IF ASKED, most people probably wouldn’t know strictly what multidisciplinary or interdisciplinary care is, though such knowledge might prove very useful at some point in their lives. In terms of healthcare, the terms are relatively new, and represent a somewhat unexplored ground, as the current playing field offers very little by way of that which would constitute multidisciplinary care.
Dr Elham Hamdan, however, has proven to be one of the pioneering forces behind introducing multidisciplinary care to Kuwait, and her efforts ensure that this care continues to expand to encompass various different departments and aspects of healthcare, ensuring the most comprehensive and optimal approach to treating patients undergoing rehabilitation or pain management.

As one of the founders and president of Fawzia Sultan Rehabilitation Institute (FSRI), she began the steady road towards building a type of healthcare which is not only far more convenient for patients, but more importantly allows the patient more independence, and helps build awareness in the community, as well as providing preventative measures for primary symptoms. Multidisciplinary and interdisciplinary healthcare, though relatively new, have proven to be one of the most effective platforms for providing patient care and rehabilitation, particularly in the areas of chronic pain and bone and muscle conditions.
Having founded Zama Wellness and Wellness Consulting International, Dr Hamdan is also the National Action Network Coordinator for the Bone and Joint Decade, a nationwide program aimed at mobilizing specialists in bone and joint conditions. Her efforts are an attempt to provide more proactive healthcare, and encourage patients to be more involved in their own treatment.

Question: Tell us something about yourself, your background, etc.
Answer: I graduated from medical school in Ireland in 1993 and then I went on to study orthopedic surgery at the University of Toronto in Canada. I then sub-specialized in chronic pain-management and spine surgery. When I returned to Kuwait I worked for a while at the orthopedic hospital in the Kuwaiti Ministry of Health. Seven years ago I was offered the opportunity to set up a private non-profit rehabilitation center which became the Fawzia Sultan Rehabilitation Institute.

Q: Tell us more about FSRI?
A: FSRI is the first non-profit health center in Kuwait. We provide clinical services including physical therapy, speech therapy, occupational therapy, nutritional consultation services and psychological services. We also have a research and education department. The center was established about seven years ago, because it was thought that there’s a need for good quality multidisciplinary rehabilitation services. It was established as a subsidiary of FAWSEC Education Company that owns Bayan Bilingual School and Fawzia Sultan International School.

Q: And what is the mission of FSRI?
A: Our goal is to become a leader in the provision of multidisciplinary rehabilitation and psychological services in the Middle East in a research and educational setting. It is founded on the ideals of maintaining a structure of service through clinical care and rehabilitation; education for our clients, our community and healthcare professionals. Research and education are also very important, because you can’t implement change in policy if you don’t know what the extent of the problem is.

Q: What kind of services does it provide?
A: We offer a variety of rehabilitation services; we started initially providing physical therapy. The majority of patients that come for rehabilitation are physical therapy patients, so it started out as a small physiotherapy center. But we slowly discovered that there was a need for a more comprehensive service and began adding other specialties like speech therapy, occupational therapy, massage therapy, nutritional services, personal training etc., and finally last year we added a psychological services department which employs five full time staff.
It is important to provide a multidisciplinary approach in caring for the patient. This means that a patient can have several specialists caring for him/her. These clinicians are able to communicate their diagnosis and care plan to each other so that they end up offering the patient the best care possible.

For example: a patient who has suffered a stroke will likely need physiotherapy to help him/her move, strengthen weekend muscles and prevent stiffness. He/she may also need to see an occupational therapist who will help with dressing, bathing and eating. This specialist may also visit the patient at home and help modify the patients environment to reduce falls and make daily activities and tasks for the patient easier. In addition the patient may see a speech therapist if speech has been affected. A psychologist maybe needed for counseling the patient and the family. All these specialists work together to optimize the patients recovery.
These are the main services, and the reason you do this is because if you want to take care of a patient, the ideal is to have their care encompass all aspects of what the patient needs.

Q: What kinds of patients do you see at FSRI?
A: The majority of patients we see in the physical therapy department are patients with bone and joint problems, back pain, knee arthritis etc, or they may have recently sustained a sports injury or had surgery. We also see a number of patients who have had a stroke, Parkinsons disease and multiple sclerosis. In the psychology department we see a variety of conditions like depression, mood disorders, addiction. We also see couples and families for therapy and we see many children for IQ and disability assessments.

