Medical Teams Bring Tuberculosis Treatment to Patients’ Doors in Aftermath of Beirut Explosions

Beirut – When two explosions rocked the Port of Beirut on 4 August, Hamido had one immediate concern: what had happened to the medicine that was helping him defeat his tuberculosis (TB) infection and would he be able to continue his treatment at the clinic?  

The TB control health centre in the Beirut neighbourhood of Karantina that he relied on for treatment and the warehouse that stored his medicine were heavily damaged by the blast. Glass was shattered throughout the building, doors flew off and equipment was destroyed. 

Any interruption to his treatment, he knew, would compromise his body’s ability to fight off the bacteria and overcome tuberculosis, which had left him sick for the past two months.  

Staff of the clinic – run through a joint initiative between the International Organization for Migration, Lebanon’s Ministry of Health, the World Health Organization and local NGOs – quickly came together to save and transport the medicine and lab consumables from the warehouse.  The drugs were then distributed to eight health centres run by the National Tuberculosis Programme to ensure delivery of services for the next six months. 

In the following days, staff and other volunteers came from as far as Bekaa Valley to help clean up the damaged centre. They then came together to find new ways to adapt the clinic-based services and outreach into a more mobile response. 

"The first thing we did after cleaning up the centre was to meet with all the staff on the premises and figure out a way to continue serving our patients. This was a relief for all of us, we could remind ourselves that life continues,” said Dr Nada Najem, an IOM doctor who oversees the joint programme. 

Established in 2015, the Middle East Response (MER) supports the NTP to provide Lebanese people, migrants and refugees free testing and treatment for TB and HIV in nine health centres across the country. Currently, 750 people are receiving support for TB services. 

Staff have started referring those needing tests to the nearest health facility for a chest X-ray. Teams then go to the patient’s home to take a sputum sample and deliver it to a laboratory for analysis.  

For patients who need to start or continue their treatment, health teams scaled up home-based care plans – a modality that began months before the explosion to reduce the risk of COVID-19 transmission. All patients who used to have to go frequently to the health centre for their TB treatment started receiving the medicine directly at home.  

“We should not forget that the blast happened in the middle of the COVID-19 pandemic. Already our medical and health partners were becoming more concerned about the impact of the disease on TB patients. If they get infected, it is much worse for them,” said Dr. Najem. 

“Ensuring people can continue their treatment is crucial so that the bacteria does not develop resistance to the medicine, weaken people’s immune system and disrupt the body’s ability to overcome the disease,” she added. 

The approach was appreciated by patients like Hamido. 

“I was so relieved to learn that people would be coming to my home to bring me my medicine,” he said.  

Health workers are accompanied by community health volunteers – members of diverse communities who are attuned to the cultural backgrounds and sensitivities of each patient. Most of the volunteers have themselves recovered from TB through the programme.  

Yacoub is one of dozens of community health volunteers working with Syrian and Sudanese patients. Originally from Sudan, he came to Lebanon to work as a cleaner. A few years ago, he contracted TB and was treated at the clinic. 

“I’m able to help them because I understand their culture and I understand what it means to be sick with TB. When I tell them why they need to take their medication and listen to the doctor, they trust us. It’s easier for us to communicate with patients who are migrants and refugees,” said Yacoub. 

Before contracting TB, Hamido sold vegetables in the local market to provide for his family.  

After his wife contracted the disease, she moved away to isolate herself while taking treatment. Two months ago, he began to feel pain in his lungs and lost his appetite and a lot of weight.  

“I went to the hospital because I thought I had COVID-19. After I tested negative for COVID-19, they referred me to the TB centre in Karantina where I did the tests and X-ray,” he recalled. He was then diagnosed with TB and put on a treatment plan by the staff of the clinic.  

“I went on medication for two months while I stayed isolated away from others. My sister and children also tested positive for TB but theirs is latent. We are all thankfully now on medication. Now I must be very careful not to go out or spread it to others,” said Hamido. 

This is no small challenge. He shares a bedroom with two children and his sister who lives with a disability.  

“Most TB patients come from less privileged backgrounds. They live in overcrowded homes – sometimes with two or three families in one room – where the hygiene situation is inadequate. Some are living in unfinished buildings. These conditions put people at a really high risk of contracting and spreading diseases like TB and COVID-19,” said Dr Najem. 

These living conditions are far too common for migrants in Lebanon. The economic crisis exacerbated by COVID-19, and now the blast, have left thousands of migrants without jobs or homes.  

Many have no choice but to live in closed quarters with others. Those who recently came from countries with higher TB rates are at an even higher risk. 

Bizualme, a 21-year-old Ethiopian migrant, had been working as a cleaner in Lebanon until the economic crisis took hold last October. Since then, she’s been unable to find stable work.  
“A nice woman found me sleeping on the streets when I didn't have a place to live and knew no one in Beirut,” said Bizualme who currently shares a bedroom with a friend and her friend’s child.  

“She took me in and now sometimes I stay with her or I move to stay with other friends.” 

Two months ago, she became sick with TB. 

“I was showing symptoms of TB and I got tested at the clinic in Karantina. I later received medicine I needed to get better,” she said in the bedroom she shares with her friend and her friend’s child. 

“My TB is still active so I'm staying home and taking medication so that I don't spread the disease.” 

For patients like Bizualme and Hamido, a mobile medical response means they do not have to risk infecting others, but it also keeps them safe from the risk of contracting COVID-19 which would severely compromise their health. 

The programme’s staff have begun to spread vital awareness materials on COVID-19 infection control with the patients through social media and via WhatsApp with community health volunteers so they can share with their networks.  

IOM hopes that a new clinic will be ready to serve patients in the next two weeks so that diagnostics and treatment for drop-in patients can continue. Door to door outreach will also continue to reach people which will ease the pressure on patients who must remain home while they finish their treatment. 

“It’s true that all of us have lost something or maybe someone in the blast, but there are people who are less privileged than us who have already lost a lot. It is even more important for us to stand up and be there for them,” said Dr. Najem. 

This article was written by Angela Wells, IOM Communications Officer for the Department of Operations and Emergencies.