There is a secret that very few in the western hemisphere are privy to: there is peace in the Middle East. Its name is Jordan.
A small country of only 35,000 square miles and a little over six million people, Jordan is situated in a contentious neighborhood comprised of Syria to the north, Iraq to the west, Jerusalem to the east and Saudi Arabia to the south. Yet, this little country has managed to form a perfect union of people who are not only tolerant, but who also live in harmony with people of multiple religions and cultural backgrounds.
As I stand in front of a Christian church, on top of the sacred Mt. Nebo (the site where Moses looked out upon Jerusalem and proclaimed it the Promised Land just before he died), I can hear the rhythmical Muslim call to prayer echoing through the hills of nearby Madaba, and I wonder … how did Jordan surround itself with this invisible force field, which fends off the clash of religious titans? Is it the magic of Mt. Nebo, which is recognized as a holy site for Christians, Jews and Muslims alike, that brings this country together as one?
A brief lesson in history taught me that the credit goes to the ruling party of Jordan, both past and present. The late King Hussein worked diligently and effectively to foster neutral relations between Jordan and its neighbors. It was always his vision to achieve peace in the Middle East, and he managed to remain objective, with both eastern fundamentalists and western conservatives tugging at his sleeve for support.
After the Six Day War, King Hussein was able to forge a peace treaty with Israel in 1994, which he had secretly been working on since the early 1960s. As a 42nd generation, direct descendant of the Islamic Prophet Muhammad, King Hussein was revered by the Muslim world. As the longest serving executive head of state in history, his counsel and guidance were sought out by leaders in the west.
He proclaimed that those who use terrorist acts of violence in the name of religion only succeeded in eroding the very foundation of their religion. King Hussein later embodied his words in his memorial tribute to Israeli Prime Minister, Yitzhak Rabin, by calling him: “A man I came to know because I realized, as he did, that we have to cross over the divide, establish a dialogue, get to know each other and strive to leave for those who follow us a legacy that is worthy of them. And so we did. And so we became brethren and friends…”
King Hussein did not limit his efforts to world leaders. His campaign of cross-cultural education enlightened his kingdom’s subjects to the value of understanding those who think and act differently. So rather than spreading the dreaded plague of xenophobia that we see all too commonly in the world today, at the Summit of Peacemakers in 1996, King Hussein was quoted as saying; “We must shoulder our responsibilities and work together to protect the dignity of human beings, whoever and wherever they may be.”
In 1978, Lisa Halaby, an American, married King Hussein and became Queen Noor. She joined the King’s cause to promote peace, human rights, cross-cultural understanding and dialogue. Ahead of her years in her efforts to conserve the environment, Queen Noor also championed the effort to promote sustainable growth in her newly adopted and much beloved country. After the death of King Hussein, his first-born son, Abdullah, succeeded the throne and chose the stunning Rania as his Queen.
They have successfully continued the endeavor to vaccinate their kingdom, through education, against the viruses of hatred and persecution, while keeping Jordan’s borders, citizens and visitors protected and secure.
First Hand Impact
Upon my arrival in Jordan the balmy temperature and majestic mountains made me realize that I was not in Kansas anymore. After a scenic drive from Queen Alia airport in Amman to the Dead Sea, we made a turn off the winding road, which seemed to be painted onto the side of a cliff, and started the treacherous climb up one of the gold and rose-colored mountains. The almost vertical drop down into the mouth of the mountain made me suddenly religious, as I prayed and gave thanks that we were in a Cadillac and not a recalled Toyota.
The sightseeing possibilities in Jordan seemed endless: a day trip to the River Jordan to see where Jesus was baptized; a trip to Petra to see the dramatic pink city carved into the side of a mountain (where the Indiana Jones movie was filmed); a wake-up call at 5 a.m. to catch the sun rising over the Dead Sea; or a trek through the pink sands and pastel mountains of Wadi Rum, on the back of a Bedouin camel (or in the modern day equivalent—an adrenaline pumping 4x4). My new friend, Ossama, from the Evason hotel, took his time explaining the history of each of these sights.
Finally, the day arrived when I was to visit Jordan Hospital. Jordan hospital welcomed me with open arms and open doors. A simple request made to the hospital chairman of the board, Dr. Abdalla Bashir, from a person he had never met, was answered with the warmth and familiarity you would expect from an old friend. I was greeted with a warm cup of cardamom scented, Turkish coffee and an even warmer smile from Medical Tourism Director, Hashem Irshaid.
I immediately started firing questions at him like a semi-automatic machine gun. He patiently answered each one and provided me with back-up material in the form of brochures, outcomes reports and a DVD (complete with a narrative by King Abdullah).
What was that middle thing? Yes, you heard correctly—outcomes reports. Jordan Hospital was the first in the country to become JIC (JCAHO equivalent) accredited, and, as a result, the paperwork factor just multiplied times a thousand, as nursing director, Nadia Shahin would confirm.
In another testament to their hospitality, Hashem had arranged, at my request, a consortium consisting of: Dr. Sa’eb Hamoudeh, their medical director (just as imposing in the Middle East as they are in the U.S.); Nadia Shahin, and Dr. Nazih Kadri, an EPS cardiologist who practices in both Jordan and the U.S. at Creighton University. Like the Knights of the Round Table, they all came, swords drawn, to help me in my quest for the Holy Grail: peace on earth and health care for all.
As I walk the halls of this modern hospital and pass several Americans in the hallway that had flown there for medical care, I see all the quality assurance signs on the walls and feel a sense of déjà vu sweep over me. Despite all of the familiarities, two huge differences stand out like red flags: the abundance of health care coverage, and the lack of a litigious society.
