Tag Archives: Medicine

In The Lebanese Jungle, (El Jamal) Nader (Wa) Saab Can Practice “Medicine” … While Laws Look Away

When I graduated from medical school about two years ago, the most important part of the Hyppocratic Oath that we took was to “do no harm.” It’s our moral and legal obligation as doctors to do the most that we can to improve our patients’ health, while making sure that our work does not prove to be at the detriment of their health and, even worse, constitute us taking advantage of them to increase our bottom line.

Farah Kassab was a 32 year old Iraqi-Jordanian mother of two, previously healthy contrary to the rumors trying to defend the surgeon who killed her, who presented to (El Jamal) Nader (Wa) Saab’s clinic, by virtue of the ads he has inundated the country and its airline carrier with, to do a procedure that would help her lose weight. It wouldn’t have been considered an expensive plastic surgery: an injection to her stomach area that would regulate the amount of food she could eat.

Instead, Saab worked at convincing Farah Kassab that she needed to do liposuctions to her entire body in order to reach the figure she wanted, along with an eyebrow lift and a rhinoplasty. Saab took advantage of a woman who sought the care of a physician hoping he had her best interest at heart, and managed to convince her to sign on to a drastic procedure that would cost her north of $50,000 and involve more than 4-5 hours of operational work.

Later on, (El Jamal) Nader (Wa) Saab started operating on Farah. 19 injections later, the 32 year old suffered a rare complication that usually occurs when patients suffer fractures in some of their long bones, but has been shown to exist in liposuctions, especially when they’re as massive volume as hers: a fat embolism.

Essentially, fat tissue that gathers together travels through the patient’s vessels and targets multiple organs, the most dangerous of which is the lungs which could lead to death especially when the patient in question is not in an equipped hospital to deal with such things.

Of course, (El Jamal) Nader (Wa) Saab’s hospital was not equipped to deal with any of the complications that arise of his surgeries. His hospital did not have the facilities needed to monitor patients post operation to manage any arising complications. Farah was transferred back to her room. Soon enough, she became a frigid body whose mother had to frantically shout for the medical crew to come give her attention. Farah had passed away.

Instead of taking the blame, (El Jamal) Nader (Wa) Saab proceeded to do what he does best: bend the system that he’s been bending for years to his advantage. He contacted his friend who works at Notre Dame du Liban hospital and they agreed to transfer Farah to that hospital and make it look like she died there, while issuing official death certificates with that information.

His friend agreed, but their plan did not go as planned when Farah’s family found out what happened with her forcing the other hospital to admit they received the patient already dead, according to Arabic news site Ammon News.

(El Jamal) Nader (Wa) Saab has since fled to Cyprus, and his hospital has been closed down.

If there’s anything for you to wish in life, especially if you live in Lebanon, it’s for a wasta that’s as strong as consistent as the one (El Jamal) Nader (Wa) Saab has enjoyed over the years.

Facing recurrent suspensions from the Lebanese Order of Physicians because of him breaking their law that forbids physicians from advertising for themselves (Al jamal Nader wa Saab), he should have not been legally allowed to practice medicine in the country, especially on such a high level. And yet, he did.

In fact, he faced suspensions from the Lebanese Order of Physicians for the past five years, including one for 6 months, as well as a one month legal ban from pursuing what he calls “medicine.” He was still brought back to the frontline, in the full sight of the Lebanese government, without anyone addressing it, and not even with a higher level of vigilance from concerned authorities.

(El Jamal) Nader (Wa) Saab has been banned by more than one Arab country already from practicing his brand of medicine there, including the U.A.E, K.S.A and Kuwait. The reason for those bans are not perfectly clear, but even then he was still allowed to practice medicine in Lebanon with full liberty.

