 Asalaamu alaikum. Welcome. I'm Richard Roberts, Professor Emeritus at the University of Wisconsin in the United States. And it's my honor to serve as a moderator for today's panel on the development of family medicine in the East Mediterranean region. First slide. We have six experts today that will go through in detail some of the achievements and challenges that the region has experienced in the past 20 or so years. Next slide, please. I'll be speaking about the region, looking at it from an outside point of view to just get us started. So as a region of Wonka, the various countries that are listed here on this slide became members starting as far back as 1994. And the region had enough countries as Wonka member organizations that the entire region became a separate region of Wonka in the year 2010. The estimates are there that these 15 countries and their member organizations represent about 20,000 qualified family doctors or family physicians. Next slide, please. And as you think about this region, I think it can be helpful to compare and contrast the economies, the resources available to people in the region, what's spent on healthcare. And so that'll be some of what I'll be doing in the next very few minutes. This slide shows the gross domestic product by country in billions of US dollars per year. The data are taken from the year 2019. And in the left column are the largest economies. And on the right column are the economies of the 15 member organizations in the region, the Wonka region. And you can see that there are a number of the countries that in the region that are large in rank in the top 20%. But there are many more that are further down the list. Next slide, please. But part of this is driven, of course, by population, generally countries with more people have larger gross domestic products. And so again, the most populous countries are listed in the left. And on the right, the populations of the regional countries, Egypt being the largest and it's also among the top 15 of all the countries in the world for population. One thing I would point out is that in my country, the United States, we have population of 330 million. That means that there are about 2,200 people per family doctor. Whereas in the entire East Mediterranean region of Wonka, there are about 440 million people and roughly 20,000 family doctors or a ratio of 22,000 people per family doctor. Or to say a slightly different, the United States has 10 times more family doctors per capita than the entire East Mediterranean region. And even in the United States, we feel like we have too few family doctors. There are some countries that aim for a ratio of 1,000 or 800 people per family doctor. Next slide, please. And when we look at the matter of income and wealth, it's important to not only look at the entire country's domestic output, but to look at it per person. And here the numbers get very interesting because there are several countries that rank in the top 10 from this region in terms of wealth. And yet there are also several countries that rank near the bottom in terms of income per person or gross domestic product per person. Next slide, please. Now, there was an important paper published about 10 years ago that was a nice snapshot of the region just as family medicine was beginning to roll out across the area. And in this slide, the numbers that are in bold represent the highest or greatest amount of a particular country for the various things that are being measured in the table. And when they're underlined, that's the lowest country. So for instance, if you look at the number of graduates per year when this study was done around 2010, Jordan had 29 graduates per year and had 472 practicing family doctors. Egypt had 74 million people at that time. So those are the largest. And what's very impressive to me is that some of the countries have a ratio of family doctors to population that would be pretty close to the United States. One family doctor for every 1971 people in Bahrain, but in Sudan, which is not technically an EMR region but was in the study, it was one family doctor for almost 2 million people. Not surprisingly, the incomes for family doctors across the region corresponded with the overall wealth of the country. So countries that were wealthier like Kuwait had a higher average income for the family doctor than did countries that were much lower on the economic scale, such as Syria. Qatar did not have data for their GDP per person, their gross domestic product. So that wasn't part of the study table here. Next slide, please. And then to focus more precisely on healthcare and what countries are spending for healthcare services, the countries that have their numbers highlighted in yellow under the most recent year, which is 2018 on the far left column, those are the countries that are spending a higher proportion of their gross domestic product on healthcare services. So eight, nine percent, which is what you see in many advanced economies. But it can also be related to the fact that if a country does not have much of a gross domestic product to begin with, but they're spending a sizable portion of it on healthcare, they would have a higher current health expenditures as a percent of gross domestic product. And perhaps interestingly, the wealthier country, Kuwait, Qatar, Bahrain have a lower spend than the other countries down around two to four percent are going into healthcare. But that may likely be that the fact that they have a much larger economy and so don't have to spend as proportionately much on healthcare as some other country. Next slide, please. So as you step back and think about how the region has looked, at least to me, I think there's some things that I would call achievements or our assets or resources for the region. The population is young, but the challenge that to some extent offsets that is that there's been chronic conflict in the region and many displaced persons, which means many young people may not be having educational opportunities. There are extremes of wealth in terms of the regional