[MUSIC] I have the pleasure to interview Professor Michael Silbermann, the Founder and Executive Director of the Middle East Cancer Consortium. And I would like to ask you about the Middle East Consortium or MEC about its activities regarding palliative care in the middle east. >> First of all, thank you very much for inviting me to be with you. I'm very excited to be in this beautiful place here in the Technion. And with regard to the Middle East Cancer Consortium, MECC. We started actually with establishing a cancer registry network in the Middle East in order to understand what is the scope of the problem of cancer in this part of the globe. And it turned out very quickly that about two-thirds of all cancer patients in the Middle East, and I mean the Middle East extending from the [INAUDIBLE] North African countries to Central Asia. Come to a physician for the first time when the cancer has reached already a very advanced stage, and in most cases, it's not operable anymore. The only treatment left for the physician is palliation, the problem is that in the middle east about eight ten years ago the term palliative care was totally unknown. And our first goal was to do an extensive educational program to let people understand first of all that cancer does not mean automatically death. And secondly, even if you are coming at the late stage, we can help you in alleviating the suffering that is associated with late stage or terminal stage cancer. So we were very excited about launching this new project throughout the Middle East and it focused on two main issues. One, education and secondly, training of professionals. I have to admit that the success was beyond any expectations, and I'm really happy because what we did was really a humane gesture toward thousands and thousands of people who really suffer. And so far, didn't get any treatment, any attention from the professionals in the hospitals in the region. A big surprise, which was associated with this kind of activity, was the role of the nurses. Physicians were skeptic about introducing palliative care into the mainstream of oncology treatment to patients. That was not the case with nurses. And one of the reasons that physicians did not feel that comfortable to start with palliative care treatments. Is a fact that physicians until today have not received any training your medical school studies, your residency program, about the basic issue how to talk to a patient. And this lack of communication tend to be the focus of the entire program. And let alone the fact that we are talking and we'll talk later on about the fact that people from the Middle East, Arab countries and non-Arab countries. Like Iran, Afghanistan and Nigeria are coming to Europe Come from totally different cultural background, and here are European, modern physicians who have no idea how to approach the patient. But let's talk about now the physicians within the countries, within the institutions. And especially those working in the primary healthcare settings in the community, and that's what really bothers us. Because when a patient is diagnosed with cancer, he usually gets the treatment, whatever it is being it surgery, radiation, chemotherapy, combination of the two, hormonal therapy. According to the protocols that every year at the ACA meeting in Chicago people receive. But that is absolutely not enough. We have to think about the human that is beyond the cancer, beyond the tumor, and yet unfortunately it's quite often forgotten. Maybe physicians cannot pay that much attention to the patient as a human being because of lack of time. There is overburden of work for physicians all over the world as well as our region in the Middle East. So they prefer not to start, because they feel very, very uncomfortable starting talking with a patient. About prognosis, diagnosis, and the most severe issue is about terminal stage, conveying the patient that he reaches the final stage of his life. Nurses on the other hand are in more contact on a daily basis with the patient and the families. And the family is a very important component in our story here, because in the Middle East and in other developing countries the family is a community. Is serving as a very important component in the overall approach to the cancer, which is a collective approach of the community and their family. Whereas in western societies, it's more individualistic. Patient care for himself is not relying that much of support emotional Psychological support of the relatives, and because of other demographic reasons. So nurses grab the challenge, and they are doing fantastic work. And I have to admit that due to the nurse's courage and understanding and the sense of compassion to human being, especially those who suffer. We have changed the entire picture in the Middle East and we are continuing. Next week, I'm going to the Sultanate of Oman where we are finishing a big series of palliative care to nurses and physicians and pharmacists and psychologists. And we get many invitations from far away from the Middle East. For example from China, because they understand that they have to do something about their patient and at least reduce the suffering. So of course, today, when we are talking about palative care automatically we think of pain management. But this is really the very first stage of treatment and that you can do with injection of morphine or any other opioids. But then we start. And I will give you a short story, I visited the Calvary Hospital in New York City which is the biggest care hospital in the world. And while visiting there they received the patient from the Cancer Center in New York. He was in a terminal stage. When he was brought to the hospital, he was screaming, he was dirty, you could see that he was not taken care of. So first of all, the palliative care physician gave him a shot of opioid coming down. The nurses watched him. And after he was lying quietly in his bed, the doctor came to me and said, and now we start with pilotive care. Which means now we get in contact with the patient. We ask them how are you Mr. Smith? That is a big thing to do for a patient. We are talking as a family, what do they have to say. Therefore, we understand much better the entire circumstances and we also have to understand to whom should we communicate in the future? Because, in many societies, and in the Middle East, many