Cardiac health a concern for all

Updated 23 December 2012
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Cardiac health a concern for all

Dr. Hani Najm, a cardiac surgeon at the King Abdulaziz Cardiac Center in Riyadh and vice president of the Saudi Heart Association, will highlight his concerns about the heart health of the Saudi population at the 5th Middle East Cardiovascular Disease and Intervention Conference in Dubai on Jan. 28-31. Najm will be speaking extensively on this topic and share the Kingdom’s experience with the international audience at the conference.
In an exclusive interview with Arab News, he also discussed his worries about cardiac health in the Kingdom. He pointed to the lifestyle here as one of the major reasons for the high incidence of cardiac disease.

With the high incidence of lifestyle diseases in Saudi Arabia, cardiac health is a concern for the population. What steps are being taken to educate people on the prevention of cardiac disease?
Cardiovascular diseases have become one of the most alarming disease threats in the Kingdom. Statistics show that a quarter of the population is diabetic, and an even higher percentage suffers from hypertension. Similarly, 6-7 percent suffers from high cholesterol and coronary disease, both of which are a major cardiovascular burden that will require specific preventative measures to combat the risk factors.
Currently, cardiac care in Saudi Arabia is sophisticated and advanced, but we do not have in place the necessary preventative measures that would adequately control the risk factors. More recently, laws have been passed banning smoking tobacco in public areas, and although these laws are being enforced, we may not have seen enough real action so far.
An important factor that could lead to a drop in disease rates and prevention of these conditions is the drive to educate the public about heart disease. This has mainly been conducted by the Saudi Heart Association via media campaigns, education programs, and the distribution of brochures and information packages.
Public awareness should target different sectors of the population – school children, working adults, senior citizens – to educate them on how to control their weight, control carbohydrate and sugar intake, in addition to monitoring and learning how to avoid hypertension.
“Moreover, to successfully implement a public awareness program of this magnitude, there is a need for a more systematic approach to the issue – something currently lacking in Saudi Arabia. The heart health of the general public should be the responsibility of the civil society; however, currently only the medical society is actively tackling this issue from a professional education and scientific perspective at conferences such as the 5th Middle East Cardiovascular Disease and Intervention Conference taking place at Arab Health 2013.
The Saudi Heart Association is hosting outreach programs in malls along with educational lectures; these types of initiatives need to be identified and spread amongst all sectors of society.
Is obesity not a concern for cardiac health, as it is also part of the Saudi lifestyle and a major cause of diabetes?
Obesity in general is associated with multiple medical problems such as diabetes, hypertension and what you call a metabolic syndrome, but if all these associated diseases are not present, then obesity itself is not directly related to cardiac health. This means overweight people without any of the other major risk factors for heart disease may not develop heart disease just because they are overweight.

What are the latest statistics on the incidence of cardiac disease in Saudi Arabia?
We have some statistics that have concluded there is a prevalence of cardiac disease, such as coronary heart disease, in around 6 percent of the population. A quarter of the Saudi population suffers from diabetes, around 27 percent from hypertension, and 35-40 percent suffers from hypercholesterolemia; all of which will add up to an increasing level of cardiac diseases in the Kingdom.
There is an important issue worth mentioning in terms of incidence of cardio disease, which is that 50 percent of the population is still below 25 years of age. There is a high-risk profile, and we expect a rise in cardiovascular illness in the next 15-20 years, when most 25-year-olds will be aged 40-50, and that is when the manifestation of cardiovascular disease occurs.
If we do not control the risk factors in the young population immediately, it won’t matter how many advanced cardiac centers we have, as it will not cover the number of cardiovascular patients.
So, as we can see, the incidences of conditions that may lead to cardiovascular illnesses are on the rise. Unfortunately, there are bad habits within the Saudi society that have been acquired culturally and socially, such as smoking water pipes. This has become prevalent in homes and in public despite control from the government. Cigarette smoking is also prevalent in schools, and the rates are increasing alarmingly.