resources. There are some countries that are among the top economies in the world on a per person basis, but there are also some that are among the poorest in the world. And I think it's a region that has been ready and eager, frankly, for innovation and reform, especially in the health sector. And yet the challenge at a macroeconomic level is that many of the economies in the East Mediterranean region are petrol economies. They're very dependent on oil production 60 to 80% of their of their gross national income relates to petrol. And that makes the economies much more vulnerable to price fluctuations. There has been rapid growth in the specialty. It's been really exciting to see that. And I think that there is an expressed public commitment to health services generally and to primary care in particular, but it has not always translated into sufficient resources or frankly, even respected for primary care that one's going to need to truly have the region leap forward around their health income health outcomes and indicators. One other positive that is unique to this region is the presence of the airport. I'm not aware of any other region in the world that has a certifying board examination that anyone in the region can take. And I think that provides a platform to work from to help the entire region develop. But the ability to develop, as I said, will depend on a number of these economic factors as well as dealing with the issues of conflict and displaced persons and the like. So we're going to next turn to our panel of six speakers and we'll introduce each of them in turn. I'm very pleased to introduce next the video clip for Dr. Arab Al-Smadi from Jordan. She's the treasurer for the East Mediterranean region of Wonka. Good evening, everybody. And at the beginning, I would like to thank all the organizers and the scientific committee for this great conference. And I'm honored to be one of the presenters for the Wonka EMRO achievements and the challenges because this is a very important topic that we need to address it in our panel. The first thing I would like to thank all the Wonka residents and all the Wonka World past presidents and all the Wonka World members who supported the establishment of the Wonka EMRO. Wonka EMRO is the youngest branch of the Wonka World and it was established on 2010 in Cancun, Mexico during the Wonka World Council. And before that, it was a part of the South Asia region because of the hard work and the efforts from the EMRO countries and the Wonka World collaboration and support. The Wonka EMRO was established and composed of eight countries at early stages and currently because of all the efforts of the Wonka EMRO presidents and members and all the countries who were very active in growing up this region. Currently, we have 15 countries joined the Wonka EMRO. And again, I would like to thank all the people who was critically involved and critically important role in the establishment of the Wonka EMRO. A lot of achievements of the Wonka EMRO has been done since its establishment and I think our huge and big achievement, what we are seeing now in 23 Wonka World that has been now running on Abu Dhabi. Also, it's virtual because of the COVID-19 challenge, but we are very proud to welcome all the people in Abu Dhabi and very proud that Wonka EMRO bid and won this 23 Wonka conference while we bid it for in Brazil 2016. Another very important achievement for the Wonka EMRO that we were able to complete six regional conferences and it was a very successful conference and attracted many of the international and national speakers all around the world. We had also many local conferences in the majority of Wonka of EMRO countries and it was also endorsed and supported by Wonka EMRO. In addition to many workshops in the Wonka EMRO that has been done during all these years for mental health, for NCDs, for ICPC2, for any for other important topics that has been addressed during these workshops. Another important milestone that has achieved during the Wonka EMRO journey is the establishment of a Razi Young Movement which was branch of the Wonka World Young Movements and also they have a lot of activities and achievements all through the journey of Wonka EMRO. We are always proud of our excellent collaboration and coordination with the WHO EMRO that has been started in 2013. We had too many meetings, too many collaborations and one also another milestone achieved and it was addressing one of the important challenges in the family physicians across the region, the shortage of family physicians across the region and in order to accelerate this shortage Wonka EMRO in collaboration with AUB and WHO EMRO we were able to create a diploma of family medicine that it's for one year and for the ordinary GPs and I think it will be a very good role for the family medicine across the EMRO regions. We are looking forward for adaptation for adoption and further policy makers supportive to all EMRO countries. Actually we are progressing in this issue and I think there are many of the policy makers around our region who are supporting family medicine but we are looking forward for more and more support. We need also for more generations to more number of family physicians to be able to work with the health systems around our EMRO countries. Financial resources also needs to be allocated for primary healthcare as we all know that the budget allocated for primary healthcare in most of our regions is not enough to address all the challenges related to the family physician and generating new members of family medicine. The role of Wonka also is very important to promote integrated researchers in our region. We have actually Wonka party group for researchers but we are looking for more and more support for the researchers in our country and we have too many lessons learned sharing from the different systems among our countries and COVID-19 as one of the most challenges that currently is that currently is facing our EMRO region and we learned a lot from our work with the COVID-19 pandemic that we need to maybe learn more