Lebanon’s Healthcare Crisis

DR | 26min
Postproduction script

 

00:00:03,031 Jihad Chihimi: -Hadil? Was it the state electricity or what?

00:00:07,293 Hadil: -I don't know, there's only been power for an hour.

00:00:10,423 Jihad: -Now we have to check the generators...

00:00:14,698 VO: -Jihad Chihimi is on a near impossible task. As operations manager at Beirut's largest public hospital, he struggles with daily power outages and shortages of just about everything.

00:00:28,438 Jihad: -You see many problems. What can I do? I have to fight every day.

00:00:35,978 VO: Lebanon's healthcare systems - once the best in the Middle East - is suffering from the deep economic crisis the country is currently in.

00:00:45,126 Roula Itani: -It's the last ampoule available in the hospital right now. I hope he doesn't get worse. The mortality and morbidity is affected now and this is high alert.

00:00:56,696 Patient: -Give me some painkillers.

00:01:01,146 VO: -We visited the staff of Rafik Hariri University Hospital and followed two of the staff on what they call an ordinary working day.

1’21 Beirut, Lebanon

00:01:26,833 Jihad: -So now I have to prepare coffee. I'm lucky because I have a solar power system. So I save gas, I start to boil water in the kettle, because I get energy from the sun, so I save gas. You see, you have to arrange and manage yourself.

1’38 Jihad Chihimi, Operations manager

00:01:49,432 VO: -Just a few years ago, Jihad Chihimi and his family belonged to the upper middle class in Lebanon, but now they have to scrimp on even the most basic items.

00:02:00,032 Jihad: -It's very difficult. I work, my wife also works. My son, my daughter... there are four of us working in the house. Before it was very good, but now it is very bad, how can I explain it... you try to save money every day. Now they are talking about the crisis. This is from the hospital. I have to follow up on everything from my house. Every ten minutes there is a problem. I have problems every hour. I have to make one call, just one minute please.

00:02:50,949 Jihad on phone: Good morning Ali. How is everything? Yes, they're the ones who have to fix it. You're right. Because there is no electricity, you have to...

00:03:17,288 Jihad: I bought this car four years ago before the inflation. For 2,000 dollars. For that I am lucky. Now I cannot buy any car. I can't buy anything. If you have a problem in the wheel for example, or anything in the car, you have to pay 'fresh dollars', that means you spend your salary only on one problem.

3’54 Beirut, 1973

00:03:56,084 VO: -Beirut was once known as the Paris of the Middle East. Throughout the 60s and 70s, the European jet set travelled to the city to cut loose. It was a melting pot of a city that could offer it all. But in 1975, civil war broke out and split the country. Around 150,000 people died. From 2011, the war in neighbouring Syria sent over a million refugees across its borders. This put severe pressure on Lebanon, with just 5 million inhabitants. Today, it is the Lebanese themselves who are fleeing due to a deep economic crisis that began in earnest in 2019 after years of corrupt politicians and mismanagement in the country.

4’26 November 2013

00:04:50,150 Jihad: -You see the rubbish here. Maybe there's a problem with the company that collects the rubbish. Because the company needs fresh dollars, I think. Here is a traffic light not working, you see. This is the situation for every traffic light. No red, no green nothing. You have to be careful.

00:05:20,933 VO: -Portraits adorn the tall lampposts along the harbour road: a reminder of a disaster that exposed the heart of all the problems the country struggles with.

00:05:30,555 Jihad: -These people died in the blast. They say justice for them. More than 200 people died here and 5,000 injured.

00:05:46,939 News report: -Beirut seen from above. Half a city lies in ruins. Its inhabitants are in the midst of an unimaginable tragedy.

00:05:54,987 News report 2: -Disaster strikes at the worst possible time.

00:05:59,449 News report 3: -We know that there were over 2,000 tonnes of highly explosive material here in the harbour behind me, lying there for years without anyone doing anything about it.

00:06:09,183 News report 4: -So for many Lebanese people, this is a classic example for them of what they see as incompetence, a corrupt system that just lets things happen.

00:06:19,234 Jihad: -The blast made the economic situation worse. 18 months later, it's still not renovated. They need money. Any problems today? The CCD's are still not working? Today we have lots of problems with the boiler. It's not been working since this morning. We'll have a look at it and then we'll go to the office to see the maps.

00:07:14,066 Roula: -She has a chest tube because she is on Novotax.

00:07:17,163 Mustafa: -Yes, Novotax and she is post-Covid.

00:07:20,306 VO: In the hospital's emergency room, lead nurse Roula Itani has arrived. A woman has been admitted with very low blood pressure due to a serious infection. And she needs both antibiotics and epinephrine.

