Tag Archives: healthcare

Let’s Help 56 Year Old Rozine Moughalian Get The Liver Transplant That Would Save Her Life

Rozine Moughalian is a 56 year old mother of two from Bourj Hammoud and if she doesn’t get a liver transplant within a month, Rozine will be no more. This is as simple as that statement could be formulated.

Over the past three months, Mrs. Moughalian developed subacute liver failure. Doctors have not yet been able to identify a cause but her condition has deteriorated so fast that the only cure for her is a liver transplant operation, one that no hospitals in Lebanon can do.

As such, in order to save her life, Rozine’s Moughalian’s daughter, Catherine, turned to the only entity that she knew had the power to save her mother: us. This is not the time to disappoint.

We have less than 10 days to raise the required hefty amount to ensure that Mrs. Moughalian is covered for the operation and all its associated expenses. I believe we can do this. A couple of years ago, we all got together and pitched in to give my friend Simon a fighting chance at beating his leukemia. Let’s do the same for Rozine, a psychologist and a mother, who still has plenty to give to her family, her country and herself.

We should not let Rozine be the victim of the Lebanese condition, where only those who are rich enough can access healthcare while those who can’t pay up wait for their souls to be reaped. This is not how things should be and we should not allow it. Minister Wael Faour, if you or your people happen to read this, it is your duty as a minister of health to make sure that citizens like Rozine, who at times like these need governmental assistance the most, to get it and have a fighting chance at life. This is as important as ensuring coverage for those above 64 years of age.

Donate here.

The following is a statement from Catherine Moughalian, Rozine’s daughter:

My mom, Rozine Moughalian, is a 56 year-old psychologist and mother of two. She lives in Bourj Hammoud, an area that has been recently piled with garbage and darkened by black smoke from burning trash. In the last three months, my mom developed subacute liver failure, which doctors were unable to diagnose and suspect possible drug or toxin exposure. The condition developed quickly, and mom went from working three jobs two months ago to being hospitalized with a terminal condition today. She is currently in need of a liver transplant without delay (within the next two weeks).

It is an extremely difficult process to find donors and secure funds in such a short period of time. So, due to bureaucratic procedures and time constraints, she can’t receive a liver transplant in Lebanon and it was recommended by doctors that she be transferred abroad for proper assessment and treatment. We are currently aiming for transferring her to Iran or India, these being the cheapest options. France was also an option earlier but it costs double what the surgery would cost in Iran or India.

Mom does not have the money for such a surgery, and she doesn’t have access to free quality healthcare. We need to raise at least 200,000 USD by the end of the month to be able to fund her surgery or it will be too late.

I find it absurd that my mom won’t get to live out the month because we can’t afford the money or a donor. She has the right to access free medical care, she has the right to get appointments with doctors without wasta, and the right to be admitted into the hospital at the expense of the National Social Security Fund (NSSF) without having to wait a day in the ER while we make the “right calls to the right people.”

In a country where our basic rights are not available, or only available to a select few, sticking together is more of a basic need than duty. If you feel you can donate, any amount will bring us closer to the goal of keeping my mom alive.

I understand if you can’t donate, but please share this message with people who you think can help, either financially or by pointing us to people who have had a similar experience and can help with procedures and logistics.

I urge you to gather your resources as I am gathering mine. Thank you for reading this.

In solidarity,

Catherine Moughalian

If you have means of helping other than donations please contact me:

catherine.moughalian@gmail.com 961 3 098 817

This is Aleppo: In A World Where Doctors Have Become Martyrs & Hospitals Battlegrounds

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Tucked in the lower floor of a building was Al-Quds hospital in Aleppo, Syria, a small 34 bed facility in the Sukkari neighborhood. Its windows and entrance were fortified with mostly sandbags for extra protection despite the many buildings around it that, in theory, protected it from being attacked.

The hospital was not a rebel-run hospital, despite it existing in a rebel-controlled neighborhood. It was a Médecins Sans Frontières (Doctors Without Borders) and International Red Cross affiliated institution with an emergency room and an 8 bed pediatrics ward. It was as fully equipped as a hospital in times of war could be.

In the rules of warfare, horrifying as such a notion’s existence is, and as dictated by multiple conventions, notably the Geneva ones, attacks on medical institutions by any side of a conflict is considered a severe violation.

A few hours ago, a fighter jet, flying at low altitude, charged a missile through Al-Quds hospital, to the background of a Syrian citizen being killed every 25 minutes over the past 48 hours.

The jet in question was commissioned by the conjoined Assad-Putin forces trying to reclaim their hegemony over Syria, despite what some anti-resistance news outlets would want you to believe, with them taking videos of the government forces attacking and portraying them as resistance fighters doing so.

The above picture is that of Dr. Muhammad Waseem Maaz. He was a man who spent most of his adult life finishing medical school, and then specializing in pediatrics, before spending his days doing the most self-less thing that any man, especially a physician could do, leave his family behind in Turkey while he helped the ailing children in Aleppo. Al-Quds was the hospital where he worked. Aleppo was the city he called home, the city that is now being ravaged by regime forces. He was the last pediatrician in Aleppo.

As regime fighter jets attacked his hospital head on, Dr. Maaz did not run for his life. He ran to the incubators to try and save as many lives as he could. His life was not one of those that made it out of that building alive, along with 27 others.