Farah Kassab isn’t the first victim of (El Jamal) Nader (Wa) Saab, albeit she’s the first one to have died because of his negligence. The patients we’ve seen who have presented to clinics for other reasons with massively botched operations at his hands are recurrent, and have always found deaf ears in any governmental function they pursued. Refer to the insurmountable wasta that allows him to do so. He has already harmed a Jordanian woman before as he operated on one in his hotel room in Amman. He was still allowed to practice here afterwards.

For a hospital doing such high level surgeries, the Lebanese government, especially through the Ministry of Health, should have made sure that the minimum required facilities to monitor patients post-op and to manage any arising complications that occur is there. How could they allow operations with general anesthesia to occur without high level of pre and post op monitoring?

With (El Jamal) Nader (Wa) Saab’s hospital, high profile as it is, they did not. In fact, his center getting the hospital label occurred through a governmental decree without passing through the necessary regulatory bodies, as per LBC, and without it being part of the Lebanese syndicate of hospitals which would have oversight over regulation.

Of course, his hospital is not the only lacking one in the country, but his hospital is not one that exists in the middle of nowhere and whose shortage in facilities is because our government doesn’t have the capacity to provide them. A physician such as him was allowed to operate a plastic surgery hospital without the minimum requirements to operate it in in the first place in full sight of the law.

How can a hospital based on surgical procedures not have any post-op monitoring? How is this severe lack of oversight even allowed? Or is our government only capable of banning movies? With no decent hospital, no legal basis to work here, (El Jamal) Nader (Wa) Saab still did surgeries. Why?

How many more of these horrible stories are we supposed to hear, of physicians who give all of us a bad name because they are allowed to practice by a government who doesn’t bother to check and doesn’t listen to the many victims they’ve left in their path over the years?

Today, this 32 year old mother of a four year old girl and a one year old boy exists no more not only because of (El Jamal) Nader (Wa) Saab, but because the Lebanese government in this jungle they call a country has allowed such a creature to not only exist, but to thrive.

A Lebanese Healthcare Milestone: Mental Health Is Now Covered By The Ministry Of Health

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One of the major problems that psychiatry patients in Lebanon face is having their mental health disorders not recognized by any insurance or governmental payment agency, which forces them to foot medical bills that can reach astronomical rates very fast.

There are next to zero insurance companies in the country that cover anything mental health related, even though about a quarter of the Lebanese population can be diagnosed with one mental health disorder or another.

On Friday, as reported by The Daily Star, Minister of Health Ghassan Hasbani announced that his Ministry will now, and for the first time ever in Lebanon, begin to cover mental health under its care plans which are available for all Lebanese citizens.

This isn’t the only accomplishment to be attributed to the Ministry. Hasbani also declared that eight mental health institutes will be created by the ministry for treatment and administration of care, as well as more focused training of professionals in the field.

“The Ministry of Health will begin to cover mental health as part of a comprehensive medical plan, managed by the Primary Health Care Department and supported by the World Bank. We will work on curing it of these issues that can frustrate and cause damage to citizens.”

To say how important such steps are in the Lebanese healthcare sector is not enough. Mental Health has always been considered a taboo in Lebanese society, even if perceptions are ever slowly changing. It hasn’t been a year that we spoke about a young Lebanese girl committing suicide because she had become so clinically depressed and unable to seek help, because such help is not as easy to come by as it should.

This measure by the MoH will save lives, and further improve the level of medical care that we can administer as doctors to our patients in this country, by lessening the fragmentation of care that arises when you have an entire facet of medicine without any form of coverage.

The next step that Minister Hasbani and the ministry should undertake is to reform insurance laws in the country to get insurance companies not to stigmatize mental health, by having them cover it like any normal illness that they’d cover in any circumstance.

I commend the ministry of health for this step, with hope to see more like it from other facets of the Lebanese government. It’s a very important step, and an essential one at that, in our fight against the stigmatization of mental health, as we try to remove it from our long list of Lebanese taboos.

