São Paulo – Taking Brazilian medical knowledge to the Arab countries, helping them fill their medical gaps, and at the same time spreading Brazil’s name as a reference in healthcare. It’s a large project, and at its helm stands one of the leading names in the country’s medical sector: the oncologist Riad Younes, who was born in Lebanon but adopted Brazil as his homeland.
Way before his name became a landmark in cancer treatment, Younes arrived in Brazil as a refugee. Coming in from the civil war that wrecked Lebanon, he disembarked in the country on September 7th, 1976. “I arrived on Independence Day,” he recalls. Here, free from the conflict, he learned Portuguese, “a tough language,” he says, and studied, a lot, before he joined the School of Medicine of the University of São Paulo (USP).
Now, he is Surgical Oncology coordinator at the São José Hospital. In the past, he has run the Thoracic Surgery Department at A.C. Camargo Hospital and served two terms as clinical director at the Syrian-Lebanese Hospital (HSL), where he still works as a surgeon. He is also a full professor at USP’s School of Medicine.
Still, it’s not his Brazilian career that puts a gleam in the eyes of the 52-year-old doctor, a son to teachers who loves doing research. What really moves the oncologist is his Brazilian medicine internationalization project, which has been providing training to Middle Eastern doctors since the early 2000s, thus helping to gradually improve healthcare in the region.
The cause garnered support from important funding bodies, such as the Arab Brazilian Chamber of Commerce, the Brazilian Cooperation Agency (ABC), the Brazilian Ministry of Foreign Relations, and the Syrian-Lebanese Hospital. “This is the project of my dreams. If I have to choose between what I do now and this project, I’ll choose the project,” he says with a smile on his face.
In an exclusive interview to ANBA, Younes explains how the project started, what has been conquered and what is yet to come, such as plans to give onsite training for up to one year to Palestinian doctors who cannot leave their region, one of neediest areas of the Arab world. Read below the main parts of the interview.
ANBA – When did you begin and what led you to devise a project aimed at improving healthcare in Arab countries?
Riad Younes – It started out in 2002, 2003. At that time, I spoke with the superintendent at the Syrian Lebanese Hospital and told him that after September 11th, 2001, sick people from the Middle East who travelled to the United States and to other regions felt uncomfortable because of the restrictions.
The Arabs were looked upon with fear and they would travel alongside their families. It also became harder to get visas. There was growing discomfort. So I said: Brazilian medicine is great, but has no publicity. And we, at the Syrian Lebanese Hospital, started putting together a system to promote Brazilian medicine, to promote the quality of this hospital outside the country’s borders.
I started contacting Lebanese universities by telephone. The project started out very timidly. Each time I went to the Middle East, I would speak to somebody. We also started inviting people to visit us.
What countries did the project start in?
Chiefly in Lebanon, because that’s where I had many more contacts. Things started out at that pace until Lula (former Brazilian president Luiz Inácio Lula da Silva) travelled to the Middle East. That gave it a different spin, because then you are able to talk to ministers much faster. So then I had official meetings in Lebanon, in Syria. From then on the project went in another direction, because both the Brazilian ministries of Foreign Relations and Development and the Syrian Lebanese (hospital) started putting together a larger project.
I started traveling to several Arab countries and learning about the idiosyncrasies of each in order to ascertain where we might be helpful. I would travel, we would give lectures covering the areas that interested each country, we would bring along specialists, we would attend congresses. The project started taking shape. When I became the HSL director it all started progressing much more quickly. I started contacting several universities and hospitals. We reached agreements with several universities in Beirut, Lebanon, and in Syria. We had people visit us from Tunisia, we got in touch with physicians from Dubai, Abu Dhabi and Qatar, and I travelled to Bahrain. An exchange started to take place.
What is the Middle East healthcare scenario like?
There are “many countries” within each Middle Eastern country. Saudi Arabia specifically has a hyper healthcare system. They invested a lot in healthcare, they created good hospitals, they hired people long ago, they brought in foreign doctors, and they created highly efficient departments and services in university hospitals, something that did not take place in other countries, even though they have the cash. In the Emirates, which also have a lot of money, they will bring a hospital (renowned abroad) into the country. They will bring the brand in. In Qatar, they established a university, so they have (medical services) both ways. They started out their own university, managed by themselves, and at the same time they invited people from other countries to work.
What about the less wealthy countries?
Lebanon is a country that came out of a war so it has a deficit in technology, in the reach that public or non-public medicine has amidst the population. You have regions that have next to no adequate medicine. Most sick people need to go to Beirut, the capital, to get
treated. There is a flaw, a lag in medical quality between the capital, the big cities and the countryside. And 90% of Lebanon’s territory is the countryside. You can’t get any treatment there, you need to go to the large centres for everything, and that’s saddening to most the population. The poorest ones must spend the most on healthcare.
And just like Lebanon, that applies to Syria, Jordan, Tunisia. Not to speak of Palestine, they are even worse off. In those other countries, everyone has access to healthcare in the capitals, but once you move 10, 15 kilometres away from the capitals, then the access to adequate medicine drastically declines.
How can Brazil aid these countries that have no funds available?
