2020; Volume 21, No 3, March
Progress Report — Lebanon
We at IAHPC know that advocating for, and implementing, palliative care programs is challenging, uphill work. This is why we love to celebrate your successes and inspire our readers, who can learn from your experience.
A SANAD patient supported and assisted in remaining as alert, functional, and comfortable as possible. Photo used with permission.
SANAD’s Thoughtful, Adaptive Methods Breed Expansion Beyond Beirut
By Alison Ramsey, IAHPC Newsletter Editor
SANAD’s ambitions were never small.
Established in January 2010 in Beirut, when hospice care in Lebanon was in its infancy, Lubna Izziddin and the other founding members took steps to establish a strong foundation for widespread growth.
A non-profit, non-government, apolitical organization, SANAD provides home hospice care — including both medical and mental health — free of charge to patients in Beirut and Mid-Beqaa regardless of their nationality, religion, gender, or diagnosis. Its mission goes beyond Beirut. To achieve its lofty goals, SANAD gathered a varied board of directors, went door-to-door to raise awareness among oncologists and health care administrators, and carefully designed its model with step-by-step planning, making adjustments as needed, and enacting follow-up procedures to evaluate progress.
SANAD by the numbers
Patients cared for: almost 1,000
Community referrals: 47%
Health care professionals’ referrals: 53%
Patients dying at home (in the last 4 years): 68%
Word of mouth has been uniformly good
Lubna Izziddin
“Today, the palliative care and hospice scene in Lebanon is flourishing,” wrote Mrs. Izziddin, now SANAD president, in its 2018 annual report.
Community awareness spread by fundraising events, lectures, meetings, media appearances, and word of mouth.
“I met a friend I hadn’t seen in years, who knows marathoner Ali Kedami,” says Farah Demachkieh, head of SANAD’s Quality, Research & Development Unit. “My friend said that Ali speaks highly about SANAD. He fundraises for us through national and international marathons — and Ali doesn’t run for just anyone!”
Careful planning supports new programs
In 2016, after its Beirut home hospice service was established, SANAD took on three major projects. Two are close to home: bringing palliative and hospice care to Lebanon’s biggest public hospital, Rafik Hariri University Hospital; and a home hospice pilot project at nearby Ain Wazein Medical Village, in the Chouf district. The third project, however, is 930 miles to the east, in Kuwait — a home hospice service to complement psychological care provided by the Al-Sidra Association to cancer patients.
These projects, helping others develop palliative care services, involve:
- preparing a needs assessment, by gathering quantitative and qualitative data from different stakeholders;
- a program design phase to develop a model, organizational structure, staffing, clinical and operational policies, and documentation forms and indicators;
- a knowledge transfer phase, where the on-site team receives training and a period of practical observation by experienced SANAD members; and
- an implementation phase, where the service is launched and the team is shadowed by SANAD, which provides technical support and conducts post-case discussions to identify and fill knowledge gaps.
Farah Demachkieh
Each new program is unique
Creating new programs has been a valuable learning experience.
“When a country is interested in establishing a model,” says Mrs. Izziddin, “we need to find out about local rules and regulations, and understand the legal issues, permissions, and certifications required to draw a model that is applicable, manageable, culturally appropriate, and responsive to physicians’ views. Constraints in finance and human resources are major challenges. It’s very satisfying to do a full-fledged service, but to be more realistic, we have to know what is feasible to get things moving... Models will take different forms; sustainability is key!”
In an effort to evaluate and improve its service, SANAD has just translated the U.S.-based Consumer Assessment of Healthcare Providers and Systems Hospice Survey into Arabic, adapting it to the Middle East, to ensure continuous quality improvement.
Government policy to aid growth
All palliative care stakeholders got a huge boost when, in March 2019, the Lebanese Ministry of Public Health issued a decree that defines criteria for the reimbursement of palliative care services, both in-hospital and home-based. Once implemented, this decree will provide SANAD (among others) with a sustainable source of income. In the long run, the decree will help ensure wider access for palliative care in Lebanon.
Looking to the future, “maybe,” says Ms. Demachkieh, “this will be the research year.” But that won’t curb their desire to develop programs. “Our next step,” says Mrs. Izziddin, “is growth, growth, growth!”
An IAHPC member, SANAD is listed in the IAHPC Directory of Palliative Care Organizations.