In the pediatric department we see many children with cerebral palsy, some traumatic brain injury patients, patients with brain tumors and children with a range of disabilities from mild to severe. We are working on developing this department further and trying to get external funding for it so that children may be able to be treated at a lower cost or even free of charge. This is important because if a child has a condition that needs ongoing care the price maybe prohibitive for most parents.

Q: What are the most common conditions you see in children?
A: Cerebral palsy is by far the most common childhood condition we see in the clinic.

Q: What is cerebral palsy?
A: This is an umbrella term used to describe a persistent disorder of movement or posture. It is caused by an abnormality in the immature brain due to damage which is non progressive. The damage can be caused before, during or shortly after birth. It is very common, 1 in 400 live births but ranges in severity from mild to severe.

Q: How is cerebral palsy detected?
A: Sometimes the child is known to be high risk and the physicians know to look for the signs. The child may have seizures early on which can lead the physician to suspect the diagnosis of CP. At other instances the child maybe noted to be developing abnormally as there may be an abnormality in movement or they may not be progressing normally within their milestones, so not sitting or walking at the right time. Once the child is diagnosed with CP, he/she will need to be cared for by a multidisciplinary team or team of developmental specialists who will work together to optimize the child’s care.

Q: When was the children’s program started?
A: We’ve actually started collecting funds and we have a lot of interest in this program. The plan is to start officially in October with 20 children. They’re all going to be funded for a year, and it’s going to be done in affiliation with Glenrose Rehabilitation Hospital in Canada. We will not only be treating these children, we will host consultants from abroad training local staff to build sustainability. They will be training doctors, physiotherapists and occupational therapists in the community and in our clinic, and they’ll also be consulting on treating these patients. We’re hoping that we’ll be able to start this by November.

Q: Do you work in association with other external hospitals or institutes?
A: Yes, we have affiliations with the physiotherapy departments at the University of Toronto and Queens University in Canada. We have had physiotherapy students do their internships at our clinic from both those institutions. We are also clinically affiliated with Glenrose Rehabilitation Hospital in Alberta, Canada and are now working on organizing a spasticity workshop in Kuwait with their staff.
We also have affiliations with the University of Wisconsin-Madison and Duke University.

Q: What kind of community work do you do?
A: We have many collaborations with partners in the community. One of them is the Community Eye Health Initiative. This is a project that was developed by Dr Manal Bouhaimed, an Ophthalmologist at Kuwait University and was funded by Zain. It is an initiative that includes various projects like educating teachers and nurses in schools on how to examine children’s eyes or identify causes of preventable blindness. We also organized the Porsche Driving School project located in Qadsiyah Club. Also, every year we work with students from LOYAC, and because of their hard work we have been able to publish research almost every year since our establishment. The University of Toronto helps us design the study and publish it. We then coordinate and the students collect the data and enter it, and do a bit of reviewing of the data.

Q: What kind of data do the students collect?
A: Mostly epidemiological data like the number of people who wear seatbelts, or the number of people who use sunscreen etc. Two years ago we asked them to interview mothers of children with disability for us to be able to study the perceptions of disability among those mothers. We did our first study, which is the prevalence of back pain in healthcare workers in a Kuwaiti hospital. Another study was the perception of disability amongst mothers who have children with disabilities. Another one was the prevalence of carpal tunnel syndrome; because we don’t have these numbers in Kuwait.

Q: Do you think that the Kuwaiti lifestyle may predispose people to certain conditions?
A: Yes, I think that we don’t move much in Kuwait, we drive everywhere, and eat lots of fatty and sugary foods which predisposes us to obesity, diabetes and heart disease which are all preventable.

Q: Do you work on preventative measures?
A: Yes, we do. We try to educate our patients on what constitutes a healthy lifestyle. We write articles in the newspaper on a regular basis and provide free lectures for the public. We also recently started a back class for the patients who have chronic back pain.

Q: How would you characterize the kind of care that FSRI provides? How is it different from other rehabilitation centers?
A: I think one of the main things we do is provide quality care by senior qualified staff in a multidisciplinary setting. Also, we focus on educating the patient to give them time and help them. We try to encourage the patient to be more independent and do their exercises at home, rather than continue coming to get treatment.

biography
Dr Elham Hamdan is the President and Medical Director of the Fawzia Sultan Rehabilitation Institute (FSRI). She received her MD from the Royal College of Surgeons in Ireland, and completed her residency at the University of Toronto. She is one of the founders of FSRI, as well as being founding partner of Zama Wellness and founder of Wellness Consulting International.