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Harvard Medical School plans a center in Gulf

United Arab Emirates project continues a US-Arab trend

Harvard Medical School plans to break ground today on a branch in the Persian Gulf that will help oversee a massive “healthcare city” in the United Arab Emirates, the latest in a wave of US-Arab medical projects that was accelerated by the post-Sept. 11 restrictions on travel to the United States by the Middle East’s elite.

The Harvard Medical School Dubai Center, the school’s biggest international project ever, will train medical staff, direct research, and provide quality control for the 435-acre medical campus taking shape in the coastal city of Dubai. Local government and business leaders recruited Harvard to help manage their quest for “world class” medicine in the desert, agreeing to accept Harvard’s standards on both medicine and equal opportunity for women.

Though the US occupation of Iraq has stirred anti-American feelings across the Arab world, the war on terror actually has hastened efforts to bring American medicine to the region. People from the Middle East, who account for up to half of international patients in US hospitals, face more background scrutiny and visa delays since the 2001 terror attacks, increasing their desire for better health care at home.

In response, Joslin Diabetes Center of Boston just opened a treatment center in Bahrain, which has one of the world's highest diabetes rates, while Cornell University has launched a medical school in Doha, Qatar. And the Cleveland Clinic will help run a hospital under construction in Saudi Arabia.

"To have an American presence where we are building capacity as opposed to making war is a very important contribution," said Dr. Robert K. Crone, dean for international programs at Harvard Medical School. "It's an indication of both how the medical school and the university are increasingly reaching out to the rest of the world."

So far, the Americans say, they have faced no protests over their presence. Harvard officials say they sense a hunger for their help, illustrated by the 1,200 medical professionals who crammed a workshop Harvard offered in Dubai last winter.

But there are enormous hurdles to fostering US-style health care in a region where medicine is so spotty that the 100 million Persian Gulf residents spend $25 billion a year getting treatment elsewhere, according to Dubai Healthcare City officials. Many medical school students enroll straight out of high school and receive little training to keep up with advances after they finish. Cornell is opening not only the first medical school in Qatar, but also the first coeducational institution of higher learning.

"There is a huge reputational risk in doing this," said Dr. Daniel Alonso, dean of the Qatar medical school, a dramatic white structure complete with egg-shaped lecture halls where 25 to 30 students will begin training in the fall. "So we tried to put every conceivable protection in place."

For instance, Cornell offered two years of pre-med training to prepare Middle Eastern students for the rigors of medical school, and final decisions about who gets in are made in New York, based in part on US standardized tests.

Middle East analysts say the biggest challenge for the Americans could be controlling their expectations. "They should be especially concerned about the American tendency to think you can do it overnight," said Andrew Hess, diplomacy professor at Tufts University's Fletcher School. He said US institutions need to take a long-term view, especially since they will be "instilling values that may conflict with traditional society."

But the moderate Gulf states of Bahrain, Qatar, and the United Arab Emirates are more focused on building modern societies than protecting tradition, as women play increasingly public roles and foreign workers outnumber natives in cities such as Dubai. Over the last five years, they have increasingly focused on poor health care as a major weakness.

By the late 1990s, the World Health Organization had identified diabetes as an epidemic that threatened to bankrupt governments in the Middle East if they did not take action. Doctors believe that genetic factors, such as traditional intermarriage of cousins, and lifestyle issues, such as their increasingly Westernized diet and limited exercise because of the heat, put Arabs at heightened risk for the disease.

Joslin signed up 1,200 patients within three months of opening in Bahrain, which "exceeds everybody's expectations in Boston," said Dr. Antoine Kaldany, Joslin's director of international programs. He said he has been impressed by the quality of the medical staff available in Bahrain as well as the state-of-the-art electronic record-keeping that allows him to monitor patient care from Boston.

Arab interest in importing American medicine comes at an opportune time for medical schools and hospitals that have been battered by the limits on income as a result of managed care and a leveling off of private donations. Over the last decade, leading institutions have increasingly looked to export their services, such as Columbia University's medical degree through Ben-Gurion University in Israel and the Cleveland Clinic's part-ownership of a hospital in Cairo.

"American health-care institutions are reaching out to find ways to buttress their bottom lines," said Dr. Alan Jacobson, director of strategic initiatives at Joslin, which considered programs in various countries before settling on the island nation of Bahrain for its first international center.

The Dubai Center is by far the biggest venture for Harvard Medical International, the 10-year-old nonprofit subsidiary set up by the medical school to advise health-care providers abroad. Through HMI, Harvard has worked in 40 countries, but the Dubai project is the first overseas bricks-and-mortar branch of the medical school since a Shanghai campus closed in 1915.

Crone, who serves as president of HMI, estimates that the center eventually will bring in $4 million to $5 million a year in revenue, compared with HMI's $8.2 million in income for 2003. More importantly, say Harvard officials, is the long-term relationship with one of the fastest-growing, most Westernized cities in the region. Dr. George Thibeault, an HMI board member, calls Dubai "almost a mind-blowing experience, this creation out of the desert."

Saeed al Muntafiq, chairman of Dubai Healthcare City, said business and political leaders have been considering a major medical complex for five years, but they did not invite Harvard to take a leading role until the government had set aside land for the project and begun installing the powerlines and fiber-optic cables that would permit first-class medicine to take place.

Harvard was impressed with Dubai's can-do approach, but it was also nervous about anything that would compromise the school's reputation. At a meeting in Dubai last year, Harvard officials told United Arab Emirate leaders that they would insist on Harvard-quality standards and would not tolerate prejudice against women or religious or ethnic groups "or we're out," recalled Thibeault.

Muntafiq said it was easy to agree to Harvard's conditions because Dubai wants the best health care in the world. Otherwise, he said, "we might as well just call it the Joe Blow Medical School. I'll be the founding dean and we'll be done with it."

But Muntafiq has higher ambitions, viewing Healthcare City as a cornerstone to making Dubai "a global hub of the knowledge economy by 2010." In addition to a hospital, medical school, a "healthcare mall," and other facilities planned for the city, the Dubaians are raising a $100 million endowment to support scientific research through the Harvard Medical School Foundation for Dubai. The first phase of the project is expected to cost $1.8 billion.

Harvard will employ only about 25 to 30 people initially in Dubai, with top leadership drawn from Boston. But Harvard officials agree the project's importance to the medical school far exceeds those numbers. "We've never done this before and we're used to succeeding at everything we do," said Thibeault. "The Harvard name means a lot. It stands for excellence. We cannot, must not, diminish that in any way."

Tufts' Hess said the payoff for American medicine in the Middle East could be equally enormous, drawing a parallel to the 19th-century missionaries who helped set up the American Universities, which are among the best educational institutions in the region. "They can be a modernizing force," said Hess, "as long as they don't get in with those guys who think the only thing the Middle East understands is force."

Scott Allen can be reached at allen@globe.com.

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