What are the reasons of extreme hypertension in the Kingdom? Is it because of the lifestyle, food, environment, or other reasons? How can awareness help in diminishing heart problems?
Hypertension is prevalent in the Kingdom for all the reasons mentioned above, in addition that diabetes, which is very closely related to hypertension, is highly common in the people of Saudi Arabia. These are all acquired risk factors for heart diseases, due to the sedentary lifestyle, improper eating habits, as well as the environmental and generic factors that contribute to all this.

How well is the Kingdom doing in terms of offering world-class cardiology care for its patients?
Cardiac surgery in general follows very strict detrimental factors for outcome. This means the outcome of surgery is measured either by major outcomes such as death, or minor outcomes such as morbidity or complications. These outcomes are measured very carefully in heart surgery, and these are what we call ‘code risk-adjusted outcome’, so it is a risk-adjusted outcome based on the population.
In Saudi Arabia, in particular at King Abdulaziz Cardiac Center, we use international benchmarks for cardiac surgery such as the STS (Society of Thoracic Surgery) Database, an American system; and the EACTS (European Association of Cardio Thoracic Surgery) Database. These produce a very robust number of statistics to benchmark the outcome of cardiac surgery across the world.
We have also started a nationwide cardiac surgery database that we are enrolling across all cardiac surgeries done in the country in order to benchmark the entire database of Saudi Arabia against what is happening in the rest of the world.

Does Saudi Arabia attract mostly foreign cardiac surgeons or does the country have the mechanisms to educate and train local surgeons?
Over the last 30 years, the government has made a tremendous effort to send young, bright Saudi doctors abroad to continue their education. All these doctors have returned with advanced sophisticated training from North America and Europe, and they now form a robust corps of cardiac surgeons as well as cardiologists, resulting in the most advanced cardiovascular care in Saudi Arabia.
Now, in addition to the presence of these physicians trained abroad and matured through this system, we have also local training. Certification for both cardiac surgery and cardiology is provided to allow for local certification in advanced subspecialties in cardiac surgery and imaging as well as cardiac catheterization.

What future developments do you foresee for Saudi Arabia in terms of its cardiology services?
I see an acute need for the organization of cardiovascular services, in particular the streamlining of cardiac services that are offered by different caregivers, i.e., the Ministry of Health, National Guard, private sector, universities, and so on. In order to lower the mortality rate for cardiac disease, we need to coordinate the services offered by different caregivers, so that a patient who is suffering from a heart attack can get to the closest hospital and receive intervention during the ‘golden hour’ (first 90 minutes) after the heart attack.
There have been some proposed solutions to network and integrate the advanced cardiac care in the Kingdom that are currently being discussed.

Why is it important for cardiology physicians to attend educational conferences and keep up with the latest research in the field?
As medical professionals, we need to keep up with the latest technologies, studies, and research papers that address our practices. This is a continuation of our education and training, because clinical trials as well as the way we manage patients change based on new sciences.
The only way to be able to acquire such knowledge is through meetings conducted in the region, such as the 5th Middle East Cardiovascular Disease and Intervention Conference at Arab Health 2013, where global leaders from all over the world are invited to give briefs of studies, consensus statements, and guidelines for the management of patients.
Physicians can attend the event and will be able to transfer the knowledge from the West to East. Additionally, there is regionally produced research that can be shared amongst the Middle Eastern countries as well as with the Western representatives.

Besides awareness, what should people do to avoid the problem of cardiovascular diseases?
The problem with awareness is that people are aware, but they do not act on what they know. If you asked people if exercise is good for your health, they would say ‘yes’; nevertheless, they do not exercise. Smoking is bad for your health – they would also say ‘yes, it is bad’ – but they will continue to smoke. The bottom line is: First, the actual piece of knowledge of cardiovascular disease prevention should get to the public, but then practicing this becomes very difficult. Based on my experience, most people, at least in Saudi Arabia, may know that piece of knowledge of what helps to prevent cardiac diseases, but they do not practice it.