societies prefer not to involve the patient with the diagnosis. Not to tell him that this is a terminal stage because he will become discouraged. So they actually forbid the doctor to tell the patient, and the nurse tells things in a more smooth, polite, easy way, and that's the way we proceed. >> I wanted to ask you, it builds the issue of traditional and the herbal medicine in the Middle East. A few years ago, we established within the Middle East Cancer Consortium a research group, which we named MERGIO, Middle East Research Group in Interpretive Oncology. And I would like to have your input regarding the activities of this group. And what's the meaning of herbal medicine, traditional medicine? How significant it is in terms of palliative care in the Middle East? >> I, from the beginning, I want to tell you that we see integrative oncology as integral part of palliative care. And therefore, we are very excited about working together with you on this issue and bring them together. And here I have to go back to what I said several minutes ago. Our real problem is to understand the patient and his family. And it goes through communication. We have very difficult barriers concerning the language. We have to make every effort possible, first of all, to establish the relationship of trust between the doctor, the nurse, the professional team, and the patient and his family. If I, as a doctor, come to a patient, I tell him that the gold standard of treatment is using hydromorphone at this and this dose. That doesn't mean anything to him. We have to start to establish our communications to ensure that he has understanding. And especially, you have sympathy for them because he and his family and his community for hundreds of years used traditional Islamic, Arabic, Greek born kind of treatment for the relief of the suffering of all kinds and sorts. So I strongly believe that when we are talking about herbal treatment, this is more accepted by the patient than talking about very modern genetic molecular target organ treatment. The first issue, if we care about the patient as a human being, is to build the trust and to build a common language. And thereby to show him that we respect him, his faith, his tradition, his habits, and we respect his wishes as far as we can. Therefore, introducing herbal treatment and others like meditation which I personally am exercising with big success. I think it's a extremely important vehicle to promote palliative care. And today, we are talking about palliative care that ought to start once a diagnosis of cancer is made not waiting until the last phase of the journey. >> From the moment of breaking big news. >> You're right, today, we face a problem. Doctors don't feel that well to tell the diagnosis to the patient. And therefore they try to eliminate this situation, and usually what they do, they leave it to the nurse. In Western countries, they leave it to the social worker or psychologist who is in the team. After all, in care we're talking about Interdisciplinary teams not just a doctor. So I strongly support the fact that herbal treatment, herbal, Approach of treatment should be incorporated into palliative care. And eventually we'll be approved as another, in additional way of treatment within the mainstream of oncology treatment. So, let me reiterate herbal treatment, an integrative and complementary approach, by and large, help us, and can help us build the communication, thereby the trust, and thereby improve the well-being of the cancer patient. Therefore, we are strongly for it. Now, we are talking about the Middle East. And the Middle East, we are today working, we started in the Middle East but palliative care became an issues that interest many people including governmental authorities in other countries far away from the Middle East, mostly in developing countries. So we have to really to start from scratch because people still don't believe, that is the main problem, they don't believe that routine oncology therapy can help them. And by the way, they accept the fact that they got cancer because apparently it's God's decision. They have done something wrong and it's kind of a punishment. And, therefore, they accept it. And they even accept in many cases what is associated with being a cancer patient, namely suffering from pains. We now try to educate that it's not necessary to suffer. So we have to get to the patient and I believe that get to the patient for things that the patient has already empathy like the herbal and other treatment could facilitate a lot, our overall approach to a cancer treatment. Not only the Middle East, not only in Arab countries, in the other Islamic countries like Turkey, like Iran, like Afghanistan, like Pakistan. And more and more we get now requests from a country like China and they understand, the government understands in 2017 we cannot ignore the suffering of our citizens. And I think that is a very clever decision and accordingly, for example, the government of Turkey, the government of Oman and other governments. The government of Cyprus. The government of Jordan. They really decided to invest in that. Not a lot of money and that is one of the beauties about what we are talking here. This doesn't need big budgets. We don't need big equipment, modern equipment, big buildings, it's just small things that can make big changes. And therefore I can tell you, with guarantee, that what we are starting today here in the Middle East will have implication. Very important, practical implication in many countries in Asia, in Africa, and other continents. Latin America for example also highly interested in that. Of course, we'll do it in an orderly way. We don't want to jump. We want to do it slowly, but successfully. >> In that context, I wanted to ask you about the connection between the gross cultural approach you have developed through MAC in the Middle East and its potential contribution to European countries. Which now there is a challenge by refugees that come from Iraq and from Syria, all over the Middle East from North Africa. What's the insights that you have gathered through MAC? How could they promote communication in communities inside Western countries, such as Europe, and Italy, and Germany, and so on? >> This is a very good and relevant question, and I want to thank you for the question. Yes, through our vast experience in the Middle East