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One of the major problems that psychiatry patients in Lebanon face is having their mental health disorders not recognized by any insurance or governmental payment agency, which forces them to foot medical bills that can reach astronomical rates very fast.
There are next to zero insurance companies in the country that cover anything mental health related, even though about a quarter of the Lebanese population can be diagnosed with one mental health disorder or another.
On Friday, as reported by The Daily Star, Minister of Health Ghassan Hasbani announced that his Ministry will now, and for the first time ever in Lebanon, begin to cover mental health under its care plans which are available for all Lebanese citizens.
This isn’t the only accomplishment to be attributed to the Ministry. Hasbani also declared that eight mental health institutes will be created by the ministry for treatment and administration of care, as well as more focused training of professionals in the field.
“The Ministry of Health will begin to cover mental health as part of a comprehensive medical plan, managed by the Primary Health Care Department and supported by the World Bank. We will work on curing it of these issues that can frustrate and cause damage to citizens.”
To say how important such steps are in the Lebanese healthcare sector is not enough. Mental Health has always been considered a taboo in Lebanese society, even if perceptions are ever slowly changing. It hasn’t been a year that we spoke about a young Lebanese girl committing suicide because she had become so clinically depressed and unable to seek help, because such help is not as easy to come by as it should.
This measure by the MoH will save lives, and further improve the level of medical care that we can administer as doctors to our patients in this country, by lessening the fragmentation of care that arises when you have an entire facet of medicine without any form of coverage.
The next step that Minister Hasbani and the ministry should undertake is to reform insurance laws in the country to get insurance companies not to stigmatize mental health, by having them cover it like any normal illness that they’d cover in any circumstance.
I commend the ministry of health for this step, with hope to see more like it from other facets of the Lebanese government. It’s a very important step, and an essential one at that, in our fight against the stigmatization of mental health, as we try to remove it from our long list of Lebanese taboos.
In the context of a country with any ounce of self-respect, speaking about a garbage crisis that has been going on since July would not only be old news by now, it would be solved old news. Except we don’t live in a country with an any amount of self-respect, and as such Greater Beirut’s garbage situation is still a topic, albeit less hot, of discussion.
A few months ago, when people were actually interested in the garbage crisis, which is to say when the garbage was visible on their streets and not tucked away in some valley somewhere or in a makeshift pyramid near the port, I wrote an article on this blog (link) about the health risks that the crisis might involve especially with the rain season.
As a very brief summary, in theory the garbage crisis and the many variables around it would cause the following:
Many types of bacterial infiltration of the waters,
Many heavy metals and other elements-related pollution,
Burning it will increase the amount of carcinogens in the air, as well as exacerbate respiratory conditions in people who have pulmonary disease when they have it.
As long term effects, we could be looking at an increased cancer incidence as a study after Italy’s waste management crisis in 2004 showed.
What the garbage crisis is not doing, however, is giving you the flu or other common infections that we encounter yearly.
Over the past few weeks, which happens to be the yearly flu season in Lebanon, everyone and their mother decided that whenever they got sick, it was because of the garbage crisis in Beirut. H1N1 – or as it’s more commonly known in the country now H1 and 1 – has become so commonly associated with the garbage crisis that the scientific community is probably considering whether to reconsider all the details surrounding H1N1 altogether.
We’ve also heard about “new” viruses attacking the country, such as metapneumovirus B, causing severe respiratory diseases.
This is, quite simply, incorrect.
For starters, metapneumovirus B is not a new virus. It’s been known for at least 40 years now and is actually one of the leading causes of respiratory infections in children worldwide. Lebanon has had this virus before, and it gets treated the same way we treat most viral infections: address the symptoms and provide the patient relief while their ailment resolves.
The case illustrated in this eTobb article (link) about a 25 year old who had a devastating respiratory infection secondary to the aforementioned virus remains, as it stands, a case that fell through the cracks of medicine in the sense that some people will get complications from common infections and we have no way to predict who would be the victim of such complications.
When it comes to H1N1, this is the current state worldwide:
Outbreaks are being reported in Bulgaria, Canada, Ireland, Ethiopia, Pakistan, etc. What do these countries have in common? Nothing, which is precisely the point.
Every year, the world is swept up by a strain of the Influenza virus which, when a person infected, gives them what is referred to as the flu: runny nose, sore throat, sneezing, fatigue, feeling pain all over your body for a few days, etc…. These symptoms usually resolve in a few days and you’re off on your merry way to health.
Some people may also be infected and not show any symptoms. The way this occurs is in sort of a pyramid fashion:
Assume 100,000 people in Lebanon got infected this year. 10,000 of those would show symptoms of the flu. Out of those 10,000 maybe around 100 would require hospitalization. And out of those 100 that needed hospitalization, 1 might die because of complications.
