Dear Lebanon, The Garbage Crisis Is Not Giving You The Flu

Lebanon Garbage - 3

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.

 

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Attempting To Bring Affordable Medicine To Every Lebanese And Refugee in Lebanon

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.

The Ella Tannous Case: When Every Lebanese Suddenly Becomes A Doctor

Ella Tannous

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 wanted to convince you we had a Guillain-Barré virus.

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.

Dear Lebanon, There’s No Such Thing As A “Guillain-Barre” Virus

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.

Why Lebanon’s Health Sector Is Messed Up

Abdul Ra’ouf was a 4 months old baby boy and he is another Lebanese tragedy. He was refused admission to hospitals in Akkar and has passed away. I suspect Abou Faour will hold a press conference soon.

In late February, a scandal hit Hotel Dieu as the Ministry of Health, led by Abou Faour, froze its contract with that hospital over them not admitting a patient who had no other form of coverage.

Heartbreaking stories of children dying make headlines, but they don’t tell you the truth of the health sector in Lebanon. That truth is in the numbers:

Before going into what thosee numbers mean, let’s take the hypothetical scenario of a hospital with 100 beds. The beds in that hospital are divided according to coverage: those covered by insurance have the biggest chunk allocated to them (let’s say 70), while those covered by NSSF have 20 beds and those covered by the Ministry of Health have the remaining 10.

Hold that thought for a second and let’s talk about the numbers.

Half of the Lebanese population (48%) is covered by the Ministry of Health (MOH), while 23% are covered by the NSSF (daman) and only 8% are covered by private insurance. This means that about 2 million Lebanese have the MOH as their ONLY way to afford hospital care in the country.

Having half of your people covered by the ministry doesn’t seem too bad right? The truth of the matter is far less utopian.

Having half the country covered by the MOH means those 48% are entirely dependent on the MOH’s budget. The disaster is when you find out that out of all the ministries running this country, the budget allocated for the MOH to cover the needs for HALF of the country is 3%.

How The Ministry of Health’s Budget Is Divided:

16% that budget goes towards expensive drugs notably cancer treatment. Patients not covered by the NSSF have to resort to the ministry for their medication (if they can’t afford it, which is the case of  99.7% of Lebanese).

Getting the medication out of the MOH isn’t easy. Sometimes they run out of the medication and you end up having to wait until they bring it back into the country. Other times, as has happened with a friend of mine who needed a $12,000 treatment over the course of a couple of months, other people come in and take the medication that was allocated to you, sign for you and leave.

The system is rigged with wastas, bureaucracy and corruption.

80% goes to hospital care, which is where most of the people need the MOH: operations, hospital admission, etc.

So imagine ONLY having 80% of the country’s 3% budget used to essentially treat 50% of the Lebanese population. This is why the MOH has the least number of beds at the country’s major hospitals: the MOH often doesn’t pay, and when it pays, it does so extremely late.

So when you hear that a patient couldn’t find a bed at a particular hospital, it doesn’t always mean that every single bed in the hospital is full, it means that the beds for that patient’s coverage are fully occupied, and that is very easy to occur when 48% of the country gets a minimal amount of beds in the country’s major hospitals.

Does that sound harsh? Of course it does. All Lebanese are entitled to excellent care and that level of care is, sadly, rarely available outside of Beirut and its major hospitals. Why so? Because excellent care is not cheap. Those imaging equipment with fancy names you hear being thrown around on shows like House, MD and Grey’s Anatomy cost in the millions. Every time a hospital buys something to advance its level of care, they pay figures in the seven digits. Even the research that goes into advancing care is expensive.

The level of care being expensive is a big problem. The bigger problem is not having hospitals that are close to the level of those inside Beirut outside of the capital. Most of the people in the country cannot afford places like AUBMC, SGH or HDF, but they can go to public hospitals where the level of care has the potential to be excellent but is handicapped by how little funding those hospitals get.

