The only thing that never changes is change itself. The changes in Saudi Arabia over the last seventy years are not all as high profile as architecture and oil. Changes in social attitudes, especially in the family, are as real though not as easy to see. However, they affect people — often older people — in different but as profound ways as the arrival of telecommunications and transport.
Many families have allowed the provision of health care, which used to be the family’s responsibility, to become the responsibility of the state or the private medical care system. It is sad but true that the elderly are too often left in institutions and ignored. Perhaps the provision of medical attention for the acutely ill is better handled by the mechanism of the hospital system. Acute care often means that a family member goes into hospital.
An essential feature of a hospital system is that the patient goes to receive care.What happens when even that seemingly simple requirement breaks down? What happens when the change in responsibility from family care to hospital care does not work? If that is the case, does this mean the family should absolve itself of responsibility for its ailing member? What happens when the family member, cured of the acute condition but not fully recovered, returns to the community?
The National Home Health Care Foundation is a national charity founded in 1997 by Crown Prince Abdullah and chaired by Princess Hessa Al-Shalan.
In the Western Region, the charity is chaired by Princess Adila bint Abdullah bin Abdulaziz. It addresses these questions directly and is supported by direct donations from industry, private contributions and membership fees. The aim is to provide continuing medical and nursing care within the context of the family while the patient lives at home. It is thus a reversal of the ‘Come to us’ ethos of the mainstream hospital system. This charity goes to the patient.
Dr Nivien Al-Khaldi, the Executive Medical Director of the Jeddah Home Health Care unit is passionate about her work. “Part of the aim is to change attitudes towards long- term care at home, both in the family and at the national level,” she said. “It is not only better for the majority of patients but it is also highly cost-effective.”
The fact that the charity exists at all indicates that there has been a huge change in many families in their attitudes towards care for their own elderly and chronically ill. Saudi Arabia is not unique in this respect.
In Europe, homes for the elderly and chronically ill are a growth industry, grossing massive profits.
With the elderly accounting for an increasing proportion in European societies, it is set to continue that way, with the resulting isolation of the elderly from mainstream society and their families. This is not going to happen if the staff of the Jeddah Home Health Care unit has its way.
Patients for whom home care would be effective are chosen on the basis of need and whether home care could provide adequate cover. “They come to us through the hospital most of the time,”said Zahra Wassi, the team leader in the unit. “If a patient is identified as a candidate by the social workers in the hospital, then we assess the possibility for home care and provide it if he or she is suitable.”
Acute cases, with special needs or requiring intensive care have to be hospitalised but the vast majority do not. “Returning a patient to the family can sometimes be difficult,” Zahra said, “but we find it is often just a process of gentle education. Once the family realises that its member will be visited regularly, monitored and any necessary medication given, there is almost never resistance.”
Every morning, teams of home-care nurses begin their rounds -visiting patients. They do not simply bring medication but something much less tangible. They bring the certainty of human contact. Some families are very small and feel isolated from the outside world. Contact with the carers becomes a social lifeline and part of the healing process.
It is the human and social contact that changes the service from simple delivery of a medical service into a whole-person caring service. This applies not only to the elderly. Children are a major part of the program and as well as caring for long-term sick children in their family homes, the unit also organises outings, parties and entertainments.
“Those are wonderful days,”said Ibtihal Saleh, Unit Assistant. :We involve local colleges in acting as voluntary guides and carers for small groups of children for the day. For the home care children, it is a day out somewhere for them. Their parents leave them with us and we all have a lot of fun,” she beamed. “We also organise treats for seriously ill in-patients too,” she said. “There was tremendous enthusiasm when the Tash Ma Tash actors ivisited the children last December.”
Home care is a comprehensive concept, involving not simply the medical aspect.
Working on the assumption that prevention is better than cure, teams visit outlying communities on a fortnightly basis, teaching simple hygiene and health care techniques to rural communities. “If we can train one member of the community in simple and very effective hygiene techniques, she will be the basis for a spreading network of knowledge,” said Zahra. “We have seen just how effective this can be in preventing disease.”
Sometimes home care can be helped by simple house maintenance.
Zahra cited a case where one daughter was trying to care for her father in a one-room house, the entire furnishings of which were a mattress and a pillow. “We were able to donate cooking, washing and other equipment to help out as well as providing medical care for the old man.”
Not all change is for the better although change is inevitable. “It’s not anybody’s fault,” says the Home Care Foundation’s mission statement, “but certainly we have to change and cope with what is new to be able to live the life we deserve.” Grand sentiments, turned into meaningful realities for hundreds of sometimes isolated and impoverished people by the dedication of the Jeddah Home Health Care Centre team.
