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.

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How Lebanese Women Can Save Their Lives

Almost a year ago, my October turned pink as my mother got news that she had breast cancer. After the initial shock of the matter subsides, you’re left with one of two options: you either think rationally and fight or succumb to your emotions and crumble. It was a tough year, that’s for sure. My mom wasted away because of the chemo. She lost her hair, vomited anything she’d eat. But she’s getting better now.

My mom, however, is not your typical breast cancer patient: she doesn’t have a family history that would cause anyone to be more vigilant. The other risk factors associated with breast cancer do not apply in her case. And yet, there she was getting a needle stuck in her central IV line. My mother fell through the statistical cracks of medicine, like so many other people out there.

October may be breast cancer awareness month but I figured I’d shed some light on other cancers that aren’t discussed often and which might be prevented with some careful attention.

Breast Cancer:

I’m especially happy at the response I got after writing about my mother’s diagnosis, with many readers coming up to me to tell me that they got their mother to go get tested as well and they’re relieved she has nothing or, in the case of some unlucky few, had a very early stage of the disease. A lot of research and money has gone into breast cancer. We’re at a stage, medically, where early detection is almost synonymous with cure.

Early detection happens by personal observation first and foremost. If you feel any difference in the shape of your breast or any odd sensation that wasn’t there before, make sure you consult a gynecologist who will do a breast exam. Don’t worry, though, the exam is not painful. It consists of very careful inspection of the breast for any masses as well as how any potential mass might be affecting shape, texture, etc.

Seeing as October is free mammography month, there’s absolutely no reason for every woman aged 40 and above not to get one. If you have a family history of breast cancer, mammographies should have started by age 30-35. The sad part is that despite mammographies being either free or at a greatly reduced price during October, Lebanon’s medical community has had trouble in getting the message to some sectors of Lebanese women.

Make sure the women you know get tested this month. Make sure you haven’t had any changes. They might sound like small steps but they can go a long way in saving the lives of the women you love.

Cervical cancer:

The thing about cervical cancer is that there’s a quick screening method for it called a pap smear. It’s recommended to do the pap smear annually until you’re 30, with the test starting preferably by the age of 21. It’s a screening exam so it cannot give you a diagnosis.

The other thing about cervical cancer is that there’s a vaccine which could cut your risk of getting it by about 90%. Why so? Because the main causative agent of the cancer is a virus that’s called HPV, which is acquired by sexual intercourse. It’s preferable  to get the vaccine prior to your first sexual relation. However, even if you have had a sexual relation without taking the vaccine, you can still take it and have your risk reduced dramatically.

A lot of Lebanese women don’t take the vaccine or do a pap smear for the following reasons:

  • They believe it’s a taboo to take a vaccine for something that’s related to sex,
  • The vaccine itself is quite expensive, especially since doctors charge quite a hefty sum to administer it,
  • Many women don’t trust vaccines to begin with,
  • Having a gynecologist is, to many, only a matter that should happen after marriage.

The HPV vaccine, however, has proven itself to be very efficient. With its introduction into the medical field, cervical cancer deaths have drastically decreased. So in case you haven’t taken the vaccine or done a pap smear yet, consider this a sign that you should do so.

Ovarian Cancer:

Ovarian cancer is sometimes called the silent killer of women. It’s currently the leading cause of gynecological cancer deaths among women. It’s so inconspicuous that its diagnosis usually happens at a very advanced stage, when the disease has already metastasized. Less than 20% of women survive an advanced stage of some types of ovarian cancer. This cancer metastasizes to the lungs, liver, bowels, among other organs. The operation required to resect and manage the spread is considered a marathon and often only buys a little time for treatment, which is usually very harsh.

Ovarian cancer doesn’t have screening methods or vaccines. It requires you to be vigilant. A yearly visit to your gynecologist who does a pelvic examination should suffice. If there’s any suspicion, your physician will order an ultrasound to guide any possible diagnosis.

Your Life Matters:

My mother, like many other women, took her health way too lightly. She paid the price for it. Don’t let that happen to you or the ones you love because your health and life matter. There are other types of gynecological cancers than the aforementioned that affect women. The common denominator is not to treat any sign that your body might be telling you lightly, not to have a sense of immortality or denial imprinted on you despite all forms of common sense and, most importantly, not to so shy as to no seek out a gynecologist for any possible reason. On the contrary, make sure you find a gynecologist who proves to be the best fit for you, with whom you can be comfortable and with whom you feel free to discuss whatever’s making you worry.

