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Tackling Kuwait's Diabetes problem

Interview - March 27, 2014
While Kuwait enjoys one of the best healthcare systems in the world, the country suffers of the highest rates of diabetes with 25-30% of the population already living with the chronic disease. In an interview with United World, Director General of the world renowned Dasman Diabetes Instiute – Dr. Kazem Behbehani – says that while the only real way to combat the oncoming of the disease is through the promotion of more healthy lifestyles, he also stresses how DDI has developed one of the world’s most productive biomedical and clinical research and training programs, its work with the government to provide public health policy support, and its cooperation with major institutions such as Harvard University
The State of Kuwait has been blessed with two natural resources - its oil on one hand, and most importantly, it’s people.  None of them had been developed to its fullest, the first one because it has been relied upon too much, and the second one, the personnel factor not that much.  Dr. Kazem, what do you consider Kuwait needs in order to develop its potential?
I would say that we need to invest even more resources in the education of our children and also not forget the need to continue educating the adult population of Kuwait on matters of health maintenance. I am happy to say that Kuwait has already given very high priority to education and that today everyone in the country has access to education.  It is one of the things that Kuwait and Kuwaitis can be proud of. 
In a democratic system such as the one we enjoy in Kuwait, education and information are seen as key ingredients to social development. In this regard we have benefitted enormously from a far-sighted government and his HH the Amir of Kuwait, who has always made the welfare of the people of Kuwait a prime objective.  The investment Kuwait has made in education and information is paying off in many ways. At the Dasman Diabetes Institute (DDI), where we are committed to fighting the scourge of diabetes, I see a rapidly growing interest by the public - as well as by our staff - in sharing new knowledge and empowering people to fight diabetes.
This is not easy, however. Life-styles have changed rapidly everywhere and people’s dietary behaviors have evolved in fundamental ways. We are exposed to more junk-food than ever before, and we have become far more sedentary. We no longer get the type of everyday exercise we used to, and which is so essential to healthy living. This is something I would like to see change and it is something that the DDI is working on with the Ministry of Health and its other partners in Kuwait.  
Unless we focus on this problem, the health and welfare of people in Kuwait could deteriorate dramatically.  We are already seeing young children aged under ten years developing diabetes which until recently was a disease of the elderly. We must now act aggressively as a society if we are to survive this modern-day plague.  One of the problems is that diabetes and obesity, which is one of the causes of diabetes, are silent conditions. They creep up on people, and before they know it, they have reached a point of critical disease that is dangerous for them and more difficult to manage clinically. 
At the DDI we have taken up a number of key actions to fight the problem of diabetes. We have developed one of the most productive biomedical and clinical research and training programs in the world and we are now working hand in hand with major institutions such as Harvard, Oxford and University College London. We are also developing a public health research and policy program that is already providing support to the Ministry of Health and the Ministry of Education in introducing new evidence-based policies and programs designed to reach out to children and adolescents, adults and people already living with diabetes. 
You’re talking about a very particular disease which is diabetes.  In general aspect regarding the healthcare system in Kuwait, what do you consider this country is facing as its main challenges in this service?  
In Kuwait we enjoy an excellent healthcare system. We have a solid primary health care system that is backed up by specialist hospitals and staff. Everyone has access to these facilities and in addition our medical care is free, including surgery and medicine. 
But we must remember that health is not only dependent on the type of care we can get if and when we become ill. Good health means preventing disease in the first place and leading lifestyles that sustain good health. In Kuwait, just as elsewhere, many people have forgotten this and they have also forgotten that we all have a responsibility to try to stay healthy by avoiding risky behaviour. In the case of diabetes and many other diseases, this means eating carefully and exercising as much as possible. I believe we could cut the rate of new cases of diabetes by half if we could get people to lead nutritionally sound lives and get people to walk and run more on a regular basis.

I know this is not easy.

We live in a part of the world where the climate does not help and where there are many months of the year when it is difficult to be physically active.  Fortunately we have massive air-conditioned malls where people of all ages can walk all year round. We must get the private sector to join with us in encouraging people to use these new malls as places of positive living as well as shopping.     
Today when we have one of the highest diabetes rates in the world, with between 25% and 30% of the population already living with diabetes, we must act fast and firmly. We must engage everyone including employers and schools, medical practioners and public health staff. There is not a moment to lose.   
You mentioned 25%-30%, which percentage would you target as an objective?
Diabetes is a chronic disease so it will never be possible to quickly reduce the prevalence of the disease. But I am a firm believer in the ideal of secondary prevention, which means ensuring that people with diabetes are able to avoid the complications that can come with diabetes.

