Dr. Dujanah H. Mousa at Diaverum shares her story of working as a Nephrologist in Saudi Arabia

Posted June 22, 2018

Tell us a little bit about your background, where did you grow up and where did you go to school?

I was born in 1959 and grew up in Jeddah, Saudi Arabia. The first school for girls, called Dar El Hanan, opened in 1955 and I started there when I was three years old. The school was built by late King Faisal. To encourage families to send their daughters to school, he sent his own daughters (the princesses) and all the other girls in the palace to get an education. At that time, families were not accustomed to send their daughters to school and if they did it was normally only up to the point where they had learned the basics of reading and writing.
 
In the 70’s teenagers were usually getting married but I had a desire to go to school and become a doctor. I was very lucky that the medical school (Kind Abdulaziz University – Medical College in Jeddah) opened in 1975, just after I had finished high school. I was 16 and was the youngest high school graduate but because I am quite tall, everyone thought I was the eldest.

The University was very strict when it came to accepting students. Student who took more than two years to complete high school were not admitted. I was the only female student in the medical school. I completed my M.B.B.C.H degree and graduated with honors from Kind Abdulaziz University – Medical College. At age 22, I started as an intern, a resident and a medical registrar at the same university.

My cousins teased me for being a “spinster” for not getting married earlier. I did however get married after graduation. Today I am the mother of six children, five girls and one boy.

When did you know that you wanted to become a doctor?

I have always known that I wanted to become a doctor. If I would ever live my life again I would still become a doctor and a nephrologist. I love medicine and I love being a nephrologist. Nephrology fits my personality because it requires me to be very committed, dedicated and focused.

Why did you choose to specialize in nephrology?

When the headquarters of my husband’s company moved to Riyadh, the whole family went with him and I had to find a new career. Since I love teaching and the academic works, I was looking for a job within that area but it was hard to find any available positions. Initially I wanted to become surgeon but when a fellowship within Nephrology became available, I decided to grab the opportunity. The introduction to Nephrology came by chance. In 1989, I started to work for the Armed Forces Hospital in Riyadh as a Renal Medicine Registrar of the Nephrology Department.

Have you faced any challenges in your career?

There have been many challenges that I had to rise above. But I have a driving force that tells me that I can do better and accomplish more and when you do, people will eventually notice you. At that time, surgeons were not granted scholarships to train abroad, only a few selected medical fields were, and the cost was too high for me to pay out of my own pocket. The trend and the feeling at that time was that if you had not received training in the US or Canada you were not to be counted with. It was also a lot more difficult for women to get scholarships compared with men. Luckily this has improved until today. Back then, it motivated me even more to show that women can do many things from research, produce significant results and fight for oneself and be, if not equal to men, then even better.

At one point in my career, I almost lost a new job for not mentioning that I was pregnant with my third child. This was never an issue in my previous job. The employer said that they did not recruit pregnant women. They did not think that pregnant women would work as hard as men would and that they would require a lot of leave, especially when expecting. In the end, they still decided to hire me and I have proven myself worthy of the position.
 
I have always doubled or tripled my efforts to prove that women can do equally good or even better than their male counterparts can. Even when you are the head of a transplant department, there will always be somebody who does not like to be led by a woman and who will try to find issues and demonstrate that he can do better than I can. It has also been a challenge to juggle between our domestic life and being an on-call doctor. But I have been able to manage and I am very grateful to my husband who has always been very supportive and who is a true partner in life.

Tell us a bit about your career.

In 1986, I passed the Canadian Evaluation Examination, in 1988 I had my Membership of the Royal Colleges of Physicians in UK, and in 1997 a Fellowship at the Royal College of Physicians of Edinburg. At King Abdulaziz University Hospital in Jeddah, I started as a Resident and Medical Registrar from 1982 to 1986, became a Senior Registrar in General Medicine from 1986 to 1988, and then an Assistant Professor in General Medicine from 1988 to 1989.

At the Armed Forces Hospital in Riyadh, I started as a Renal Medicine Registrar from 1989 to 1991, Renal Medicine Senior Registrar from 1991 to 1994, and a Renal Physician and Transplantation Consultant from 1994 to 2007. My fellowship at the Armed Forces Hospital gave me the chance to be mentored by Dr. Abdullah Al Khobar who was considered a pioneer within Nephrology in Saudi Arabia.

In 2007 to 2014, I became a co-chairperson and department representative and head of Renal Transplant Program of the Total Quality Management Medical Advisory Board in Saudi Arabia.
In 2012 to 2014, I was the Director of the Renal Department at Prince Sultan Military Medical City with 2,000 patients.

I have published 60 medical articles and have been a speaker, presenter, and a chairperson at national and regional level in various meetings and medical conferences in Saudi Arabia. I am also the first female consultant in Nephrology in Saudi Arabia.

