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.

 

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How The New 50,000 Summarizes Lebanon

20131115-184534.jpgCome on people, is there anything more suitable than that 50,000 to describe the state of Lebanon lately? If anything, we should look at this positively: it might be the first time ever that those in charge of running things are aware of how dismal they have made things to be, even if only with a representative bill. And they have decided to describe things. Here’s an attempt to explain what went on with their brains.

All Those Festivities:

I really don’t know what’s special about the number 70 for it to warrant an honorary bill. Why not 71? Even better, why not 69? I’m positive that number means much more to so many Lebanese than simply 70. Zeros are so overrated if you ask me. Yet again, our currency has so many of them.

I guess we have always been a country to celebrate whenever we had the opportunity. Oh, look – can we turn this into a festivity? Sure, why not, let’s do it!

Identity Crisis:

One look at that bill and the entirety of our Lebanese existence is summarized in front of you with the monetary version of our infamous “hi, kifak, ca va.” Arabic, French and even a word of English thrown in there by mistake is the perfect summary of how this country is: lost in translation, unaware of what it wants to be or what it is.

Let’s stick to our frenchiness would say the people who only know the ca va to every kifak. Except we barely know how to speak French lately as is evident by that hilariously shameful typo on the bill. Side note, is there any other country with a typo on their bills, regardless of what that typo is?

No, let’s move on to English man. That is where the future is. Never. We are Arabs. Mutliple personality disorder, perhaps? Who cares, it’s unique.

Inefficiency:

Let’s leave the fact that the new 50,000 will still be big enough for you to use as a picnic mattress. Shouldn’t they resize all our money into something that fits in normal wallets before redesigning the bills at every possible opportunity?

Anyway, I’d hate to think our bills can get less efficient than they are. There are just so many zeros there and they’re as useless as they come. That 50,000 bill is so inefficient that it cannot afford you a burger at Roadster’s anymore.

Inefficient… I like it.

Blame others:

Our central bank head decided to blame the British company that printed the bill for the fiasco. Typical, I guess. Let’s always blame others for our mistake, as long as it makes us feel better about ourselves and about the messes we keep finding ourselves in. We get into a war, we blame some mysterious entity. Our economy goes to the trash, we blame some other mysterious entity. Our 50,000 gets a tasteless makeover? Let’s blame the company that printed it, not the Lebanese who must have overseen the design (or lack thereof) process, the Lebanese who did not notice the mistakes and the people with a horrendous taste who OK’ed it.

Intact Joie de Vivre:

But no worries, ladies and gentlemen, our Joie de Vivre is still well-represented in that bill. Our love of life, love for drinks and parties and getting high is well defined within those mutliple colors that fill that monetary canvas. Pretty nifty, eh?

Lebanon, summarized:

Unless you’ve been living under a rock, you can’t but notice that Lebanon has been on a downward spiral lately. Culture is dying, sometimes at the hands of the ministry of culture. Fundamentalism is rising across the board. The country is losing whatever it has of itself with each passing day. Looking at all of that, our new bill cannot but stand and shout that infamous line: shou we2fet 3laye?

Our country is the gift that keeps on giving. Can you imagine living somewhere where life was boring? What would we blog about? When it comes to that 50,000 bill I have to ask: why not use it as our national flag instead?

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.

Ahmad el Assir’s Money Sources

I recently read an article about the financial means of Sunni extremist cleric Ahmad el Assir. After all, those weapons (that he doesn’t have) and the growing support he is garnering are not coming out of nowhere, despite his support arguably remaining very minimal across Lebanon, even among Sunnis despite what many want you to believe.

The article in question talks about where Mr. Al Assir is getting his money and the list is the following:

  • Qatar with input reaching the hundreds of thousands of dollars, through Beirut’s international airport and under the coverage of a member in the Lebanese cabinet. I want to know who.
  • Fadel Shaker. I regret buying that sporadic album I gave my mom on Mother’s Day way back when Fadel Shaker filmed music videos about love and with women.
  • Rashed Shaaban, owner of “Amir Rashed” restaurant and the uncle of one of the Islamists apprehended as a suspect in the assassination of Francois el Hajj.
  • The infamous “Kaak Abou Arab” shops.
  • Shawarma Abu Bahij in Saida
  • There are other sources which you can check at the link but these are the ones that seem familiar to me.

    Ahmad el Assir’s phenomenon isn’t “unusual” given the current situation in Lebanon. It doesn’t mean that this phenomenon is acceptable and I, for one, won’t support it in any way, even indirectly.

    That’s not to say those that those Al Assir speaks out against are better. They’re more dangerous than what he will ever become and he’s an irrelevant entity in comparison. But isn’t that how they all begin?

