ABU DHABI // Patients may be missing out on lifesaving preventive surgery because of a lack of knowledge about stroke symptoms among healthcare providers and the public, doctors say.
Patients who have minor strokes are at risk of a major stroke after about two weeks and may need lifesaving carotid surgery.
Relatively few patients have this surgery in Abu Dhabi, said Dr Mohamed Baguneid, chief of general surgery at Mafraq Hospital.
“We have a massive split between what we’re seeing here and a similar population in the UK,” Dr Baguneid said.
Doctors typically perform fewer than 30 of these operations a year in Abu Dhabi’s public healthcare system, whereas a similar-sized sample of the UK’s population may have 400 operations, he said.
“We would expect more people to have the disease because the population has a higher diabetic group,” Dr Baguneid said.
Factors such as population age, use of other surgical methods and going abroad for treatment do not account for the difference.
“The incidences we would expect to be higher but for some reason [patients] are not presenting to the doctors,” Dr Baguneid said.
He believed cases may not be investigated in the “traditional way”, or patients were not seeking treatment after the symptoms.
“Sometimes the symptoms of a mini stroke are so vague, and they completely disappear within a short amount of time,” he said.
Dr Simon Fraser, a vascular surgeon at Mafraq Hospital, said the size of Abu Dhabi’s population would lead doctors to expect to perform about one operation a week for stroke intervention.
“We have the impression that we’re not seeing as many people as we should be at Mafraq and [Sheikh Khalifa Medical City],” Dr Fraser said. “It suggests to us that people either aren’t aware of the symptoms or they are getting treatment elsewhere.” He thought it was a “combination of both”.
Surgical intervention is crucial because the symptoms “can often lead on to a complete stroke”, Dr Fraser said.
Symptoms of a minor or mini stroke can include slurred speech, weakness in an arm or leg, lack of control of face muscles and temporary blindness, he said.
The UK uses the acronym “Fast” – face, arm, speech, time – to help public awareness about stroke symptoms.
People who are over the age of 40 or who have hypertension, high cholesterol, diabetes or obesity, or who are active or passive smokers, are at an increased risk of stroke, said Dr Ahmed Majid, a stroke physician at Universal Hospital, a private centre.
“Once you are over 40, and particularly if you have the risk factors, that increases your chances,” he said. “You could have had a mini stroke without you noticing it, because it can start from less than a minute to up to 24 hours.”
Dr Majid said the hospital has a vascular surgeon who can perform carotid operations but that it was hoping to establish a cerebrovascular department and to offer patient screenings.
He said the number of intervention surgeries for strokes were probably similar in the private sector because it “doesn’t have the manpower, equipment and technical know-how” to manage them.
These procedures require trained staff, logistical support, advanced radiology and imaging technology and dedicated units, Dr Majid said.
Dr Baguneid is leading an Abu Dhabi Health Services Company vascular symposium on May 5 as part of efforts to reduce vascular mortality rates and raise awareness about cardiovascular diseases and issues such as stroke.
Cardiovascular diseases cause one in five deaths in the country, according to Mafraq Hospital.
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Tuesday's fixtures
Kyrgyzstan v Qatar, 5.45pm
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Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
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Roll of honour: Who won what in 2018/19?
West Asia Premiership: Winners – Bahrain; Runners-up – Dubai Exiles
UAE Premiership: Winners – Abu Dhabi Harlequins; Runners-up – Jebel Ali Dragons
Dubai Rugby Sevens: Winners – Dubai Hurricanes; Runners-up – Abu Dhabi Harlequins
UAE Conference: Winners – Dubai Tigers; Runners-up – Al Ain Amblers
Abu Dhabi GP starting grid
1 Lewis Hamilton (Mercedes)
2 Valtteri Bottas (Mercedes)
3 Sebastian Vettel (Ferrari)
4 Kimi Raikkonen (Ferrari)
5 Daniel Ricciardo (Red Bull)
6 Max Verstappen (Red Bull)
7 Romain Grosjean (Haas)
8 Charles Leclerc (Sauber)
9 Esteban Ocon (Force India)
10 Nico Hulkenberg (Renault)
11 Carlos Sainz (Renault)
12 Marcus Ericsson (Sauber)
13 Kevin Magnussen (Haas)
14 Sergio Perez (Force India)
15 Fernando Alonso (McLaren)
16 Brendon Hartley (Toro Rosso)
17 Pierre Gasly (Toro Rosso)
18 Stoffe Vandoorne (McLaren)
19 Sergey Sirotkin (Williams)
20 Lance Stroll (Williams)