I recently became a member of the board at the Arab Brazilian Chamber, and as a result the scope of the project has increased. Now I can reach many more hospitals, and also the (Brazilian) government to ascertain how we can help. And we can help in many ways.
First off, we can help through teaching. There are things the Middle Eastern hospitals and universities cannot teach because there are no specialists in certain fields. Each country has a different need, treatment-wise. We can get younger people, bring them over to Brazil, train them and then send them back.
For instance, plastic surgery in the Middle East is at a certain level, and in Brazil it’s at another level. You invite newly graduated plastic surgeons to stay a month or two, improve their quality and then send them back. The same applies to orthopaedics, we have cutting-edge surgery. Brazilian heart surgery is top notch. Hospitals such as Hospital do Coração, Hospital das Clínicas, and the Syrian-Lebanese have attained a high level in heart surgery, especially congenital, whereas they have very little of it. Videolaparoscopic surgery, advanced surgeries, we can train people here and send them back.
Another way is to get experienced people who do not perform the necessary procedures needed due to lack of infrastructure. Living donor liver transplant, on the other hand, is not available in all of the Middle East. The Syrian-Lebanese Hospital is among the most experienced in the world when it comes to in this procedure. We are bringing graduated doctors over and helping improve their infrastructure. For such, one doesn’t need money, one needs knowledge.
Once they start operating on their first patients, we will help them out. We don’t want to operate the patients for them, we want to teach them to do it instead. This is already taking place in Syria on a massive scale, and it will also take place in many other countries.
Which hospitals and organizations are involved in the project?
The organizations strongly involved in this project are the USP School of Medicine, Hospital do Coração (HCor) and the Syrian-Lebanese. But all the hospitals with which I discussed the project have told me that they are available for whatever I may need. I believe Brazil may emerge as a landmark in medicine through similar projects to this. Here at São José (Hospital), at Oswaldo Cruz, at any medical school, the professors are willing to help.
There’s also another way to help. Look at the Palestinians, for instance. They are in utter tragedy. You can’t even train their doctors adequately because they have a hard time coming in and leaving the area and other things. So we are trying to come up with a project to give training there. We will create a group of doctors and organize a continual training system. Each Brazilian doctor would go over, stay up to four weeks, then he comes back and another one goes, continuously, during a year. We will train them there, in Ramallah. We are scheduling things slowly.
How much money does one save by treating a patient in their own country?
You take a Palestinian or a Lebanese child and take him to Europe for a living transplant. He, his father, the family, the donor, they all travel. The cost ranges from US$ 150,000 to US$ 200,000. If he undergoes the transplant in his own country, the cost is down to US$ 40,000. The government is spending that money, but by doing it in their own country, instead of just one patient, they can operate three or four.
Have you put together a team of physicians to provide the training?
We have been travelling in pairs, me and doctor Paulo Chapchap, who is the superintendent at the Syrian-Lebanese. We are the ones who have been going to and fro, but whenever people come to Brazil to be trained a large team is engaged, including anaesthetists, ICU doctors, general practitioners, surgeons, everything. These are people who will continue the treatment abroad later on. It is a very complex program. And there are many Brazilian doctors of Arab descent who would really like to help out.
Are many Arabs coming to Brazil for treatment? Is the number growing?
There are not that many, but it’s going up. More and more ill people from Arab countries are coming to Brazil to get treated at the Syrian-Lebanese Hospital, for instance. There are people from Middle Eastern countries such as Saudi Arabia, Kuwait, Abu Dhabi, Lebanon, Syria… the potential is strong, but this is a very slow-moving project, we must do our part (in promotion) before the people start coming.
Can Brazil compare to the United States in terms of treatment costs and technology?
Cutting-edge hospitals in Brazil are on a par with cutting-edge hospitals in the United States. The physicians are very well trained, the specialists are first-rate, the technology in Brazil is excellent. Someone who leaves the Middle East to get treated in either Brazil or the United States won’t see much of a difference (in the treatment). The difference will be the cost. Brazil is cheaper. Hospitals such as the HCor and the Syrian-Lebanese offer costs a little below United States ones. That can be a differential too. Similar quality at lower cost can be very interesting to international patients.
How much does it cost to train a physician?
These days we get scholarships for everyone. We get scholarships and grants from the (Brazilian) hospitals; we try to get aid in the country and from interested industries. We are able to bring physicians over and train them without costs. The same happens over there (in the Arab world). We have gotten in touch with authorities in Doha, in the Ministry of Health, and they have funds available to aid healthcare in Palestine, for instance.
If a project of ours gets their approval, they might fund them. That way, we can put their money and our knowledge together and create an Arab-Brazilian project in the Arab countries. That is feasible.
How do you feel by helping so many people?
It’s wonderful. This is the project of my dreams. If I ever had to choose between what I do today and this project, I’d choose the project. When you go over there you feel amazing. It’s a region that has nothing, and then of a sudden you go there, do a little bit and lots of people benefit from it. It impacts a much larger number of people than doing something locally, at a hospital that lots of people have access to. It’s a very interesting and beautiful project.
*Translated by Gabriel Pomerancblum
