Basem Saab

Predictors of psychological distress in Lebanese hostages of war

A cross-sectional study addressed the experience of Lebanese hostages of war in Lebanon. It specifically assessed the prevalence of general distress and its relationship to captivity-related factors and selected psychosocial variables. Trained field researchers using standard measurements interviewed 118 Lebanese hostages released from Khiam prison, an Israeli detention center in Lebanon. Questionnaires administered included the GHQ-12 and the Harvard Trauma Questionnaire. Individuals were detained for 3.4 years on average, and 86% were tortured. Psychological distress was present in 42.1% of the sample compared to 27.8% among the control group. In the multivariate analysis, the significant predictors for distress were: years of education and increase in religiosity after release. In conclusion, even after 2 years of release, more than one-third of the Lebanese hostages released from Khiam prison were found to have psychological distress. Caregivers need to pay special attention to the mental health of hostages of war. The paper discusses the meaning and implications of the factors predicting resilience and vulnerability in this particular population.

Reflections on the plight of Syrian refugees in Lebanon

It is Thursday morning. It is my turn as an instructor in the satellite clinic where we serve marginalised populations. I say populations, as over the last year in addition to the people without legal status and a Lebanese community, we have mainly been looking after Syrian refugees. There are now more than half a million displaced Syrians in Lebanon. This is a country that has 4.5 million residents in an area half the size of Wales.1 In my 3 years of visiting this satellite clinic I have realised that the most common cause for health ailments in troubled areas like the Middle East is war. A patient was seen by a senior resident some time ago presenting with numbness in her hands, dizziness, and palpitations that she had experienced for a couple of months. A thyroid stimulating hormone …

Reflections on medical volunteerism: free medical days for refugees

The Lebanese Medical Students’ International Committee organised a free medical day under the slogan of ‘Your Health, Your Right’. This activity was sponsored by the Ministry of Public Health and involved several partners. Classes in a public school in Beirut were turned into clinics for the purpose of this day. Medical encounters and blood tests were offered free of charge. A young woman presented complaining of body and headaches. She reported an old fracture in her skull, which she attributed to a fall from a roof. An initial exam revealed a poorly groomed woman with an obvious nystagmus suggestive of central nervous system pathology. As the examining doctor discussed with her the need for brain imagining, she broke into tears explaining her financial difficulties. Money was not the only problem; her husband has been physically abusing her for years. This was the cause of the skull fracture and consequent nystagmus. A referral to an ophthalmologist was arranged and the patient encouraged to consult a non-governmental organisation (NGO) that deals with domestic violence and another to cover the …

International primary care snapshots: Sweden and Lebanon

Primary care in Sweden is delivered through around 1200 primary healthcare centres (PHCs), almost all of which are group surgeries containing more than one doctor. The largest one, situated in a suburb of Stockholm, has more than 30 GPs plus registrars. The surgeries also have nurses, secretaries and laboratory staff. Where I have worked for 33 years there are 4 senior doctors sharing 3 positions, a registrar, 2.5 surgery nurses, 1.5 district nurses, a lab nurse, and one secretary. We have contracts with physiotherapists, occupational therapists, a psychologist, social worker, and a dietician. The government owns about half of the PHCs; the other half being private practices. The latter are more common in the cities and the former more ubiquitous in rural settings. The economic conditions are the same for both type of ownership through contracts with the local county council. The average Swede sees the doctor three times per year, and 50–70% of this constitutes visits to GPs. The rest of the visits are to secondary care doctors, at hospitals or outside. However, Sweden does not have a common system for reimbursement. All GPs (in practice surgeries) have lists of citizens who have actively chosen their doctor. Sweden has 22 counties and each decides on its payment. The reimbursement (payment) amount per visit is highest (‘pay per visit’) in Stockholm but the payment per visit consists not only of what the patient pays but is also a payment per visit from the …

When we justify apathy and homicide in Syria.

> ‘Eighty thousand people died in less than a minute when the nuclear bomb was dropped over Hiroshima and another 60 000 in Nagasaki: this is almost double the estimated deaths in the Syrian conflict that completed its second year.’ I overheard this discussion while having breakfast at the hospital I work in. Later on the same day, I heard on the news a foreign minister saying that it is a moral obligation of his country to send arms to one of the parties in the Syrian conflict. A few days later, a guy who saw the movie Lincoln , was surprised to know that more than 600 000 US lives perished during the 4 years of the Civil War in the 19th century. Again, a comparison was made with the number of human beings lost to the conflict in Syria. …

Medical care: elitism or social commitment?

As a director of a family medicine programme at the American University of Beirut Medical Center, Beirut, I have to make sure that residents receive proper training. The programme I work on is based in a tertiary care hospital. This has its pluses and minuses. Our paediatrics load is minimal, and the number of deliveries requested by the Accreditation Committee for Graduate Medical Education in the US is difficult if not impossible to attain in my setting. Having a satellite clinic in a marginalised community may overcome these barriers. With the help of a resident, I identified a non-governmental organisation (NGO) that runs a clinic in Sabra Camp in Beirut. After listening to a presentation by a doctor who worked in that clinic I visited the place. The road to the clinic is narrow and barely allows the passage of two cars. This puts the cars of residents and faculty at risk of accidents. If an accident happens, neither the NGO nor the institution we work in will cover that. One of our faculty members was against sending our residents to this clinic as it will give an impression that family medicine is a specialty for the poor! After reviewing the website of the NGO, I realised that occasionally there are armed clashes between two clans in the area, which puts the residents and me in danger. In this situation lives are at risk. Why then send the residents to this set-up? My visit included the clinic and the ‘houses’ of three families in the community. The clinic consisted of three rooms, a kitchen, one bathroom, and a terrace. The doctors room occupied less than 9m2 area; but it serves the purpose. The other two rooms were bigger and are around 12m2 each. One room is used to …