Hi, Fadia. Thank you so much for joining us today. We're absolutely delighted to have you all the way, speaking to us from Riyadh in Saudi Arabia. Can I start by asking you to introduce yourself to our students who, as you know, come from all over the world and share something of your role in adolescent medicine by way of introduction. >> Hi, Susan, thank you for your invitation. It's a pleasure to be with you today. My name is Fadia Albuhairan. I'm an associate professor of pediatrics at King Abdullah Specialized Children Hospital and King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. I'm an adolescent medicine physician here and I'm in charge of the Adolescent Health Service here at the hospital. I also lead the Adolescent Health Research Program at the King Abdullah International Medical Research Center, which is also within the Ministry of National Guard Health Affairs here in Saudi Arabia. >> I think, therefore, you're in a pretty good position to share with our students what you think are the prevailing health issues affecting adolescents and young adults within the Middle Eastern region. >> I must say, first of all, that the Arab region is a very heterogeneous in terms of the different countries, economies, infrastructures, and available resources and that certainly would impact the status of health amongst adolescents in the region. But based on the evidence that is available, I can certainly say that the most troubling conditions are those related to cardiovascular disease, road, traffic and transport injuries, as well as mental health problems in this age group. Now there are, with the ongoing conflict that has been in existence in the region, many of the countries in the region, there certainly are issues that have not been addressed. So, prevalent conditions amongst adolescents in war torn countries or in conflict zones, we don't have too much data on. There is some preliminary evidence that there has been an increase in some of the eradicated communicable diseases that haven't been here for some time, so we're seeing more and more of those nowadays, unfortunately. >> Overall, in the Arab region, how well do you think health services are responding to young people's health needs? >> So, the traditional healthcare system in the region has really focused on either children or adults. Once a young person hits puberty, he or she is considered to be an adult and is provided care by the adult healthcare system. Our clinic here at the National Guard Hospital is really the first specialized adolescent health clinic in the region. There have been pockets of youth-friendly services or youth-friendly health clinics, here and there, but these have really been more of individual efforts as opposed to a system's approach to adolescent healthcare. The awareness has been increasing, there has perhaps been a relative increase. Of course, we're a very youthful population, so 20% of the Arab population are adolescents between the ages of 10 and 19 years. About 60% of our population are less than 25 years of age, so countries are now realizing that we have an abundance of young people. They're realizing that we actually have great assets and we probably need to start addressing their needs differently as opposed to what we've traditionally been doing. >> In terms of primary care services, how well might primary care services be addressing the breadth of young people's needs? >> I think it varies across different countries. I would say, for example, in Saudi Arabia, we have tended to focus more on specialty and subspecialty care as opposed to primary care. I think we certainly need to re-look at the way things are being done here with expanding primary care and public health or population health efforts. In other countries, that might not be the case. And so, adolescents can receive health care by their primary care providers or community-based providers. The challenge, I believe, lies with the insufficient training on adolescent health and their issues. Again, because most providers have gone through traditional training and healthcare services, their focus is, again, tended to be primarily on children or adults. I think focusing or increasing the awareness and the capacity building on adolescents and their health issues is really very important. >> Thank you. And I suppose one of the challenges I would imagine as a health professional working in an Arab society is the challenge of working with very conservative countries and conservative populations and conservative governments. And I'm particularly interested in how is it that health professionals in that context are able to address the sensitive issues of relevance. For example, around sexual and reproductive health or issues relating to substance abuse in the Arab world. >> I must say, teens are teens wherever you go. They go through the same developmental changes and interests, I think what is different might be the forms of expression due to cultural and religious norms and values and whatnot. Now, you're absolutely right, both of these topics are quite sensitive to address. I believe that once you're able to address that an adolescent is engaged in some sort of health risk behavior, then that will allow you, if you will, to move forward and address a more sensitive health risk behavior. But again, addressing it and communicating it in a culturally sensitive manner. For example, when it comes to tobacco or substance use, instead of being very direct and blunt about it, what we might do is, we would ask about the young person's friends or a group of friends. Whether or not they engage in tobacco or substance use, and then move forward, move on, and ask about this young individual's behaviors. We're unfortunately seeing more and more of the shisha or the water pipe and hookah used in the region amongst adults and amongst young adults and amongst youth. So bringing it in a community context will sort of allow you to address this directly and then to move forward, similarly with sexual reproductive health. Now sexual activity is considered taboo amongst young