00:07:33,642 Roula: -Mustafa, you need livovat. Are you sure they don't have it at the pharmacy?

00:07:40,066 Mustafa: -I asked yesterday and they said no.

00:07:43,142 Roula: -She's a post-Covid patient. She had an infection with Covid. This medication is very important It's maintaining her blood pressure control. If we stop it, she will have hypotension and maybe she will be in shock, so it's really vital for her. What we do if we don't have it, really I don't know.

7’53 Roula Itani, Ward nurse

00:08:09,779 Roula on phone: Good morning, do you have any adrenaline? Ok, no adrenaline, thank you.

00:08:22,810 VO: -The hospital pharmacy hasn't got new supplies, so now Roula Itani and her colleagues have to see if they can get it some other way.

00:08:31,705 Roula to woman: -Good morning. How are you?

00:08:34,390 Woman: -Ok.

00:08:35,408 Roula: -Tell me what's going on.

00:08:37,141 Woman: -I've had a caesarean section.

00:08:41,993 VO: -Out in the emergency room reception area, a woman has come in with her husband and their two-week-old baby. The mother's surgical scar has become infected.

00:08:51,661 Woman: -I'd rather not be hospitalised.

00:08:53,934 Roula: -Let me see what this is about.

00:09:05,026 Woman: -I also want to know how much it would cost.

00:09:07,605 Roula: -We will have to check with the admission, how much they usually charge for it.

00:09:12,695 Woman: -Usually I pay it myself but now I can't pay it again. If I have to be hospitalised again, where do I get the money?

00:09:19,713 Roula to woman: -I will help you.

00:09:24,884 Roula: -If we didn't accept her or receive her, I'm sure there would be no alternative. We leave the patient in our ER, many times on many days just to have a place in the hospital because we don't have an alternative. We cannot send them to a private hospital, where they cannot afford to pay.

00:10:00,555 VO: -Two floors above the emergency room is the cancer ward.

00:10:05,845 Ramzieh: -Hi Salah, all good? Everything fine?

00:10:13,151 VO: -55-year-old Ramzieh Mani sits in room seven, undergoing chemotherapy for lung cancer.

00:10:19,025 Ramzieh: -They've asked for a million, so I still have to pay 500,000.

00:10:28,730 Ramzieh’s husband: -You have to pay before you are discharged?

00:10:32,960 Ramzieh: -I have until Friday they said.

00:10:38,891 Ramzieh’s husband: -A million?

Ramzieh: -Yes.

00:10:43,248 Ramzieh’s husband: -... stupid bastards.

00:10:46,214 Ramzieh: -What can we do?

00:10:47,740 Ramzieh’s husband: -May God help us.

00:10:48,860 Ramzieh: -God bless you, dear.

00:10:52,780 VO: -Ramzieh's husband works as a bus driver and until a few years ago the family was doing fine.

00:10:59,290 Ramzieh: -Before, I used to clean houses, it was fine, thank God. Until I got sick. Then I had to stop. And it all came with the economic crisis. Then everything influenced us. And now we can't afford rent either.

11’02 Ramzieh Mani, Cancer patient

00:11:21,866 VO: -Now Ramzieh's family - like 3 in 4 Lebanese families - lives below the UN poverty line.

00:11:30,803 Zaher: -I'm just preparing the chemo treatment.

00:11:33,776 Ramzieh: -Usually I stay for three days. I came in yesterday, so I will have to stay until Friday. I can't stay longer than that because then I have to pay more.

00:11:48,309 Zaher: -We used to try and help the patients. We often collected among the staff to help patients even with token amounts. But with the situation now, we staff can no longer help with money. We also need to help ourselves.

11’52 Zaher Kaiss, Nurse

00:12:05,725 Jihad: -What do you mean the laundry stopped?

00:12:08,973 Man: -Yes, but now we are trying to fix it to make it work again.

00:12:22,020 Jihad: -Which one was working? That one or that one? If we have no steam, that means we have no work in the laundry. It sterilises the machines and medical equipment, so now you cannot do operations. This will affect the work in the hospital.

00:12:49,572 Reporter: -So it's a huge problem?

00:12:51,320 Jihad: -Yes, it's a big problem.

00:12:53,729 Jihad to receptionist: Hey, how's it going? Is it rejected? No, approved.

00:13:00,185 Jihad: You see, many problems. 2-2-3-7-2-5... Because I have no engineer and supervisor I have to go by myself as you saw in the morning. It's not my job, it's the job of the supervisor and engineer.