maybe to rely more on the telemedicine and the use of technology and the virtual learning and adaptation of more virtual courses and the academic learning for the family physicians and this is it was one of the most important lessons that we learned during our journey on EMRO. Super thank you for everybody and for listening to our achievement and the challenges in Wonka. Thank you so much. The next speaker will be Dr. Hussain Salah. He is the regional advisor on primary care and community healthcare for the World Health Organization and as Dr. Rae mentioned previously there's been a fantastic relationship between the regional office of the World Health Organization and the family doctor colleges and organizations across the area and much of that credit goes to Dr. Hussain. Hello everybody my brief presentation is about which is the primary healthcare partners for the Global Action Plan Accelerator and I mean by the primary healthcare partners here that it includes of course Wonka, UNICEF, UNPA, UNHCR and our colleague from the Arab World Health Specialization and our collaboration with World Health Organization WHO. In my brief presentation I will focus mainly our collaborative work with Wonka and we have already decided on four topics for our collaborations that I'm going to brief you about it soon. The first one it is about the online training for the role of the primary healthcare in the context of the COVID-19 pandemic and the background for this at the beginning of our work for to decide about the whole collaboration work we found actually it is very important to support our colleagues from the primary healthcare physicians working as a primary healthcare facility in which actually we identified four main functions for the primary healthcare during COVID-19 the first one is maintaining of the delivery of the essential health service pack this is the most serious function for the primary healthcare. Second dealing with prevention of the COVID-19 infection followed with assessment and the diagnosis of the COVID cases and the last function for the primary healthcare during COVID-19 pandemic is the management of the mild and moderate cases. To disseminate this four functions as I mentioned earlier to the colleagues in the working and the primary healthcare facilities we decided to develop an online training under the title of role of the primary healthcare in the context of the COVID-19 pandemic. This online training it is fully automated it includes four languages Arabic, English, French and Farsi so far we are in the stage of updating it every two months and it is available on the mobile application and it is accredited by the American Association of Continuous Medical Education who is 15 accredited our in addition to this it is endorsed by the Arab Board of Health Specialization. Our collaborative work was with Wonka and our partners for the primary healthcare for this work in particular actually it is one of the most successful experience. Over the 90,000 primary healthcare positions participated and registered in this online training as I mentioned earlier this is one of the most successful collaborative efforts were with our partners. The second part is dealing with original professional diploma in family medicine in terms of developing it and disseminating it as a background for this that just only 20% of the medical schools they provide a family medicine degree 3% of the graduates they select a family medicine as a specialty for the future work for them 93% of the primary healthcare facilities are managed by generalists on the other side there is almost a quarter of generalists that we need actually to introduce them to the family medicine concept. A couple of years ago we presented the diploma to the regional committee regional committee this is annual meeting for the minister of health and we received actually very encouragement notes and we decided to go and to implement this diploma to overcome the current challenges and to reach our target of the three family physician per 10,000 population. The diploma so far it is 12 months we expected to increase it to around say 24 months and sorry 50% of it it is online and the other 50% it is face-to-face it can be for the full time and it can be for a part time. The third piece of work it is dealing with a review of the role of the primary healthcare in COVID-19 pandemic response for leading equitable recovery and the background for this as you already know that as a response for the health system at the beginning of the COVID-19 at the first weeks actually it is most sorry the hospital care and was completely ignoring the role of the primary healthcare with its four functions. That's why we decided to go with our partners and Wonka and the primary healthcare partners to go and to review the country's experience for the role of the primary healthcare in COVID-19 and this we are using the Astana declaration three areas for the primary care which including the primary care and essential public health multi sectoralty in addition to community engagement. Expected that this kind of work for the review of the primary care it is going to help us as a partners to decide about the actions that needed and to support the member states in addition to that it is going to identify the major challenges facing the primary healthcare during this pandemic. The last piece of work is dealing with development and implementing of the primary healthcare oriented model of care and the background for this that all the countries in our regions they are committed to the universal health coverage. Actually some of the countries already bought as a target for them about the year of the 2070 what will be the situation for the UHC index coverage. For the operational framework on the dealing with primary healthcare and in the World Health Assembly back to the last year for the 2020 they already adopted and approved this operational framework with its 14 levels. The level number five which is dealing with a model of care and we mean by the model of care that it is help us to conceptualize that