This means training people to manage their disease correctly, not only eating properly but also controlling their glucose levels and responding quickly to changes in those levels. It means getting people with diabetes to check their feet and their eyes regularly for warning signs of the complications that can be dealt with in a timely fashion. I do not want people in Kuwait to lose their feet and legs to this terrible disease, and I do not want them to have to lose their eyesight. These are all avoidable complications and today we can ensure that people with diabetes can continue to live happy and productive lives, free of pain and disability.   
At another level, of course, we must do everything to dramatically cut down the number of new cases of diabetes. This is where we will make the greatest impact in this fight. We must not let diabetes become a disease of children, for if we do we will lose the valuable social capital that is our young people and be lost as a society.  I am convinced this is doable and that together as a united Kuwait we can ensure that children’s future and that of Kuwait is guaranteed. To do this we must educate them on health and we must empower them to take control of their own health and that of their loved ones. This is the key to the future.  
This reminds me of a quote from you that I read from your manifesto on global group you presented to the World Health Organization that we all have a basic human right to help but we also have a responsibility to create and protect the environments that help promote and support healthy lifestyles.  You are creating these environments so that you are plucking the problem from the very beginning.    
That is correct.  It has to come.  We have to engage in what I like to call health and social engineering, that is to say in creating the personal space in which health is possible.  Today we have allowed other things to take over without realizing that some of these things around us are not necessarily good for us. As I have already said we need to change our lifestyles and go back to some of the things which we used to do such as walking and running more, using our cars less, eating healthy diets and probably simply eating less. 
Today people worry about environment in terms of pollution and climate change and these are certainly things we all need to be concerned about. But there is another more personal everyday environment that includes a range of things we should do to take control over our health destinies and improve our overall well being.
Prevention through education. 
Exactly. That is where I see the solution.
As the director-general of this institution, what do you consider as this institute’s greatest achievements?    
There is still a great deal to do, but I am happy to say that today the DDI is internationally known as a centre of excellence. Its clinical and biomedical research is widely recognized and its clinical services component is helping the Ministry of Health of Kuwait to provide state-of-the-art treatment and rehabilitation. Our work has been recognized by the GCC Health Ministers Council which has recently designated the DDI as a Reference Centre for the region. The DDI has also received Accreditation Canada International status and been given Gold Standard approval.
Last year a team of researchers at the DDI was successful in isolating a gene that can be effective in fighting obesity and type 2 diabetes. This discovery will help to open up new avenues for the prevention and better treatment of these two diseases. It is just one example of our bio-medical research success. We are also working intensively on translational research in health education and promotion, and we are collaborating with world renowned organisations such as the Joslin Diabetes Centre in Boston and the University of Dundee in Scotland on training and educating healthcare staff so that they can provide even better care to the people of Kuwait. 
When we met with Dr. Hilal, he was very proud of the fact that before there was somebody in this institution, there were zero research papers published.  But after you worked here, there were many research papers published.  What happened?  What was the change you applied in this institution to succeed in that way?

I came to the Dasman Diabetes Institute with a long background in clinical research and public health management. I was previously on the faculty of the Kuwait Medical School where I both studied and practiced. I also trained at the Harvard Medical School in Boston and the Liverpool and London Schools of Public Health and Tropical Medicine. Before returning to Kuwait I was also the Director of Tropical Disease Control at the World Health Organization and was later appointed Assistant Director General of the WHO for External Affairs and Governing Bodies. I brought all this experience with me to the DDI.
I have also realized that helping an institute such as the DDI to grow and be able to contribute to the health of a country means choosing the right group of people to do the right job and providing the opportunities and resources needed to take science forward. As you say, when I came to the DDI, there were no publications to its name and the Institute was simply not on the map.

Today we have more than 50 research publications and many other poster presentations at national and international events. Scientists from many countries now come to the Dasman to work with us, develop new knowledge and join with Kuwaiti scientists in new cutting-edge research. 

You were just mentioning your vision for international institutions, we consider now the scope of the Dasman Institute we were talking about this link you were doing with the US and Malaysia for example, research programs you have with other leading institutions worldwide.  What comes to your mind now that you’re acting as an ambassador from a Kuwaiti institution? 

First of all I am not alone in being an ambassador for Kuwait.  Kuwait has many other scientists and health researchers who are also carrying the flag.  But certainly I am proud to be doing my part in this and in making Kuwait prominent in international scientific circles. I have just finished a document called the ‘Kuwait National Programme for Healthy Living: first five Year Plan 2013 to 2017’ and this has already drawn attention from anumber of countries.    
Among the things I would like to see is an even closer collaboration between all Kuwait’s ministries on matters that are relevant to health.

The Ministry of Health has a crucial role to play in this, but other ministries have a lot to contribute too. The Ministry of Communications has a fundamental role in promoting healthy living through TV, broadcasting live radio programs and publishing a monthly magazine to provide necessary information regarding a healthy lifestyle. Other potential stakeholders include the Ministry of Education, the Ministry of Labor and Social Affairs, the Ministry of Commerce and Industry, the Ministry of Public Works as well as the pharmaceutical sector, non-governmental organizations, banks, and Cooperative Councils.

