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With life expectancy rising, palliative care a must in Lebanon

Frank Ferris, left, palliative care expert, and Hibah Osman, director of Balsam, speak during an interview with the Daily Star in Beirut, Friday, April 25, 2014. (The Daily Star/Hasan Shaaban)

BEIRUT: Hibah Osman says she doesn’t just help those who are dying. She described a patient with curable cancer at the base of her tongue whose radiation treatment was accompanied with bouts of intense suffering. At times she couldn’t swallow or speak, vomiting because of her chemotherapy, fearful.

“She didn’t want to go through the next two cycles [of chemotherapy] because she was so afraid,” Osman said.

Her organization helped the patient get through the chemotherapy, manage the radiation and make her life more bearable.

“She came through the other end and will probably continue to live for many more years,” she said.

Osman is the director of Balsam, a Lebanese center for palliative care, and also heads a newly established palliative care program at the American University of Beirut. She is also the first licensed palliative care physician in Lebanon.

Palliative care is a relatively new medical discipline, steadily gaining traction in Lebanon. It emphasizes pain relief, especially at the end of a patient’s life.

But its mandate is broader – to alleviate the emotional and spiritual suffering of patients while controlling the pain they endure as a result of an incurable disease.

Helping develop the field is the aim of Frank Ferris’ visit to Lebanon.

Ferris is the director of palliative medicine, research and education at OhioHealth, a large network of hospitals in the U.S., where he works on integrating the discipline into American hospitals.

He has also been working on spreading the discipline globally through a long-running international program.

He visited Beirut first in 2001 to raise awareness of palliative care.

The growth of the field here is considered crucial because of the country’s demographics.

Life expectancy in Lebanon rose to 72 years in 2008. Most people now die of protracted illnesses, including cancer and heart disease, and improvements in medicine mean people are living longer with these illnesses.

The percentage of the Lebanese population over the age of 65 is expected to double in the next 15 years, and many will need help coping with chronic diseases as they age.

Ferris’ latest visit was aimed at raising awareness, introducing training programs, providing advice to government officials on a palliative care draft law in development since 2011, giving recommendations on how it can be funded, and discussing with AUB officials how to expand their budding program.

Ferris said that there was a sea change in Lebanon’s attitude toward the discipline.

For one, officials see the rising costs and pressure on hospitals as the number of people with advanced illnesses rises. But people also want the opportunity to live well in the face of illness.

While 30 years ago a woman with breast cancer that was spreading in her body could be expected to live for one to three years, now she can live up to 10 years with the illness.

“These people are living even with the active disease, but because of the success of modern cancer care, it’s controlled,” Ferris said. “Imagine living with this thing growing in you for 10 years. It’s distressing for people and it’s distressing for families.”

And Lebanon has its own challenges. Many breadwinners now work abroad, loosening the traditional family structure. Illness still carries a stigma, leading to late diagnosis of diseases.

Many families in Lebanon rely on untrained migrant workers to take care of the elderly. And because palliative care is such a new discipline here, there are few physicians and nurses who can fill the void.

Ferris said the first step was to increase awareness of the discipline, spreading it throughout the country and training nurses and doctors.

The recognition of the discipline is also a crucial step, because it could pave the way toward having insurance companies pay for the treatment of elderly patients at home.

The Health Ministry last year recognized palliative care as a medical discipline in Lebanon.

Currently, insurance companies can deny coverage of medicine if the patient is transferred into palliative care, Osman said.

Osman’s organization, Balsam, provides free palliative care at home, where most people prefer to be treated.

Teams include doctors, nurses, even social workers and psychologists. It is entirely donor-funded.

The organization also trains doctors and nurses in the discipline, and has lobbied to have it recognized by the government.

But Ferris said it was important to recognize that palliative care wasn’t just about caring for people who were dying.

Data supports the belief that palliative care, combined with traditional medicine, could help people survive longer. Palliative doctors also help patients deal with the distress of illness, relieve them from pain, preserve their quality of life and negotiate challenging decisions on life and death.

They can also help families deal with loss and suffering. And perhaps more importantly, people no longer feel abandoned.

“If you watch the death of your mother, and it will come, I hate to be ominous but it’s true, you’re also watching the potential of your own death,” Ferris said.

“Will you be fearful of your own experience, or will you come at it with a sense of knowing who to turn to?”

 
A version of this article appeared in the print edition of The Daily Star on April 28, 2014, on page 4.

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Summary

Osman is the director of Balsam, a Lebanese center for palliative care, and also heads a newly established palliative care program at the American University of Beirut. She is also the first licensed palliative care physician in Lebanon.

Palliative care is a relatively new medical discipline, steadily gaining traction in Lebanon.

Ferris said that there was a sea change in Lebanon's attitude toward the discipline.

Because palliative care is such a new discipline here, there are few physicians and nurses who can fill the void.

The Health Ministry last year recognized palliative care as a medical discipline in Lebanon.

Currently, insurance companies can deny coverage of medicine if the patient is transferred into palliative care, Osman said.

Osman's organization, Balsam, provides free palliative care at home, where most people prefer to be treated.

Ferris said it was important to recognize that palliative care wasn't just about caring for people who were dying.

Data supports the belief that palliative care, combined with traditional medicine, could help people survive longer.


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