Member Spotlight: Mohmmad Rami Al-Ahmar
August 13th, 2018
Dr. Mohmmad Rami Al-Ahmar holds a position of Physiatrist & Spinal Injury Consultant in the Jordanian Royal Medical Services at King Hussein Medical Centre in Amman, Jordan. Among his many activities, he is a member of the ISCoS Educational Committee; the representative for the Middle East and North Africa region; founder of the Middle East North Africa Spinal Cord Injury (MENASCI) network; executive member of the Jordanian PM&R Society; vice president of the charitable Jordanian Spinal Cord Injuries Society; a World Health Organization liaison officer for the Eastern Mediterranean Sub Committee; and chief or member of many committees at his local medical center. He has been member of the scientific and/or organising committees for many international conferences. He has been invited as a key note international guest speaker in Jordan, United Arab Emirates and Qatar. Among his other honors and accomplishments, he is a recipient of a United Nations Medal in 2008 (Medal of Administrative Competence); and a winner for best oral presentation for research on bacterial strains in pressure ulcers at the ISCoS/American Spinal Injuries Association joint meeting in Montreal, Canada in 2015. Dr. Al-Ahmar acquired his MBBS from Damascus University in Syria in 2000. He completed residency in Physical Medicine & Rehabilitation at the Jordanian Royal Medical Services in 2008. He completed a spinal cord injury fellowship in 2012 at the Midland Centre for Spinal Injuries at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, UK.
What inspired you to specialize in physical medicine and rehabilitation (PM&R) and spinal cord injury (SCI)?
PM&R is a relatively new specialty in my region, and this is what attracted my attention. I am always ambitious to experience new fields and helping people with disabilities inspired me. During my residency program, I encountered so many patients with SCI. Unfortunately, not every rehabilitation doctor could educate patients about everything they needed to know, so it was up to the patients to know and discover what needed to be done. Managing the difficulties after SCI became my passion. During this process, I came to realize how happiness comes from giving rather than receiving. Helping patients take care of the practical things, manage emotions, and to have as good a life as possible is my aim now!
Please describe your fellowship experience in the UK. Did you encounter any difficulties, challenges or surprises during your studies and clinical work there?
I was lucky to have met Professor Wagih El Masry two times in Jordan (in 2008 and 2011). He offered me the opportunity to join him at the Midland Centre for Spinal Injuries (in Oswestry, UK), where I familiarized myself with all aspects of SCI management. In actuality, my fellowship went smoothly, as I was well prepared by a senior colleague who received his training at Stoke Mandeville Hospital. In addition, I had been diligently studying SCI management for years before the fellowship.
Please describe the current status of PM&R and spinal cord medicine in Jordan. How many training programs and specialists in PM&R and spinal cord medicine are there in Jordan?
In Jordan, PM&R started in 1980s and now there are residency programs at three institutes: the Jordanian Royal Medical Services (JRMS), the Ministry of Health, and Jordan University. All must obtain a (Board) Certificate of Specialization, which is issued by the Jordanian Medical Council. We are now around 80 board-certified physiatrists. There are only four doctors now who are specialized in the management of SCI.
Please let us know more about the King Hussein Medical Centre and its rehabilitation center.
King Hussein Medical Centre (KHMC) is a military medical compound of six hospitals. The Centre is affiliated with JRMS, a wide network of hospitals in different provinces across the kingdom of Jordan. JRMS provides health care for the military and their families, as well as civilians. The Jordanian Royal Rehabilitation Centre, opened in 1983, is one of the hospitals in KHMC. It has a specialized SCI unit with a capacity of 30 patients. It is the only unit of its kind in Jordan and receives patients from all over Jordan and the Middle East.
What was the inspiration for the formation of the MENASCI Network which you founded?
Regional SCI Networks have been established in Asia and Africa. These networks have been proven to be effective and efficient in promoting cross regional exchange, learning, education, technical capacity development, support and research in the field of SCI management. MENA, which stands for Middle East/North Africa, is a region based on the same culture, religions and languages. It is a region for which a specific regional network was needed. After many professionals from this region expressed their wishes to be part of a network, the MENASCI network was announced and launched during my presentation at the last Pan-Arab PM&R conference held in Amman, Jordan in October 2017. This network aims to achieve similar goals to other SCI networks, but with a greater focus on the patient’s family and caregivers, who are the cornerstones of SCI care delivery in the MENA region, as opposed to western countries where patients are more independent. Other goals are translating materials and e-learning to be used by consumers and professionals, as well as adapting management to specific religious and cultural needs such as fasting, dressing and gender aggregation, as examples. Many steps are underway and many are still needed to fully activate this network.