Improving the health of Kuwait and its people must be seen as a collective responsibility and one to which all of us must bring our skills and bodies of knowledge. I believe Kuwait can and will become an international trend setter in this regard and provide an example that other countries will pick up on.

 Our work with Malaysia and Indonesia is typical of this and our work with international organizations in Switzerland and elsewhere is an example of how Kuwait is providing impetus to the global fight against diabetes.      
The whole idea is to generate a sense of the magnitude of the problem and give everyone both a responsibility and an opportunity to make a difference – be they merchants, the public, teachers, healthcare professionals or others.  At the DDI we are working hard to make this plan a reality and we are bringing people together in moving the plan to reality. This is our mission and we believe it will make a huge difference. 
You are talking about this starting point now.  Following on this everybody’s responsibility, what is the private sector response here in Kuwait towards the initiatives of Dasman Institute?

I have always seen the private sector as a partner in health. While I was at the World Health Organization I successfully brought the private sector to the table and got it involved as an equal partner in fighting a number of tropical diseases.  At the DDI I continue to believe in the role that can be played by the private sector and I have engaged it in a number of our activities. I intend to continue exploring this field of partnership in the years to come.  
Unfortunately, diabetes is a common disease in the world, especially here in Kuwait, and in the US.  What is the main relation that this institute has with American institutions?

We are working very closely with Harvard Medical School and the Harvard School of Public Health in Boston. We have joint activities with the Joslin Centre there and also with the Forsythe Institute.  We are working with the National Institutes of Health of the United States to develop areas of joint research.

Our work with Harvard institutes already covers a range of new themes, including the development of a Knowledge Based Health Record system that is being used in a number of our primary health care facilities.  It also includes work on oral health and diabetes, especially in children. We have jointly developed research to look at the impact of environmental changes on pregnancy and early child development. 
Obviously, you are a believer of the power of technology.

Yes I am. I did a lot of work on eLearning and eHealth at the World Health Organization and I have made sure to bring the fruits of that experience to the DDI and Kuwait. Today when the vast majority of our young and older people are using smart phones, electronic notepads and conversing with each other and with global databases, it would be foolish not to build on this and harness the power of this new technology for health promotion.
Do you think it is a model that can be applied in Kuwait?
We have already started working with the Ministry of Health and a number of primary healthcare centres.

The idea is to improve the quality of diabetes care through a paperless informatics system that supports patient management, in this particular case, patients with diabetes and associated complications. It provides the potential to link patient pathways across primary, secondary and tertiary care so that clinical information is shared with authorised healthcare professionals across the healthcare system and ensures minimal duplication and maximal resource efficiency through integrated clinical care. It includes a diabetes disease registry, a patient profile database, integration of laboratory results and quality performance indicators.
We are discussing now that you are trying to conceptualize the impact we are talking about.  When we talk of numbers, it is sometimes hard to imagine but we think it will be more than the population of the entire United States of America…you begin to conceptualize how big an issue this really is…

That is the problem, and that is what we are committed to fighting.
Kuwait and US relations are very important from an economic perspective, from strategic point of view as well.  Now we see NATO forces pulling out of Iraq, pulling out of Afghanistan.  How do you see the evolution of the relations between these two nations?  

Kuwait has always been open to all other countries.  We have been and always will be a peaceful country and people. It is in our cultural heritage and this is our collective strength. Today I believe that through health development, Kuwait will contribute to bringing countries in the region and from elsewhere together around the common goal of Health for All. The Kuwait Fund is an excellent example of how this country is already helping other countries, and I believe Kuwait will become a pioneer in creating a better and far more peaceful world through its message of health development.

You have such a diverse background because you were coming from a more international scale and now you’re back.  You have been called back to Kuwait. I am curious about your motivations.  What is the next step for you?  As we said earlier, this is your baby, your creation, your project.  What is next for Dr. Behbehani?

I have always said that when we leave this earthly state, we do not take anything with us. What we can do is leave a legacy behind. The legacy that I would like to leave behind is a healthier Kuwait and a world in which my children and my grand children can fulfil the World Health Organization’s dream of attaining the best level of health possible. 

You are making it a better world for your granddaughter to grow up in.

What I want is a better world for my grandchildren and for all children. We are all born equal and we must all have the same chance to live full and healthy lives, free of insult and free of threats be they of a political, environmental or health kind. At the DDI we are working to this end and in doing so we are helping Kuwait to lay the foundation for a healthy world for future generations.   
These are the things we will be highlighting about Kuwait. Thank you for your comments.