As the ‘old’ expats [international staff] are preparing for their end of mission, I am setting new goals for the extension of my time in Lebanon.
Sometimes I find myself staring into this huge mirror just in front of my desk at the office, which is like a tourist attraction to all our visitors. I am pretty sure the sole purpose of the mirror is to give me the opportunity to stare into space and get lost in my thoughts.
So what are my new goals?
One thing that has crystalised during my work with our social workers is the need for social assessment. The social workers have had to cut down on their home visits in the past year. Due to my interest, we started visiting some patients who need to be seen at home due to their immobility and other conditions.
What is social assessment good for?
We are dealing with people with unreliable incomes, or no income at all, some of whom need continuous medication which is not available in our pharmacy. The economic difficulties they face are aggravated by the burden of finding the money for their medication. The whole family gets involved in the search for financial assistance (by asking friends, neighbours or our social workers).
We have many such patients. One is Mrs B, a 45-year-old woman with scleroderma (a chronic systemic auto-immune disease characterised by hardening of the skin. In the more severe form, it also affects the internal organs). Mrs B consulted our GP to help her with her medication, which she can no longer afford. One of the drugs alone costs her US$194 per month, and the total cost for her lifelong medication is around US$250 per month.
Her clinical symptoms were those of the typical scleroderma patient: painful joint contractions; cold fingers (Raynaud’s syndrome); and hardening of the facial skin, giving her a very stern and rigid look.
After referring to our telemedicine tool, we managed to change her treatment to a less expensive drug with the same – if not better – outcome for her. The next step is to provide her with financial assistance, knowing that even if she only needs to pay around US$60 for her drugs now, and some are going to be available from our pharmacy, she will face difficulties in the future.
The other patient is Z, a 17-year-old girl who was paralysed after an incident in August 2015. Her mother shows me a photo of her before it happened: she was a beautiful young girl with a superb head of chestnut brown hair, which is now been taken care of by her mother. Z spends her day in a bed the family borrowed from neighbours as it has a special water mattress (which is not enough, as she is already developing decubitus at the tailbone). Her mother and her 14-year-old twin siblings take care of her most of the time. To do so, the twins dropped out of school, about which I expressed my sincere concern. She has three other siblings – two sisters and a young brother.
The father of the family is without work and since this event he has changed. The only one providing money for the family is one daughter, who is working as a cleaner. She earns US$500 a month, of which US$200 goes on the rent of the apartment, and around US$200 on medication, doctors’ consultations and the monthly visit of a nurse to Z. The remaining US$100$ is not enough to cover their living costs.
The family moved here from Syria five years ago. They rented a spacious basement apartment and were living a good life before the accident happened, according to Z’s mother. I could see that they must have had a worry-free life. In the apartment, the furniture was in good shape, there were enough rooms for the family to spread out, and there was a little patio leading out from the living room (which nowadays is utilised as a dumpster).
Entering these people’s house gives me the feeling that everything has ground to a halt. Furniture is covered in dust; the once-red glowing artificial roses arranged in a vase are forgotten; the pictures of the family on the wall are veiled in cobwebs. Some prints give the impression that back then there was an interest in the beauty of art (I found the magnificent sun flowers by Van Gogh hiding behind a door). I peek into a room where the curtains are not drawn and see beds with thin mattresses crammed into a tiny room.
The family of Z is very caring. They talk to her and play her music; they braid her hair after washing it, and they keep her company. Her father takes her onto the little patio three times a week in a wheelchair. Z responds to them with grunting sounds which the family can interpret as either joy, pain or discomfort.
Cash assistance for this family means more than just giving them money to buy groceries. It means that the teenage children can attend school again, that their future is not bleak because of what happened to their sister. It will also help secure the best care for Z, which is the primary goal for the whole family. To accomplish this, every one of them is forgoing their own desideratum. It is about securing their home and giving them back control over their own lives.
Social assessment involves making a record of their living conditions in order to guarantee a successful referral to an NGO in charge of cash assistance, as these organisations have very strict criteria for who is eligible for financial assistance. At the moment, medical conditions are not reason enough for financial help. But I really hope this will change. Leaving on their own people who are in need of financial help, and putting them in a position where they must decide either to buy food or to buy medicine is beyond inhuman.