The garbage crisis overtaking Beirut has nothing to do with this. This will happen again next year, with or without a garbage crisis, and it will also happen the year after as it also took place in the years prior. Having a new shiny ribbon of erroneous but appealing explanation to wrap this whole thing with won’t make it go away. People are getting sick all over Lebanese territories simply because this is an infectious disease, not a garbage-related disease; the garbage does not cause H1N1 or the flu. It’s really that simple.
At this rate, getting the first case of Zika virus infection in this country will also be attributed to the garbage.
Therefore, I’m sorry to say that the answer to your question “how did I get sick” is simply “this is how things are,” and not “it’s the garbage that’s killing you.”
You can, however, protect yourself by practicing as much hygiene as possible. Thorough hand-washing is key to prevent the transmission of the influenza virus. Avoid sick contacts if you can. If you’re sick, don’t be a jerk and go around contacting others. Don’t trust your local pharmacist to start you on Tavanic or Klacid or whatever other medication he feels like giving you. This is a virus and antibiotics don’t work. Rest as much as you can, you’ll get better in a few days.
As I’m starting my career in medicine in Lebanon, I noticed that the biggest hurdle facing patients is accessibility. This can take many forms. For the few that I serve at the tertiary center where I work, such issues are second rate: many of them can afford the healthcare provided at my institution and wouldn’t bat an eyelash at the thought that there are actually others in their country who are not as fortunate.
But the truth is that the healthcare sector in Lebanon is a tragedy. The numbers speak for themselves: Almost half of the Lebanese populace has no other means of coverage other than the Ministry of Health, whose budget is less than 5% of the total country’s budget. So what happens when that budget runs out, which happens ever so often? Over 40% of the Lebanese population finds hospital doors closing in their faces, as our news outlets race to pick up the media scoop without actually delving into the issue and finding out why it’s an issue in the first place.
To try and break this cycle, a bunch of doctors from the University of Balamand and the American University of Beirut, along with a few of their colleagues in other fields, have teamed up to attempt and get affordable healthcare to every Lebanese out there, regardless of income range and of geographical location.
It doesn’t matter whether that Lebanese can afford hospital entry or not; in a lot of the case a simple visit to a doctor can suffice to diagnose and treat a particular issue. It’s getting access to a decent doctor that’s the problem, and, when access is available, actually being able to afford the fees.
In a project launched on Zoomaal (link), the aforementioned Lebanese doctors are trying to change that reality to the best of their capacities.
They are creating a platform that allows the following:
Patients to get in direct contact with real life doctors for minimal fees, have their histories taken and maybe even get management.
Allow those patients to be visited by doctors and get examined and assessed also for minimal fees.
To achieve this, a phone call, video call or a house visit can be arranged. The details are all at this link.
This is the first attempt that I can think of by any Lebanese entity to bring healthcare to the entirety of the Lebanese populace, regardless of income and regardless of geographical constraints. This project is trying to do what the Lebanese government has failed to do: actually care about those who need it most and who don’t have the same amenities that should be a given right in the beginning of 2016.
In a country of over 4 million people, and more than 2 million refugees, having most of your population not having access to healthcare is a disgrace. It’s a shame it’s not as headline grabbing though as Mia Khalifa being the top pornstar in the world or Jbeil’s Christmas tree being listed somewhere. That would’ve gotten people interested.
I just wasted 7 years of my life in medical school.
Naturally, when you live in the country with the likes of professor Marcel Ghanem, Dr. Joe Maalouf, Tony Khalifeh and their friends, is there a point for you to remotely try to get an education? They will tell you what you need to know, give you medicine crash courses and guide public opinion on the matter.
Clearly, they’re the ones who know everything and those doctors are just backward-minded folks who only care about money.
Ella Tannous is a young 9 months old whose pediatrician is now in jail. Why is he in jail? Because we live in a corrupt country where security forces get carried away by the sensational reporting of Kalam Ennas and other similar shows to ruin the life of a man simply because of the science of Marcel Ghanem’s report and that dramatic Lord of the Rings music in the background and the tears of the child’s mother as she whispers: why can’t my little girl play with barbies?
Again, what would I know. I’m sure that policeman in between his Malek el Tawou2 sandwiches was busy reading medical textbooks. Give me the differential of a crying baby, kind sir. Oh, you have cramps from all the garlic consumption? Excuse me.
According to her parents, Ella had a high grade fever for which they contacted her pediatrician, Dr. Issam Maalouf, who ran some tests that revealed Ella most likely had a viral illness and prescribed medications to lower her fever.
However, Ella’s fever did not subside and upon contacting the doctor again, he told them not to worry and to use cold towels to try and drop her temperature.