people, amongst anyone outside of the marital context, or outside of wedlock. It would be very inappropriate of us to, again, assume that a young individual is sexually active. On the contrary, we would assume that a young individual is sexually inactive, unless proven otherwise. With the data that is available amongst adults, whether it's tobacco substance use or sexual reproductive health, we do have data available. This, again, will allow us to address these issues amongst younger generations because we now know that we need to address health and life force approach. Again, it's not easy but this has given us space or has allowed us to address these topics. Nonetheless, I think families have a very important role, schools have very important roles, and educating our adolescents and youth about sexual health, reproductive health and how to prevent certain things is really very important. >> Thanks, Fadia. This is a MOOC on global adelescent health and within that we've been really taking students through both the responsibilities that health service have. But particularly looking at the social determinants of health and at some level thinking about sexual reproductive health, as well as substance abuse issues. It does raise issues of gender, social roles, gender norms in relationship to health outcomes of young people. I'm just interested in how gender norms might play out in different countries in your region in relation to adolescent health outcomes. >> The gap in gender disparities in the region is certainly decreasing. The gap is decreasing in different ways. I'll take education as an example. The gender gap in education has markedly decreased in recent decades, and now we're seeing increasing numbers of women who are going into and achieving higher education. In some countries, the number of women have actually outnumbered that of men. Now this has important implications for societal roles, age of marriage, reproductive health, and so on. Though there certainly are gender differences when it comes to that, in some areas that gap is narrowing. In other areas such as mental health, for example, we see the reverse, and this is similar to other parts of the world, where women, for example, are suffering more from mental health problems as compared to men. Back at our region, it seems to be even bigger. >> Okay. You mentioned earlier that there is growing awareness of the importance of adolescent health and development and of the importance of capacity building in your region, as we know there is actually throughout the world. Can you tell us something about the local initiatives that are taking place in your region in relation to this? >> Yeah, so again, last year, in 2014, we established the Arab Coalition for Adolescent Health. This is a regional network where we have representation from all countries in the Arab region and we also last year established the Saudi Society for Adolescent Health. This is the first that addresses adolescent health and I'm hoping that other countries will also do the same. Both of these organizations, their focus is increasing the awareness and the needs of young people in the country and the region and also wanting to increase capacity, building local capacity on adolescent health, so we can address the needs of our young people in a comprehensive manner. >> We certainly wish you well in those endeavors. I suppose I've got one last question for you, and I'm wanting to hand you over the airwaves a magic wand and suggest that you're now a fairy godmother for young people in your region. And would ask you, with your magic wand, if you had a wish list of what you might do to be improving the health and well being of young people in your region, what might your number one or number two priorities be for actions to improve young people's health? >> Wow, I love magic wands, I wish we had plenty of them. [LAUGH] I think there are a couple of things that I would really wish and aim for or want to focus on. Number one, that is building local capacity, regional capacity in adolescent health, a multidisciplinary capacity that can approach adolescent health issues in a manner that needs to be addressed. Alongside that, increasing the awareness amongst the families, community and so on, on adolescents, their development, their developmental needs and so on. The second item would be having a system's approach adolescence health, where countries address this in a systematic manner as opposed to what is currently going on where there are individual efforts here and there. I don't think that is sustainable, we really need to have the buy in of all the different, the government and the different sectors, and to have, again, a multidisciplinary approach to such national strategies. The third item would be enhancing and encouraging research in this area. The focus has really been predominately on either children or so on adults and again, having research that is focused on adolescents and their needs, their determinants of health. Setting up surveillance systems where we can regularly monitor changes in their behaviors and in their needs, is certainly important. I think the last item and, to me, is probably the most important thing, is to include adolescents and young people in all of this decision making. What is that they want to be addressed that maybe we are not aware of, really giving them the space and the opportunity to voice their concerns and to be involved in whatever it is that is going on in the region. >> Fadia, thank you so much for joining us and our students today. I have no doubt that the young people in your region are in good hands, with such a big wishlist. I have no doubt that with the capacity of work that you're doing, I know that you're helping building a community of health professionals and community professionals who will hopefully be able to be that scaffold, together with families and communities to support the young people in the Arab region. We do wish you well and thank you for joining us today. >> Thank you, Susan, it's been a pleasure and good luck to all the students. Enjoy.