    I can’t do anything about Qatar. They have so much money they’re about to start using it as toilet paper. But I can stop going to Kaak Abou Arab and do what I can, 1000LL at a time.

    Zaitunay Bay is NOT Closing Down

    After posting news that Zaitunay Bay might be closing down because the shops and restaurants in it can’t pay their rent anymore, I was tweeted by Zaitunay Bay’s account to let me know the news is entirely false.

    Moreover, it seems that Solidere is not allowed to make such statements as it’s not the owning company of Zaitunay Bay. The company in question is BWD, Beirut Waterfront Development.

    Here are the tweets in question:

    Zaitunay Bay Closing - 1

    Zaitunay Bay Closing - 2However, I believe that the closing news may not be coming out of nowhere. As they say, there’s no smoke without fire. So perhaps Zaitunay Bay should really anticipate repercussions from the dismal state of the economy and lower the rent on its tenants, at least until these tough times blow through. Making less money transiently is better than not making money at all.

     

     

     

    The Allure Of Free

    There’s a response that is, I believe, inherent to human nature, transcending boundaries – almost unanimous. And it is the response to something that is free.

    If I tell you I’m willing to give you something for free, what would be the first thing that comes to your head? Yes, there it is… “What’s the catch?” And what do you do? You don’t take the thing.

    My cousin was telling me earlier today about her dilemma in Australia. She works at a leading TV station and is often given tickets to movie premieres. We’re talking about the star-studded events, involving red carpets and bling, not the excitement we feel when we watch the first screening of a movie on its release day. And more often than not, she can’t go to those premieres so she usually asks around if someone wants those tickets, only discovering that giving this tickets away for nothing is harder than her actual job.

    And it happened to me when I was at AUB outdoors. There was some guy offering free hugs and the moment I saw him, the second idea the crossed my mind (the first one being how weird it was) was that there was definitely a catch somehow in those hugs.

    But why do we have such a response to free stuff? Why is it that most people would take the premiere tickets from my cousin if she had asked for an insignificant amount of money but refrain from doing so if she was handing them for nothing in return?

    Our mentality is apparently wired to go away from things that are too good to be true. Even for things that are not totally free. If you find a bargain online, you are as skeptical.
    But in the world of today, do not underestimate the power of “free.” I am most definitely not an economy expert but with most things getting cheaper and cheaper because of competition, offering things for free has become a way for some companies to topple others. Offering things for free is also a way for those companies to introduce services.

    When I started buying stuff off amazon, I was offered a free trial of “amazon prime” in their attempt to hook me on speedier deliveries. And if I had been living in the US, I would have totally gone for it. Amazon redid a similar thing with Lady Gaga’s latest album: they sold the mp3 version for $0.99 along with a free trial of their newly introduced “cloud” service, as a way to get ahead of Apple before they introduce their own version of cloud services, probably later this year.

    According to Chris Anderson, “free” is the future of prices. He wrote his book Free: The Future of a Radical Price on a $250 netbook, running a free version of Linux, free Google Docs, which offer him free backup and on-the-go access and then he offered the work for free on iTunes. He argues that billion dollar industries are being formed today around the price of “zero dollars and zero cents.” And if you think about it, isn’t Google one of the leading companies in the world today and it gives almost everything for free? So don’t freak out when you’re offered something for free. Odds are, someone, somewhere, is making money off of it somehow – with no catch to you.

    This Is What A Trillion Dollars Looks Like

    During our scholastic years, we were taught that a zero is a bad grade to get, right? And we’ve all panicked nights and days over exams that we hadn’t studied well for (and yet, we all leave ourselves till the last possible  minute in order to study, every single time).

    However, with age (some age, others mature, right?), you get to know that the more zeros you have, the better. Especially when it comes to dollar bills.

    For those who don’t know, a trillion has twelve zeros. A billion has nine. So a friend sent me these pictures online to come to grasp with the US national debt. I decided to incorporate the Lebanese national debt in this as well.

    Let’s start with $100, the largest US denomination in circulation. We’ve all seen it, not many of us have owned it.

    A packet of 100 $100 bills is about 1.5 cm thick and makes up $10000.

    Now the “little” pile of money next to the man is, believe it or not, $1,000,000. That’s more money than most of us will ever make in our lifetime.

    A $100,000,000 pile, however, looks more impressive, right? Yeah, keep dreaming (or drooling). But we’re not done yet.

    Now add together ten of those precious previous piles, and you get $1 billion. Now imagine the below picture multiplied by 50 and you have the Lebanese national debt.

    But even after the 50x multiplication, you’re not even close to $1 trillion. Why’s that? because you are literally rendered insignificant compared to it. This is what $1 trillion looks like.

    The US national debt is $14 trillion. Enough said, right?