Featured Story

2021; Volume 22, No 7, July

The Balsam International Support Initiative:

Zoom Meetings with International Experts
Lighten the Load during a Dark Time in Lebanon

By Dr. Hibah Osman
Founder, Balsam–the Lebanese Center for Palliative Care
Member IAHPC board of Directors

As if COVID and its intense pressure on the health care system wasn’t bad enough—on August 4, 2020, one of the biggest non-nuclear explosions in history destroyed much of Beirut, leaving hundreds dead, thousands seriously wounded, and hundreds of thousands homeless.

The massive explosion at the Port of Beirut compounded a devastated economy and a health system that was already overwhelmed. For months before the blast, Lebanon had been struggling with political instability, violence on the streets, shortages of fuel and other essential supplies, and a financial crisis.

Others were harder hit, but the damage at Balsam was significant. Photo used with permission.

As of 2019, the multidisciplinary Balsam team, which has provided home-based palliative care to patients in Beirut and telehealth beyond the capital city since 2010, had been struggling to maintain its services under extremely challenging conditions.

The disaster led to the loss
of 3 of 12 team members

It is impossible to describe the depth and intensity of the psychological and emotional trauma caused by the disaster. Staff members were coping with family members who experienced serious injuries and suffered significant material losses to their homes and family businesses. In the aftermath, two of Balsam’s nurses and one of its physicians emigrated. This reduced the clinical team from 12 to nine members and increased the workload of a team that was already stretched.

Since February 2020, the Balsam leadership had been working to balance the responsibility of maintaining the safety and well-being of staff without interrupting services to patients and families. Fallout from the explosion upset the balance: help was needed.

Reaching out for help:
global experts respond

The Balsam International Support Initiative (BISI) was conceived in an attempt to support the critical activities of the Balsam team during an extremely challenging time. The initiative brought together six highly experienced international palliative care specialist physicians to participate in the team’s weekly interdisciplinary (IDT) meetings via Zoom. As with many home-based palliative care teams, the team’s process includes weekly IDT meetings to discuss patients and develop a comprehensive plan of care for them.

Each international consultant participated in three or four meetings between January and June 2021, providing guidance and exchanging knowledge about approaches to patient care.

BISI reminded our team
of the value of their work
A screenshot of one of the Zoom meetings, also an opportunity for learning and professional growth for Balsam staff. Photo used with permission.

The first six months have been an extremely positive experience for everyone involved. Having international palliative care experts volunteer their time to support their efforts was extremely validating for the team. It reminded them of the value and importance of their work at a time when those things were easy to lose sight of. The consultants also enjoyed the dialogue and cultural exchange; they appreciated learning about how palliative care is practiced in the Lebanese context, and the opportunity to support a team working under these challenging circumstances.

Challenges in Lebanon continue

Although the vaccination rate has been increasing and the incidence of COVID declining, the political situation in Lebanon remains precarious. The financial crisis is escalating, with a failed banking system and collapse of the local currency. Essential medicines are difficult to obtain and many health care workers have left the country. A fuel shortage has put additional strain on a medical team that depends on gasoline to provide home care.

Short-term tactic
became a lifeline

But BISI has been an unqualified success. What began as a short-term initiative to support a struggling team has become a lifeline providing connection to the global palliative care community, giving the team a sense of renewed purpose.

In its second iteration, BISI will expand beyond the weekly IDT to include monthly case discussions with experts in the fields of nursing, social work, psychology and chaplaincy. Many of our current consultants are looking forward to continuing to support the team, and an even larger pool of volunteer international consultants are welcoming the opportunity to contribute to this effort.

Dr. Hibah Osman is a member of the IAHPC Board of Directors. Read her bio to learn more about her.

To learn more about Balsam—Lebanese Center for Palliative Care visit the IAHPC Global Directory of Palliative Care Institutions and Organizations.

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