Editorial
Pediatric pulmonology services in Saudi Arabia: Past, present, and future Khalid F. Al‑Mobaireek Department of Pediatrics, King Khalid University Hospital, Riyadh, Saudi Arabia
Address for correspondence: Dr. Khalid F. Al‑Mobaireek, King Khalid university Hospital, College of Medicine, Department of Pediatrics (39), P.O. Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. E‑mail: [email protected] Submission: 30‑08‑2013 Accepted: 30‑08‑2013
Access this article online Quick Response Code:
Website: www.thoracicmedicine.org DOI: 10.4103/1817-1737.118473
I
n the early 1990’s, there were less than five pediatric pulmonologists in Saudi Arabia. In spite of this, the first National Asthma Guidelines were published in 1994.[1] Also ongoing during this time were educational activities such as the combined Pediatric Pulmonology and Allergy Club and a local center‑launched Pediatric pulmonary fellowship training. We observed steady improvement over the past two decades in the field of pediatric pulmonology. We now have more than 40 pediatric pulmonologists. We have established cystic fibrosis care centers, pediatric sleep disorder centers, and flexible bronchoscopy units in various clinical institutes. Recently, one of the most noteworthy developments has been the recognition of the National Pediatric Pulmonology Fellowship by the Saudi Commission for Health Specialties. The first batch graduated last December (2012).
pulmonology services, other cities are lacking. Compounding this problem is the decline in the work force from attrition (e.g. retirement) and the loss from clinical practice due to administrative, teaching and research allocated time.
Of course, more pediatric pulmonologists are still required to meet the needs of our growing population. Saudi Arabia contains a higher proportion of youth than the United States and Europe. In the Kingdom, 30% of the population is between 0 and 14 years of age, in comparison to 15‑20% in Western Europe and North America.[2] The age limit of pediatric medicine, in Saudi Arabia, is from 0 to 12 years of age in most of the pediatric hospitals and clinics. This population will significantly increase once adolescents are included in the scope of pediatric medical care. They will require more pediatricians and pediatric subspecialists to take care of them. Furthermore, the obesity epidemic in children will also increase the prevalence of respiratory disorders such as asthma and sleep disordered breathing. Similarly, the increasing survival of children with chronic diseases and premature babies will increase the demand on pediatric subspecialties.
Also more demands are being placed on the pediatric pulmonary field requiring addition to the cadres. Newer services need to be developed, like preschool and infant pulmonary function testing. The field is moving toward more multicenter collaborative and basic science research. The need is extended to develop a center for diagnosing disorders like Childhood Interstitial Lung Disease, which requires expertise from pathology and radiology with easy accessibility for all specialists. Lung transplantation is increasingly becoming an important mode of therapy. This is logical as we are providing more advanced pulmonary care.
In 2013, the United States has a total of 1091 board certified pediatric pulmonologists. [3] Approximately, one board certified pediatric pulmonologist per 100,000 children in the U.S. This ratio is much lower in rural areas.[4] In Saudi Arabia, with approximately 8.5 million children under the age of 14 year,[5] the rate is one pediatric pulmonologist per 190,000. Though big cities like Riyadh may have adequate pediatric
Annals of Thoracic Medicine - Vol 8, Issue 4, October-December 2013
Solidifying and expanding the pediatric pulmonary fellowship program is a necessity as international scholarships are becoming scarce. One common challenge is to attract graduates of pediatric residency programs to undergo pediatric pulmonology fellowship training. In the US, pediatric residents are less likely to consider additional subspecialty training, compared with internal medicine residents. Of those electing subspecialty training, few choose to do so in pediatric pulmonology. Thus, in 2009, 24% of pediatric pulmonary training positions remained unfilled.[4]
The Saudi Thoracic Society (STS) has developed quickly despite its young age. But now the society needs to redouble its efforts to convert groups to assemblies so that we may recruit and retain all interested in the field. Strong assemblies within the STS will enhance networking and collaboration among colleagues in research and educational programs. They will give the opportunity for juniors to meet senior colleagues who can provide mentorship. They can also unify the service, strategic planning and workforce requirements in the field. The annual STS meeting can be an opportunity to assess the previous year’s performance and plan for the upcoming year(s). 181
Al-Mobaireek: Pediatric pulmonary in Saudi Arabia
In this issue, Dr. Yousef et al.[6] published the results of a survey sent to all pediatric pulmonologists in Saudi Arabia to evaluate the available services. They concluded that the country still needs more pediatric pulmonologists, especially in areas outside the major cities. For reference, they used the pediatric pulmonologist to population ratio of 1:360000 in the Canadian province with the best ratio. This target, however, may underestimate our need as our population has a significantly higher percentage of children than Canada (almost double).[2] To assess the adequacy of pediatric pulmonology services in Saudi Arabia, we need to use indicators such as waiting times for subspecialty appointments, difficulty referring to subspecialists, difficulty recruiting subspecialists and distance to care. Lack of supportive services such as speech pathologists, respiratory educators and respiratory therapists is another challenge. In regards to the low number of pediatric bronchoscopies, one contributing factor is the lack of operating room time – as currently most procedures are carried out there. We have started the first few miles of climbing and moving closer to the top. But, not surprisingly, as we move forward, we need to work harder to reach the summit; and perhaps even harder to remain there.