how the service should be delivered in addition to the management of the population health management of the service in addition to the selection and organization of the services. So far we are working with five countries in the region Palestine, Pakistan and Sudan and recently we received requests from Yemen in addition to our colleague from Libya and what you are going to work so far to develop a regional implementation guide for a model of care to strengthen the primary care in universal health coverage. For each of these countries we are going to develop a country model of care for planning and management and this is actually going to cover the first phase which is going to end by the coming May coming year for the 2020. So far we are working on for each of these countries in two pilot sites and as I mentioned this will cover the first phase. Thank you colleagues so much. Take care. Thank you Dr. Hassan and it's been for me wonderful to watch this cooperation and collaboration between the World Health Organization's East Mediterranean Regional Office and the family doctors across the region and it's really quite exciting to see. Our next presentation will be by Professor Najwana Shat and she is at the Manulthia University in Egypt. Egypt case study by Naguanej Adhigezi assistant professor of family medicine faculty of medicine Manofia University. In response to the shortcomings of the health system Egypt launched the health sector reform program in 1997. It has made it for pillars which are ensuring the universal health coverage with basic health services, improving the organization and the management of the health system, improving the health services delivery as well as improving the pharmaceutical system. In order to do that all universities had been encouraged and advised to have a family medicine department and some of the universities had actually developed a separate family medicine department with a post-graduate studies and some of them have undergraduate curricula and while others have only undergraduate exposure to the family practice. Undergraduate exposure to the family practice had been done in primary health care settings to understand the reality of the practice. Residential station training in Egypt usually are in the form of universities training programs and Ministry of Health and Population training program, which is the family medicine Egyptian fellowship program accredited by Burial College beside the airport program. There had been also other training programs in Egypt. The density of the physicians, all the physicians per 1000 population in Egypt according to the WHO had been encountered to be between 0.45 to 1.35. If you are going to investigate this later, we are going to find that in 2014 the number was the density was 0.81 with a total number of family physicians reaching 31,944 family physicians and primary health care physicians, which resemble a density of 0.05 per 10,000 population. If you are going to go back to the density of the physicians per 1000 population, we are going to find that the number had been density the density of the number had been low in the past period except in 2000 in the last decade in the 2010 where there had been the maximum density and a price of the curve. Why this curve is decreasing? We have the dilemma of the Egyptian doctors before and after COVID. Simply according to the IPRA report 2020, the Egyptian graduate every year is nearly 7,000 new physicians. The number of the registered physicians is 213,000 registered doctors. Only 82,000 of them are working in Egypt. So Egypt faces an unproduced number and waves of immigration by the physicians causing concern that the quality of health of care could be deteriorated. Over the past three years more than 10,000 doctors have left the country according to the main association representing the physician, which is the Egyptian medical syndicate. The syndicate estimates that the half of the country's physician or 110,000 out of the 220 registered have left the country. Why do we have this brain drain? Simply because there is a workload, governance, salaries, and they are searching for the chances of continuous medical education approved. We do not deny that COVID also has an effect because Corona vaccines exceeded 500 deaths among physicians till this moment. What are the successful achievements and the way forward? The new training pathway where the Ministry of Health and Population had launched an obligation training starting after the graduation that's completely different from the previous period where we have to spend two years in the family practice. Also the universal health coverage system, which encourages more incentives to the physicians and we do not deny that vaccinations and having family physicians and doctors among all the practices in the first line to be vaccinated is also a way to help them and to protect them from the dangers. The total percentage of the vaccinated population among Egypt is 11.5%. Finally, there had been an initiative by the president, which is called a decent life that had been targeting the ruler practice in Egypt and ruler colleges that resemble 58% of the total population. Thank you. Thank you, Professor Najwa. Our next presentation will be Dr. Huda Au-Dwayson, who is from Kuwait. She is the head of the primary healthcare faculty of the Kuwait Institute for Medical Specialization, as well as the head of the Association of Family Physicians and General Practitioners. I'm Dr. Huda Au-Dwayson. I'm the chairperson for primary healthcare faculty. My presentation is about the primary with primary healthcare faculty. The outline of my presentation will be first I'll talk about the vision, our vision, and then I'll talk about our strategic goal. And then I'll talk about the our achievement and the challenges. First of all, the faculty of primary healthcare established in 1983 under the umbrella of Kuwait Institute for Medical Specialization and in collaboration with the Royal College of General Practitioners. Since then, we are accredited by the Royal College in the UK. Our