The Ultimate Lebanese Medical Taboo: Mental Health, Not Demons. Psychiatry, Not Exorcisms

“Tell me I have cancer please,” she said as I stood next to her in the Emergency Room. “Tell me I have cancer,” she repeated again as if repetition would make it true. “I have cancer, yes I do. But I’m not insane.”

1 out of 5 Lebanese will have a mental disorder during their lifetime. This is in sync with international averages, which is interesting given the proficient history that serves as precipitating factors galore that we’ve had. But be sure of this: we all know someone who has or will have a mental disorder.

50 is the approximate number of registered and licensed psychiatrists that could potentially treat these patients. 50 for slightly less than one million. We have incredible shortage and yet it doesn’t show to everyone. Why? Because we simply don’t talk about mental health.

0 is the number of local insurance companies that cover for psychiatry. People don’t care enough about the issue in order to pressure them to make it included with their healthcare bundle. It will never happen, they’d say. It only happens to other people, just like every other serious illness I suppose.

A patient my age thought she was living inside a snake on Mars. That was where she was when she presented for hospitalization with bruises all over her body.
Her family denied knowledge of those bruises at first. But they were too systematic to be coincidental. She had bruises over here wrists, torso and legs. Her parents still didn’t budge.
The patient in question was living on Mars for a few months now. She wasn’t brought in earlier because her family thought she was possessed. A religious man had tried to perform an exorcism. We live in a country where it’s more acceptable to say demons are inside a family member than to say he was admitted at a hospital and is on a few meds.

That patient wasn’t the first nor the only one I saw who had attempted many exorcisms at the hand of religious figures before finally deciding that what was wrong wasn’t, in fact, spiritual as much as it was simply biological and chemical. It’s always that way: demons, not disease. Exorcisms, not medicine.

Wasn’t it at the times of our great-great-to the power ten-grandfathers that illnesses were associated with evil spirit?
That seems to still be the case today in Lebanon, and many other countries around the world, when it comes to mental health. The way we view mental health is also that of a taboo whereby we try to hide from it, shut it away as something not to be talked about. Even the suicide of Amina Ismail, sensational as it was, didn’t turn in the media into a discussion about mental health. It was a discussion about her private life. We have it among family members but instead of looking at those family members as sick people, akin to any person with any chronic illness, we look at them as burdens who got themselves into the mess they are in. My family is no exception to the statistics. And I’ve seen both ends of the spectrum: the cancer patient is seen as the sick one. The mentally ill patient is seen as the spoiled one.

The extent that mental health is a taboo in this country is best manifested when you observe the way people act around the possibility of a mental disorder diagnosis. Some of them exchange their names with numbers as identifiers. You can name me thirteen if you want to. Others would panic when psychiatric people are called in for a consult. “I’m not crazy, get out of my room.” Few are the people who are open about the idea of possibly going to the psychiatric ward. Even fewer are those who actually present voluntarily. The least of all people are those who are open about any possible mental disorder they might have and who actually view such disorders the way they view any other illness. You should also see the reaction that doctors who are specializing in psychiatry get every time they tell people of their plans.

Then there are the diseases which have been ridiculed by people to the extent that few seem to actually see them as illnesses anymore. Schizophrenia becomes split or multiple personalities just because Hollywood says so. Substance abuse becomes an issue that doesn’t concern us because we have willpower. “Tu deprimes today?” becomes the reference for depression.

I have a friend who was diagnosed a while back depression. Treatment has greatly improved his entire lifestyle and approach. And I’ve been thinking lately how lucky my friend was to be surrounded by people who viewed his diagnosis and treatment as a true medical case, not him being a wuss. If his case had been the latter, he’d have probably never improved and he would have never known that there is a better view of life than that of a person who was always sad, who had decreased interests, decreased appetite, guilt, suicidal thoughts.

“Madness is like gravity, all it takes is a little push,” the famous saying goes. Except “madness” is nothing like gravity and it takes more than just a push to get there. It’s a collection of genetics, biological predispositions and psychological stressors – sort of like any other disease, really. A mark of the development of a society is the way they view mental health. Lebanese tell their friends who are truly depressed to suck it up. They’d rather seek out exorcisms and justify diseases with demons than with simple facts. A person who develops substance abuse is weak-minded, his abuse never seen as an actual disorder. That patient who wished she had cancer has been “living with a demon” in her house for 6 years. She had brought in a priest every month. She still doesn’t know nor does she accept that the problem is probably with her and it could have been fixed 6 years ago. I guess some people would rather find solace in demons and live in Mars in the process because society thinks a Martian habitat is better for people like them than to acknowledge the simple and yet vitally important fact that it’s mental health, not demons. It’s psychiatry, not exorcisms and voodoo.