00:13:21,947 Jihad on phone: What? Hang on. Bassam, just a minute. Bassam? Hello? What do we need besides 50 metres of cable?

00:13:45,351 VO: -Employee after employee has quit the hospital in recent years, and Jihad has lost 7 out of 10 middle managers in the department.

00:13:54,214 Jihad: -These people left. They got a new, better job. In the Gulf, in Turkey, in some area.

00:14:05,433 Hospital employee: -Ask them what they want us to do.

00:14:10,350 VO: -215,000 Lebanese people have left the country in the past five years.

00:14:16,039 Jihad: -I'm under pressure every day. I work more than 18 hours per day. I cannot sleep every day. I have to take Xanax... Really! To help me sleep. I have to check now the boiler.

00:14:36,883 Jihad to employees: Hey, how's it going? How are the water tanks?

00:14:46,613 Man: -Don't worry, the water tank on the roof is fixed.

00:14:49,560 Jihad: -Anything happening?

00:14:52,525 Laundry employee: -No, we turned this on, but then the generator stalled. So now we only have one.

00:15:02,198 Jihad: -Has it stalled too?

00:15:04,043 Man: -Yeah but the old one in here, it still works.

00:15:07,727 Roula to patient: -Ask for Hassan Issa.

00:15:17,886 Roula: Mustafa, you'd like me to call the family to search for adrenaline and livovat?

00:15:23,374 Mustafa: -Yes please.

00:15:24,677 VO: -In the emergency room, Roula Itani is still struggling to get life-saving medicine to her patient.

00:15:30,743 Roula on the phone: -Good morning. Are you with the patient? We just wanted to check because no one showed up today and we would like to inform you that we couldn't find the medicine she needs. We don't have it here in the hospital. I can't tell you on the phone. Preferably someone would come here to pick up the prescription and search for the medicine outside.

00:15:53,974 VO: -The patient's family must now hunt for the medicine in the city, but the chances are slim and black market prices are sky-high.

00:16:04,417 Roula: -This medication is vital. It's basic. It should be present in every hospital, so the problem we are facing now is really... we don't have the solution of what to do. You know the mortality and the morbidity is affected now. This is high alert.

16’09 Roula Itani, Ward nurse

00:16:25,855 Mustafa: -We really need more hands.

00:16:27,887 Roula: -Should I bring Khodr now? I don't mind.

00:16:29,737 Mustafa: -I told you about it since 11 this morning.

00:16:31,414 Roula: -Why didn't you take the decision?

00:16:34,600 Mustafa: -I was waiting for you to give the ok, so I can tell him.

00:16:37,960 Roula: -Then you have the ok. What's the big deal?

00:16:40,948 Mustafa: -Do you think Khodr will come now, if we call?

00:16:42,830 Roula: -He'll come for an evening shift.

00:16:46,573 Roula on phone: -Khodr, they asked me to call you since 11 but I was busy. It's really crazy here. We need someone, I swear. Come now and leave around 10 or 11.

00:17:02,895 VO: -In the emergency room, seven nurses have quit in the past two months alone. According to WHO, a third of all nurses and 40% of doctors in Lebanon have left the country.

00:17:16,319 Reporter: -If everybody's leaving, what will happen?

00:17:19,425 Roula: -I'm thinking about this, but I don't know the solution. I don't want to imagine this situation.

00:17:32,105 Roula answers phone: ER?

00:17:34,816 VO: -Finally, there's a small silver lining. The hospital vaccination centre has found two packets of epinephrine in their own small warehouse.

00:17:45,197 Roula: -You see it's problem solving all day... and I still have many issues to solve. She's not answering.

00:18:01,238 Roula on phone: Hi Samira, they told me you have the adrenaline. I will send someone to you to get it. Bassima told me. Just keep five ampoules, and the rest has to be for us. Maybe we should find out how to put it in the system.

00:18:29,530 Roula to patient: We got it, it's for today. The quantity is 20 ampoules. But it's a short-term solution. We've got it from another department, but they're the last ampoules available in the hospital right now. Hopefully we will get more tomorrow, but if not... we don't know what to do. That's enough for now, but we have to find a solution.

00:18:55,203 Mustafa: -Thank you.

00:19:05,098 Jihad: -Tape? Go down to May and as if they have any tape. They need tape for the electrical issues. Now there is no storekeeper, there is no supervisor to give him the tape. I have to give him by myself.

00:19:23,586 VO: -The laundry workers have been struggling for a few hours now to get the steam machines working again.

00:19:29,864 Jihad: -Hello Suad.

00:19:31,398 VO: -And now the light is finally shining.