vision is the achievement of excellence in education, training, and the most important is the individual care in our primary healthcare sectors. Our strategic goals are five goals and the first one is to ensure sustainability and through supporting our leadership skills among our members. The second one is to strengthen the available program that we are having in our faculty such as the primary medicine program, the general practitioner development program, the fellowship program and others. The third goal is to increase the uptake of the family medicine as a career by our medical students and also by our junior physician. The fourth one is, which is a new one added this year, is to ensure the appointment of specialist family medicine and also a general practitioner and encourage those who are not certified to join our program to be certified as a general practitioner. Last and not least and the most important is to ensure the provision of high quality comprehensive care and mainly we are focusing on patient centers and practice management in our goal in training. So I'll talk about our goals but I will talk about them briefly. I included any because of the time I will go over my presentation briefly. However, if there is any question the additional text available in our slide I think will be you can use them. If not then any question in the discussion I will answer it. For the first one is to prepare our leadership skills among our members. We work hard on this and the reason for that is to have a pinch strength that empower our faculty and at the same time to act as a model for our faculty and we are sure by having them we can face the challenges that we are going to have in implementing our strategy in the next coming three years. The second goal which is strengthening our local program such as the family medicine program the GBBD program and we are lucky that now we are having excellent collaboration with the Royal College of General Practitioners and also we are a member in WINCA and also we are collaborating with the WHO as a training center and the most important we have the support of the Quake Family Medicine and the General Practitioner Association. We are having we achieved a very well-structured and internationally accredited program and curriculum for the family medicine and hopefully will have them will have for the general practitioner also in the coming year and that is by having a very competent standard and the protocol for selecting trainers, the trainee and also the examiners. Also that's I'm sure that will result in having an excellent level of graduate and trainee and if they are very efficient and our evaluation process is continuous all over at all the levels and we use for this defined key performance indicators in order to measure our success. The third goal is to increase the uptake of family medicine practice as a career by our medical students and junior staff and for this we increase when we have done this we increase the number of our admitted applicants for family medicine program and in 2011 it was only 30 applicants but now it's 84 2021 and we are looking for 100 inshallah for the coming years and the reason we have done this and why we achieved this because we expand the undergraduate placement in family medicine by increasing the duration of their rotation by increasing their numbers involving six and seventh year in our program and also by involve including our curriculum in their curriculum and also in their exam. The fourth one is to ensure the appointment of specialists in family medicine and encourage the general practitioners who are not pleasant to join our general practitioner professional development program which is called the GBBD program and for doing this we have done a lot of action to increase the attraction of the GBB to join our program and also we are running a lot of research audit quality improvement project and also we are using media to influence the general practitioner to use or to apply to our GBBD program and also we are trying to develop their recruitment and asking the Minister of Health to involve us with us to make sure that the doctors who work in the primary healthcare are in higher level with good quality standard of management. The last and not least the fifth goal which is ensuring the provision of highly qualified comprehensive and continuous care to our individuals and this is the most important thing and we are doing this by excellence in our training program which is run by Al-Musallem to have highly qualified leaders and directors excellent in family medicine board program which is run by Dr. Al-Dubayib and now we are having 55 trainers in the head program and now our graduate considered to be 24.5 percent of our primary healthcare manpower. Excellent in board exam program by Dr. Bahamra and she has now 24 examiners and also excellence in the GBBD program by Al-Fabala and now she's having 26 trainers, 12 certified general practitioners and also that we have 24 general practitioners are under training. Excellent in fellowship program run by Dr. Atesneem and Mehdi and now we are having 12 family practitioners with fellowship they are certified with fellowship. Excellent in medical students program and I mentioned that briefly before by Dr. Amil Hedli and also excellent in CME program and now we issued around 2420 CME program in 2020 for 3699 attendees. Excellent in promotion program and also the most important is now we are having 170 for audit and for researches and that is led by Dr. Atahani Al-Ansari. So going now to the last slide which is what are our challenges. The first challenges is the leakage of the family practitioner from primary healthcare sectors and they are working now in administration in primary in Ministry of Health and they are the 10 challenges is that it's still till now we don't have representation of the primary healthcare faculty in great university faculty of medicine and the third one is the still the human resource non-human resource and even some of the policies still are limited resources for this for our GBPT