American Univesity of Beirut

Crisis mode

​​​September 27, 2021​​

On August 14th, AUBMC made an urgent appeal. If the hospital didn’t receive fuel supplies immediately, its generators would grind to halt and patients relying on life support machines would die. “No one believed we would make it,” says AUBMC Medical Director Joseph Otayek. “But we made the appeal and the government reacted.”

At time of writing, AUBMC has eight days’ worth of diesel fuel. The government has allowed the medical center, along with hospitals and bakeries around the country, to continue to purchase fuel at the subsidized rate. While the imminent danger has passed, the threat of another crisis looms on the horizon.

For the center’s staff, now forced to purchase fuel at higher rates, the commute has become not only more expensive but time-consuming. The difficult logistical and financial conditions have led to a hemorrhaging of physicians and nurses; Otayek estimates that more than 20 percent of non-administrative staff have left AUBMC.

And yet, AUBMC is finding workarounds. “Today. We launched a private bus service to allow our staff to reach the hospital without spending hours at the petrol stations.” The Medical Center also rolled out a Medico-social support fund for staff facing financial hardship.

Above all, Otayek and the leadership team at AUBMC recognize the importance of flexibility when it comes to running a medical center at a time when basic infrastructure appears fragile, just as likely to vanish as to reappear in new makeshift form. And so, in line with the social narrative writ large, AUBMC is having to fill-in where necessary. “There was no official bus service, so we created our own. We have to be very creative, to think out of the box, to find new solutions every day.”

Another pressing challenge, right alongside electricity and staff retention, is sourcing medical supplies. AUBMC estimates that 25 percent of the 3,307 items it has identified as critical—items like cancer drugs, sutures, anesthetics—are no longer available for purchase in Lebanon, as the Central Bank is no longer releasing below market rate dollars to medical importers. “They’re simply out of the market,” Otayek says.

This shortage is reflected in the falling vaccination rate of newborns nationwide for diseases like polio, from 89 percent in 2020 to 45 percent in 2021 thus far, with similar figures at AUBMC.

“At AUBMC, we advocate breastfeeding, but for some children with growth problems, we prescribe formula, except there’s a shortage, and whatever’s available is very expensive.” Then there’s the contrast ingested by patients to make their CT scans legible. “It’s running out, so we’re only scanning the most critical patients.”

Yet rather than cut the red tape, the Ministry of Health has added more. “If you want to import medical supplies, you must obtain pre-approval and approval when you see the goods.” Meanwhile, vaccines sourced and funded through UNICEF are stuck in customs.

And again, AUBMC is trying to find workarounds, some more sustainable than others, while avoiding black market medicine. “We’re contacting manufacturers to import from them directly.” But that requires obtaining dollars at market prices, exchanging them, paying full price for the medicines, then turning around and charging patients at the official, subsidized rate.

In other words, the subsidy is coming from AUBMC. And while some suppliers have made donations, they only cover around 2 percent of AUBMC’s needs. “It’s not sustainable.”

Ultimately, in the face of challenges too vast to enumerate, AUBMC leadership has adopted a resistance mindset. “Our decision is to continue to operate the way we think we should, which means continuing to provide the highest level of care possible,” he says. To that end, AUBMC has still managed to secure its most important medical accreditations from American and international accrediting bodies and to provide top-quality care for its patients.

The problems, Otayek says, are too big for AUBMC and must be resolved at the level of government, which is where he feels the diaspora can be most helpful. “Collecting and sending pharmaceuticals is nice, but what they can really do to help is to find ways to pressure the government to act.”


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