A Public Health Transformation from 7,000 Miles Away

Revitalizing public health practice in the Arab Gulf.

By Erin Crews 09C 09G

Fatima Al-Slail

Fatima Al-Slail is one of the first six King Abdullah Fellows from Saudi Arabia studying at Emory's Rollins School of Public Health.

Wilford Harewood

Fatima Al-Slail always dreamed of being a heart surgeon. 

The youngest of five children, she grew up discussing medical advances over the dinner table and eventually earned a scholarship from the Saudi Arabian government to attend medical school in Cairo.

“But when you actually work with a cardiac patient, you see the other side of the field,” Al-Slail says. After graduation, she had returned to Saudi Arabia and was working in the cardiology unit at Saud Al-Babtain Cardiac Center.

“It’s not just that the patient comes in with a heart attack,” she continues. “They’re diabetic, hypertensive, hyperlipidemia, smoking, obese. And when they come in with a first MI”—myocardial infarction, or heart attack in layman’s terms—“you know they will come back with a second MI. I have seen it. Within two months they’ll be back.”

What lies behind these patterns? Al-Slail believes it boils down to a deep need for education. She tells stories of patients refusing to cut sugars or simply opting not to take their hypertension medication.

“Sometimes I would just sit there and cry with these patients, saying, ‘Come on, take this medication!’ And they just don’t understand me, because nobody teaches them about these things,” she says, sounding mildly exasperated even now, after months of living an ocean away. “I was thinking, What can I do to help these patients?”


“Sometimes you just know”

Enter Scott McNabb, a public health epidemiologist and informatics expert who was working on a project with the military health care system in the Kingdom of Saudi Arabia (KSA) when he retired from the Centers for Disease Control and Prevention in 2010. Now a visiting professor in the Rollins School of Public Health (RSPH), McNabb and his team so impressed Minister of Health Abdullah Al Rabeeah that they were recruited to expand the collaboration with Saudi Arabia’s Ministry of Health to RSPH.

Al Rabeeah and his delegation visited Emory that spring, forging ties and laying the groundwork for a partnership between KSA and RSPH that would begin to answer the questions troubling Al-Slail. As part of this agreement, the KSA Ministry of Health launched the King Abdullah Fellows program, providing scholarships for Saudi students to earn their master’s of public health (MPH) at Emory.

Back in the Eastern Province, Al-Slail heard about the new program from the Ministry of Health. “They gave a presentation about an opportunity to join Emory. And he gave the criteria, and I said ‘Yes—this is where I want to go.’ Sometimes you just know.” She is now among the first cohort of six fellows who arrived in Atlanta last August.

“These are professionals working in the Ministry of Public Health who are given special scholarships to come here to train and then go back and make a difference,” McNabb explains. “So they become part of a special cohort of public health officials in the kingdom that have been specially trained by Emory. The idea is to transform the ministry in terms of their ability to deal with public health issues.”


A brand-new culture

As the adviser to each of the King Abdullah Fellows, McNabb admits that there have been challenges in the program’s first year. Half of the fellows never had visited the United States, and most moved to Atlanta for the two-year program with their families.

“For the whole family to adjust to a brand-new culture, a brand-new language, that’s the biggest challenge,” he says. “We’re trying to provide opportunities for the family members to have English-as-a-second-language training, to make sure those needs are met.”

Al-Slail echoes this concern, advising that the next cohort of students have a rock-solid background in English. When asked if her classmates are struggling with language barriers, Al-Slail—who speaks confident and fluent English—responds, “I’m struggling with it! Regular talking is not like science talk.”

Overall, the transition to life in the United States has been a smooth one for Al-Slail, who visited more than a half-dozen times growing up. The biggest difference is the rigor of RSPH’s program; she says that class sizes are about one-fifth of the size of her classes in Cairo and that “the load is heavier here—a lot heavier.”

But as McNabb points out, the Saudi fellows are near the top of their classes at RSPH. “They’re really dedicated to performing well academically, and they have done so. I give them great credit for their hard work. They have greatly honored themselves, their families, the Ministry of Health, and their country.”


Where modern technology and ancient tradition intersect

Mecca

Muslims gather around the Kaaba in Mecca, Saudi Arabia.

McNabb believes that Saudi Arabia—a country about the size of California, with relatively few silos and legacy systems in its health care sector—will leapfrog the United States in public health advances in the next 10 years.

“The kingdom is a key strategic ally of the United States, and very much misunderstood by the West,” McNabb says. “This project is playing a positive part in what I call ‘global public health diplomacy,’ and Emory is making a significant, peaceful impact on the region by supporting the revitalization and reform of public health practice in the Arab Gulf.”

One of the major issues the Ministry of Health is tackling is how to prevent the spread of communicable diseases during the hajj, the annual convocation of more than three million Muslim faithful in Mecca. “You can imagine the potential public health issues related to that many people coming to your country for a short period of time. And this occurs every year,” McNabb says. “People come from 140 countries and oftentimes are poor, with poor access to health care, so in the past there have been large epidemics that have occurred during the hajj. The ministry has a responsibility to protect the pilgrims, but then the pilgrims also go back to their own countries.”

McNabb and his team are helping the Saudis combine the use of mobile phones and health care informatics to understand better the distribution of disease among pilgrims. During the hajj, staff have been trained to enter health data into smart phones, which communicate that data electronically and in real time back to a central operations center in Mecca. RSPH sent two MPH Global Field Experience students to help the ministry analyze health care databases as part of this effort.

“The exchange of students, the exchange of faculty, the opportunity to do creative research that is mutually beneficial are elements of the growing partnership,” according to McNabb. “Together, we are building our friendship, the science base, the collaboration, and the peace.”


Building health, building peace

For now, public health as a science remains a relatively new venture in Saudi Arabia. There is just one school of public health in the country—McNabb happens to be an adjunct professor there—and Jazan University has approached Emory for help in developing a new school of public health in the southern part of the kingdom.

“This is a powerful opportunity to build the relationship between our countries,” McNabb says. “Emory is providing expertise and supporting the development of best practices in public health on a global scale. That’s a part of how we grow through understanding and social justice, and public health is a tool for building relationships and friendships that create true peace."

Erin Crews 09C 09G is editor of Emory in the World.

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