Welcome Dr Styles. Welcome to World Monitor magazine, which is an official partner for European Business Association of Kazakhstan.

Thank you for asking me to do this interview. It’s a great pleasure.

You represent the American Medical Centers, and today the American Medical Centers have almost 25 years of experience with the family medical services with many countries of the world. How do you assess the state of medicine in Kazakhstan though?

I think what is happening in Kazakhstan is quite interesting. Historically I’ve done quite a lot of work in the development of what we call primary health care services in countries emerging from the Soviet Union. Kazakhstan, I think is interesting, in that it is developing; but what is interesting about it’s development is that you are also taking some focus from some other countries. And one can see that in some of the secondary care services, the hospital services that are available in Kazakhstan. And you can also see it, I think, in the way that Kazakhstan dealt with the Covid-19 epidemic, that it actually used experience from other countries to develop its services. And I think it’s extremely positive because what has happened in some countries is that their development has been isolated and they haven’t taken experience from others – and there’s a huge amount of worldwide experience from other countries.

And, so, I’m quite excited about where Kazakhstan is coming from. There’s quite a lot to be done. I think most of all in terms of preventive medicine, in terms of integrating the healthcare services so that they’re much more seamless, and they’re much more available and accessible to the general population. And of course, Kazakhstan has a huge rural population, and there are good examples in the world, and indeed in Europe, Spain, Greece, where a large percentage of the population is rural, so you can take some evidence from those.

So, I’m optimistic about where Kazakhstan is going, and I think it’s also doctors who have been trained in European countries, and there are scholarship schemes, which is a very positive thing, so people are bringing experience from Europe and other countries into Kazakhstan, young doctors, and I think that’ s positive.

But, of course, the development of English is also medically important because most of the research and most of the evidence of good practice is available in English and is published in English. Historically, and quite interestingly, it was available, some 10 or 15 years ago, in Russian as well but it is less so. A lot of the evidence was translated into Russian at that time when there were very good relations but sadly that has collapsed in a way. But there is a growth among young doctors in the use of English, and that’s very, very positive for the development of medicine.

That’s really great to hear. Thank you. And today, the American Medical Centers has three offices in Kazakhstan, three difference cities. Do you have any plans to expand?

The answer to that is a little bit two-fold. One is the expansion within those three clinics. And today I’m really happy that we’ve been interviewing a mental health specialist who can work in our clinics. We take mental health very seriously; it’s a part of people’s health profile and it’s a part of the health profile that is often neglected when services are developing. But mental health is a very important part of what we do and what health services in general do. So, some of that is internal development. And in Almaty we are looking at a bigger clinic, so we are able to bring more specialists into the clinic and provide more seamless service. In Atyrau we’ve started our
clinic and that will develop.

The other part of AMC is what we call managed care and that means that we are able to provide services to people who perhaps are taken ill in other parts of Kazakhstan, people who have care accidents or whatever it happens to be. And we work, we develop, a group of associated hospitals and clinics that we can work with, and certainly our clients find that very helpful. And so if somebody is taken ill in another part of Kazakhstan, we are able to coordinate and make sure their care is good.

The American Medical Center positions itself as a family clinic, more aimed at providing medical services to the whole family. Could you tell us how this approach differs from other clinics? And what is the fundamental difference between the approach in standardized clinical methods for providing medical services in your clinic then?

That’s a very interesting question. It goes very much back to the ethos of how we work. In the American Medical Centers the services we provide are about whole people. They are about people’s physical health, very much about people’s preventive health in terms of good mental health, good diet, good nutrition.

And, of course, people sit inside families, so understanding the family is very important. For example, pregnant mothers will make investment in their physicians for their future children. And to have a service that looks after families, I think is very important. Of course, there are certain things that run in families as well; genetic diseases and as science progresses we come to understand how important genetics actually are. And to see what is happening in families gives a depth, another perspective, I think to the individual’s health. So, I think family medicine is quite important. It brings together, mothers (and I say mothers because women normally organize the healthcare of their families) – it means that women can access a seamless service, to their children, to their husbands, to themselves, indeed, to their parents as well. And the physician can see those interactions and know why they’re important.