program. So what could have been done differently that's what we are going to discuss and hope to find a solution for it during the panel. Thank you very much for listening and watching and hope that you benefit from this slide. Thank you very much. Thank you very much Dr. Huda our next presentation will be by Professor Abdul Aziz Al-Marazi. He's the president of the Oman Family Medicine Society and is a professor at the Sultan Kaboos University in Oman. Good evening ladies and gentlemen I'm Abdul Aziz Al-Marazi I'm senior consultant department of family medicine public health of Sultan Kaboos University and the president of Oman Family Medicine Society. I'm going to talk about family medicine Oman challenges and opportunities. The outline of my presentation will include the background information. I'll talk about the achievements of the healthcare system. I'll talk about the challenges and I'll end up the presentation by giving some conclusions. So as an introduction Oman is situated in the south eastern part of the Arabian peninsula it has an area of 309,000 kilometers and it's mostly valleys and desert and has a population of 4.4 million. The healthcare services in Oman evolved since 1970 and the development plan was according to phases. So the phase one started in 1971 until 1980 and included the building of the infrastructures such as the establishment of the Ministry of Health, the building of a few hospitals and health care centers and the major landmark at that time was the clear commitment to primary healthcare as a main path to reach health for all by the year 2000 and since that time plans have continued until we reach at this stage where the focus is strengthening of primary healthcare and the quality improvement movement. Major events at that time was the establishment of the first family medicine department in 1987 under the College of Medicine and Health Sciences of Sultana Public University and the initiation of the first national family medicine residency training program in 1994 as the first speciality structured residency program in Oman. This is Oman and as you can see the hospitals and health centers and extended healthcare centers are scattered throughout the country and throughout the 11 governorates of Oman. So what were the major successes? There was a remarkable improvement of the major health indicators. Oman gained international recognition of its health achievements and there were specific successes reported within the primary health care. As health care indicators infant mortality rate has dropped significantly from around 350 to around 9.8 per thousand live births and the life expectancy has dramatically increased from around 40 to close to 80 in 2015. As an example of the international recognition Oman in 2000 the report of the WHO was ranked as number eight in the best performing health care system in the world and in 2008 in the World Health Report Oman was recognized also as selected as best performing country in reducing under five mortality by 80 percent in the region. What were the major successes within primary health care? With graduation of family physicians, non-communicable disease clinics were open such as diabetes and asthma clinics national primary health care clinical guidelines were developed and implemented. Screening clinics were introduced such as breast screening, disability and elderly care. The drugs and the health care centers have changed and glued the important drugs which are commonly used such as insulin, statins and other drugs. There was improvement in the electronic medical records to match the national clinical guidelines and quality improvement in the form of regular audits and defined catchment areas were introduced and telemedicine has been widely used especially during the pandemic of COVID-19. Other general challenges were like human resources, infrastructure, growing demands and expectations of the public, the need to strengthen preventive care, the need to introduce proper home care, the need to transform into digital health, changing disease patterns as we have seen with the pandemic and probably other emerging diseases, non-communicable diseases and the need for better coordination and integration of health care services. Specific challenges in Oman in terms of governance, we need stronger commitment to family medicine as a foundation of the primary health care from the decision makers. We need family medicine to be recognized as a specialty and as equal to any other specialty. We need equal opportunities for family physicians for career progression, sub-specialty training and work in private practice and we need a better balance in the medical workforce to tilt more towards generalists compared to what is right now which is like tilting more towards specialists. In terms of supply of new graduates, we have inadequate supply of new family physicians as you can see. And in conclusions, family medicine evolved and the health care systems were mainly attributed to a strong primary health care system. Major reforms are needed to ensure a bright future for family medicine in Oman. Thank you for listening. Thank you, professor. And our next presentation will be by professor Suha Amshari. She's an assistant professor at the Najah National University in Palestine. So, welcome from Palestine. This is Suha Amshari. I'm the head of the Palestinian Association of Family Medicine. I'm working also as an assistant professor in the family and community medicine department at Najah National University. So, in my presentation, I will discuss our history and our current situation in Palestine in the family medicine specialty. So, I will start to speak about about our history and family medicine, how Palestine started and the initiative of family medicine in Palestine. Actually, we started our residency program in family medicine in 2011. At that time, there were only one doctor who had a board or an American board of family medicine and this doctor who started this residency program. Actually, at that time, the Palestinian Ministry of Health and Najah National