goes to the patient's home to manage the patient. The system is here to stay, and with the move to reduce healthcare costs in South Africa, it will add value for the patients and us. The medical schemes are quite receptive to it because it lowers the cost of care, and the patient is getting appropriate care at the right time and in a convenient place. We have also set up Chronic Disease Management Centers. During Covid, the patients were scared to come into hospitals, but they still needed assistance managing their chronic diseases and complications. Hence, we set up satellite Chronic Disease Management Centers, and people could walk in either weekly or monthly to have their chronic conditions managed. The patients were controlled, outcomes improved, the hospital environment was avoided, and the risk of getting Covid was reduced. Even today, patients are reluctant to come, so having the Chronic Disease Management Centers separate from hospitals was a big inducement to control their chronic conditions. Throughout, technology was instrumental; with digital platforms, zooms, remote patient monitoring, telemedicine, etc., we leveraged all the digital options to benefit the patients and the hospital. Technology is here to stay, and the patient's mindset has also changed; they now like having a teleconference with their doctors from the comfort of their homes. Technology and remote patient monitoring allow doctors to access all the needed data. House visits allow for readily available oncology treatments and pathology, and we can offer the complete spectrum of care without the patients having to come in or be hospitalized.  

EF: Do you have educational programs for your physicians to prepare them for upcoming innovative technologies and artificial intelligence used in healthcare?  

EA: We haven't started yet, but we will be changing things bit by bit. We will soon make doctors familiar with what is available in the market and how it will be easier for all involved to consult with the best. Although ideally, patients should physically see the physician when necessary, in my estimation, 70 to 75% of the patients don't need to be physically in front of the doctor for a consult. At the hospital, this is our aim, but we are not there yet. I think that the trickiest part of the equation will be educating and convincing both patients and some physicians of the benefits of AI –despite the fact it is already among us: i-watches or house security monitoring. We need to take it a step further to educate people and end up with a much healthier population. Technology and AI will make physicians' jobs easier and more efficient, and they still will be the decision-makers offering more personalized treatments to patients. There is a mixed bag of physicians with older and younger generations, the younger accepting it. In contrast, the older generation needs more time to see it as a positive addition.

EF: Is the generational difference a challenge for the hospital?

EA: The older generation of doctors like the old way of doing things; convincing them to adapt to new technologies is challenging as they are used to making decisions based on their training and experience. The difference in acceptance between the generations is very much there; the younger generation embraces technology. When visitors were not allowed to visit patients during the pandemic, we offered video communications; the youths easily took to it, whereas the older generation wanted human contact.  

EF: How do you see the role of the healthcare infrastructure in developing the economy in South Africa?

EA: Investment in infrastructure is critical to the sector and country, as it leads to the creation of employment, and opportunities for social growth, and healthcare takes on a pivotal role, giving quality in terms of human capital. A healthy population means productive people, which makes investment in healthcare infrastructure critical to a country. We need to ensure that our very young population is healthy, and the more we spend on health infrastructure, the more productive human capital is available. While others put investments on hold during the pandemic, we have invested and continue to invest a lot of money in health infrastructure to prepare for the future. Health infrastructure: healthcare services, sanitation, and vaccination programs play a key role in helping a country's economy in mobile and efficient delivery. Investment in healthcare is an investment in the country; one cannot grow without the other.  

EF: What would be your advice to investors looking to invest in healthcare services in South Africa?  

EA: From an investment perspective, I think there are huge opportunities in South Africa. We might be considered a third-world country, but the private health sector is first-world. The quality of private healthcare in South Africa has always been good, equivalent to what you would get in Europe. We have invested in bringing the latest technology to South Africa. Having the latest technology would be a huge boon for the country because we are looking forward. Healthcare has changed and will continue changing dramatically; the scenario will be different in three years; we will have increased our innovation and technology. In sanitation, for example, we have an excellent track record in reducing disease burdens. Regarding patient interaction, we will be seeing 30 or 40% of the patients through healthcare apps –today, it is only 3%- but the investment is required. I believe the investor should not build hospitals but invest in healthcare support services systems.  

EF: There is a statistic that 90% of multinational pharmaceutical companies use South Africa as their regional headquarters. How do you see South Africa's role as a healthcare hub from a global perspective?

EA: As aforementioned, South Africa has first-class private healthcare, and medical tours are something South Africa has not pushed, but we have resources and have been doing the research and trying to put something together. We have all the procedures in South Africa at a quarter of what they cost in the UK, including travel. Cardiac and bypass surgeries are substantially cheaper and done by the best professionals. Our doctors are very well trained and internationally recognized in many fields. We are ideally positioned geographically to be a hub for first-world medicine at a fraction of the cost.  

EF: In the changing scenario, what are the skill sets you are looking for when hiring doctors and nurses for the hospital?

EA: We are leaning toward physician sub-specialities, infectious disease specialists -the nitty-gritty of medicine- and not general physicians. We want the right doctor for the patient's condition; after seeing a general practitioner, the patient can then go and see the super-specialist in the disease area the patient needs. Unfortunately, nursing skills have suffered in South Africa, especially among ICU care nurses. We have set up a training program to upscale and train our staff nurses rather than wait and source them from other facilities. We need higher skilled nursing staff for the facility, so we work on training our nurses on the homegrown skills we require. Since Covid, the patient profile has changed, and patients come in a lot sicker, and intensivist nurses are needed as much as general nurses. We need nurses with a lot more experience and training to manage these patients as their condition can quickly change or deteriorate, and we need nurses that can pick up the signs. We have a clinical facilitator who attends sessions with our staff every week to highlight these aspects and subjects, upscaling our nursing staff to a high level.  

EF: You were the first hospital in South Africa to be selected by Discovery 2017/18; how do you keep your team engaged?

EA: As things stand, we spend two-thirds of the day in the hospital, so it is practically our home and family. The staff must work in a home environment, and we have employee initiatives to support our staff, either financially or with support services, trying to engage them at all times. We have an open-door policy; if a person has a problem, they can come in and talk to us, and we will try and assist. We have weekly sessions with staff and listening forums where they are allowed to speak up and vent in a neutral space and express themselves freely. They can give their opinion on how things work and suggest improvements, allowing them to be part of the decision-making process of the facility. The ongoing training and development have also added value, creating opportunities that keep them engaged.  

EF: How would you like to be remembered for your management over the last few years?

EA: Our motto is healthcare excellency, and we want to be recognized as leaders in patient care. Our facility offers the best patient experience and the best clinical outcome at the right time. Patients enjoy quality care at our facility delivered with smiling faces. Our maternity unit has been so successful over the last two years that it is known as the Royal Maternity Experience. Patients say they feel like royalty when they get here. Our aim is for all patients to enjoy the best possible experience at Al-Kadi Hospital.

February 2022
South Africa