Particularly, I think in the upbringing of children there are several things that are important to be addressed on a family basis. The most important of those, of course, is nutrition. And it’s the job of a good family physician to quietly and considerately alter the behavior of people in terms of nutrition. I could give you the example of the myth that children must of sugar; in fact, children must not have sugar, and that is an example of things that have to be altered. And it can be done by a good family physician, so that’s why I think family medicine is important.

So, let me clarify this: children should have sugar or shouldn’t have sugar?

Children shouldn’t have sugar.

Shouldn’t have sugar.

The evidence is that in children their gums, from a very early age, get used to sugar so they get almost an addiction to sugar. And of course, refined sugar is one of the causes of diabetes and diabetes is a quite prevalent disease, and it is actually quite prevalent in Kazakhstan as well. And if you look at populations, as populations develop and become more sophisticated, they become more diabetic. And as they become more diabetic, they also suffer from more heart disease. So removing sugar from people’s diets is incredibly important.

You touched a little bit on the benefits of this approach, but could you elaborate a little bit more on this approach for the whole family, not only the children? And maybe you have special programs with some special discount, bonuses, or provisions in the clinic?

So, yes, we have programs for special groups of people and families. We have programs for newborns in their first year of life, and then we have programs for pregnancy care, and we have programs for general healthcare. And, of course, if families have those programs, they get a discount as well. We have other specific programs that people can purchase if they have worries, like a women’s program, things like that. And we market or we sell or we present, from time to
time, special programs. For example, quite recently in Kazakhstan we were running a program for the diagnosis of diabetes. So a lot of our focus is about preventative health and about nutrition. We publish a regular magazine which also deals with many of these topics. For some of our major clients perhaps – we offer corporate programs as well, which include often a complimentary medical check and special discounts. In working with some big banks, we’ve
developed that service.

Speaking of this, it sounds like you’re working with corporations, and you work with individuals. You work with local people, and you also work with the expat community as well.

Yes, we have a mixed community. In Kazakhstan there are some quite big schools, and they have an international basis – we look after the teachers and some of the parents and children.

Within the scope of your services, you also have health insurance, and in this direction are you also focused on the family insurance or can corporate clients also take out medical insurance in your center?

People can take insurance as individuals or a family can take a policy or mix a policy if they have a young child. Or if they’re corporate groups, we’re happy to negotiate not only what is in the policy, and for example some large corporate groups may want something different for their top executives and something less comprehensive for their managerial staff. So, we’re very open to discussing and tailoring what policy people need.

If we go back to the model of your clinics, which is a family clinic model, where did this come from and why are more and more medical centers moving to this model?

I think there are a number of reasons for that. One is about health economics, and it’s generally understood that having family physicians – you can think of them as gate keepers to the service – they make sure that services are used economically. And they do that in two ways. One is by actually providing some services themselves through skilled doctors and the other is by making sure people only see specialists or only use specialist services when it is necessary. Now that’s done, I suppose, in a quiet way. It’s not done in a very sort of controlled way, but economically it is quite effective.

And generally good family medicine provides good preventative services or coordinates good preventive services. And that means that many disease processes can be stopped before they develop. Good screening programs, for example for breast cancer or for cancer of the neck of the womb can take place in family medicine quite effectively and that helps to control the cost. And I think the other development has been about a renaissance, or a rebirth in the concept that doctors need to talk to patients and patients need to talk to doctors. And that has come about because I think because medicine has become very, very technical. And people tend to now go and see the doctor, and he says, “Oh, you have a pain. Have a CT scan.” That’s not only very expensive, but it doesn’t actually open up why the person has the pain. It doesn’t allow people to talk about their anxieties. The pain may be psychologically related.

