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Lebanon: "I am thrilled to see women look after their health despite all the challenges"
Mireille Zreika, Patient Support, Education, and Counselling Supervisor, Médecins sans Frontières, north Lebanon project
The most vulnerable people in Lebanon - whether women or men, citizens or refugees - face difficulties in receiving healthcare, mostly because of the high cost for medical consultations, laboratory tests, medication, transportation, and other requirements.
At Médecins sans Frontières (MSF) in Lebanon, we receive a significant number of patients including refugees who seek free healthcare. On a daily basis we see the immense challenges they face that affect their commitment to treatment and their response to medical guidance. Some challenges may even restrict them from coming to the clinic on time, or accessing healthcare at all.
Those who work hard to provide their families with food and shelter may not always prioritise their health. For example, many people may sacrifice seeking treatment for their chronic diseases which can include obtaining medication, a visit to a doctor, or a diet for their children, as they do not realise that this can lead to major health complications that may be more costly to cure in the long run.
Economic and social challenges facing women
Whilst women and men alike face financial challenges, we witness additional difficulties faced by women, such as the social environment, the multiple roles that women occupy in the family, and their relation to men, whether as a wife, a mother, a daughter or a sister.
Around 56% of the 94,700 chronic disease consultations carried out by MSF in Lebanon in 2018 were given to female patients. A common problem that we encounter is that a number of diabetic women forget to take their medicine in the morning because they try to finish all their household chores before the rest of the family wakes up. Other diabetic women might delay taking their morning insulin dose until after breakfast is prepared and eaten, or until after coming back from a morning-shift at work. Some of them cannot prepare a healthy meal for their own condition because they can only eat what is available for themselves and their families.
On the other hand, one of the reasons why some women are absent from medical appointments is that a family member should accompany the woman to visit the clinic, which requires additional money to cover the transportation costs for more than one person - an amount that may not be available most of the time.
In extreme cases, the mother might reach a birth centre late, refuse to stay for the post-partum care period, or she might deliver at home because she cannot leave her children alone when the father and relatives are away. Despite these challenges, our teams were able to offer 79,584 sexual reproductive health consultations and carry out around 5,000 deliveries in 2018.
One of the most pressing issues we strive to overcome for our female patients is their feeling of a sense of shame, whether due to their chronic diseases or their need for psychological support. This can affect their society's perception of them and their chances of marriage. "If they knew I was diabetic, no one would ask for my hand in marriage," is a common sentiment we hear.
Another challenge is ensuring that women value the importance of psychosocial support. Out of the 8,800 individual mental health sessions we held last year, 67% were offered to women. Some women complain that their husbands do not consider mental health counselling a sufficient reason to visit the clinic regularly. Some of our patients receive mental health support while visiting the clinic under other pretexts, such as a medical consultation for their children or a sexual reproductive health consultation for themselves. Seeing what women have to do in order to receive the health care they need, we hugely appreciate their efforts.
Some customs and traditions may affect the health choices of our patients, especially women. Some of our female patients are reluctant to use family planning methods because of the family's desire for children, particularly for having boys. Even if some women want to adopt family planning methods, their choices ultimately depend on their husbands’ final decision.
As a health education team, we try as much as possible to involve men and other family members in MSF run community awareness sessions to raise awareness about important health issues, whether mental health, family planning or any other topic. We seek to make them more familiar, more supportive and more understanding of health needs of the family in general and of women in particular.
The role of the education and health support team
I work with a multidisciplinary team to support and educate patients about their illnesses and help them overcome the challenges they face in managing them. We help them to change their lifestyles to healthier ones or their commitment to stick to their medical treatment and follow-up. Through regular sessions of education and health support, patients feel medical staff are listening to them and concerns and are trying to help them find the most appropriate way to live with chronic disease or overcome psychological conditions. Sometimes our patients rush to make changes, other times they are tired and reluctant to make any necessary changes in their lives.
We are always keen to address the specificity of each situation by devising a bespoke plan with specific goals for each patient, taking into account social and economic conditions and the environment surrounding each of them so that we can find feasible and practical means to support their treatment.
My work made me closer to the patients. I witness their condition not only from the medical aspect, but also from the many and varied factors that affect their health.
I continually see and hear stories every day of women who do their best to meet the basic needs of their families. Nothing makes me happier and more thrilled than seeing women looking after their own health, despite all the challenges they face.
MSF provides free health services, through primary health care clinics located in the Beqaa, north Lebanon and south of Beirut. These services include general medical care for children and the treatment and management of chronic diseases such as diabetes and hypertension, sexual reproductive health services like pregnancy care and family planning, mental health counselling, health promotion and education, and it operates maternity centres that provide normal deliveries that are also free of charge.