00:19:35,017 Laundry employee: -We observed the barometer of the steam...

00:19:42,137 Jihad: -Which one of them?

00:19:43,727 Laundry employee: -The one that shows the pressure.

00:19:45,669 Jihad: -Which one?

Laundry employee: -The pressure and the steam.

00:19:49,676 Jihad: -Now it starts to rise.

00:19:52,484 Laundry employee: -It must be between three and four...

00:19:56,169 Jihad: -And now it's rising.

00:19:58,687 Man: -Hopefully now it works.

00:20:00,398 Jihad: -Now it works. All of the systems now are working.

00:20:04,863 Reporter: -How do you feel?

00:20:06,269 Jihad: -Happy. How do you want me to feel? Happy. To move to another problem. Ok congratulations. Hopefully it won't happen again. I think the electricity from the government stopped. No power. Hadil? Was it state electricity or what?

00:20:55,454 Hadil: I don't know, there's only been power for an hour.

00:21:00,833 Jihad: Now I have this system.

00:21:05,144 Reporter: -So there's no electricity in the entire hospital right now?

00:21:08,830 Jihad: -Now yes, for a couple of seconds. Now the generator will start now. We have 6 generators here. Now you will see them start one by one. What's the time now? Ok you see? We have four generators now.

00:21:33,421 VO: The hospital only receives power from the state for a few hours a day. The rest of the time, six giant generators run at full speed to keep the hospital running.

00:21:43,918 Jihad: -We need more than 10,000 litres per day of fuel.

00:21:50,186 VO: -But after ten minutes, the state electricity suddenly starts again.

00:21:55,436 Man: -We can turn them off now.

00:21:57,527 Jihad: -Do they turn off by themselves?

00:22:00,960 Man: -It takes fifteen minutes to shut down the system.

00:22:03,883 Jihad: -Is anything happening?

Man: -No.

00:22:05,399 Jihad: -Ok then. Only ten minutes without power from the government. There is no schedule from the government.

00:22:21,613 Roula to patient: -Are you looking for reception? Down there on the left.

00:22:25,835 Roula on phone: I just got off work, I'm going home now.

00:22:29,306 VO: -Today Roula Itani can drive straight home to her family, but for the past year she's had to take extra shifts at another hospital to make ends meet.

00:22:40,140 Roula: -Everything is increasing, all the prices increase. But our salary is still the same.

00:22:49,749 VO: -The Lebanese lira has lost more than 90% of its value since 2019. And skyrocketing inflation has made Roula's salary nearly worthless.

00:23:01,065 Roula: -Our basic salary... for me it was 2,000 dollars before, but now it's 100 dollars. These two bags cost 100,000 lira [66 dollars].

00:23:16,375 VO: -High inflation has made shopping about 12 times more expensive for families than just two years ago.

00:23:23,827 Roula: -But for me the salary is the same. I have help from my sister and brother-in-law. They send us a small amount of dollars so we can live.

00:23:40,226 Roula: Hi!

00:23:45,901 Roula’s son: -Hi Mommy.

00:23:46,926 Roula: -Hi Habibi. Just turn on the flashlight. I'm using it in the kitchen. It's like this... it's rechargeable. When we have electricity, we recharge it and we use it when's it's dark.

00:24:14,453 Roula to son: What are you doing, Karim?

00:24:16,342 Karim: -I'm playing football, Mum.

00:24:19,222 Roula’s husband: -Are you making tabbouleh, Roula? Let me peel the potatoes while you make tabbouleh.

00:24:27,903 VO: -There's a generator in the property, but due to high oil prices, the family has to do without power for 12 hours a day. And that poses challenges with things like the fridge and oven.

00:24:52,625 Karim: -Dad, the power's back on.

00:24:55,564 Roula’s husband: -Charge your phones.

00:24:58,389 Karim: -I'll only have fries and ketchup.

00:25:08,587 Roula: -Many times I think about the idea of leaving, but I always want to stay here with my family, especially near my father. But now I have to look after my family. I have to get a good offer to go. We can't wait any more. Every day the situation is getting worse.

00:25:29,770 VO: -So Roula Itani now sits every night and seeks a better future.

00:25:34,452 Roula: -They send me all the vacancies available in the Gulf. I apply for them and I wait for a good offer to leave. It's really hard. This is my country, I love this country. But the problem now is the country is forcing us out.

25’55 Credits

Producer – Maria C. Andersen

Camera – Lau Kræn Svensson

Editing – Ann Michele Max-Jakobsen

Text – Fayes Kanafani

Music – Upright Music

Editor – Søren Klovborg

Program manager – Niels Kvale