BEIRUT: Lamis stands next to the fifth-floor window of her hospital room, looking out over the playground of a school in Beirut’s Al-Tariq al-Jadideh neighborhood.
Unable to move far from her bed because of the intravenous drip in her wrist, the 32-year-old adjusts her neatly tied hijab as she speaks of the difficulties she faced in securing funding for the bone-marrow transplant she needs to treat her lymphoma.
Before beginning her treatment at Makassed General Hospital, she had to go through another battle: to obtain the necessary funding. Of the thousands of dollars she needed, she says, “I only had a very small amount. It was impossible.”
Dr. Ahmad Ibrahim is the director of the hospital’s bone-marrow transplant center, the first of its kind in Lebanon, which was founded in 1997 in collaboration with the Paris-based Institut Gustave Roussy, a leading European cancer center. Ibrahim’s not-for-profit program has become one of the leading units of its kind in Lebanon and the region, and continues to pioneer innovative techniques.
Lamis’ treatment, for instance, is a radical new lymphoma treatment called T-cell protocol. According to Ibrahim, his center is the only one in the region that currently performs the procedure.
The center’s experience and facilities mean that 40 percent of its patients are referred from other health care institutions around the country, says Arabia Osseiran, director of marketing for the Makassed Philanthropic Islamic Association, which owns and runs the hospital.
The hospital’s main barrier to providing treatment for its patients is financial. Autologous transplants, those that use the patient’s own stem cells that are harvested before a damaging therapy such as chemotherapy or radiation, can cost $35,000. Allogeneic transplants, which involve taking cells from a donor, are more complex and high-risk, and can carry a cost of $75,000-$80,000.
Even if a patient foots just a fraction of the cost, “it’s still [a] very heavy [burden] for the majority of patients here in Lebanon,” Dr. Ali Youssef, head of division for the hospital’s hematology and oncology department, tells The Daily Star.
To make up the difference, many patients rely on a variety of funders: Some may receive a degree of financial assistance from the Health Ministry, private insurers, NGOs or philanthropic associations.
It’s “a kind of soup,” Ibrahim says. This “soup” frequently leads to delays for patients, and invariably causes headaches and leads to extra bureaucratic hurdles for the medical team as it tries to negotiate with patients’ different funding providers.
Such delays put the health of many patients at risk, Ibrahim says. “You could have a relapse of the disease, you could have a complication, you could have a deviation.”
Half of the approximately $35,000 Lamis needed for her treatment was provided by the Health Ministry. “The remaining amount I couldn’t pay,” she remembers, as she was able to foot only $6,000 of the bill herself. She had to approach a number of NGOs and religious organizations to make up most of the difference, which delayed her treatment by a number of months.
Some poorer patients can rely heavily on religious organizations: Ibrahim mentioned one political group that manages to procure funding for all of its members or affiliates, and then refers them to Makassed. Those without such wealthy patrons, like Lamis, are forced to seek alternative sources of funding.
Both Ibrahim and Youssef advocate a single-payer health care solution to overcome the issues presented by Lebanon’s soup of health care providers, but Ibrahim acknowledged that such a notion was “impossible” in the current political-economic climate.
George Akoury, an adviser to the health minister, says that while the ministry would wholeheartedly endorse the need for greater coverage, a fundamental problem remains: “There are no finances.”
With little chance of an increase in funding from the government for less privileged patients, Makassed is looking elsewhere. “What we are trying to do until the situation of the health system in Lebanon improves is to try and secure financial resources for the patients,” Osseiran says.
In this vein, the Makassed Association is holding a fundraising dinner Saturday evening at the Four Seasons Hotel, set to be attended by 500 guests, and the funds raised will go toward assisting vulnerable cancer patients at the hospital.
Ibrahim hopes that in the future, his patients’ background will not be a factor in his ability to provide treatment for them.
“What is important is not to think like this,” he says. “It is to think, [these patients] are ... to be treated as Lebanese with dignity.”