His death is not a number. Dr. Maaz’s murder is a war crime, plane and simple. The more horrifying part is that this is not a lone event. His death is one of the most worrying trends of the Syrian Civil War, and conflicts of the 21st century. It’s becoming a trend.

In Syria alone, 654 medical personnel have been killed until September 2015, according to the UN, and, in the past year alone, 7 attacks have been reported by MSF against its facilities in the country.

Syria is not the only place where attacks against hospitals and doctors occur. All sides have been attacking healthcare workers and instutions: rebels, armed groups, and governments.

A few months ago, American military led a 30 minute barrage on an MSF-led hospital which they believed to be a Taliban HQ. They killed 42 people. They justified themselves as it being an “intelligence error.” Intelligence must have come a long way not to be able to differentiate between a hospital and a terrorist haven.

MSF reports their hospitals sustaining 106 attacks in 2015, with the loss of countless lives as well as extremely valuable equipment that is, for thousands and hundreds of thousands, the only difference between life and death.

The most dangerous aspect in such attacks is that they’ve begun to be considered as normal, not as a war anomaly, setting a war precedence into them becoming not only more “mainstream” in conflict, but also more deadly and more unchecked.

The more threatened doctors are, the less they will be willing to work in those areas that require them the most. It’s already started. Over 60% of Syrian areas, for instance, have no possibility to access any

We are doctors, not martyr projects. We work at hospitals, not battle ground sites. We save lives, regardless of who those lives belong to, irrespective of green lines and battle sides. Our lives are not worthier than others, that’s for sure, but us dying because of horrifying war crimes in which we are targets means the lives of those who are equally worthy of saving are lost forever.

We are doctors, not martyrs. We promise to go to the extreme of what we can to save anyone who can be saved. Dr. Maaz was one of those doctors who did just that. The hundreds of MSF doctors who have been killed over the past years have also been doing just that. When did medicine become open season? When did the act of warfare become one that plays out in surgical theaters and in pediatric incubators?

Everyone is at fault. The Assad regime was the culprit in this case, but this is something that everyone is doing. The targeting of healthcare personnel cannot be normalized. In a world where war is everyone’s favorite pastime, certain entities should always remain off limits. These are doctors, not martyrs. They save lives without asking for theirs to be saved. Don’t make them need to.

Aleppo is dying. Aleppo is bleeding. With labels such as “humanitarian disaster” becoming way too common, one cannot but wonder: what is causing this particular disaster? It’s not an earthquake. It’s not a natural disaster. It’s missiles, and terrorist regimes, and armed factions and other men who know no morality. The murder of people just because they exist, the targeting of hospitals just because they are, the killing of doctors just because they are doing their job is not a humanitarian disaster. It’s a war crime. Call it as such.

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.

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.

 

When Lebanese People Cannot Afford Hospitals

Hospitals have a way of desensitizing you. They overwhelm you so much that shutting off that part of you that is forced to care all the time is the only way possible at coping. And no, I’m not talking about medicine.

There’s a lot to be said about the state of healthcare in Lebanon. I’ve seen some aspects of it. The numbers behind it are all over the place. But no matter how those numbers are shuffled, you are left with almost 1 million or so Lebanese, in a best case scenario, that are not covered in any way or another and are forced to withstand the pressure of Lebanon’s increasingly costly medicine on their own.

Many crumble under that pressure and figure that dying is simply better than getting overwhelmed with debts or simply getting a hospital’s door slammed in your face.

There are a lot of stories to tell. They happen at a lot of the country’s hospitals. I’ve heard of a well-known hospital that wouldn’t take in a 2 month old patient because his parents couldn’t afford to pay down the required deposit for his surgery. I’ve seen old people who have no one left and nothing left to pay for the simplest of blood tests. I’ve seen exorbitant prices for surgeries, some of them possibly warranted given their complexity, that cannot be afforded by 99% of the Lebanese population.

Perhaps Lebanese hospitals focus on the business part of their affairs much more than they should. But are they to blame? They need to run their facilities, pay their employees and still make enough profit to constantly improve their brand of medicine seeing as Lebanese medicine is so specified that not having the latest it-machine at your facility means you’ve fallen behind the times. The people who can pay simply hospital-shop and go to the one with the newest toy, newest hotshot doctor….

Should they provide such highly costly services for free and then not be able to run themselves anymore?

A lot of patients cannot afford healthcare in Lebanon. Insurance companies make sure to screw you whenever they can. The Lebanese ministry of health has a limited budget that is allocated in an even more limited way and benefits mostly those who know someone who knows the minister more than those who actually need something. Many of the people who can afford insurance, for instance, simply do not buy it because they have good enough connections not to pay while those who cannot afford insurance rot at hospital doors.
The national social security fund is not really national and hospitals find themselves in financial problems because of it more often than not and decide to relegate patients who present with that form of coverage into the “we don’t have a place for you bin.”

What does a Lebanese person have to do to receive one of his fundamental human rights? I guess they can just die in a state that couldn’t care less. Many of you probably don’t give this a second thought but it’s time you do. If you can afford insurance, go and buy one as soon as you can. If you can get enrolled in the National Social Security Fund, make sure you do so as well. If you can find any possible means of coverage for you and your loved ones, seek it. There’s no better investment.

After all, we live in a place that is so behind the times that talk about universal healthcare is light years from becoming mainstream enough and where our grandparents’ fate is to get people to feel sorry enough for them to raise money for them to do their blood tests.

I wish I could tell all the stories that I have to tell. Maybe someday.