Historical report account on the development of anesthesiology and medical services in Kingdom Saudi Arabia 1956-1987: M. I. Al-Khawashki's letter dated April 25(th) 1997.

In this historical report, a new light is spotting new details of the development of anesthesiology and medical services in Kingdom Saudi Arabia 1956-1987. The value of this letter written in Arabic language and cannot be accessible to non-Arabic speakers. The translation and verification of author publications to support its evidence would augment the current of scientific history writing. The time covered was since 1952 to the eighties. It reflects the ambition of various ministers of health in Saudi Arabia and international health body WHO that allowed many health care providers to build the services. It is first-hand experience of the writer Al Khawashki. The picture would be more complete when more research would follow this paper publication.

INTRODUCTION

In response to a recently published article on services rendered by two Saudi Anesthesiologists in the last century.[1] The senior author of this report proposed to publish a historical paper send to him by late MI Al Khawashki as it is a relevant historical document of our departed college. So the junior author (F. T.) put an intellectual effort in translating the Arabic letter and researched the names and data.

Mohamed Seraj[1] in his article indicated “He is considered to be the first qualified Saudi anesthetist in the Kingdom.” He graduated in 1958 from Cairo Medical College and worked for a few years in Riyadh Hospital.

In 1960, the first two Saudi graduate doctors, Abdullah Al-Enazy and Ishaq Al Khawashki were sent to Denmark on scholarship to obtain their diploma degrees in anesthesia. Both graduated successfully in 1962.

Only Dr. Ishaq Al Khawashki returned and worked in Riyadh Central Hospital, Ministry of Health. At that time there were very few expatriate anesthetists who covered several operating theatres and nights on call. Sometimes they even covered more than one hospital within the city. Dr. Ishaq Al Khawashki started to build the department of anesthesia and participated actively in supervising and updating the curriculum for the diploma of anesthesia for technicians, which had started earlier. The program consisted of a 3 year training program. This period was called the technician's era. The main objective was to produce anesthesia technicians to overcome the shortage of specialist manpower and provide a reasonable service at that time. He was highly respected as a commander with dedication and leadership in his field. He was loved by everyone. His leadership was extended to manage the main hospital in Riyadh. During his successful practice as consultant anesthetist and general director of Riyadh Central Hospital he managed to obtain his medical doctorate in anesthesia from Cairo Medical College in 1977. He continued as general director of the anesthesia department and director of the hospital until 1982. He served as Consultant to the WHO from 1982 until he died. He has several publications on safety of intravenous agents in anesthesia, road traffic accidents, spinal cord injury, and body cooling unit.[2-5]

One of the most important developing points in his life was being the principle inventor of the “body cooling unit” that became the standard of care for heat stroke management since the eighties and until now in numerous hospitals during Hajj seasons [affirmed in the pages of Figure 1 the covering letter]. He was selected Member of the Editorial Board of the Saudi Medical Journal, Middle East Journal of Anesthesia, and the Medical Journal issued by the Ministry of Health. He departed on August 12 2006.

Figure 1

(a) second page Arabic letter and (b) first page Arabic letter [Arabic is read from right to left]

By Presenting the personal account of Dr MI Al-Khawashki as it was dated April 25th 1997 [Figure 2]. This account is having same title published in 1989, but information update was noticed. This letter was written on the invitation of (M. S. T.) to document the history of anesthesia in Middle East with names and stages of anesthesia (a book edited by M. T. al Jassir in Araabic). Although Professor Seraj had an excellent effort to enlighten the readers about this issue still many loose ends were not presented yet. In this letter he ascertained all facts documented by Professor Seraj and he outlined the role of WHO in initiation of training in Denmark for local anesthesiologists, it showed as an effort to propagate anesthesia services mainly in ministry of health some help in recruiting practitioners and teachers from Egypt. The limitation of posthumously publishing would carry certain defect in perusing all mentioned data, but even the late Dr M. I. Al-Khawashki ended his document that Professor Seraj is instrusted to report the rest of the story [Figure 1].

Figure 2

(a) History report p. 1, (b) history report p.2, (c) history report p. 3 and (d) history report p.4

In the Aeabic document [Figure 2] M. I. Khawashki wrote: We can consider the year 1956 the start point of anesthesiology and its development as one of the basic supporting medical sciences for the modern medical services in the Kingdom of Saudi Arabia [Figure 2]. There were no apparent evidence for the existing of this branch before that year. To show the stages of development of that brand over 40 years, it is appropriate to divide those stages into four decades as follows.

Initiation and foundation decade 1956–1965: This started when the late Dr. Rachad Faroon was appointed the minister of health. When the debut development of anesthesia, the late Dr. Bashir Al Roumi and Dr. Hassan Al Nassif, the director general, who introduced the anesthesia service into its major health care.