So, there has been a renaissance, and that’s come from doctors who felt that having time to talk to people enables them to use their experience. But it also comes from patients who want – not always but on lots of occasions – to have an ongoing relationship with a physician. And the evidence is that those sorts of relationships are much more effective in preventative care and encouraging people to take up preventative medicine. So, for example at AMC, if you come for the first time you will probably spend 45 minutes with a physician. This is not a 10-minute thing. And during that time the physician gets an idea of your health, and not only your health but about your family’s health, what has happened in the past and what your anxieties are. And of those 45 minutes, you have quite a lot of time to talk and develop that relationship with the physician. So those are the sort of emphases that we put in family medicine, in delivering our service.

It does make a huge difference. In Soviet times, there was a very famous saying that “human resources decide everything,” that it’s the base for everything. And, how do you solve this issue in your centers, because it is known that competition in the medical services market today is very high. Why should the residents of Almaty, Nur-Sultan and Atyrau choose your center? What is the qualitative advantage of your centers?

That is actually not a difficult question, because if you look at many of the centers, they provide really quite excellent medical care. People are going to get good medical care. But at AMC we have something with the concept called patient journey, that is the idea that when you’re ill, not only do you have an illness to deal with, but you also have a lot of administrative difficulties – you have to make appointments, you might have to get translations, you have to go and have x-rays and things. Where HEALTHCARE supported AMC really differs, and I think where our patients are really satisfied, is that we manage that journey for them. So, from the moment they call us on the telephone to the moment they get their discharge papers, they have one physician who takes care of that. And a team coordinates everything. If they’re having a scan somewhere, a nurse goes with them; if they’re in the hospital, a nurse or a doctor visits them. So their journey, the difficulties they’re having administratively are completely taken care of.

Everything that we do is electronic and that means we can not only provide good information for people, but we can also liaise with specialists in other countries. The other day I was talking with a neurosurgeon in Paris, just two hours after a guy had fallen over and broken his back and we have the MRI scan in Paris, so you know we had the pictures in Paris because the internet shrinks everything. So that is about AMC, it’s about managing that journey for the patient, coordinating all those difficult things as well as providing first-class care. We provide time and we I think we provide care as well.

And what languages do you use in your centers?

I suppose English is the main operating language because we look after a lot of expatriates, but also all our clinics operate in Russian and some of our physicians obviously in Kazakh, and even occasionally in other languages. And because we’re a bigger group and we have quite a lot of staff, we can provide facilities in other languages. There’s a nurse for example in Ukraine still working who speaks Arabic, so we provide all sorts of languages. Our team in
Georgia obviously speaks Georgian so they can provide Georgian for any Georgian in Kazakhstan.

That really covers the world, right?

It covers a large part of it. I don’t know about Japanese. We occasionally have people who speak Korean or students who speak Korean, so, yes, we’re quite international.

What can American Medical Centers bring to Kazakhstan’s healthcare culture, in your opinion?

First of all I think they can bring that sense of family medicine. They can bring a more western perspective, perhaps a more American perspective, and that’s as I referred to it earlier, that’s something that Kazakhstan is open to; it’s omething that Kazakhstan is happy to consume and look at different models and to get experience through different models. So, I think that we can bring that.

We can bring the sort of administration that provides a seamless service and really to emphasize the importance for that for the patients. When I worked in the UK, I had the job of coordinating cancer services for patients and that brought to me how important it is to help people through that journey – people that were worried, people that were depressed because of their illness, people that just couldn’t get an appointment, etc. All of that is very difficult and to demonstrate that it’s possible to make an effective, a wellmanaged healthcare system, I think is important, because that isn’t always so in different parts of the world. Not all European countries have well-managed healthcare systems. A lot of Kazakhs and a lot of Ukrainians who as refugees went to Europe find huge difficulties in their healthcare systems, and that’s possibly down to economics. So, I think AMC can bring the examples that family medicine is important and providing that seamless service of preventative medicine is also important.

Do you have any innovative products that you are introducing to the clinics in Kazakhstan?

In medicine, one of the major advances that we’ve seen, probably in the last five years to last decade, is genetic medicine, is about being able to determine what diseases people are at risk from and taking the steps to prevent that. And AMC has certainly been very active in that field, developing special tests for breast cancer and other cancers. And every year we have genetic markers for some of these diseases. So this is a very exciting part of medicine and it’s something, I think, we’ve really sort of led with.