References 1. 2.
3. 4.
5.
6.
The National Protocol for the Management of Asthma, Saudi Arabia. 1st ed. Riyadh (KSA): Ministry of Health 1994. The World Bank. Available from: http://data.worldbank. org/indicator/SP.POP. 0014.TO.ZS [Last accessed on 2013 Aug 29]. American Board of Pediatrics. Available from: http://www.abp. org. [Last accessed on 2013 Aug 29]. Ferkol T, Zeitlin P, Abman S, Blaisdell CJ, O’Brodovich H. NHLBI training workshop report: The vanishing pediatric pulmonary investigator and recommendations for recovery. Pediatr Pulmonol 2010;45:25‑33. United Nation, Department of Economic and Social Affairs (DESA), Population division population estimates and projections section. Available from: http://esa.un.org/wpp/Excel‑Data/population. htm [Last accessed on 2013 Aug 29]. Yousef A, Al‑Shamrani AS, Al‑Haider SA, Yazan S, Al Harbi S, Al‑Harbi A. Pediatric pulmonary services in Saudi Arabia. Ann Thorac Med 2013;8:33‑41.
How to cite this article: Al-Mobaireek KF. Pediatric pulmonology services in Saudi Arabia: Past, present, and future. Ann Thorac Med 2013;8:181-2. Source of Support: Nil, Conflict of Interest: None declared.
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Annals of Thoracic Medicine - Vol 8, Issue 4, October-December 2013
Copyright of Annals of Thoracic Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Pediatric pulmonology services in Saudi Arabia: Past, present, and future Khalid F. Al‑Mobaireek Department of Pediatrics, King Khalid University Hospital, Riyadh, Saudi Arabia
Address for correspondence: Dr. Khalid F. Al‑Mobaireek, King Khalid university Hospital, College of Medicine, Department of Pediatrics (39), P.O. Box 2925, Riyadh 11461, Kingdom of Saudi Arabia. E‑mail: [email protected] Submission: 30‑08‑2013 Accepted: 30‑08‑2013
Access this article online Quick Response Code:
Website: www.thoracicmedicine.org DOI: 10.4103/1817-1737.118473
I
n the early 1990’s, there were less than five pediatric pulmonologists in Saudi Arabia. In spite of this, the first National Asthma Guidelines were published in 1994.[1] Also ongoing during this time were educational activities such as the combined Pediatric Pulmonology and Allergy Club and a local center‑launched Pediatric pulmonary fellowship training. We observed steady improvement over the past two decades in the field of pediatric pulmonology. We now have more than 40 pediatric pulmonologists. We have established cystic fibrosis care centers, pediatric sleep disorder centers, and flexible bronchoscopy units in various clinical institutes. Recently, one of the most noteworthy developments has been the recognition of the National Pediatric Pulmonology Fellowship by the Saudi Commission for Health Specialties. The first batch graduated last December (2012).
pulmonology services, other cities are lacking. Compounding this problem is the decline in the work force from attrition (e.g. retirement) and the loss from clinical practice due to administrative, teaching and research allocated time.
Of course, more pediatric pulmonologists are still required to meet the needs of our growing population. Saudi Arabia contains a higher proportion of youth than the United States and Europe. In the Kingdom, 30% of the population is between 0 and 14 years of age, in comparison to 15‑20% in Western Europe and North America.[2] The age limit of pediatric medicine, in Saudi Arabia, is from 0 to 12 years of age in most of the pediatric hospitals and clinics. This population will significantly increase once adolescents are included in the scope of pediatric medical care. They will require more pediatricians and pediatric subspecialists to take care of them. Furthermore, the obesity epidemic in children will also increase the prevalence of respiratory disorders such as asthma and sleep disordered breathing. Similarly, the increasing survival of children with chronic diseases and premature babies will increase the demand on pediatric subspecialties.
