Medicine shortages

Small-scale initiatives step in to overcome medicines shortages, but their sustainability is questionable

Many medicine-sourcing initiatives entail travelers stuffing their suitcases with drugs whenever they are flying back to Lebanon. (Credit: AFP)

BEIRUT — For a whole month, Sami, a hypertension patient who also has high blood sugar levels, did not take any of the medications his doctor prescribed — he simply could not find them. He drove to pharmacies both near and far to no avail. He contemplated ordering the drugs from abroad, but knew he did not have access to foreign currency to pay for them. But, just as despair set in, a friend told Sami of an initiative that might come to his aid.

The 54-year-old took his friend’s suggestion and reached out to medonations, an initiative that aims to fill medical needs for families in Lebanon, which successfully fundraised for and delivered a month’s supply of medicine to him.

Many people like Sami are unable to find their medications in pharmacies because of the countrywide shortages that have arisen amid Lebanon’s economic collapse. To fill the gap and ensure that patients can continue taking their medicines, small-scale initiatives have emerged at the community level.

Turning to such grassroots initiatives is now not uncommon. Charaf Abou Charaf, a doctor and the head of the Order of Physicians, said patients are not finding their prescribed drugs in pharmacies and are resorting to help from people abroad, NGOs and other initiatives to source them. “Even generic drugs have evaporated from the Lebanese market,” he added.

The head of the pharmacists’ syndicate, Ghassan al-Amin, attributed the low availability of medicine supplies to Banque du Liban’s tardiness in processing subsidy payments, coupled with drug hoarding on the part of both importers and patients.

However, while several medicine-sourcing initiatives are now operating and have upscaled their activities in recent weeks as medicine donations and funds from Lebanese and non-Lebanese flood in, the sustainability of such mechanisms as long-term drug supply sources remains in question.

“We will continue operating as long as people continue supporting our initiative,” said Marina Khawand, medonations’ founder.

Representatives from the initiatives told L’Orient Today that they do not have long-term funding sources and instead rely on ad hoc donations. They added that the initiatives were established to meet immediate needs only. These initiatives became part of the medical supply chain because patients kept on referring to them for medications. However, without in-kind donations they won’t be able to continue operating for free.

Abou Charaf also pointed out that the initiatives alone cannot cater to the needs of Lebanon’s 6 million residents, asking them “to work closely with the Health Ministry, which can and should supervise the drugs entering the country for quality control.”

Khawand started medonations in August of last year following the Beirut port explosion. Initially run by her alone, the initiative now boasts a team of six women in their early 20s.

The team started off with door-to-door field assessments in underprivileged areas of Beirut, looking for people in dire need of medical supplies. By September 2020, medonations had been able to cover 500 families’ medical needs.

As COVID-19 cases surged in January, medonations helped provide those who tested positive for the virus with oxygen machines free of charge, through social media fundraising activities. Oxygen machines at hospitals were running low as the number of infected people increased, especially because the Lebanese lira’s depreciation made it hard for medical health supplies importers to order them as BDL delayed payments for invoices.

“The group was able to save 31 lives through the free-of-charge oxygen machines,” Khawand said.

But when gasoline became hard to access and the number of people needing medications grew, the team stopped its field activities and shifted its work online.

“The group also fundraises for cancer treatments and surgeries amid the difficult economic situation and poor living conditions,” Khawand added.

A 19-year-old who suffered a severe head injury in the Beirut blast needed head equipment worth about $7,000 from the United States, which was fully covered by medonations. To date, the group has funded 45 surgeries for people in need.

To avoid abuse of the campaign’s provision of free medications, the group “asks for screenshots of prescriptions not older than six months,” Khawand noted.

But the assistance Khawand’s team is able to provide can go only so far. There is a list of medications that medonations is not able to obtain, such as antibiotic injections and vaccines, given that such medicines are not present in pharmacies abroad but rather at hospitals and can be imported to Lebanon only through an official drug company.

There is a severity in shortages of chronic disease drugs, even among NGOs and initiatives trying to provide them, pharmacists’ syndicate head Amin said.

Given that donation-based initiatives have insufficient human and financial resources to cover the whole Lebanese population’s pharmaceutical drug needs over the long term, Amin said, “The government along with BDL should create a plan to pay importers at a reasonable rate in order to bring shortages to an end.”

Banque du Liban’s failed attempts to pay out drug importers’ invoices has led importing entities to abstain from selling medicine stocks to pharmacies, fearing financial losses when subsidy payments come to end.