I would like to think that we’re quite innovative in the way that we control and assess our staff and that we’re quite European in that way, so every physician has an appraisal each year, every physician has feedback from a number of patients in that appraisal on all aspects of their consultations. Their work is look at, certainly, in their early stages working for us. And that appraisal is, in a way, connected with their professional development, which is very important to medicine, people spend more than 40 years in this profession. One’s professional development is very important in that time, and that’s going to be important for physicians in Kazakhstan as well. So, this year, for example, from Almaty we’re sending three physicians on international courses abroad to increase their study. So I would like to think medically the innovations are going to be very much about genetics and about preventing disease through that, and the innovation, as I say, in managing our staff are what you would expect from any big European or American corporation.

And is there any research that is going on right now, anything you’re working on today?

We’re not a research establishment in a way, I mean to do such is not only expensive, but you have to have really large numbers of patients to make it statistically relevant. We do talk to some of the major hospitals about researches that they’re doing, but as a group, we don’t involve ourselves in research. Having said that, we have on occasion been involved in more social aspects of medicine research or people asking our clients how the language problems interfere with medicine. It’s very important when you’re a communicating with people from many, many countries as we do with our expatriates to develop a clear language, to remove the sophisticated language from your diction. So that’s a challenge – to see a Japanese person and then to see a Kazakh and then to see an Italian – they’re all very different.

And, to wrap up our interview, you have your impressions of Kazakhstan or maybe wishes to Kazakhstan’s health system or to the patients (I kind of know what you are going to wish to the patients), talking about the healthcare system, and how you see yourself as part of it in the future?

I think for Kazakhstan one of the challenges is to bring a healthcare system to its rural population. You’re a huge country and it takes hours to go from one side to the other. And in the middle of that there are many people who are not easily able to access health services. And changes in that need to be both administrative and they need to be medical as well. You need to get people out into those communities, and you need to provide emergency care for those communities, which is a very great challenge. You know, children still die from infectious diseases if they’re not treated correctly and treated rapidly. And, of course, the other great challenge is that the good doctors want to work in cities, and this is a worldwide problem, it’s nothing about Kazakhstan. You know, good doctors always gravitate to major centers, that’s where they want to be, that’s where their families want to be, and that makes rural medicine quite difficult. So, there are challenges there for Kazakhstan of how to get good medicine into the rural communities.

And the other challenge is, as I said earlier, that is to integrate the very good services that Kazakhstan has in terms of hospital care and other ways to make sure that those are not only more seamless and more accessible to patients but perhaps operate in more economical environment. Where healthcare operates in chaos, in some organized chaos, it’s very expensive. People end up going to specialists when they don’t need to go to a specialist. The role that Kazakhstan needs to have is perhaps to control that, to understand that the stomach pain may be due to the fact that they are worried they may have a cancer that their father had and they don’t need a gastroscopy, they need us to understand what the problem is. So that is rather challenging to bring healthcare that is more seamless, more accessible, more economically viable than it is at the moment.

A lot of people spend a lot of money on healthcare and that’s sometimes not necessary, and in terms of national money it’s a wastage of money. The problem with healthcare is the money that is wasted isn’t accessible to what I call ‘Cinderella Services’ – so the money that is wasted doesn’t become accessible to mental health services, those who have severe mental illness; it doesn’t become accessible to those who have disability, either a learning disability
or a physical disability. These are the things that in a chaotic healthcare system tend to get overlooked, they tend not to have the resources that other systems can provide for. And that’s why some people argue that insurance-based medicine is not an effective way of collecting tax for healthcare. Estonia was one of the best countries for insurance-based medicine, but something like 15% of the population was left out and that was during a time of economic
growth and inflation, and as soon as you get recession insurance-based medicine becomes very difficult and a lot of people get left out. You can see the problems America has with it.

Very interesting. Thank you very much for your time. Thank you very much for your expertise. We wish American Medical Centers growth and development, and we thank you for what you are doing for the people of Kazakhstan as well as the expats from other countries. Thank you, and all the best.