Tag Archives: Hospitals

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.

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.

Lack of Money Can Cost One Year Old Elie Sadaqa His Life

One year old Elie Sadaqa is suffering from a form of vasculitis – inflammation that affects blood vessels – and his parents, like so many others in Lebanon, cannot afford the medical measures required to save their son’s life.

I don’t have more information on the child’s diagnosis to explain it. LBC had listed it as temporal arteritis – a condition that affects one of the arteries reaching the head – but I notified them that such a diagnosis is unlikely given its age of onset is usually above 50. But exceptions in medicine do exist. They have since changed their wording on their news link.

According to the child’s father, the lack of a medical code for the procedures required to help Elie – a pure bureaucratic measure – means the ministry of public health in the country won’t cover it. I guess they need any excuse not to pay the approximated $150,000 for treatment. Or it could be that Elie Sadaqa simply doesn’t have the required wasta to save his life. Welcome to Lebanon, where your life is contingent upon your connections.

Elie Sadaqa is not a lone case in the country. Lebanon has next to no primary care. Our hospitals are in competition amongst each other and many of them are, as such, so specialized they are borderline unaffordable to people who don’t have insurance, aren’t super rich, or – like Elie’s case – do not belong to the inner circles of the minister of health.

What will happen to Elie Sadaqa? I can tell you that it’ll take some doctor with very, very good intentions to help. It’ll take a hospital who puts aside the business aspect of medicine for a moment. It’ll take a lot of people who are willing to pitch in with whatever means they can afford. The question, though, is what happens to the other Elie Sadaqas whose stories don’t make it to national TV amidst the situation of medicine in Lebanon today?

LBC hasn’t listed a way to help the family so if anyone knows how, let me know. And for those who are interested, I intend to write an article soon detailing why medicine in Lebanon is the way it is. Until then, hopefully Elie Sadaqa finds the ways to grow up, go to school and give joy to his family and friends.