Abou Charaf adds that a solution that can solve the issue from its roots is enforcing prescriptions in Lebanon and digitizing the pharmaceutical business. “Each person should be able to present a prescription whereby the pharmacist through a computerized data set can confirm the credibility of the order from the doctor and when that patient last bought the drug.”

He said this would help end drug hoarding.

Another initiative on Instagram called @medsforlebanon is led by Lebanese expats living in France. The group was co-founded in July by Mario Chalhoub, a pharmacist in France, and includes other Lebanese who work in the business and engineering fields.

The group accepts payments from Lebanese patients to send them medications from France. When patients are financially unable to send money, @medsforlebanon raises funds via its webpage to pay for the drugs.

This group operates by buying the medications from France and other European countries and sending them with travelers to Lebanon. It doesn’t send stocks of medicines to pharmacies or importers, but rather only to individuals on an on-demand basis.

“The initiative is fully transparent. We publish a monthly report of the amount of money raised in donations along with how we spend it,” Chalhoub said.

Unlike medonations, the French initiative is flexible enough to get patients their medications without prescriptions.

While 90 percent of the patients have prescriptions from doctors for prescription drugs, those who do not have ones, because they are financially unable to visit the doctor as often, are not left without aid. In some cases, European pharmacists have bent the rules for Lebanese who have outdated prescriptions. In others, L’Orient Today learned that some patients ordering their medications from abroad have obtained prescriptions from doctors without having a consultation with them. Abou Charaf noted that this phenomenon is unethical but widespread.

@medsforlebanon invites other initiatives in need of medications to send them the list of drugs they are finding difficulties accessing in Lebanon so that they can be sent from France.

One concern arising out of this method of sourcing drugs is that some medications may not be stored in proper temperatures while being transported in travelers’ luggage. “In such cases many patients can receive poisoned drugs rather than curative ones,” Amin points out.

A third model is found on the Instagram page @medsforleb, which allows donors to connect with patients.

The initiative was founded in March 2021 by siblings Lian and Mohamad Farran, aided by a group of friends.

“On our Instagram page we have a spreadsheet that organizes usernames and their medical needs,” Lian said. @medsforleb teams then post about each medication on Instagram stories to promote it so that individuals who have the relevant medication can find out about the need and “sign their name next in the spreadsheet as a donor.”

@medsforleb then connects each donor to the relevant patient so that they can meet up and hand the medications over. The initiative refuses to receive monetary donations, on the basis that it is not a service provider but rather a platform to coordinate the exchange of medications.

“Mental health medications are in the highest demand,” Mohamad said. “For such medications we always ask patients to send us prescriptions for the drugs.”

Just like the two other initiatives, @medsforleb has a diaspora group sending medications for the Lebanese. Countries on the list are: USA, Ireland, UAE, Saudi Arabia, Australia, France, Italy, Armenia, Belgium, UK, Austria, Egypt, Netherlands, Turkey, Canada and Norway.

All the representatives of the initiatives L’Orient Today spoke with agreed that the number of people approaching them or using their services is growing, pointing out that medication shortages are becoming only more severe. Khawand from medonations said the number of requests they receive doubles each month.

According to Amin, no pill was imported to Lebanon from June to August; however, Karim Gebara, the head of the pharmaceutical importers’ syndicate, confirmed that “BDL had granted preapprovals between the end of August and the first of September, and corresponding drugs were imported.”

Abou Charaf, meanwhile, stressed the need to hold importers who are hoarding medications accountable and that drug distributors must encourage local manufacturers by promoting locally produced brands “because the initiatives without government intervention can’t survive forever.”

On Aug. 31, the Health Ministry raided a warehouse hoarding 7,000 pills of out-of-stock medicines. Some of the drugs found treat burns and were required for victims of the Akkar fuel tanker explosion. Similarly, on Aug. 29 more than 130 boxes of medical supplies for cancer treatment were found in a warehouse that belongs to the former head of Lebanon’s pharmacists’ syndicate, Rabih Hassoun.

BEIRUT — For a whole month, Sami, a hypertension patient who also has high blood sugar levels, did not take any of the medications his doctor prescribed — he simply could not find them. He drove to pharmacies both near and far to no avail. He contemplated ordering the drugs from abroad, but knew he did not have access to foreign currency to pay for them. But, just as despair set in, a friend...