When the parents saw that their child’s situation did not improve they took her to the hospital. It was a Sunday. The pediatrician did not see Ella that day and instead saw her the following day when she had already deteriorated.
He got her transferred to AUBMC where further treatment was done. Ella, however, was in shock and in a state called DIC (Disseminated Intravascular Coagulation) and had gangrene in her limbs, which had to be amputated to save her life.
This is what happened with Ella Tannous according to her parents:
*cue in dramatic music.*
What happened to their child is surely devastating to them and Ella’s parents have every right to be sad and heartbroken over what happened to their daughter.
But just because someone’s daughter had complications does not make that person a doctor who can go on air and pretend they know what makes sense scientifically and what doesn’t. It also does not give Marcel Ghanem or any Lebanese media, who were quick to jump on this very delicious scoop, the right to become full blown medical professionals who spent their times doing night duties in pediatrics.
So let’s go with what we know one by one:
1) Ella’s blood tests revealed a viral illness. Viruses are not treated with antibiotics as Ella’s father was alluding should have happened. In fact, the side effects of those antibiotics and possible increasing resistance to them make their use in viral illness not recommended. How do you treat a viral illness, scientifically? You provide symptomatic relief. A patient has fever? You give anti fever medication. A patient has a sore throat? You provide pain relief, etc.
2) Ella’s fever persisted. Viral illnesses can have fevers that persist. You still give anti-fever medications and monitor. This is what you do, unless LBC or Annahar have new guidelines that we need to be aware of, in which case enlight us please.
3) Ella deteriorated and they contacted her physician as they took her to the hospital. He didn’t recognize them at first. Well, bring the guillotines. A pediatrician could not recognize over the phone a patient out of the hundreds that he has. He must be incompetent. Issam Maalouf’s mistake? He did not go see Ella that day at the hospital. However, that hospital is a university hospital and they should have been reporting back to him every single that happened with Ella as she would’ve been admitted under his care.
4) Ella’s fever continues and she starts experiencing decreasing urine output and becomes lethargic. These are signs of dehydration and deterioration. Dehydration can lead to kidney damage because blood flow to the kidney is decreased which causes something that is called acute kidney injury. This is not what probably happened to Ella, however.
5) Because of her decreasing immunity fighting the virus, Ella contracted another bacteria called Group A Strep (GAS). This bacteria is virulent and has been known to cause a wide array of complications when not recognized and treated early. To recognize and treat it early, you need to maintain a very high level of suspicion which in the setting of a clear viral illness, such as Ella’s case, was not the case.
Due to her low immunity, Ella had a dissemination of GAS. This led her to go into septic shock and full blown DIC. Septic shock is an extremely lethal condition whereby the body cannot adequately find the overwhelming infection. DIC is a complication of septic shock that leads to the depletion of the body’s ability to coagulate the blood through the formation of little clots that block blood vessels across many organs and vessels. The condition is extremely lethal.
In fact, the combination of septic shock and DIC is usually unescapable. Ella is lucky to be alive. Do you know why she’s lucky to be alive? Because her pediatrician saw the signs early enough to transfer her to a hospital that can manage her well.
Bring The Pitchforks, Why Don’t You:
After all that they’ve done, I can’t believe the Lebanese populace still trusts Lebanese media blindly when it comes to medical issues just because they’re sensationalized enough for their liking.
This is the same media that, a few years ago, ruined an OBGYN’s life by pretending they know medicine and accused him of killing one of his patients who was giving birth. That patient had an amniotic fluid embolism that is a lethal and extremely rare complication of giving birth. That doctor’s future was ruined anyway. He was also thrown in jail for something out of his hands before the courts realized that he was thrown in jail simply because of Tony Khalifeh’s report at the time.
Issam Maalouf joins the growing list of doctors whose entire career rests upon the whims of a reporter who understands nothing and who goes by what the parents or family of a patient are saying as if they know what’s happening, as if they know the medicine behind diseases. A devastated parent is not a doctor.
This is the same media that now has you convinced a competent doctor is now where he belongs, behind bars, and has you changing your display pictures to “Justice for Ella” snapshots.
When faced with a report from the Lebanese Order of Physicians about what actually happened, that same media downplays the report as inaccurate. Because clearly, the Order of Physicians does not know the medicine behind what’s going on. Those physicians did not go to med school for years and then did residency and fellowship programs for more years only to be ridiculed on air for being imbeciles.
Complications in medical scenarios happen. Not every single complication, despite how deliciously journalistic it looks, is a headline story.
With all due respect to a patient’s family, the esteemed reporters across the Lebanese republic and the people holding the pitchforks in Ella’s defense: You really have no freaking clue what you’re saying. Stop suggesting treatment modalities. Stop suggesting scientific explanations. Stop ruining people’s lives just because it makes for fancy headlines.