University took a decision to start residency program, which was integrated between both institutes. Then there was a voluntary British doctor, help us in this initiative and I will discuss their rule later. And many workshops was hold at that time in order to start this residency program. Our numbers are increased from one doctor to 38 family medicine physicians right now. In our residency program, now we have, in the first year, 25 residents, in the second year, nine residents, and in the third year, five residents. What we achieve in those years, mainly we started our Palestinian Association of Family Medicine. And for us, this was a great achievement. We started this society in 2015. At that time, we were nine family physicians and now we are almost 38. The number of the graduation of physicians who are graduated from this program are increasing, as I said, from one specialist to 38 doctors. And now we have a special committee, sorry, for the Palestinian Board Exam and Family Medicine. Actually, when we start our residency program, the committee of our board was mainly from different speciality, from internal medicine, from diatrics, surgery, and other speciality. But now our boarded committee are composed mainly from family medicine doctors. And one of the most important thing we achieve during those years that we secure our training program in this specialty. Because after three groups of residency program graduated from the university and from the Ministry of Health, as this is a collaborative program, there was a pause for two to three years that the stakeholders and the policymakers in Palestine said at that time, we don't need this specialty in Palestine. So for that reason, we rearrange our situation and we advocate for our situation and we restart the training program in this specialty. Maybe the challenges is the common word that we use actually in Palestine in every day. Because we have a lot of challenges. Our political situation, the barriers in Palestine, the geographical situation, and what happens even if we have a low resources. So we have a lot of challenges actually. But mainly to the family medicine, the transformation of health system toward the family medicine is one of the major challenges. Actually, right now the primary care in Palestine are working through many vertical programs. We have a specialty. We have a family of doctors who are working in the primary care. But right now they are working somehow as a GPs. They have a very few opportunities through which they can work as a holistic approach or through which they can apply the family medicine concept. We are a few numbers right now. Because in Palestine, we have almost three to four million people. But we have only 38 family doctors for those people and most of them, they are working in the south area. The training center is another challenge in Palestine. We have many, many sectors for primary care. Some of them are related to the Ministry of Health and which is a governmental section and other related to the NGOs. But we don't have a special center for the training and family medicine. So, or because this program is a collaboration between the academic institute and other governmental institute, there is a big gap in the clinical supervision between two institutes. I will finish this presentation or I will finish this vision for family medicine in Palestine to speak about our needs. What we need now? Actually, we need accredited family centers. This accreditation will help us in doing our supervision, in training our doctors in the perfect way and in the same manner how they are learning in the university they can apply in their centers. We need a clinical supervisors in those cities and actually we have a vision for that. But still the low resources that we have is a major barrier that we need to go over it in order to have those clinical supervisors in the site to train those physicians. Finally, we need the local support. Actually, we have a great support from the British voluntary GPs. But there is many barriers like cultural barriers and a lot of the barriers that make the dealing with them is difficult for us. So, our main aim that we need or our needs that we need the support from the local country because we have same culture, we have same situation. So, at this stage we can collaborate with each other and they can help us in this collaboration to develop many family medicine in Palestine more and more. Finally, I will thanks everyone that helped me or share with me this participation because this was an great opportunity for me to share the Palestinian challenges and the Palestinian situation in family medicine. Thank you very much for that. Thank you very much, Dr. Suha. Now we would like to use the remaining minutes that we have to have the panel members address questions that the audience might have. There is one question that I put to each of the panel members and I would ask them to speak briefly perhaps a minute or so and just to go in turn and I will try to prompt the next speaker as to what the next person's turn is. But the question is, if I were a general practitioner in the region, what would be the one reason that you would give me that I should spend the time and energy to train to become a family physician? Dr. Orib, could we start with you? Yes. Thank you, Rich, and thank you for this question. Actually, there are many, but I will be stick to one of these. The highly demanded for the family physician in our region and if we are talking about the work environment, it's a total different from being a GP rather than being a family physician. For family physician, you will earn more, you will be more knowledgeable and more skillful to give the right medication in the right time and to be a safe doctor. Thank you very much. Let's next go to Dr. Hassan. Can you please repeat the question if you can kindly, because I wasn't available. No, that's quite all right. So the question is, if I'm a general practitioner in the East Mediterranean region, why would I spend the time and energy to train as a specialized