Often when we think of Oman, we think of warmth, the sun and the desert of the middle east and oil. If we know a little more, we know it is a sultanate, an absolute monarchy that only started a process of modernization in 1970. But what they have accomplished in such a short period of time is nothing short of incredible, and Amna Al-Harrasi, a family and palliative care physician is at the forefront of that change.
Dr. Al-Harrasi recently completed a palliative care residency at McGill and with the skills she learned, she decided to build the country’s first-ever palliative care team in the country. Her team is located within The Sultan Qaboos Comprehensive Cancer Care and Research Centre. Deeply forward thinking, the centre has yoga, acupuncture, and other alternative approaches to cancer care.
I interviewed Dr. Al-Harrasi over Zoom with her curtains drawn tightly closed to keep the January sun from streaming in, she said it is their “cold season.” I laughed thinking about our minus 25˚ temperatures and an impending blizzard. Despite it only being a year ago that she finished her program, she has clearly forgotten how Canadian winters feel!
What struck me most was the speed, commitment and consideration with which Dr. Al-Harrasi has built this program. She has clearly integrated so many aspects of wholeperson care, understanding that patients are people with emotional and spiritual needs that are not distinct from their medical ones. She has been training her team with this same approach and has been deeply successful in creating meaningful and trusting relationships with the oncologists she works with. She says that many have started to integrate her approach and palliative thinking into their practice with their patients asking her advice.
Dr. Al-Harrasi graduated from Sultan Qaboos University (you’ll note his majesty’s name comes up time and again as the main funder and source of change in Oman), where she did a post graduate residency in family medicine. She traveled specifically to McGill to do a palliative care residency and a further year with a cancer pain fellowship.
I was curious as to what motivated Dr. Al-Harrasi to bring palliative care back to Oman. She told me that palliative care didn’t exist in Oman and that when she started her practice as a family physician in a rural health centre (which is like the CLSC in Quebec) she said there were so many patients who would come to them in desperate states, and they had no training or knowledge in how to help them. One man stood out for her in particular she said, an older man who was living alone with no family support. He kept coming to her clinic with different ailments that they could not help him with. He became deeply demoralized, depressed, and was clearly suffering. Dr. Al-Harrasi looked for some guidance and started to read about how to help people at the end of life. She said her clinic started with small gestures such as arranging transportation for this man to the hospital, making sure he got three meals a day, and even found someone to clean his house. She said: “We didn’t know what we were doing, but we tried to help him socially. We found that when he came back, he was more interactive and felt he was being cared for.”
After Dr. Al-Harrasi called one of the oncologists in another town a few times about patients in similar states, the doctor asked her if perhaps she would be interested in attending a conference about palliative care? Like so many, Dr. Al-Harrasi said: “what’s that?”
And so began her journey from attending a conference to knowing this was what she wanted to do; eventually leading her to McGill for the residency in Palliative Care.
In her time at McGill, Dr. Al-Harrasi said she learnt such an enormous amount in a short period of time. “Each day was like learning by ‘osmosis,’ – it all just kept filtering in.” Not knowing a soul in Montreal, she arrived to a massive cultural shift, two small children in tow, and a husband doing a residency across the country in Alberta; not to mention a full-blown pandemic! When her kids couldn’t go to daycare, she would have to attend her classes online and couldn’t attend to patients IRL (“In Real Life” for anyone who hasn’t adopted the new idioms). But she said that because of the cultural understanding of working women and the incredible warmth and support of her supervisors and colleagues at McGill, the time flew by and was life changing.
Back home in Oman, there are of course cultural differences that Dr Al-Harrasi says need to be overcome. But while we have burgeoning studies in cannabis for pain management for example, which is illegal in Oman, or new turns towards psychedelics, after talking to her for some time, I wasn’t convinced our cultures were that far apart in our practice of palliative medicine. She tells me about a doctor who insisted that a patient who was actively dying be admitted to ICU and have tubes inserted — but of course this sadly occurs in Canada too. Dr. Al-Harrasi’s biggest challenge she said is education, both of other doctors, but also families who feel they are letting their loved ones down if they don’t “take all measures.” This is of course something we contend with here too. “But I have found a way to negotiate with them however, I say: “I know you are hopeful, but what if that patient were your relative? Put yourself in their shoes; would you like to end in this way?”
Despite the obstacles, Dr. Al-Harrasi is optimistic about the evolution of Palliative Care in Oman, and is moving at breakneck speed. Her commitment to alleviating suffering, her compassion and her nuanced approach have brought many of her colleagues on board and curious to know more.
At the end of our conversation Dr. Al-Harrasi veers to her patients and tells me how they are the ones who guide her the most and that listening is her priority. She says that she knows she will achieve the changes necessary because time and again her patients tell her that they want to be at home: that they want to be with their families, they want to see their sky, their sun, and gardens. I see the sun peeking through her window over her shoulder and I know it is what we all want.