A Historical Perspective of the EBM Evolution in Gaza

Dr Khamis Elessi, Head of EBM Unit

Evidence-Based Medicine (EBM) emerged in the 1990s at McMaster University, Canada, and travelled to Oxford University in the United Kingdom as an effective strategy to integrate the best available evidence into decision-making during clinical practice, alongside patient values and clinical expertise.

In developing countries like Palestine, the introduction of such advanced philosophies in the education and practice of medicine has taken much longer, and in Palestine, we were lucky to be among the few Arab countries to introduce EBM concepts into our medical curricula.

Why do we need Evidence-Based Medicine in Palestine?

EBM helps clinicians adopt interventions that are more likely to benefit their patients and, like other developing countries, Palestine faces many problems, including a modest healthcare system; fragmented healthcare providers; interventions supported by weak evidence; and inconsistent quality of care. Relentless occupation, and the ongoing siege imposed on Gaza since 2006, has further aggravated the situation, adding misery to the already deplorable situation. However, such challenges cannot be used as an excuse for failing to promote the use of reliable evidence to inform decisions in health care. Our strong belief is that in Palestine, we need interventions based on the best available evidence for the same reasons that EBM is needed elsewhere. Prior to 2009, the principles of EBM were not appreciated in Palestine. Initial steps were taken to attract professionals with an interest in EBM to the Gaza Strip. This included conducting a series of lectures and workshops to medical students and practicing doctors, which were organized by the EBM Unit and the Faculty of Medicine, Islamic University, Gaza.

Such educational steps succeeded in generating some interest in EBM and at least overcome some of the barriers. Indeed, since our first EBM promotion classes to medical students in 2009, the EBM Unit has conducted more than nine workshops, covering EBM concepts and practice, as well as a clinical audit, and the Unit has participated in many local and international conferences.

Due to our humble initial successes, we decided to take much bigger steps in order to promote EBM to a wider audience and help integrate it into day-to-day clinical practice.

Amazingly, we accomplished this brave step by organizing the first ever EBM conference in Palestine, and possibly one of the first in many Arab countries. It was entitled Evidence-Based Medicine as Part of Medical Education and Clinical Practice. Held at the Islamic University, Gaza on October 25-26, 2013, the conference covered 15 different local medical practices in the Gaza Strip Hospital. Five subcommittees were formed: General Surgery; Medicine; Pediatrics; Obstetrics; and Orthopedics combined with Neurosurgery. Each subcommittee included both a senior and junior specialist and was given five months to:

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A preparatory workshop on EBM and clinical auditing was held for all members of the subcommittees. The current local practices were all audited by committee members with differing specialties and compared against the best available evidence from international EBM guidelines. They were then thoroughly discussed in specialized workshops followed by agreed recommendations to improve our local practice. As well as local speakers, 15 specialists from Oxford attended in person and presentations were given by Professor Carl Heneghan, Director of the Centre for Evidence-Based Medicine at Oxford, and Professor Matthew Thompson, University of Washington, USA. The conference was a huge success and was highly appreciated. The success of this conference has encouraged us to organize a similar conference for a different set of local practices under the title of Evidence Based Practice in Gaza: Reality and Aspirations.

Objectives of the conference, to be held on October 28-29, 2016 are:

I hope we will be able to achieve all of these objectives, and that we too can share with the modern world the improvement of the health care for fellow human beings. I shall let you know how it goes!

Dr Khamis Elessi

Head of EBM Unit, Faculty of Medicine – Islamic University, Gaza

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