What You May Not Have Known About Abortion & Some Medical Ethical Issues in Lebanon

You’d think class discussing ethics in medical school are the most boring. The truth, however, is that those classes are the only ones capable of engaging the entire class. The sloths wake up because of a rising tone with their classmates. The conservatives rise because the liberals in class are infringing on their beliefs. The liberals get infuriated at everyone else because they just don’t get it. And the physicians giving the lecture sit back and watch.

Pop corn material? You bet.

Because I am receiving my medical training in Lebanon, we have to also deal with certain aspects of Lebanese law pertaining to these issues and to say our laws are bipolar, nonsensical and surprising is an understatement.

  • Abortion:

We all know abortion is illegal in Lebanon. There’s no pro-life, pro-choice debate. Women have no choice when it comes to this. However, did you also know abortion is illegal even when it comes to congenital abnormalities? In other words, it is illegal for a physician to abort a baby in Lebanon if the baby has, for example, Down’s Syndrome or any other defect which would render his life extremely difficult. The only situation in which abortion can be performed in Lebanon legally is when the pregnancy is endangering the mother’s life – and even that comes with its own baggage of morality clauses.

In fact, any physician who performs abortions that are not indicated – even if they are for what many perceive as common sense causes – can be targeted by the law especially if he rubs a prosecutor the wrong way. Some physicians refuse to do abortions fearing legal issues while others refuse to do so for religious issues. In fact, a physician who is training me said to my face: “I wouldn’t even abort my own sister if the baby was a product of rape.” I was outraged but this is how it goes.

Certain major hospitals in the country do not even do amniocentesis, which is a component in prenatal care and diagnosis to detect certain abnormalities. Their argument? We’re not aborting anyway so what’s the point of the mother knowing if the child has Down’s Syndrome or not? Besides, amniocentesis carries a theoretical 1/250 chance of causing a miscarriage – who needs that risk?

A relevant abortion real life story we were told is when a radiologist missed the absent right arm of her fetus, a condition called phocomelia. She later found out of the condition at a gynecologist’s visit and decided to abort. She then wanted to sue the radiologist for missing the condition but was eventually talked out of it because having the case reach a court of law would get both the mother and physician in jail.

  • Gamete donation:

I daresay Lebanon doesn’t need more fertility. If anything, we need to have population control. But some people just need those little bundles of joy in their lives. Some want to because they feel a need to be parents. Others want to because society looks down upon the women who don’t give their husbands children. Many couples resort to In Vitro Fertilization or other methods of Assisted Reproductive Technology. Insurance companies pay for such practices without knowing so because hospitals cover it up in their charts.

For some couples, however, gamete donation is required for them to have children. Yes, the child wouldn’t be theirs biologically but that’s not all that matters now, right?

Here comes the interesting part, Lebanon-style: There’s absolutely nothing – no religious decree, law – allows sperm donation. It doesn’t matter what the man’s fertility status is. It doesn’t matter if the woman is as fertile as they come. Oocyte donation, however, is an entirely different story that is governed by each person’s sect. Meaning: whether or not a person is allowed to donate or receive donated oocyte is correlated with that person’s sectarian personal status. Move over civil marriage, I guess.

Don’t worry though, the sects agree on this. The Christian, Druze and Sunni sects prohibit this. Shiites are the ones who have gone off the rails – but not all of them. Lebanese Shiites fall under two main branches. There are those who follow Mohammad Hussein Fadalallah in their practices while others follow Iran’s Khamenei. Those who follow the latter are not allowed to donate or receive oocytes while those who follow the former can do so as per a fatwa which he issued shortly before his death. The condition? The oocytes have to donated by someone by the man’s other wives.

  • Embryo Research:

Not a lot of research is being done in Lebanon. This is especially lower when it comes to embryo research – the number is zero. However, who would have thought that the law can actually be interpreted in a way that permits such research?

In fact, the Lebanese law pertaining to this issue stipulates that the embryo is a product of conception and can be manipulated as long as both parents agree. Other products of conception include the placenta. This effectively renders the embryo prone for research. So in a way, we are ahead Western countries in this regard.

Why hasn’t this law gained traction? Mainly because no institutions actually allow such forms of research to happen in their premises. Most of the country’s main hospitals are religious institutes at their base. The law has also passed unnoticed by the radar of sects because they’re all busy elsewhere and we still don’t know if it’s been put into effect. Interestingly though, at least some MP members (Kassem Hachem, I believe) tackled the issue at hand. Meanwhile, women are still waiting on their own domestic violence law.

