ABU DHABI // Safia Kamel had been confined to a wheelchair for more than four years. She needed knee replacement surgery but could not find a doctor willing to take her on as a patient.
Health problems and an obstructive sleep apnoea condition that made it difficult for her to breathe when lying down meant anaesthesiologists were afraid of putting her under.
"I even sleep in an upright position, propped up with pillows, because I cannot breathe when I am lying down," said Mrs Kamel, 60, a retired university professor. "Every doctor I met or hospital I visited would tell me it is impossible for me to do the surgery because it is too dangerous for me to be under anaesthesia."
Mrs Kamel was also diagnosed with pulmonary fibrosis, which is the scarring or thickening of the lungs. This meant that she could not be placed on a ventilator.
"There were just too many complications so I was stuck in my wheelchair, with no solutions," she said.
The situation changed when Mrs Kamel was directed to Mafraq Hospital in Abu Dhabi. Her medical team, led by Dr Rashed al Shaeel, the chief of orthopaedics, does not perform knee replacement surgeries on patients under general anaesthesia.
Instead, Dr al Shaeel said he preferred localised anaesthesia, with the patient awake and involved.
The procedure, which takes between 60 and 90 minutes, is minimally invasive.
"We create the smallest incision possible, around five centimetres long, never more than 7cm or 8cm," he said. Most other surgical teams cannot do it with an incision that is less than 10cm to 12cm, he added.
"We have developed our own instruments with the manufacturers to enable us to work in such a small incision, which is why it is such a delicate procedure that takes a little more time than the old way."
This way, the damage on the surface of the skin and within the tissue is minimal, and a patient's recovery time is faster.
Dr al Shaeel said the challenge in Mrs Kamel's case was her inability to lie down.
"She is the first person we have operated on in a sitting position; the muscles of the leg have a different shape when the torso is sitting up and the leg is extended, so we had to adapt to the awkward positioning," he said.
Mrs Kamel was awake throughout, with an epidural blocking sensation from the waist down.
"This meant she had no pain, but by the end of the procedure, I could ask her to move her knee for me and make sure everything was working well," said Dr al Shaeel.
Nine months ago, Dr al Shaeel replaced Mrs Kamel's right knee. Two weeks ago, she underwent the same procedure for her left knee.
"When she walked into my office a little after her first knee replacement, leaning on a cane, so happy and proud that she can finally walk and stand, I told her she's ready to get the second one done - that was my condition," said Dr al Shaeel.
Mrs Kamel said it was her dream to be able to walk again. "I am undergoing physiotherapy now, and before long, I'll be walking next to my family and ready to get my life back," she said.
hkhalaf@thenational.ae
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Directed by: Sandeep Reddy Vanga
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Plan to boost public schools
A major shake-up of government-run schools was rolled out across the country in 2017. Known as the Emirati School Model, it placed more emphasis on maths and science while also adding practical skills to the curriculum.
It was accompanied by the promise of a Dh5 billion investment, over six years, to pay for state-of-the-art infrastructure improvements.
Aspects of the school model will be extended to international private schools, the education minister has previously suggested.
Recent developments have also included the introduction of moral education - which public and private schools both must teach - along with reform of the exams system and tougher teacher licensing requirements.
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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.”