Also more demands are being placed on the pediatric pulmonary field requiring addition to the cadres. Newer services need to be developed, like preschool and infant pulmonary function testing. The field is moving toward more multicenter collaborative and basic science research. The need is extended to develop a center for diagnosing disorders like Childhood Interstitial Lung Disease, which requires expertise from pathology and radiology with easy accessibility for all specialists. Lung transplantation is increasingly becoming an important mode of therapy. This is logical as we are providing more advanced pulmonary care.
In 2013, the United States has a total of 1091 board certified pediatric pulmonologists. [3] Approximately, one board certified pediatric pulmonologist per 100,000 children in the U.S. This ratio is much lower in rural areas.[4] In Saudi Arabia, with approximately 8.5 million children under the age of 14 year,[5] the rate is one pediatric pulmonologist per 190,000. Though big cities like Riyadh may have adequate pediatric
Annals of Thoracic Medicine - Vol 8, Issue 4, October-December 2013
Solidifying and expanding the pediatric pulmonary fellowship program is a necessity as international scholarships are becoming scarce. One common challenge is to attract graduates of pediatric residency programs to undergo pediatric pulmonology fellowship training. In the US, pediatric residents are less likely to consider additional subspecialty training, compared with internal medicine residents. Of those electing subspecialty training, few choose to do so in pediatric pulmonology. Thus, in 2009, 24% of pediatric pulmonary training positions remained unfilled.[4]
The Saudi Thoracic Society (STS) has developed quickly despite its young age. But now the society needs to redouble its efforts to convert groups to assemblies so that we may recruit and retain all interested in the field. Strong assemblies within the STS will enhance networking and collaboration among colleagues in research and educational programs. They will give the opportunity for juniors to meet senior colleagues who can provide mentorship. They can also unify the service, strategic planning and workforce requirements in the field. The annual STS meeting can be an opportunity to assess the previous year’s performance and plan for the upcoming year(s). 181
Al-Mobaireek: Pediatric pulmonary in Saudi Arabia
In this issue, Dr. Yousef et al.[6] published the results of a survey sent to all pediatric pulmonologists in Saudi Arabia to evaluate the available services. They concluded that the country still needs more pediatric pulmonologists, especially in areas outside the major cities. For reference, they used the pediatric pulmonologist to population ratio of 1:360000 in the Canadian province with the best ratio. This target, however, may underestimate our need as our population has a significantly higher percentage of children than Canada (almost double).[2] To assess the adequacy of pediatric pulmonology services in Saudi Arabia, we need to use indicators such as waiting times for subspecialty appointments, difficulty referring to subspecialists, difficulty recruiting subspecialists and distance to care. Lack of supportive services such as speech pathologists, respiratory educators and respiratory therapists is another challenge. In regards to the low number of pediatric bronchoscopies, one contributing factor is the lack of operating room time – as currently most procedures are carried out there. We have started the first few miles of climbing and moving closer to the top. But, not surprisingly, as we move forward, we need to work harder to reach the summit; and perhaps even harder to remain there.
References 1. 2.
3. 4.
5.
6.
The National Protocol for the Management of Asthma, Saudi Arabia. 1st ed. Riyadh (KSA): Ministry of Health 1994. The World Bank. Available from: http://data.worldbank. org/indicator/SP.POP. 0014.TO.ZS [Last accessed on 2013 Aug 29]. American Board of Pediatrics. Available from: http://www.abp. org. [Last accessed on 2013 Aug 29]. Ferkol T, Zeitlin P, Abman S, Blaisdell CJ, O’Brodovich H. NHLBI training workshop report: The vanishing pediatric pulmonary investigator and recommendations for recovery. Pediatr Pulmonol 2010;45:25‑33. United Nation, Department of Economic and Social Affairs (DESA), Population division population estimates and projections section. Available from: http://esa.un.org/wpp/Excel‑Data/population. htm [Last accessed on 2013 Aug 29]. Yousef A, Al‑Shamrani AS, Al‑Haider SA, Yazan S, Al Harbi S, Al‑Harbi A. Pediatric pulmonary services in Saudi Arabia. Ann Thorac Med 2013;8:33‑41.
How to cite this article: Al-Mobaireek KF. Pediatric pulmonology services in Saudi Arabia: Past, present, and future. Ann Thorac Med 2013;8:181-2. Source of Support: Nil, Conflict of Interest: None declared.
Announcement
Android App A free application to browse and search the journal’s content is now available for Android based mobiles and devices. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is compatible with all the versions of Android. The application can be downloaded from https:// market.android.com/details?id=comm.app.medknow. For suggestions and comments do write back to us. 182
Annals of Thoracic Medicine - Vol 8, Issue 4, October-December 2013
Copyright of Annals of Thoracic Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