4% of the MOH’s budget goes to help public hospitals. What you need to know is that public hospitals are not exactly under the jurisdiction of the MOH, which means that the Ministry isn’t responsible for their finances and how they run: they have a separate board of directors that is required to run them and keep them within profit margins. However, as is the case with almost all public hospitals in the country, very few (if not none) are success stories because of the lack of governmental support that goes toward them.

I rotated at one of those public hospitals not too long ago. It wasn’t an eye opening experience because I do come from a non-privileged area of the country, but it was a heartbreaking one. The hospital was in a state of near-decay. Some of the equipment didn’t work.  And all the patients were one sad story after the next.

The latest high profile example is Beirut’s Governmental Hospital which has been in the news for months now because of the lack of payment to employees. Imagine not getting your salary for months. Does it make it okay just because you’re a doctor or a nurse?

What Happens When The MOH Freezes Its Contract With A Hospital:

As a response to HDF not admitting the patient (who wasn’t a case of emergency in which case the hospital is required by law to take care of a patient), Abou Faour decided to put his ministry’s contract with the hospital on hold. I suppose he thought that was punishing the hospital enough, and you thought he was defending your rights in doing so.

What freezing that contract means is that those 10 beds in that hypothetical hospital are no longer allocated to patients covered by the MOH. Freezing a contract with a hospital affects the patients, not on the hospital.

Hospitals And Doctors Can Also Be Greedy:

There are a lot of hospitals and doctors in the country that are greedy, and the system permits the perpetuation of that greed.

The most relevant story to that regard is of someone I knew who required a major surgery. That person’s community tried to intervene by raising the funds. Eventually a high profile charity heard of that person’s problem and donated. In doing so, they forced the hospital in question to lower their required fees by a decent amount, because that charity needed the invoices to be audited abroad.

A lot of this goes on behind closed doors. The lack of regulations means that you don’t know which part of the money is going where.

The Media Doesn’t Help:

Out of all sectors in the country, medicine and healthcare are the juiciest to be spoken about in the media, and the way the media talks about hospitals and about patients dying is ignorant.

A couple of weeks ago, Marcel Ghanem shared a story on his show about a woman who died at a hospital in Jbeil because they didn’t give her some covers from the cold. People were outraged. Were those nurses seriously watching Yasmina and not giving the woman a blanket? What an atrocity!

The truth is very different.

That patient was a cancer patient. As a result of her chemotherapy (which she was able to afford!), her immunity was immensely suppressed, rendering her unable to defend against infection. The patient presented to the ER of that hospital with what we call “neutropenic fever,” which is fever in the background of immensely suppressed immunity. Why did the patient die? Because she ended up in septic shock, a condition with extremely high mortality.

But that doesn’t sound too media-appropriate. The problem with Lebanese media isn’t that they talk about stuff that go wrong in hospitals. They should, and they should do it more. It’s that the angle they often use is useless, leads to zero changes and doesn’t highlight the real problems here: inequality, lack of funding, lack of coverage, etc.

My Own Sensational Story:

She was such an adorable 4 year old when she walked into the doctor’s clinic in Beirut, coming all the way from Tripoli. What’s your name, we asked. Farah, she answered in a barely audible singsong voice.

Farah was there for further reparative surgeries for a congenital defect she had. A tube was sticking out of her neck to allow her to breathe. The doctor offered to do the operation pro-bono, but the hospital had no beds available for her.

I saw her father weep. I have already lost two daughters, he said, by settling to hospitals in the North because I couldn’t afford Beirut. I don’t want to lose her too. And in a corner of the room, I saw my colleague tear up.

Farah is 48% of the Lebanese population.

My colleague then approached me and said: this is something you need to write about, and so I did.

 

How Lebanon Is Bracing Itself For Ebola

Earlier today, my phone buzzed with a breaking news notification about a patient being investigated for Ebola at a, as of now, unnamed Beirut hospital. An hour or so later, as I had figured, the patient turned out to have malaria. But that didn’t stop people from freaking out about the disease’s possibility of invading Lebanese territory. I mean, it’s only a matter of time anyway as Ebola is the only thing, possibly, that hasn’t strutted across our borders yet.