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Meet the cheese maker with a lot of bottle

Razan Alsous decided to make her own halloumi after a fruitless search for the family staple. Her Yorkshire Dama Cheese firm (below) now employs eight people and counts Princess Anne (far left) among its admirers. (Alex Cousins)
Updated 20 August 2018
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Meet the cheese maker with a lot of bottle

YORKSHIRE, UK: This is a very cheesy story, in the best possible way. It is also a story about resourcefulness, determination and how to build a new life when an old one is lost.
It takes place in a small factory in northern England, where Razan Alsous, 34, a refugee from the war in her native Syria, is forging a reputation as a producer of top-quality halloumi cheese.
She founded her company, Yorkshire Dama Cheese (Dama being short for Damascus) in 2014, less than two years after arriving in England with her husband, Raghid Sandouk, 53, and their three children. Just four months later, Razan won a bronze medal at the World Cheese Awards. The following year she took gold.
Now branded Yorkshire Squeaky Cheese, her halloumi went on sale earlier this year in 40 branches of Morrisons, one of Britain’s biggest supermarket chains. It was an instant hit and now Morrisons want to stock it in 275 stores nationwide.
Sainsbury’s and Waitrose, the supermarket giants, also want Razan’s halloumi on their shelves. No wonder, then, that Yorkshire Dama Cheese is looking into acquiring more equipment and bigger premises to meet the increasing clamour for its products.
For a young mother-of-three with zero experience of the food industry to go from complete novice to prize-winner in a matter of months would be impressive enough if Razan had lived in Yorkshire all her life.
That she started a business in a foreign country, with unfamiliar laws and customs, and is succeeding, makes her story inspirational.
Being foreign, from Syria, and a Muslim, has barely provoked comment, she said.
“There was a taxi driver — an Asian — who asked me if I was Muslim. I said, ‘Look at me, I’m wearing a headscarf, of course I’m Muslim.’ And he said he thought I might be a nun.
“Generally, I find people are not focused on how I look. They focus on the product. They see someone who is working hard, trying to do something and they want to support you. It’s very positive. I love the personal contact I have with the farmers, who accepted me straight away. I see that England and Syria are quite similar. They are both old civilizations that value history. I feel I am with people who understand me.”
Until six years ago, the family enjoyed a comfortable, middle-class lifestyle with a home on the outskirts of Damascus. Razan, who has a degree in microbiology, was studying pharmacology at Damascus University. Raghid, an electronics engineer, owned his own company supplying quality control equipment to the pharmaceutical industry.
When the conflict began in 2011, they tried to suppress their fears, even as it began to affect their lives more and more.
“We couldn’t visit our family. Each time Raghid went to work I didn’t know if he’d be back. His warehouse was smashed up by armed gangs. There were people being kidnapped just for dealing with British companies,” said Razan.
Then, on July 23, 2012, a car bomb exploded outside the building where Raghid had his office.
“He called me and said, ‘I’m alive but everything is destroyed.’ All he could see was dust,” said Razan. Three days later, the family were on a plane out of Syria.
“My father didn’t want us to leave. He said everything will be all right, and if it had just been Raghid and me, we would have stayed. It was harder for Raghid because he had a business he had built up over 15 years, with 15 employees. I asked him to leave. I could cope with no electricity. I could cope with limited water. I could cope with everything except lack of safety for my children. You can’t just sit there and wait to die.”
The family came to the UK because Raghid had a multiple-entry business visa and they had connections in the country. Raghid’s grandfather used to travel regularly to Huddersfield, a wool-producing town, to buy cloth for his textile shop, and Raghid’s brother had settled there 30 years ago.
Although the couple clung to the belief that their stay would be temporary, Raghid’s brother advised them to apply for asylum. Razan was granted temporary permission to stay after five weeks. For Raghid, it took almost two years.
“At first, we felt we were on holiday. It was summer, people were relaxed,” said Razan. But with the Syrian pound plummeting in value, their life savings were quickly depleted. They could not get jobs as their qualifications were not recognized. Nor could they study to re-qualify. Razan picked up some translation work, but it was irregular. She hated “signing on” — applying for welfare benefits.
