Palliative Care in Lebanon

by Dr. Maha Kassem

My journey as a palliative care physician started when I always questioned myself, ‘what is it that I can do to improve patient’s quality of life, increase their comfort, preserve their dignity and meet their self-image expectations at end of life? I transformed my career and became a palliative care physician in a hospital and charity setting. I have promised myself to make every day count for each patient and provide the needed palliative care for patients and caregivers. From a medical and ethical perspective, every person has the right to live and die with dignity. I started the journey and faced the bitter and the sweet. I set myself on a path to implement and improve palliative care in Lebanon.

I was delighted when approached by PallCHASE to write about my experience as a practising palliative care physician in Lebanon. Lebanon is suffering from humanitarian, economical, and political crises. During the previous two years, the population of Lebanon have lived through the Beirut port blast (4th August, 2021 ‘black day’), inflation, lack of electricity, food, water and medicine.

My path recently has been full of obstacles. I have tried to maintain the same quality of care for patients, but this has been extremely challenging due to the humanitarian crisis here. It is hard to practice palliative care when patients struggle to access medical care and medications. Seventy five percent of the Lebanese population live below the poverty level.

Patients are unable to secure the cost of their pain medications. The economic crisis has affected not only availability but also cost of pain medications, for instance oral opioid price increased from 20$ to 50$ and at a time when a person’s income may be only 50$ per month. Our efforts focus on trying to switch patients to available opioids, rely on donations that we receive as a charity from abroad, and contact suppliers and pharmacies to access analgesia.

We faced so many heart touching scenarios and so many tears are buried inside our eyes or behind a ‘hope’ smile but I will share those two near to my heart. A few days ago, I visited a woman with metastatic lung cancer. She is a single mother to two children and is unemployed. She started on regular sustained release morphine and immediate release morphine for breakthrough pain. Her pain persisted despite this yet we were unable to increase the analgesia as pharmacies will not provide more than one box of sustained release morphine per patient. I remembered the training of my palliative mentor Dr Shamieh; he had recommended ‘increase the immediate release morphine in this case and keep the sustained dose the same’. This worked, and we were able to get her pain under control.

The second story is of a young man with metastatic pancreatic cancer and severe abdominal pain. We were not able to secure morphine for his pain as it was unavailable throughout Lebanon. Fortunately, our charity received a donation of medicines including morphine from France, and we were able to manage his pain.

Even as we try our best under these circumstances, our best does not relieve the pain for all the patients in need.

Dr Maha Kassem is a palliative care physician working with SANAD. SANAD is a home hospice organisation, which was the first organization of this kind in Lebanon , which was founded in 2010. https://sanadhospice.org/ . To support SANAD from outside Lebanon, you can use this link: https://www.actforlebanonusa.org/categories/?cat=b93d3375-fe31-11e9-ad28-001a4a350023#

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