I always like challenges and I like to thrive and to be the best in whatever position that I am in.

When did you join Diaverum and what made you decide to join?

I started at Diaverum in May 2014. Diaverum is the first outsourcing program from the Saudi Arabia government. It was new and unique, a great challenge to deliver on, and I wanted to be part of it. Despite the fact that Diaverum is offering dialysis and I came from a transplant background I was excited about the challenge and the possibility to be part of a pioneer project and contribute to its success.

What is your role at Diaverum?

In short, as Deputy Country Medical Director, I make sure we keep delivering high medical outcomes, deliver on our KPIs (Key Performance Indicators), I conduct education and training and I am the head of the Vascular Access management team.

In 2014, I joined as Medical Director (MD) for the Nazer medical group and regional MD for the Eastern Province of the Ministry of Health (MoH) project. I am particularly proud of the great success of the Prince Naif Dialysis center which, during the first year, received the highest quality ranking according to Diaverum’s internal ranking system. This was only possible through the hard work of everyone within the group.

By 2016, I became the Regional MD for Eastern Region and Deputy Country MD of Diaverum Saudi Arabia. Another main project that I am managing in Diaverum is leading the Vascular Access (VA) for renal patients. VA is the backbone of dialysis, it is important to have a valid VA. The goal is to deliver the target with minimized cost or within the budget through excellent procedures and correct invoicing. The aim is to have less than 15% catheters and increase fistula/graft to more than 80%. This is despite the challenge of acquiring new patients referred by the MOH who have catheters.
 
I regularly visit all the 35 clinics in the Kingdom to keep contact with both doctors and patients. An in-person visit or living with them for a day shows that I am there to care, to help, to support, to educate, to share information, to set goals together, to set tasks, to see the results, and to aim to deliver with excellent medical outcome. Without sincere presence from management, the team will not have a driving force to perform and will not be motivated. Patients who see high-ranking doctor from the headquarters of Diaverum Saudi Arabia feel that they are being looked after and cared for.

What do you find most inspiring/rewarding with your work at Diaverum?

It is to meet patients, to educate them and to establish trust. When you have their trust, they will listen to and follow your advice, take proper medications and care for their own well-being. The reflection of a job well done is when the CPM scores are high. This means that patients are well-taken care of by their medical team and that they help themselves by following the medical advice they get.

Which are the greatest challenges that renal patients face in Saudi Arabia? How can you help them as a doctor?

Renal patients often suffer from depression. This is not surprising since they are required to completely change their life and dedicate around 6 hours per dialysis session, including transport to and from the clinic, and the normal frequency of dialysis sessions is three times per week. The only way to get out of the situation is to have a successful transplant. Nephrologists can help patients by empowering them through education and by being there as support for them. It is very important that renal patients learn the “right way” to undergo dialysis treatment and to manage their illness. When patients feel that doctors care for them in a genuine way they will reciprocate by following their medical advice. 

How does Diaverum work with quality in Saudi Arabia?

Diaverum has strict adherence to policies and procedures and continuous audits ensure that we deliver high-quality care to our patients. We provide education for the patients and give them good structure.

I can seriously say that Diaverum has changed the quality of dialysis in Saudi Arabia by providing excellent medical care. We have established world-class renal care in the Kingdom. Quality is a pre-requisite by the contract with the MoH and Diaverum Saudi Arabia also answers to Diaverum Global which provides global best practices and standard measurements to follow.
 
Do you have any advice for young Saudis who would like to become doctors?

Not everyone is cut out to be a doctor. If you decide to become a doctor, you should aim to become an excellent one. This will require the right kind of dedication, hard work and unselfishness. You need to ask yourself if you are willing to spend around 15 years (at medical school, residency, fellowship) before you are ready. You need to really want it and be totally dedicated.

On a personal note, I have three nieces who have joined me in the medical field and who are now great doctors. Women nowadays have bigger opportunities to receive scholarships, to study or get trained abroad. Saudi Arabia is progressing for the better, which is good for aspiring and future female doctors.

Thank you Dr. Dujanah for sharing your story and experience of working in the medical field as a female doctor in Saudi Arabia!

We also took the opportunity to ask Ziyad Kabli, Diaverum Managing Director for Middle East, who has successfully led Diaverum's expansion and growth in Saudi Arabia for a comment on the company's history and future plans in the market.

“Diaverum entered the Saudi Arabian market in 2011 when we opened our first dialysis center in Dammam. In 2013, we were awarded a contract by the MoH, and today we have 35 clinics and care for more than 4,000 renal patients in the Kingdom. The medical performance of our clinics is consistently improving and I am extremely proud of the results we have delivered so far. We are also looking forward to continue investing in new clinics for MoH and utilize its expertise in the field of dialysis to improve the quality of life for renal patients in Saudi,” said Ziyad Kabli.