  • Conclusion:

We were asked the following question about frozen embryos: if you freeze an embryo for 5 years and then implant it, is the fetus one day or 5 years old?

All hell would have broken loose if we hadn’t been a small group in the discussion. I guess it doesn’t really matter where we legally stand from such issues. What is clear, at least to me, is that we are lightyears away from having a decent discussion about them. But I still find them fascinating.

Medicine in Lebanon: The VVVVIP Patients

The following are bits and pieces of things several of my medical student colleagues and I, at many Lebanese hospitals across the country, have lived over the past few weeks. 

“What do you mean I have to deliver in third class? I DON’T DELIVER IN THIRD CLASS.”

Beautiful thing to wake up to in the morning, right? Well, such things are not fiction – they are every day reality in Lebanese hospitals. The woman in question was very very pregnant to say the least. She was also very very angry. Why? Because two emergency C-sections had taken up the first class beds she was promised to welcome her bundle of sunshine into the world.

“We couldn’t help it,” the nurse pleaded. “Those two women just came here in labor!” The nurse was almost begging as I stood there watching.

“I don’t give a shit.” The woman shrieked. “I want first class – I am not a person who can deliver a baby in third class. Take them to third class, they already delivered.”

A few phone calls later, that woman got her way. I guess some vaginas are more precious than others. Literally.

The separate classes in the Lebanese social hierarchy also reflect in its hospitals. There’s really very few things that hospitals can do. They accommodate what they can given how messed up and archaic our health sector financing is. What is bad, however, is the sense with which some people view medicine in this country: it’s not a human right that should be guaranteed to everyone. It’s a privilege, a luxury that only they should be entitled to.

“My ovaries hurt.” I was staring at the face of a supposed emergency condition who had just presented to the emergency room. I could see sunscreen all over her body. She was definitely tanning a few minutes earlier.

“How are your ovaries hurting you exactly?” I had no idea how ovaries could actually hurt a person, not to mention how a person would know where their ovaries actually are. When had the pain started? Well, the pain had happened 6 months ago and had died since but she wanted to know why that pain happened then… now. Bref, there was absolutely nothing urgent with her. But she knew enough people and had enough resources to take away physicians from places where they could be needed and keep them busy for a couple of hours in order to make sure her ovaries are perfect.

And then there are those patients who are so important they book two first class rooms because, you know, what if they got visitors? Can you imagine hosting them in one first class room? They are the patients who are so revered their treating physicians would drag themselves out of bed at times they shouldn’t be at the hospital just to do an exam that I, as a medical student, should be doing – just because it’s that particular patient. Those are the patients who are even treated differently in operating rooms just because they can enforce such levels of fear: “be careful with her… she’s important.” They are the patients on whom we don’t learn simply because they would get “too annoyed” to have that many students in their room. So no one enter please.” That vagina glows of gold, I was told.

Those are the super duper very very important patients that come to Lebanese hospitals: patients whose medical cases are nothing more than mundane, simple and even boring… patients who can turn those cases into a matter of national security. And there’s nothing you can do but smile and the most professional individual that you can be be while you secretly hate on the system that hammers hospitals and medical education alike.

Memorial Hermann, a Houston Hospital, Live-Tweeting Brain Surgery

The day has come where Twitter is used effectively as a learning tool in medecine. Memorial Hermann, an institution based in Houston, Texas is currently broadcasting updates and answering questions during a brain surgery that’s going underway right now. You can check out their Twitter account here.

As a sample of what they’ve been talking, I took the following screenshots:

They’ve also tweeted a few pictures live from the operating room, as well as a brief video of the brain while they operated on it.

I think this is great. While I am familiar with some of the terms they’re throwing around, I think this a great educational opportunity for medical students, current MDs, and knowledge enthusiasts. I hope they do this again some other time as well because it sure is interesting.

 

To All Med Students: The Rise and Fall of Medicus Studentus

This is an absolutely hilarious video done by medical students at the American University of Beirut (AUB) that was presented during an annual gala dinner which serves as a fundraiser for the Lebanese Medical Students International Committee (LeMSIC).

I was fortunate enough to watch this firsthand at the aforementioned gala dinner and I thought it was totally awesome. Other med students, you will eat this up. For those who have nothing to do with med school, here’s the setting you need to put in your head: cut-throat competition, your med school books are neo-scripture. Caffeine is your BFF. You also hate everyone.

It’s long but definitely worth it. And hey, we have unlimited internet at night now. So why not?