Severe shortcomings in the Lebanese health care system highlight that medical treatment is a fundamental right, not a privilege
At the epicentre of the Middle East’s controversies lies its second smallest country. Lebanon, a mere dot on the map, represents both the epitome of the region, and a break from tradition. Secular, yet a hotbed of religious feuding; westernised, yet intensely proud of its Phoenician heritage; modernised but with electricity that is, at best, sporadic during the summer months. The country is a fusion of extremes at every turn.
I recently had the opportunity to visit the Lebanese capital as part of a medical elective. Having risen from the ashes following the brutal civil war of the 1970s, the capital has reinvented itself as best as it can. And yet remnants of its past remain. There’s just something about Beirut – broken, battered, beautiful. Mosques are heard calling worshippers to prayer, buildings lie bullet-ridden and the pounding night-life of the Christian districts are a world away from the run-down community feel of the southern Muslim suburbs. Never stable, always buzzing; you know it’s a unique place that you’re visiting when health insurance includes coverage against terrorist attacks – and health insurance is something of a big deal.
You can tell a lot about a country from its health system. As Walter Cronkite sagely quipped, “America’s health care system is neither healthy, caring, nor a system.” The UK’s NHS was a remarkable concept at its inception, yet is now vaguely floundering in despair, trying hard to please everyone but being criticized at every turn. And Lebanon? Lebanon’s healthcare was an eye-opener.
Ranging from Hezbollah-run hospitals in the south, to the flashy American and French medical centres of the capital, Lebanese healthcare is privatised and politicised, as fragmented as its eclectic mix of lifestyles, ideals and religions. The country is divided between the very rich, generally living in affluent Christian areas, and the rather less affluent, living the most basic of lives in rural villages. In trying to cater for the two, the Ministry of Public Health has founded 27 state hospitals over the past 20 years. Unfortunately, the majority of these have eventually had to close down. By comparison, Lebanon’s private hospitals number 175, with 14,500 functioning beds compared to the state capacity of 300.
Lebanese citizens must hold very expensive private healthcare insurance, or pay very expensive private healthcare bills. Yet only twenty-seven percent of the population is able to pay for insurance. A certain proportion has their insurance or bills covered by the government or the army. There is a third route: that taken by 58% of the population – no insurance.
The implications of this are far-reaching. Poor public health, limited education in rural areas, and hugely expensive medical bills mean preventable conditions lead to preventable disability and death. Desperate patients seen in ‘probono’ clinics at centres like the American University Hospital, presumably the best in the country, are treated with some derision, whereas the private clinics entertain several clients with more money than sense, paying for a whole consultation to ask one ridiculous question. Certainly, they are more clients than patients; the whole thing is somewhat businesslike.
And what of emergency situations? Generally, if you are taken to a private hospital and found not to have insurance, you will not be treated. The disconnect between need and treatment extends along sectarian lines also; patients are transferred from one hospital to another if they are of the other sect, and a few die during the transit. Healthcare exposes schisms in Lebanese society, where it should be unifying and non-judgmental. Political, sectarian and class struggles are laid bare in the white sterile corridors of both state and private hospitals.
Facts and figures are all very well, but it’s difficult to relate to something until you see it for yourself. It was the personal stories and individual cases that I remembered long after I’d returned. One example particularly stood out for me involving a young boy diagnosed with the rare metabolic syndrome, phenylketonuria, which is very treatable, but very damaging if missed. In the UK, all newborn babies are tested for this through a mandatory test to rule it, and other similar conditions, out. In Lebanon, this test must be paid for. Although cheap, its importance is not impressed upon the public and so for many it presents another avoidable expense. Having not been screened, the boy developed severe symptoms and was finally diagnosed and treated, making remarkable improvement. However, treatment is not cheap. As prices of basic commodities increased and wages declined, the parents, like so many others in their situation, hoped to make a little medication last as long as possible, reducing the dosage and giving it sporadically. The results proved tragic; the child is now left with permanent physical and mental impairment, just one victim of Lebanon’s healthcare system.
Upon returning to the UK, all that went through my mind was ‘thank God for the lack of privatisation here’. At its very essence, the NHS blurs the lines of class and caste, putting everyone on an equal footing once they step through those emergency doors. And that’s how it should be. Where treatment is available, treatment should be given. Health insurance may be a privilege, but healthcare is a fundamental right. Indeed, within the confines of medicine, all men are equal.
The NHS may be falling apart at the seams, it may deserve much of the abuse it gets and it may even be coming to the end of its tether in its current form. But one thing is for certain – it could be far worse. We don’t know how lucky we are.
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Photo Credits: Sarah Jawad