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

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

Lebanon Garbage - 3

In the context of a country with any ounce of self-respect, speaking about a garbage crisis that has been going on since July would not only be old news by now, it would be solved old news. Except we don’t live in a country with an any amount of self-respect, and as such Greater Beirut’s garbage situation is still a topic, albeit less hot, of discussion.

A few months ago, when people were actually interested in the garbage crisis, which is to say when the garbage was visible on their streets and not tucked away in some valley somewhere or in a makeshift pyramid near the port, I wrote an article on this blog (link) about the health risks that the crisis might involve especially with the rain season.

As a very brief summary, in theory the garbage crisis and the many variables around it would cause the following:

  • Many types of bacterial infiltration of the waters,
  • Many heavy metals and other elements-related pollution,
  • Burning it will increase the amount of carcinogens in the air, as well as exacerbate respiratory conditions in people who have pulmonary disease when they have it.

As long term effects, we could be looking at an increased cancer incidence as a study after Italy’s waste management crisis in 2004 showed.

What the garbage crisis is not doing, however, is giving you the flu or other common infections that we encounter yearly.

Over the past few weeks, which happens to be the yearly flu season in Lebanon, everyone and their mother decided that whenever they got sick, it was because of the garbage crisis in Beirut. H1N1 – or as it’s more commonly known in the country now H1 and 1 – has become so commonly associated with the garbage crisis that the scientific community is probably considering whether to reconsider all the details surrounding H1N1 altogether.

We’ve also heard about “new” viruses attacking the country, such as metapneumovirus B, causing severe respiratory diseases.

This is, quite simply, incorrect.

For starters, metapneumovirus B is not a new virus. It’s been known for at least 40 years now and is actually one of the leading causes of respiratory infections in children worldwide. Lebanon has had this virus before, and it gets treated the same way we treat most viral infections: address the symptoms and provide the patient relief while their ailment resolves.

The case illustrated in this eTobb article (link) about a 25 year old who had a devastating respiratory infection secondary to the aforementioned virus remains, as it stands, a case that fell through the cracks of medicine in the sense that some people will get complications from common infections and we have no way to predict who would be the victim of such complications.

When it comes to H1N1, this is the current state worldwide:

Outbreaks are being reported in Bulgaria, Canada, Ireland, Ethiopia, Pakistan, etc. What do these countries have in common? Nothing, which is precisely the point.

Every year, the world is swept up by a strain of the Influenza virus which, when a person infected, gives them what is referred to as the flu: runny nose, sore throat, sneezing, fatigue, feeling pain all over your body for a few days, etc…. These symptoms usually resolve in a few days and you’re off on your merry way to health.

Some people may also be infected and not show any symptoms. The way this occurs is in sort of a pyramid fashion:

Assume 100,000 people in Lebanon got infected this year. 10,000 of those would show symptoms of the flu. Out of those 10,000 maybe around 100 would require hospitalization. And out of those 100 that needed hospitalization, 1 might die because of complications.

The garbage crisis overtaking Beirut has nothing to do with this. This will happen again next year, with or without a garbage crisis, and it will also happen the year after as it also took place in the years prior. Having a new shiny ribbon of erroneous but appealing explanation to wrap this whole thing with won’t make it go away. People are getting sick all over Lebanese territories simply because this is an infectious disease, not a garbage-related disease; the garbage does not cause H1N1 or the flu. It’s really that simple.

At this rate, getting the first case of Zika virus infection in this country will also be attributed to the garbage.

Therefore, I’m sorry to say that the answer to your question “how did I get sick” is simply “this is how things are,” and not “it’s the garbage that’s killing you.”

You can, however, protect yourself by practicing as much hygiene as possible. Thorough hand-washing is key to prevent the transmission of the influenza virus. Avoid sick contacts if you can. If you’re sick, don’t be a jerk and go around contacting others. Don’t trust your local pharmacist to start you on Tavanic or Klacid or whatever other medication he feels like giving you. This is a virus and antibiotics don’t work. Rest as much as you can, you’ll get better in a few days.

 

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.