A LETTER FROM: Doha, Qatar

– Written by Celeste Geertsema, Rachid Bouras and Katharina Grimm, Qatar.

Qatar hosted the 24th edition of the Men’s Handball World Championship of the International Handball Federation (IHF) between 15 January and 1 February 2015. It was one of the biggest sport events ever held in the country. For the Local Organising Committee (LOC), it was perceived as an excellent opportunity to showcase Qatar’s readiness to host upcoming major international events, such as the FIFA Football World CupTM in 2022. For the world’s public, it was an excellent opportunity to critically scrutinise the same. There could be no doubt that the media would fully seize this opportunity.

The focus of any LOC should be on providing athletes with optimum conditions to perform at their best. For the Championship, the provision of medical services for this event was entrusted to Aspetar   Orthopaedic and Sports Medicine Hospital, considering its expertise in providing medical services for athletes at multiple sports events in the past. Aspetar has achieved this through its National Sports Medicine Programme (NSMP), which provides not only medical staff but also the required administrative and infrastructure resources. Over recent years – and with Qatar’s ever increasing popularity as a host of sports events of all sizes and kinds – the NSMP have tailored their services to the needs of athletes at all levels and across the whole spectrum of sports and disciplines.

Our service provision at the Championship had to show the high-quality standards of medical care offered in Qatar – not only to elite athletes, but also to other important stakeholder groups. The experiences of officials and the media when facing health issues would shape the international impression of Qatar as a host country just as much.

HOSTING LARGE WORLD CHAMPIONSHIPS IN A SMALL COUNTRY

Qatar is a small country with big aspirations. Several major international competitions are regularly hosted in Doha, such as the WTA and ATP tennis tournaments, the IAAF Diamond League meeting and the FINA Swimming World Cup.

For the Men’s Handball World Championship 2015, three new stadiums were built: Lusail Sports Arena (15,300 seats), Ali Bin Hamad Al Attiya Arena (7700 seats) and Duhail Handball Sports Hall (5500 seats). A further venue was used for training only. The event lasted 18 days with only one rest day. The 24 teams stayed at five hotels, two further hotels were assigned to officials.

There is still limited experience in the country with mass events involving large-scale temporary immigration, flocks of volunteers, international VIP patients and several-thousand seater venues. The planning, preparation and delivery of health-related services at mass gatherings and the level of community preparedness for disasters had not been extensively tested so far. Additionally, in a country with a population of less than 2.5 million people, providing for any major influx of athletes and spectators will place a significant burden on its public medical services, including ambulances and hospitals, regardless of the financial resources available.

In co-ordinating and supervising services, Aspetar needed to synchronise different service providers who had so far not been routinely working together: the Qatar Red Crescent (QRC), the Hamad Medical Corporation (HMC – the government tertiary referral institution in Qatar), the Medical Unit of the Internal Security Forces (ISF) of Qatar and the Supreme Council of Health (SCH). Creating one medical team across institutions, specialties, cultures and established hierarchies was absolutely critical to us.

While the QRC and HMC had provided excellent services to sport events in the past, the medical staff was – for the first time – faced with such considerable time commitment over an extended period and after their usual working hours. With such high demands on their resources, not all staff of these providers had previously been exposed to the logistical and other standards (such as strictly applied accreditation and access rules) at a major World Championship.

At Aspetar, we established a medical commission to include all the different specialties whose services were needed as well as a smaller executive board to direct and supervise implementation.

THE SERVICES PROVIDED TO STAKEHOLDERS

Based on IHF requirements, the following services were delivered:

• Athletes: different from the traditional approach of a Venue Medical Officer (VMO) being responsible for the entire stadium, our VMO was responsible for athletes only, and a Venue Medical Co-ordinator (VMC) for all other stakeholder groups. An athlete medical room, staffed by a sports physician and a nurse, was located close to the locker rooms at each venue. The designated hospital for all athlete care within their scope of services was Aspetar, and the team was determined to offer premium services. The process of receiving care at Aspetar was simplified and expedited as much as possible. A single phone call was sufficient to mobilise transport, registration, medical assessment and imaging services with hardly any waiting time. At each of the five team hotels, there were dedicated athlete clinics staffed by a QRC nurse and a floating physician providing for the delegations.
• Team physicians: we provided comprehensive information on all services to the IHF in advance for distribution to team physicians. This included the procedure for the importation of medication and requirements for visiting team physicians in Qatar. We hosted a Team Physician Meeting at Aspetar on the opening day of the Championship to inform the colleagues personally. All team physicians were provided with a 24-hour contact number to access Aspetar services.
• Officials: at all competition venues, there were clinics adjacent to the VVIP and VIP lounges, as well as a dedicated ambulance and a VIP Medical Co-ordinator experienced at international elite level to attend to their needs. Clinics were also provided at both the VIP and VVIP hotel of the IHF and staffed by the QRC around the clock.
• Spectators: spectator clinics were set up on every concourse level at each venue and run by the QRC. In addition, patrols were continuously controlling the spectator areas from the time of the opening of the gates until the last spectator had left. In the stadium surroundings, golf carts operated. Ambulances were stationed at all venues in sufficient numbers to cater for the expected spectator volumes.
• Event Medical Guide: a guide for Championship visitors with all relevant health-related information from environmental considerations to the available medical services was developed and published as part of the official Event Guide.

However, the medical team wanted to showcase what Qatar could accomplish beyond the official requirements:

• Nutrition services provided at athlete hotels: this included instruction and training of hotel kitchen staff, regular testing of food hygiene and standards at the hotels by independent specialists and education material for athletes, including a video shown in the dining halls.
• Immediate access to the services at Hamad Medical Corporation: Aspetar has an excellent relationship with HMC. This greatly facilitated the developing of a pathway to ensure immediate consultation for both officials and athletes who needed transfer for problems either unrelated to sport or outside of Aspetar’s scope – both in non- and emergency cases. This pathway was activated with a single phone call.
• Match officials: all match officials were served at the athlete medical rooms should they experience any problem at the venues. They could further use the medical services provided at the designated VIP and VVIP hotels.
• Referee massage therapy: four specialised NSMP massage therapists were dedicated to the event. Referees could sign up for daily massage sessions at their hotel.
• Main media centre: a nurse was permanently stationed at the centre in order to assist media staff with minor problems and to direct them to the spectator clinic for any more serious issues.
• Workforce clinic: one to two workforce clinics were operated at each venue and proved to be the most busy clinics. First aid bags were provided to the accreditation and uniform centre during the preparation phase.
• Injury and illness epidemiology study: our knowledge of the injury epidemiology in handball is still limited. A comprehensive injury and illness surveillance study at the Championship was designed and proposed to the IHF Medical Commission. The Aspetar research team delivered the logistics of the study including a comprehensive manual for team physicians and met daily to collect all data for analysis.
• Video motion analysis: in collaboration with Aspire Academy, a video analysis protocol was developed in order to complement the epidemiology study. The research team together with software producers recorded and analysed all matches and provided feedback to the IHF.
• Conference on New Sports Medicine Concepts in Handball: the Aspetar Orthopaedic Surgery Department developed the programme together with the IHF Medical Commission and then organised and hosted this conference during 2 days of the event.

WHAT WORKED WELL AT THIS CHAMPIONSHIP IN QATAR?

During the debrief meetings, our staff highlighted the following as something to be built on for future events:

• Working as one team at the venues: one of the biggest successes was the teamwork which developed between the different independent healthcare providers (Aspetar, HMC, QRC and ISF). All staff unanimously said that such team spirit was unprecedented and laid the foundations for a unified medical team at future events.
• Medical pathways: the standardised action and communication pathways for most common situations were displayed as flowcharts at each clinic. This helped to maintain consistency and avoid ambiguity with changing staff.
• Daily debriefs at the end of each match day: while this is a common procedure at most large international events, we once again realised how indispensable daily debriefs are to share experiences and to give every staff member the opportunity to make suggestions for improvement. The open discussions also strengthened the team spirit.
• Mock drills for medical staff at the venues: daily mock drills were absolutely critical with some of the venues being brand new and some medical staff changing on a daily basis. The mock drills also served to continuously learn from each other’s expertise and build one medical team.
• Communications: the use of ‘WhatsApp’ groups proved to be a valuable tool, which superseded the need for emails for low-level communications and allowed for instant and simultaneous information of all relevant providers on site and in the background.
• Appreciation of staff members: from the beginning, it was considered critical to acknowledge and give importance to every single member of the medical team, regardless of their position, title or specialty. Senior staff made a point of regularly visiting the teams at venues to show that they highly valued each individual’s contribution and considered them essential to the success of the event. We sent notes of appreciation during the event and individual letters afterwards.