As the contracted Egyptian anesthesiologist Dr. Saed Al Rays and Dr. Mohamad Rifaat, the first Doctor worked in Bab Shareef hospital and the women hospital then in King Saud Hospital. The second doctor worked in Ajeyad hospital along with the women hospital in Mekkah. Also the ministry contracted two anesthesia assistant technicians from English Hospital in Ghaza who worked in Riyadh city and other in Taayef. Thus, the Kingdom had only two anesthesiologists and two anesthesia assistant technicians working for it. Also, in the military hospital in Riyadh there was Dr. Fouad Hamdi who worked as anesthesiologist.

Avoiding this deficiency, the ministry of health requested from the WHO Mediterranean area office to send an expert anesthesiologist, Dr. Mohamad Kamal Ghalb, to work in King Saud hospital (Riyadh Central Hospital that was opened in 1956) so that he could initiate the training program for anesthesia in the anesthesia technician institute. Dr. Ghalb could not attract any physician to this anesthesia specialty but only he laid the foundation of the program of assistant physician in the health technical institute.

In October 1957 after my graduation from Kasr Al Einy Medical School in Cairo University, I was appointed as general practitioner in King Saud Hospital. Then I took the post of anesthesia physician after consultations with Dr. Ghalb and Dr. Romy. Later on, I was naturalized as Saudi and was sent to Copenhagen, Denmarkto study anesthesia for 2 years. I returned back in 1962 to Riyadh, assumed the responsibility in the same department. Our ministry of health contracted later on that year with many anesthesiologists from Egypt and Britain who participated in the effort of serving the surgical patients and establishing the tradition of anesthesia in kingdom hospitals.[2-5]

The ministry of health institute for anesthesia technician qualified six anesthesia technician every year. Then they were distributed over the hospitals in kingdom to work under supervision of anesthesiologists. In that year when late Dr. Youssef Al Hagery was minister of health, administrative decision was taken to put the entire anesthesia department in the central Riyadh hospital to coordinate the service and staff effort.

Increased number of surgery under the anesthesia led to the appearance of a new problem. When we have complication or postoperative death, people tended to sue the whole surgical team including the anesthesiologist or sue the anesthesia team alone when some surgeons put the complications or postoperative death blame on the anesthesiologist. That led to a Royal Decree to form medical and clerical jury committee to look into these cases. And that was a new advance in the medical environment. In that it re-assured the practitioners and the patient relatives of the fair judgment of this legal body.

Settlement and advances decade 1966–1975: In 1976, many development and expansions in the field of anesthesiology and the increasing number of anesthesiologist led to the fair distribution of man power on major hospital in the kingdom. On the other hand, the project of building intensive care unit in King Saud Hospital was allocated to German company that later on built an intensive care unit with eight beds. In 1969, it was operated under directorship of Professor Mohamad Bdoor from Alexandria University.

Later on in 1972, the minister of health Dr. Jameel Al Hujelan commissioned me to build five units of intensive care in Bab Shareef hospital in Mekkah, jedah, tayef, madina al mounwaram and Damam, under the directorship of Professor Jalal Aarf. Riyadh central Hospital (King Saud Hospital) provided the training for other staff such as physicians and nurses to this satellite units. In that era Professor Seraj was sent to Britain by Riyadh University, today King Saud University, to get the highest qualification of anesthesia and to be the first anesthesia professor in the kingdom. Due to low numbers of physicians working in anesthesia fields I was unable to follow up with external examination but I was able to go to QasrAyni Medical School in Cairo University in 1973 to present my PHD in anesthesia in 1976.

Growth and spread decades 1976–1985: New blood came to the scene like Dr. HussainAbd Al Razak Al Jazaery who was the founder dean of faculty of medicine in King Saud University and later the minister of health. He assigned me to be the director of Riyadh Center hospital as well as the director of anesthesia department and an advisor for anesthesia affair in the ministry.

After this I managed to put a development plan for human resources needs for all anesthesia services in the ministry of health. Also starting the applied science institute in the late seventies, under the deanship of Dr. Ibrahim Al Swagh. I was hired as member in its board after a decision that was taken in that anesthesia will be one of its sciences majors.

Then the practical and academic activity augmented in the kingdom either in government hospitals or in private hospitals. In this era, the Saudi anesthesia association was founded under Professor Seraj presidency who created as well the anesthesia club of Riyadh, which is monthly meeting in Riyadh were a paper will be presented and dinner will be served for the attended members. In this time period and explosion in the development of anesthesia was established with modern hospitals and highly advanced surgeries.

Academic and scientific advances in anesthesia decade 1987–1997 I leave that on Professor Seraj to describe.