focusing on cancer patients. But as I told you what we as palliative care physicians, we are interested in the human being. If oncologists, with all his will treat the tumor, but beyond the tumors is a person. So as we said, we need to do a good psychological work. And after a long thinking and work and consideration, I became convinced that what we saw in the Middle East during the past two decades can be applicable to people who are coming to Europe as refugees, illegal refugees and migrants who are fleeing from countries who are in conflict for years. Military conflicts, political conflicts and here as they come to a new continent, to begin, with is not highly enthusiastic about getting strangers. That's additional problem that we will not discuss here. But the fact is that hundred and thousands of people are coming nowadays more to Italy, and from Italy, they try to go to Austria, to Germany, to Scandinavia. And here they're coming after a long journey with inhumane conditions, going through rotten boats over the Mediterranean, coming to a new country, they don't know the language. They don't know the habits. They don't know nothing about the people. And they don't know how to start to cope with this new trauma. We learned that these people, many of them Suffer from emotional psychological distress, and if we don't treat that distress right on the beginning. It turns to become depression, anxiety, and other psychological situation, that really needs psychological care. And that we have, we want to eliminate, so what those immigrants, being it, women. Who went through all kinds of gender violations through the road, little children. Most of them are not old people, because old people don't have the card note to leave. The family is a tradition, everything to a new country. We have to approach them, and again, to try to get their trust in us that we really want, and wish to do something about their well-being. And that can be only done if we build a common language, a language where they feel that we respect what they are. Because for them this respect means we keep their dignity as a human being. And here we come, if we come and tell them, you know, we can new thing that you, it's not new to you. We can add them, we can try them, we will see, maybe it works, maybe it- >> Like herbal medicine? >> Like herbal medicine, and other modalities within this integral oncology, and I think that this is an excellent in an example. Where you can learn from one situation of cancer patient, to another situation of people who suffer like cancer patients. They suffer both physically, but mostly emotionally, and that reminds me everyone, very well, on cancer patients. Young cancer women that I met in hospitals in, there's a King Hussein Cancer Center in Amman, Jordan. Or the National Cancer Institute in Cairo, well, I understand Arabic, so I could communicate with them a little bit. Well, I was impressed that there really's a physical issues were not bothering them so much. What was bothering them is emotional, and that was a real suffering. And the Founder of Palliative care, Dame, Cicely Saunders, in London, after the second World War. She already then stated that Palliative care, at that time she didn't even define it as Palliative care. But caring for suffering people doesn't mean only for physical, it means also psychological and spiritual. And now I see that spiritual is becoming more and more important, because people, when they're in the relief phase of desperation. They feel alienation, they feel that they don't belong here, and people don't want us, they turn back to whoever is in God in Heaven. And they ask for spiritual support, and I think this combination, palliation with the traditional medicine, spirituality. All these come together beautifully, and I am very optimistic that in this way, we can really help people who need our help, absolutely. >> So if to conclude, what is your vision regarding negativities in the following years? In the area of integrative oncology, herbal medicine, traditional medicine, which is the focus of our talk today. >> Right. What is essential, and we are now in November 2017, we cannot treat patients just according to our personal feeling. It has to be evidence-based, somewhere, somehow, so in other word, we need research. And we need to provide the practicing physicians and nurses some evidence. So they can feel more comfortable and confident with what they're doing. So the first thing I think we ought to start with collaborative research projects, and there are barriers, there no question. There are barriers in the region, I don't have to go into details, we know it, it's not from yesterday. And unfortunately, I don't see it passing in tomorrow morning, these are political, social, I don't want to enter it, but are big barriers. Because a local institution's research is not part of their daily dialogue. And here we come and urge them to work with us on the research project, so after lot of consideration. We thought that the first step would be to carry service multinational service, which include multicultural aspects of the problem. And thereby to get an input, what is important, what is less important, and how can we continue? I think the logical next step would be to do some clinical trials, that is, of course, more expensive. It demands also, the approval of the values, ethical committees in developed countries, and it differs from one country to another. It's more difficult, but if it work, we'll get there, I don't see that in the foreseeable future. We can carry real basic research like we see in the United States, which is mostly financed by the farmhouses. Farmhouses are not that interested yet in the Middle East, because the market. The big money comes from the US, and Western Europe, Australia, Japan, but not so much from the developing world. So we need patience and we'll get there, but I'm optimistic because we have good experiences and successes so far. >> So with these closing remarks, I would like to thank you for coming here to the Ecological and Botanical Garden in the Technion. On Mount Carmel, thank you very much. >> Thank you, I am really happy to be here, I myself. A Technion Professor Emeritus, and I'm always very happy to come back here. And if I can contribute in any way to a project like MARK, I, of course, will do it with pleasure, thank you very much. [MUSIC]
