“(…) We have 40 patients for whom we are unable to secure lines. If there are hospitals in Beirut that can accommodate some of them, I would be grateful.” This call, made by the kidney specialist and head of internal medicine at Al-Maqasid Hospital, Dr. Hussam Rabah, marked the last glimmer of hope he could offer to his dialysis patients after finding himself unable to provide treatment sessions due to the supply of bloodlines tubing being interrupted for two days. Indeed, this call brought a temporary solution to the problem, as some hospitals sent equipment to Al-Maqasid to complete the treatment for 40 patients the day before yesterday and 20 patients yesterday… However, these temporary solutions do not exempt the hospital from what is to come, as the hospital faces the risk of this interruption affecting 127 patients undergoing treatments at the dialysis center, including 4 children. Today, there are 60 new patients preparing for treatment sessions, the procurement of which still depends on “news” from the company that supplies the hospital. This news is awaited not only by Al-Maqasid but also by many dialysis centers in hospitals that obtain this equipment from the same company!
**Crisis of the 5008 Machines**
Years ago, many hospitals, including Al-Maqasid, worked on upgrading their dialysis machines, replacing the old ones with the new 5008 dialysis machines. They imported their equipment, including the tubes, from Fresenius, the company that has become the sole supplier for 60% of dialysis centers in hospitals. During the post-upgrade period, things were running smoothly until the economic crisis began in early 2019, specifically with the implementation of the support mechanism. This latter event paved the way for the emergence of an irregular cycle in the importation of medications and medical supplies, where all purchasing mechanisms became subject to what the Governor of the Central Bank of Lebanon deemed appropriate.
With the diminishing amounts of money the central bank has been spending on medical equipment (10 million dollars), and delays in disbursement processes, the pace at which hospitals received equipment became inconsistent and “often subject to rationing,” says Saad Abu Hemein, a member of the Physicians' Syndicate and a nephrologist. Gradually, a “severe shortage” affected some supplies, which began to arrive “a drop at a time.” These include the bloodlines tubes utilized in the 5008 machines now used by the majority of dialysis centers.
A few days ago, the crisis reached a choking point, and Al-Maqasid Hospital was the first to be impacted, announcing the interruption of these tubes and its inability to operate the center due to the impossibility of “installing other tubes for those machines since they have a specific type, unlike the older machines.” Rabah found himself compelled to ask capable patients to go to other centers; however, those unable to afford the high bills would certainly remain untreated, “with all the risks that entails.”
Rabah recounts the details of the recent crisis, indicating, “The shipment was supposed to arrive on Saturday but did not come. We contacted the company, and they told us that a cargo plane would arrive on Sunday, and we were supposed to receive the equipment on Monday.” However, on the designated day, “we were surprised to find that the equipment was still at customs, and we received nothing until we were completely out of supplies the day before yesterday, and we still are.”
Patients at Al-Maqasid are without dialysis, with the implications of that word potentially leading to death, while other patients at Al-Zahra Hospital have experienced the same situation due to a previous delayed shipment from the same company. This time, some doctors are not counting on what will arrive due to the small amount of equipment, as one doctor pointed out, “The entire shipment consists of 3,000 tubes, which is not enough for more than two days for the dialysis centers.”
Regarding the reasons for the delay, Assem Jarrah points out, “This is due to the procedures at Beirut International Airport, and we have been promised that things will be resolved soon.” He discusses another aspect of the crisis related to the losses incurred due to air shipping “due to delays in shipments by sea,” noting that “a shipment expected to arrive via the port next week has been reported to be delayed until the end of the month”! And that is another crisis.
**Withdrawal of Companies!**
These shipments are just an initial warning of the struggles that kidney patients will face today with the complication of the support mechanism managed by the Central Bank of Lebanon and the complaints from companies about the rising cost of shipping, as well as the options that some companies have begun to take… away from Lebanon.
In the first aspect, Jarrah summarizes the relationship with the Central Bank as half of the crisis, noting that this mechanism “restricts companies within complex procedures. For example, we could not open a pharma account to deal with the Central Bank since no bank accepted to open this account due to delays in settling accounts with the Central Bank, in addition to the accumulation of debts at the Central Bank from previous files, with Fresenius's debts reaching 1.3 million euros still pending, while we are paid by hospitals in Lebanese pounds.”
Despite the profits that companies have accrued due to this mechanism, their accounts today no longer reflect the Lebanese reality, “Companies today have other concerns beyond ours, and none of them is willing to take risks beyond their capabilities,” adds Jarrah. Consequently, some global companies have withdrawn from Lebanon as the risk approached “their pockets,” indicating that these companies “can no longer bear it.” In corporate language, “We are tired,” and it has become more prudent to “search for a new agent capable of handling the burdens in a troubled country.”