The extensive coverage of their citizens comes from a generous government insurance policy that covers 70 to 80 percent of the population. This comes from the fact that every government or military employee receives lifetime coverage for himself/herself and all of their non-government employed family members (including siblings, parents, children, grandchildren, etc…). The tentacles of that type of coverage are far-reaching and have a strong hold. Additionally, there are private insurance companies, the largest of which seems to be MedNet. These private insurance companies currently enjoy healthy competition, although I noticed that MedNet has its own private office in this hospital, while there is a second office for all other insurance policy holders. This could be an isolated arrangement with this particular hospital, or “the beginning of a beautiful friendship…”
This hospital’s current malpractice policy covers 40 employed physicians and costs the equivalent of $2 million per year. They have had no claims filed against them in the two years that they have been with their current insurance company. However, as Dr. Kadri points out, that “non-litigious attitude” is slowly starting to change.
He described to me the culture shock he feels when he travels between the U.S. and Jordan. He cited one example of a particular patient that he met at Creighton who was visiting from Jordan and had some chest pain. Dr. Kadri saw her in consultation, performed an EKG, an echo and drew basic blood-work. The cost of that combination of services came to $1,200.
He then saw the same patient, in follow-up, back in Jordan. He performed the same services for a cost of $150. Admittedly, his fee-for-service in Jordan was much lower than that in the U.S., but he also has no overhead in Jordan (in terms of malpractice, office space, employees, etc…). His style of living is in the same echelon (by Jordanian standards) as a specialist in his field in the U.S, but his cost of working is lower in Jordan.
The cost of living in the U.S. is relatively low compared to other nations, however, the cost of practicing medicine in the U.S. is among the highest in the world.
Dollars And Sense
This reduced cost of practicing medicine in Jordan translates to a reduced cost of health care for the patient. Dr. Kadri showed me a package price list (in U.S. dollars) for individual procedures at Jordan Hospital. The cash cost for CABG (hospital, anesthesia and surgeon) in the U.S. averages in the area of $56,000 for a seven-day hospital stay (according to www.HeathCareBlueBook.com). Compare this to the cost for the same procedure in Jordan, where the seven-day package price for a medical tourist is $14,000.
Yet, you have to balance cost against standard of care. In a country where only a handful of hospitals have attempted to set the bar high for international standards of care, Jordan Hospital is one of those few. Standard of care is something that Dr. Kadri points out to me as being an enviable quality of the U.S. health care system. He explains that you can travel from state to state and see the same procedure performed with the same basic standards of care. Traveling abroad may bring cheaper rates, but does not always bring the same quality of care.
The JIC (Joint International Commission) is the organization designed to establish those standards in participating, credentialed hospitals. As Nadia points to the JIC signs on the walls of Jordan Hospital and recites the mantra of “quality, reliance, mission and vision”, she shakes her head and says, “We repeat that over and over, all day long.”
Their hard work to attract international medical tourists is paying off, and as they prepare for their upcoming JIC recertification, I have no doubts that they will pass with flying colors. What concerns me are the side effects that come along with this credibility. As I look at the stack of paperwork they have created to document their compliance, I can see the dismay in Nadia’s face as she voices the all too familiar complaint of having less time to spend with patients because of the increased demands of documentation. I can see the writing on the wall, and I hope they will find a way to balance the scales of quality and accessibility.
Today, Jordan Hospital is teetering on the precipice between the pursuit of excellence and the desire for commercialization of health care. As we in the U.S. try to learn from our own mistakes, the best advice I can give my new friends is this: On your honorable journey to achieve excellence in health care in the Middle East, don’t let business principles dictate the path you take, or else your vision will become clouded by paperwork and profits. You will lose sight of your ultimate goal, and it will be your own citizens who end up paying the price.
This golden rule applies not only to medicine but also to all forms of business (including the business of government). As Akio Toyada, the current president of Toyota, recently testified in Washington, in its effort to expand, Toyota lost sight of its customer, and the company is paying the price for this costly mistake.
For now, however, it seems that Jordan Hospital is on the right path, and I wish them safe travels down the road they have chosen. My quest for the Holy Grail in the mountains of Jordan lead me to this conclusion: Jordan’s ethereal sense of peace and enlightenment comes from its natural resources—and lack thereof.
Where there is oil, there is war. Jordan is one of the few countries in the Middle East with no oil. Their greatest natural resource is their human capital. Therefore, they have expanded that capital by exploiting the best qualities of human nature—the capacity to learn, the ability to care and the desire to coexist in harmony.
Their magic Mt. Nebo reminds me of the 1970s folk song, "One Tin Soldier," which describes the people of the mountains and the valley folk below. Surrounded by greed and hatred, the mountain people offered to share their treasure will all those around them. In the end, the much sought-after treasure turned out to be the simple principle of “peace on earth”.
Jordan’s Royal family, its landscape, its people and its culture are a beacon of beauty and peace in the war-torn Middle East. During this critical time for health care reform in the U.S., one can only wonder what advice the Late King Hussein would have given President Obama today. I imagine President Obama would say, “I vow to make quality health care affordable and available to all U.S. citizens, or my middle name isn’t Hussein.”
But, as my return flight from Jordan makes its approach to a scheduled stopover in Montreal, the flight attendant announces that there is a sick passenger on board, and they need a doctor. I am ashamed to say that my first thought was not of the welfare of the sick passenger, but rather, whether my malpractice insurance would cover me in Canada.
As I stood up to help this young lady, I realized … I must almost be home.