At an almost 30% chance of having Ebola spread to it, Lebanon is not at bay. 30% is a lot in medical terms. However, that isn’t to say that nothing is being done regarding the issue or that it’s being ignored as we’ve ignored almost every other pertinent matter that could potentially affect this country. I guess when it comes to health, people pay more attention.

In a matter of weeks, Ebola has become something that we, as medical professionals (or soon to be medical professionals), had to keep at the forefront of our minds as we saw patients in ERs or in any other setting for that matter for patients who have fever or a constellation of indicative symptoms.

Back in the old days, we’d start by asking about associated symptoms to try and draw a picture of a syndrome, a viral illness or any possible etiologies that made sense give the season, the condition of the patient, etc. Nowadays, we start by asking: have you had any recent travel history, sir?

Our cut-off to rule out Ebola in someone who presented from an endemic area, few as those people are, is about 3 weeks. I’ve seen people panic that they’ve encountered someone who visited Lebanon from Nigeria 3 months ago and are currently presenting with fever. No, it doesn’t work that way.

The Ministry of Health, in its capacities, has circulated memos to Lebanon’s hospital to educate employees, nurses and doctors about Ebola and about the proper ways to handle patients suspected with the disease. I have taken pictures of the memo in question, which you can find as follows:

When it comes to our airports, however, the story is entirely different. Sure, there’s probably not a massive influx of Lebanese coming from West Africa, but even with the global worry regarding the virus, there’s been basically zero measures at our airport to screen passengers or attempt to keep ebola in the back of their minds, just in case, especially in passengers from Sierra Leone, Guinea and Liberia. I guess there are more important airport-related issues at hand, such as fixing that A/C.

The media, on another hand, isn’t doing a terrific job either at spreading awareness regarding the virus or educating people on it in order to decrease mass hysteria and help catch suspected cases earlier, in case they happen to be there as unlikely as that is.

In a way, Lebanon is better prepared for Ebola than it is for any of our average crisis. Our hospitals are well equipped and can handle such cases extremely well. We have excellent equipment and doctors and, believe it or not, excellent medical management – at least at Beirut’s major hospitals that is.

The status of Ebola and Lebanon can be summarized as follows: there are more people in Lebanon that have been attacked by MP Nicolas Fattouch than have had Ebola.

Vaccinate Your Children Against Polio Starting Tomorrow

The Lebanese ministry of Public Health is starting a massive polio vaccination campaign tomorrow. As I’m currently rotating in pediatrics, I’ve seen a lot of parents who are unaware of the vaccine, who are having second thoughts about giving it to their children and who have not given the vaccine much thought to begin with.

Why You Should Care:

With the increasing influx of Syrian refugees, Lebanon is at an increased risk of a resurgence of diseases that we thought had long died off in the country, second to successful campaigns, such as polio.
Because the Syrian refugees in the country are uncontrolled, we cannot ascertain the disease load they’re bringing with them as as such we have to be extra careful with our children’s well being.

Poliomyelitis is a viral infection that can leave your kid paralyzed. Why take the risk?

Why You Should Spread The Word:

Polio vaccines are in two forms: an oral form and an inactivated injectable form. Both have 100% efficiency. The latter has no side effects while the former has a side effect that happens at about 1 in 2.4 million. The form that will most probably be employed in the campaign is the oral form and this provides the country with something that is called herd immunity and is actually able to help the children that have not be vaccinated.

How?

Herd immunity is basically the following: when people in a setting are all incapable of catching a disease and therefore spreading it, those who are not vaccinated will be protected by default. In case of the oral polio vaccine, the vaccine gets excreted by the child and can be transferred to other children. Therefore, the more you spread the word and the more children get vaccinated, the more the country will be protected.

Consult Your Pediatrician:

Your doctors are there to help you. Many of you have most probably had their children take the polio vaccine already but if you have any doubt on the matter, consult your pediatrician and ask them what to do. They will be more than helpful given that they are active components of the campaign set forth by the ministry of health.

I know this isn’t the regular stuff you’d expect from this blog but I find this matter of utmost importance and I hope you find that is the case as well.