family physician? What would be the one reason you would give me that you think would be most important to persuade me? Yeah, very good one. Actually, the general practitioner, it is not kind of a speciality in our region. We just call it general practitioner in reality is generalist. So to be from generalist, to be a family physician, it means that you are going to go for specializations. You are going to be working on that as a family practice or the family medicine thing. So this is complete professional career. To be a family physician, this is the future. I mean, having just only a generalist, as I mentioned my earlier presentation, we have almost a quarter of a million. But to be on the cycle for the primary healthcare and to go for the insurance schemes and all of these kinds of things, definitely to go for them as a family physician, this is the future. Over to you. Thank you. Thank you very much. Professor Nadra, how would you answer this question? Okay, if I'm going to persuade you to be a family physician, then I have to sell my dream and my passion for family practice and being a doctor, a family doctor for a whole family, treating them having the holistic approach in a comprehensive way. Unfortunately, reality is not like that because physicians are looking from a different perspective. So they need a sustainable, decent life. So from that approach, I will tell them we are going to apply the UHC and government is supporting that. So all the problems is going to be solved in the matter of finance, incentive, career pathway. Thank you. Over to you. Thank you very much. Next would be Dr. Huda. I will not repeat the same what they have done, what they have said to my colleague, but actually at the level of the doctor themselves, as they said, a professional job, better finance, and even will be much better with having the specialized in family medicine. At the level of the patient, of course, that will improve the care of the patient and the quality of the care will be much better. At the level of the practice, the center self will have much better reputation and even the internal environment of working in a center with their family practitioners, much better and the quality of it and it will be accredited by the Ministry of Health. For that reason, I think better to be qualified as family medicine, having practitioners. Thank you very much. Professor Abdul Aziz, what would be your answer? Thank you, Prof. My answer would be that they will get better recognition amongst their peers and also by their patients. If they are qualified family physicians, they will be able to provide better patient care and they'll be able to make a difference in the lives of their patients in terms of outcomes. Thank you. Thank you. And Professor Suha. Thank you very much. Actually, what happens in Palestine, despite their few numbers that we have in family medicine, but they connect the patient in a different way from other specialties. So the communication skills and the consultation pattern that they use with their patients is making them different from another specialty. And this is actually my argument when I defense about family medicine and advocate about family medicine with my medical students. So this will be mainly the main reason why I will choose family medicine in practice. Thank you very much. I knew this panel was good. I did not realize how good they were because they each managed in a minute or less to give, I think, some fantastic answers. You'll be a better doctor. You are the future. You will be able to fulfill a dream of taking care of the entire family, a more holistic approach to health care. Your patients will do better. You'll work in a better environment. In the end, you'll be financially better off. You'll have the recognition and respect of your colleagues. I think those are all terrific answers. Now, I don't see any additional questions. And we may be coming to the end of our time, but with the permission of the panel, I just ask us to perhaps conclude with a final thought. And this is what I'd like you to think about. The past two years have been very difficult for all of us around the world. We've lost loved ones and family members and colleagues to COVID. It's been very difficult. But what I'd like you to imagine for a moment is that where you live is in the middle of a conflict zone. Where you live, you're losing colleagues not to just death from COVID, but sometimes from conflict, or they've become a displaced person, or they've had to leave to try to find a financially viable job somewhere. The economy has collapsed around you. These are the challenges that I've seen developing, and it's all been made worse by the pandemic in this region. And it could easily leave any of us to feel very discouraged. But I'm going to tell you that I'm not discouraged because I've spent more than 20 years visiting the region. I've met many of the family doctors, many of the family doctor leaders, and political and health leaders. And there's something special happening in this region. And I think it's going to be the case eventually that what will help lift the region out of many of the troubles they have are the contributions of family doctors. Because what they tell me is that when I help one person, I help the family. And when I help one family, I help the community. And when I help the community, I've helped our country. And when I've helped the country, I've helped the region. And the region has pretty good cohesion across all the family doctors, an error board, a desire for regional cooperation and training. So while it can be very discouraging, I'm actually quite excited about this future. And I hope all of you out there have a chance someday to come visit. We were denied that chance this year, but do come visit. There are fantastic people, fantastic family doctors here. And I think the future of family medicine is very bright in this region. So on behalf of my panel members, I'd like to thank you all for your attention. I hope the rest of your meeting goes very well. Thank you all very much. Thank you.