Please tell us about the situation of persons with SCI in Jordan and in the Middle East and North Africa region. What is the situation with respect to accessibility, attitudes and durable medical equipment availability? Are there any challenges regionally that are unique to the area that you typically would not see elsewhere in the world?
All soldiers and their eligible family members and the majority of civilian patients who have sustained SCI are fully insured in Jordan and have the opportunity to be treated in the spinal unit at KHMC. They are covered for all their medical supplies, with the help of NGOs (non-governmental organizations), and are followed regularly in outpatient clinics, with the exception of those who have sustained SCI inflicted by others, such as in road traffic accidents or gun shot wounds. In richer Middle Eastern countries, specialized care and equipment are available. Wheelchairs are advanced and well-provided, but users may receive limited training in wheelchair skills, depending on the availability of occupational therapists and other professionals. Social barriers exist, including the hesitation of wheelchair users to use their wheelchairs in public places. Of interest in Jordan, there is a new Law regarding the Rights of Persons with Disabilities which takes into considration:
a. The respect for the inherent rights and dignity, individual autonomy, and freedom of choice for persons with disabilities.
b. The participation of persons with disabilities and their organizations in policymaking, drawing up plans, programs, and decision-making operations related to them.
c. Not to discriminate against persons with disabilities on the basis of, or because of, disability.
d. The acceptance of persons with disabilities as part of human diversity and difference.
e. The inclusion of the rights and issues of persons with disabilities into national policies, strategies, plans, and programs as well as the state budget.
f. Equality between men and women with disabilities in terms of rights and duties.
g. Equal opportunities for persons with disabilities.
h. To ensure the rights of children with disabilities, develop their abilities and skills, and enhance their inclusion and participation in the community.
i. To ensure that reasonable accommodation and accessible formats.
j. The removal of physical and behavioral barriers for persons with disabilities.
While some or all of these regulations are available in several of the countries of this region there is still great need for implementation and enforcement of the regulations in these countries . In addition, there are no federal standards or guidelines and no legislation regulating the accessibility of public buildings for wheelchair users in many countries. and in the other countries, there is need to implement the statutes and to enforce them. Accessible transportation is limited in most of the MENA countries. In Jordan, the Higher Council for the Rights of Persons with Disabilities is collaborating with the government, community and NGOs to solve these issues in the future. In North Africa and poorer countries, persons with SCI face many difficulties due to the lack of specialized care and accessibility. In our region, families and caregivers can provide too much help and interfere with patients regaining their independence and reintegrating into the community. As an example, manual wheelchair users are mostly observed to be pushed by a family member or a caregiver rather than propelling themselves. We badly need to change the perspective of the able-bodied towards persons with disabilities to accept them, and not to judge them based on appearances.
Please tell us about your most memorable patient encounter.
My most memorable patient is a highly intelligent but unfortunate young man, who was 14 years old when he sustained a SCI. There were family issues at the time and the cause of his injury is still not obvious. After he adapted to his paraplegia, we helped him return back to school as a home study student. When he turned 17 years old, he gained a scholarship at the King Abdullah School for Excellence to join the engineering college. Unfortunately after one month of college, he developed Stevens-Johnson syndrome after he took antibiotics for a urinary tract infection. It affected his eyes and he became almost blind. He told me that he would be okay with remaining paralyzed, if he could only see clearly again.
What professional and personal accomplishments are you most proud of?
The professional and personal accomplishment which I am really most proud of is being a member of JoSCIS, the Jordanian Spinal Cord Injuries Society. This is a charitable NGO which was established by one of my seniors for people with SCI. I joined JoSCIS in 2011 and became an executive committee board member in 2014. In 2018, I became the vice president. My colleagues and I do a lot of volunteer work to support people with SCI in society through education, social activities, solving practical problems, and being available for contact for help with any medical, personal or psychological needs.
Who would you like to thank?
Humbly, I would like to thank my mother who always lights the candles when they are off, my wife, my two sons Laith and Hani for standing by during all the busy days and nights, my Institute JRMS, my teacher Dr. A. Otom who trained me, Professor El Masry who inspired me to think globally, and finally Mr. Aheed Osman who introduced me to the ISCoS Educational Committee and continues to always support me.