Combat doctors alarmed at resistance to antibiotics



DUBAI // Doctors who treat victims of Middle East conflicts have expressed alarm at the ineffectiveness of antibiotics, which are too readily available without prescriptions in regional pharmacies.

Overuse of antibiotics can make bacteria resistant to them and doctors say this contributes to the evolution of “superbugs”.

“The situation is terrifying,” said Dr Rasheed Fakhri. “The problem is the effectiveness of generations of antibiotics is decreasing so new generations are very limited by comparison.

“The level of education and acceptance by populations, even by medical teams, for respecting antibiotic prescriptions is not high enough.”

Dr Fakhri was recruited by the Dubai office of Medicins Sans Frontieres (MSF), the volunteer group that treats patients with combat injuries, to work in a reconstruction hospital in Amman, Jordan.

MSF’s project to treat patients with combat injuries began a decade ago, but in that time Dr Fakhri has witnessed a worrying level of bacterial resistance.

Some pharmacists in Abu Dhabi and Dubai hand out antibiotics without prescriptions to treat minor ailments.

“Many patients do not often challenge the need for a prescription from a pharmacy for these kind of drugs,” said Dr Arthur Williams, a family medicine specialist at the American Spine Centre in Dubai.

“Antibiotics should only be prescribed in accordance with illness and by medical professionals. A lot of work is needed here on awareness in the UAE.”

Dr Fakhri’s hospital treats patients who have injuries such as loss of limbs, but sometimes 18 months after they sustained the wounds.

Between 50 and 60 per cent of orthopaedic patients are from Iraq, Yemen, Syria and Jordan.

Drug-resistant bacteria has been steadily increasing since 2009, doctors at the hospital said.

One infection that is hard to treat is war-related osteomyelitis, which is found in the bones of casualties.

There have been six recorded hospital cases where the bug is resistant to all available drugs – four of them in the past 12 months.

Dr Fakhri, who has also worked in Iraq, said: “I am not optimistic that there is a significant strategy to tackle the issues we are facing as a result in these countries.

“We have a very specific war injury in Iraq and Syria [osteomyelitis], so antibiotic resistance is not a direct result of malpractice by doctors.

“But it is a concern for the future as such practices will lead to the development of resistant bacteria. There should be more government control over antibiotics.”

Syrian patient Oday suffered several bullet wounds to his right leg in Duma, Damascus, in November 2012. He was treated in a field hospital but developed severe bone infection osteomyelitis.

Bone samples showed very resistant types of bacteria that could not be treated by the usual antibiotics.

Surgery was done to remove the infected area, with a longer course of stronger antibiotics to stop further infection.

MSF findings support a strong link between war-associated injuries and infection with drug-resistant organisms. To recover, on average, patients need on average at least an extra one or two operations and a six-week course of medication.

“MSF has experienced antibiotic resistance in war-injured Iraqi and Syrian patients in its reconstructive surgery hospital,” said Mohamed Bali, MSF’s executive director in the UAE.

“For a humanitarian surgical project, patients infected with MDR [multiple drug-resistant] organisms lead to formidable diagnostic, treatment, and control challenges. It considered one of the biggest medical humanitarian challenges that MSF is facing in the region.

“Implementing restricted regulations on over-the-counter antibiotic sales and raising consumer awareness to reduce patient demand for antibiotics are critical steps to address antibiotic resistance in the region.”

nwebster@thenational.ae

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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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