October 2, 2024

Report from a Palliative Care Nurse in Lebanon

By Alison Ramsey
Pallinews Editor

Registered nurse Batoul Haidar. Photo used with permission.

 IAHPC arranged to speak with home care nurse Batoul Haidar in September. A staff member at Balsam-the Lebanese Center for Palliative Care, she lives and works in a southern suburb of Beirut. On the day of the interview, September 23, a rocket attack targeted southern Lebanon. Batoul, reached late that afternoon, was rushing to prepare herself, her daughter, and her mother to leave their home and relocate to the relative safety of Beirut.

Patients were still receiving home care in the capital but, that day, all visits in southern Beirut were suspended until further notice. When possible, the nurses called their patients instead.

"Every day requires a kind of mental preparation just to take the phones and to help them over the phone," said Batoul. "Being a palliative care nurse in this circumstance pushes me to give more—to be more compassionate, and more empathetic."

But it's not easy.

To prepare mentally, "I try some psychological 'tricks' we were trained to do: breathing techniques, focusing more on what we can control, having conversations with colleagues. Sometimes music helps, family rituals, prayers. Actually, it helps that I'm helping people in their most vulnerable moments. That helps to push me through."

This experience is especially harrowing, as Batoul had already known fear and loss due to violence. Her husband died in an explosion in Dahye about a decade ago, leaving her to raise her daughter on her own. 

"Despite the financial and practical challenges of being a single mother, Batoul has been a model nurse," says IAHPC Board Member Hibah Osman, whose work focuses on palliative care in Lebanon and the Middle East. "She is incredibly skilled and caring and thoughtful, and continues to impress all of us with her wisdom, eloquence, and depth."

When she was 17, in 2006, Batoul was living in a neighborhood targeted in attacks.

"I'm having flashbacks. At the time, it was very different, it was just myself [to care for]. Now, I'm the provider of the safety. I have to provide all the things we need to survive." Batoul paused, to collect her words. "The least of human needs is feeling safe. These basics, we're losing them.

"It's hard to see how fragile our medical and social structure are. It's a reality for our teams, our families, and the whole community. We try as much as we can to hold each other up, even when we feel the ground beneath us crumbling.”

October 4, 2024

Beirut-based Balsam: All patients moved to safety & care continues

Balsam, a palliative care provider based in Beirut, has reverted to the Covid-induced strategy of suspending all home care and moving patients to its distance support program. All patients in areas being targeted by missiles have relocated to safer areas, reported Operations Manager Roula Doughan in an interview today.

When an emergency kit, which contains opioids, has to be delivered, a meeting in a safe location is arranged with that patient's designated family caregiver on file. Balsam provides medical care but not medicines: to date, pharmacies have remained open.

Only one of the four nurses who care for Balsam's 40 patients needed to relocate. Each full-time nurse (one is part-time) has a caseload of a dozen patients, half of whom are categorized as "high need." In normal times, these patients receive daily phone calls as well as two or three home visits per week.

Providing care in a city being repeatedly bombarded is extremely difficult for everyone, including Balsam's nurses, says Roula. "It is unsafe for our nurses even within Beirut." Their pay remains the same, though "in these circumstances, I think they should be paid more." She adds that continuing their emotionally heavy work in an atmosphere of danger and fear while maintaining their own sanity, "is insane."

An added worry at the forefront of Roula's mind is funding.

Normally, daily operations are heavily funded by new patients and their families: 80% or more of them make a donation. In normal times, Balsam makes bereavement calls and attends memorials, which also spark donations. This past month has seen a huge decrease in patient referrals, and not a single donation was received.

"I think that people are so worried about safety that they are not thinking about their health," she says. "What is particularly worrying to me is that, while Balsam has enough funds for a couple of months, after that I'm wondering how we will sustain ourself."

—Alison Ramsey, IAHPC Pallinews Editor

Read more of this week's issue of Pallinews

Divinity Within & In The Moment

A report on IAHPC/PallCHASE World Peace Day webinar—"Spiritual Care in Serious Illness: Cultivating a culture of peace"—by Katherine Pettus, Senior Director of Partnerships & Advocacy.

Threats to global health

Sepsis, antimicrobial resistance & their impact on the most vulnerable: palliative care proponents can be part of the solution, say Natalie Greaves and Michael Campbell.

Plus

What's New in the IAHPC Calendar

Giant ECHO Session October 18: At the upcoming McGill Palliative Care Congress in Montreal, Pallium Canada is hosting an event it describes as "the world's largest palliative care ECHO session" that anyone can sign up for right up until the start.

Reminder Gear up for talking to people about your work, and the goal of alleviating serious health-related suffering, on October 12, World Hospice & Palliative Care Day.