Razan hit on her business idea one day after a fruitless search for halloumi that tasted as good as the cheese that is a staple of family breakfasts back home in Syria. The shops stocked what she describes as “tasteless” halloumi, imported from Cyprus, and made with powdered milk.
“That’s when it struck me: I would make cheese,” she said.
In her research she discovered that the British were the biggest consumers of halloumi in Europe. Her brother-in-law, who owned a string of fast-food businesses, gave her the use of the kitchen in a defunct chicken shop, where she spent a year experimenting with recipes. She found the key ingredient right under her nose.
“Yorkshire milk. The quality is excellent — much creamier with a high percentage of solids,” said Razan. “In Syria, the best halloumi is made in springtime when the grass is new and green. But here the climate is more consistent for good pasture, so the milk is more consistent in quality.”
She mentioned her idea to an adviser at the local Job Center, who referred her to the Enterprise Agency. She was assigned a mentor who steered her through researching the market and drawing up a business plan before applying for a start-up loan.
She received £2,500 to be repaid within two years. The loan was not enough to buy all the equipment she needed, but the ever-resourceful Raghid adapted an ice-cream maker so that it heated the milk instead of cooling it, and converted an insulated fish tank into a fridge.
They began by selling to local delis and cafes. Razan spent her last £500 on the fee for an exhibitor’s stall at the Harrogate Fine Food Show. It proved to be a wise move.
“People loved the cheese and we met our first distributor. He said: ‘This is what we need in Yorkshire,’ and we are still working with him.”
Four months after beginning production, they entered the World Cheese Awards, held in the huge exhibition center in London’s Olympia. It was an eye-opener.
“We knew nothing about it. There were 2,750 different cheeses on display, big blocks of Cheddar … and we arrived with just a few blocks of cheese. We looked very silly,” said Razan. Her initial reaction was to turn and go home. But Raghid said they might as well stay and just enjoy it.
To their amazement, they won the bronze medal. “We were jumping around, shouting. I phoned all my family. We were overjoyed.”
The next year, they entered again and won gold. “It proved the first time was not a fluke. We really did have a good product that people like,” said Razan.
The walls and every spare surface of the office above the factory floor are now covered in awards. For the Queen’s 90th birthday in 2016, they supplied cheese for the British embassy party in Vienna.
Razan and her halloumi have appeared on television and when he was prime minister, David Cameron nominated her as an ambassador for International Women’s Day in 2015.
Last year, Yorkshire Dama Cheese moved out of the disused chicken shop into their current premises on a small industrial estate. Princess Anne, the Queen’s daughter, came to open the new factory last year and stayed for lunch.
“She requested it, and she stayed almost two hours, much longer than her schedule,” said Raghid. “It was a proud day,” Razan said.
The 1,200 liters of milk collected daily from a local dairy farmer is turned into around 2,500 blocks of halloumi each week. The Yorkshire Squeaky Cheese brand came about because Cyprus was seeking Protected Designated Origin status for the halloumi name, a label granted by the EU to a small number of products. The name stuck.
“It works because the test of good halloumi is the squeak when you squeeze it, and also kids like it,” said Razan.
As well as five varieties of halloumi, they make labneh, also labelled “spreadable yogurt” for customers unfamiliar with the Middle Eastern name. The whey left over from making halloumi becomes ricotta cheese. Nothing is wasted and nothing is added, said Razan.
Weekends are spent at food fairs and farmers’ markets. Sales to restaurants, independent shops and online customers have “gone crazy” in the past six months.
They have now bought a house and the children — Angie, 9, Yara, 8, and Kareem, 6 — are happily settled in school. “They are Yorkshire kids now. They laugh at my accent,” said Razan.
Razan’s parents and siblings have followed her to Britain. Her father volunteers at the Buzz Project, running community beehives, where he is known by the nickname Mr. Honey.
Though it pains her to admit it, the prospect of returning to Damascus is receding. “I cannot close down because we have eight employees depending on us,” said Razan. “But I want my children to know where they came from and we will take them when it is safe.”
That’s not all they intend to take back to Syria.
“We aim to export our halloumi to Syria,” said Raghid. “With Yorkshire milk and Syrian know-how, we will make the UK the halloumi capital of the world.”