And then you get the Ministry of Health pretending they suddenly understand medicine to bring their pitchforks too. You know, that same ministry who turned Lebanon’s food safety issue into a Star Academy-like nominee-every-week report fashion.
There is a reason we go to medical school for endless years. There is a reason we do residency for another batch of endless years. Only doctors can know when medical errors occur. Only doctors can judge another doctor who does a medical error. Only doctors know how to treat patients and diagnose them. Only doctors know how to manage complications.
This is not elitism. This is common sense. This extends to other professions as well. I can’t judge the work of an architect, but an architect can. I can’t judge the work of an electrical engineer, but another electrical engineer can, etc.
The bottom line is: I just wasted 7 years of my life in medical school, that much is clear. Because clearly, Marcel Ghanem and his friends know better than me and all my colleagues.
When you think the Lebanese press circle couldn’t sink lower, they surprise you. Be it with their super horrible reporting which happens often, to them jumping on anything they’d deem as a scoop to lately causing the entire Lebanese population to panic over something called “Guillain-Barre” virus that’s ravaging the country.
I have no idea who told them about that so-called virus, but this is bullshit.
I first saw the story on MTV. And like the good media that they are, everyone else immediately jumped on the story because clearly we have nothing else to worry about in Lebanon so let’s add a horrible-looking virus flying in the air among us that can kill us at any moment.
Behold the credibility:
It’s the apocalypse I tell you, MTV-style.
In their defense, MTV did ask a doctor about it. And he gave them a more or less correct answer of what Guillan-Barre actually is. But I suppose MTV decided that the explanation was too non-dramatic and not-attention grabbing, so they figured they’d make up an entirely new virus strain and get Lebanese across the country to panic.
Let’s get a few things in order:
There’s no such thing as a “Guillain-Barre” virus, but there is something called a “Guillain-Barre” syndrome. That is to say there is no virus floating in the Lebanese air that will paralyze you, but there is a very well-documented syndrome called “Guillain-Barre” that is quite rare, albeit present, that affects the nerves and whose effect, when diagnosed and promptly treated, is almost entirely reversible.
This is what Guillain-Barre syndrome is:
Following an infection by a virus or a bacteria, some people develop antibodies that end up attacking their own nerves. The most common pathogen isolated in patients who have developed Guillain-Barre is a bacteria called “Campylobacter Jejuni” (don’t try to pronounce it).
As such, this syndrome is autoimmune (your own body attacking itself) and inflammatory (there’s an inflammation taking place) that targets myelin in your peripheral nervous system. Myelin is a form of insulation that covers nerve endings leading to much-faster propagation of messages. Damaging myelin leads to very slow nerve conduction, if not minimal conduction altogether.
This manifests in tingling in a person’s feet at first that propagates upwards to their legs and thighs, then hands and arms. Ultimately, a person would also stop being able to move their limbs altogether. The disease is progressive and ascending.
The main life threat of Guillain-Barre comes in it affecting a person’s respiratory muscles, that is to say since it ends up paralyzing muscles across the body, it might also paralyze the muscles that you need to breathe which causes a person to end up in respiratory failure. Don’t freak out, however, because this is a sign of a late progression of the disease and most people do not reach this stage and are managed well before it.
There’s no way to know if a person will develop Guillain-Barre or not. It doesn’t matter if you’re Lebanese, Sudanese or Vietnamese: the processes that cause a person to end up with the syndrome are under study. Being infected with a bacteria or a virus does not mean you will end up with this syndrome. It’s an extremely rare disease. However, it is manageable.
Since Guillain-Barre syndrome involves your own body attacking itself, treatment essentially alters this process of attack by blocking it or decreasing it. I have no idea about the cost of treatment, but it works well at stopping the progression of the disease and bringing back any person towards a full recovery.
Lebanese media want you to think Guillain-Barre is a death sentence. It’s a disease with a fancy name that most people know absolutely nothing about, so why not turn it into yet another Lebanese panic-du-jour to make people rush to their doctors and wonder if their seasonal allergies come spring time will get them paralyzed in a few weeks?
I have seen Guillain-Barre often. The patients I have seen were all okay. A neighbor and family friend was so unlucky she had Guillain-Barre twice. She made a full recovery both times and is now a fully functional woman in her thirties with absolutely no care in the world.
My advice is as follows: do not trust MTV, LBC, OTV, etc., when it comes to medical information. In the age of the internet, it is your duty first and foremost to make sure that what they’re saying is true or not. As a rule of thumb, they’re full of it most of the time. Deal with them as such.
Shame on MTV and whichever media outlet jumped on the story without fact-checking it. Google is your friend. Or, you know, a 3rd year medical student would’ve told you that you’re wrong.
A Separate State of Mind | A Blog by Elie Fares 