Category Archives: Random

Lebanon’s Cheesecake Factory Was Very Bad

chesecake-logo

My attempts at trying the Cheesecake Factory go back to when I was in the U.S. a few months ago and couldn’t manage to find a table back then. I stood around, watching as servers shuffled around seemingly endless tables, carrying plates with enormous food portions. The cheesecake fridge looked great, but that was the extent of my experience at the time in early April.

Fast forward around 8 months, and the renowned American chain has recently opened up in Lebanon, in its continuing development in the Middle East, after opening up several branches in GCC countries.

Lebanon’s Cheesecake Factory is super busy. Wait times so far, even a week later, are still in the one hour range. They could rise even more. The hostesses were boasting yesterday, as they informed us we were lucky enough to only have to face a 20 minutes delay, that earlier that day some people had to wait three hours.

I have no idea why anyone would want to wait anyone for anything food related, and I’m really thankful I only had to wait 20 minutes to get my “Cheesecake Factory Experience, Lebanon style” because that was the maximum extent of my time – or anyone’s time – that such an experience deserves.

Me No Speak Arabic:

 

When your wait time is done and your buzzer vibrates for salvation, you get a very cheerful hostess – American style – take you to your seat. She gives you the menus, informs you in English that servers will be with you shortly and disappears.

So far so good. At that point, her English doesn’t feel out of place even though you’ve used only Arabic to communicate with all the employees, but no matter.

The server shows up. You ask them in Arabic about their recommendation, because the menu is barely readable with the super dim lighting in the place. They reply in English, sometimes borderline incomprehensible, but you try to maintain the conversation anyway. After taking your order, all forms of interactions with the server occur in English. That is you talk to them in Arabic and they reply in English.

When asked why they kept talking to me in English, their reply was that: this was the store’s policy. As I asked the manager about this, because it gets super annoying, and he said that the American head company has such a stipulation as a requirement to give customers the “American” experience.

Except we’re not American – sadly (unless the experience comes with a free passport) – and while many of us are bi or trilingual, there is absolutely no need to use any other language than my native tongue at a restaurant in my home country unless I wish to do so, and in most cases I do not, and I sure as hell did not want to feel like I was being rendered stupid by talking Lebanese to a server and being replied to in English, à la “get your language up to standards, sir.”

Perhaps this rule works best in GCC countries where most of the Factor’s customers are not native Arabic-speakers, but they desperately need to re-check this policy over here.

Overwhelmed Staff & Subpar Service:

Lebanon’s Cheesecake Factory boasts, according to the manager, more than 96 servers at an average of around 2 tables per server. You’d think with such a low ratio of tables to servers, you’d get excellent service.

It’s far from the case.

The huge number of servers leads to total chaos across the entire restaurant. You get to a point where you don’t know who you’re supposed to talk to in order to communicate a request or a complaint.

The level of the staff being overwhelmed is so high that there were serious shortcomings across the board. I’m not the only one who suffered from this, as several of my colleagues and friends also noted on their visits earlier in the week.

Perhaps it’s opening-week-jitters, but with the presence of staff from already-established Cheesecake Factory outlets to help in the launching phase, I don’t know how much of the service’s shortcomings can be attributed to nervousness.

Maybe it’s the language requirement?

Besides, the service is definitely not as “American” as you’d think it is. We got an aluminum foil piece in the item we ordered and no one reacted until, before paying the bill, we requested to see the manager to inform him about how horrible the experience was and about how we would most likely not visit again, not that they need our business anyway.

The Food Is Overpriced, But The Cakes Are Great:

I don’t know about the bloggers who were invited there for the opening, but if you go there as a normal civilian, you are looking at a bill that is above and beyond anything you’d pay at any other similar Lebanese restaurant, even if it’s American in origin.

In deciding what I wanted to order, I googled the best items of the Factory and found a bunch of results that agreed on a couple of chicken-based dishes, which I ended up ordering. While they food was good enough, it was definitely not worth the $24 price per dish that we paid.

The food is also extremely fatty. Even the “skinnilicious” menu is not that “light.” I’m still stuffed more than 15 hours later, and we were sharing.

The saving grace, however, is that the cheesecakes are great. Seriously. I really hope they offer a way for people just to buy pieces of the cakes without queuing. We ordered a couple different kinds and the “Godiva Chocolate Cheesecake” is God-send. Absolutely great.

Stay Away For Now:

My advice to you, dear reader, is to resist the urge and steer clear of that place until either the mania dies down, or the staff becomes better trained, or they become more accustomed to the Lebanese market and adapt accordingly.

Until then, I have to say I was severely disappointed and would not recommend this place to anyone who’d listen.

It’s nice for the country to bring business in, but I refuse to be taken for granted as a Lebanese customer who can’t wait to set foot in any given franchise, which is sad really because I honestly had high hopes.

 

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.

 

Pictures of Lebanon from the International Space Station

On Christmas Day, the International Space Station (ISS) wanted to show a different side of the region where Christmas came to be. For a place known to be war-torn, with blood-filled conflicts taking place every day, the astronauts at ISS wanted to show the world exactly how peaceful we looked from up there on a day that is all about peace, a time that is about anything but.

The pictures in question have been around for days now but they haven’t made the round yet. One explanation could be the caption with which they shared the pictures was the following:

Israel – completely clear – on Christmas morning from the International Space Station. Astronaut Barry Wilmore woke up early on Christmas to reflect upon the beauty of the Earth and snap some images to share with the world.

Obviously, that’s a big no-no around these parts. But seeing as how small the region is, a picture of space cannot contain one country alone, and I thought the way Lebanon looked on Christmas day from space, peaceful as it it, is always something nice to look at, which is quite is ironic given the situation and the additional rage we got from hellish traffic during that period.

For those who aren’t familiar with Lebanese geography, in order to find Lebanon just spot the snowy mountains. We are the only country in the region to have them. Those are the Cedar mountains in the North of the country. I’ve said over and over again that our best winter resorts are up there, but Beirutis just don’t believe me. Now you have proof.

Our country is the area around those mountains, with the very crooked coastline, from the Akkar in the North to the Naqoura tip in the South. The Eastern part is tougher to delineate.

You can also see Palestine, the Dead Sea, as well as parts of Syria.

The ISS has made it a habit of sharing wonderful pictures of Earth from space. A few weeks ago, upon a request from a Lebanese Twitter user, the ISS shared with him a picture of Beirut from space:

Beirut from ISS

You can check out pictures of other places on Earth on their Facebook page.