WHAT TO CELEBRATE AND BE PROUD OF

It was very important for Aspetar and the other providers to ensure that the service delivery was excellent and to use this opportunity to identify aspects that needed to be improved in future.

To this end, we requested informal feedback not only from staff members, but also from athletes and officials. We sent a structured questionnaire to all team physicians, inquiring about the different aspects of services provided to athletes.

The IHF, in recognition of the services delivered, considered Aspetar as a candidate to become an IHF Reference Centre. Both the IHF President and Medical Co-ordinator stated publicly on several occasions that the medical services at the Qatar Championship were the best they had ever seen.

The feedback from team physicians was unanimously positive. The level of the medical infrastructure and facilities, the 24/7 availability of any required service upon a phone call, the prompt professional assistance at the venues and the high-quality, multidisciplinary services at Aspetar were extremely valued by all colleagues.

Considering that the epidemiology study was a first at this Championship, our research team achieved an exceptionally high response rate of 94%. This success was considered to be the result of continuous direct daily interaction and relationship-building with the team physicians.

The positive experience for all medical staff was made complete by the absence of any serious injuries among players despite fast-paced, uncompromisingly physical and technically demanding Championship handball being played.

WHAT TO RECOMMEND TO FUTURE LOCS

Acknowledging the specificities of this Championship in Qatar, some key recommendations appear universally applicable:

• Establishing clear responsibility, command and reporting lines from the early planning phase – this is particularly important when several service providers are involved. Job descriptions and pathways are essential.
• The key medical staff should be appointed as early as possible. This enables the development of sound relationships with all stakeholders, the planning and implementation of policies and procedures well in advance, but also input during the construction phase of venues on the location and exact setup of medical facilities.
• Early collaboration with other functional areas in the LOC, such as spectator services, protocol, venue management and security is crucial to facilitate mutual understanding of each other’s roles   and the appropriate accreditations for the medical team.
• All medical staff should be assigned to one venue only to foster familiarity with the venue and develop a working routine.
• Covering high-level sports events for weeks at a time can be exhausting work - therefore, staff should ideally be freed from other work commitments during the event period.
• Look after your staff – workforce clinics were the most frequented and must be foreseen.

CONCLUSION

The 24th Men’s Handball World Championship was a very exciting event for Aspetar, the LOC and Qatar and a unique opportunity to show the world what we are capable of.

 Based on the feedback regularly received from various stakeholders, the medical cover at this event was perceived as outstanding. Our medical staff's celebrations of this recognition were greatly enhanced when the Qatari National Team made it to the final. It was a symbol of what could be achieved when a group of dedicated people representing a small country with big ambitions work together as a team to make their dreams come true.

For the people of Qatar, it was a fantastic experience to see their team progress from round to round and finally receive the silver medal. The team’s achievement brought together people from all walks of life and from all over the world to enthusiastically celebrate their players. Such experiences might be invaluable in a country where immigration has within only a decade become a prominent feature of daily life - with all its challenges and opportunities.

However, while celebrating this success, local organisers are determined to improve for the next event, and subsequent events   which are already lined up, ultimately culminating in the 2022 FIFA World CupTM. There is no doubt that the world’s collective eyes will continue to be focused on this small desert country – and Qatar intends to deliver, much more than the world might expect.

Celeste Geertsema M.D.

Sports Medicine Physician

Rachid Bouras M.D., Ph.D.

Club and Federation Doctor

National Sports Medicine Programme

Katharina Grimm M.D., M.Sc. (Med)

Sportsmed SA

Director of Medical Affairs

Aspetar – Orthopaedic and Sports Medicine Hospital

Doha, Qatar

Contact: celeste.geertsema@aspetar.com