Balsam – the Lebanese Center for Palliative Care is a nongovernmental organization founded in 2010 and registered in the Lebanese Ministry of Interior in March 2011. Balsam aims to relieve suffering and improve the quality of life of people facing life-threatening illness through patient care, advocacy, capacity building, and research. Balsam is committed to developing palliative care in Lebanon to ensure its integration into our healthcare system.
We believe in:
Providing the best quality of life for as long as life lasts.
Respecting our patients’ wishes, values, and beliefs.
Supporting life; not hastening death.
We believe that:
No one should live in pain.
No one should live in fear.
No one should die feeling alone.
Everyone deserves a dignified death.
Behind every great organization is a powerful story. This is especially the case with Balsam, the Lebanese Center for Palliative Care. In 2007, Dr. Hibah Osman, then a family physician at the Department of Family Medicine at the American University of Beirut Medical Center (AUBMC), took on the care of Mrs. Najla Cortas Zurayk when she was diagnosed with cancer. Dr. Osman followed protocol and referred Mrs. Zurayk to the relevant medical specialists. Over the course of the following year, however, Mrs. Zurayk and her family faced a stressful ordeal trying to manage the associated complications with her illness. Physicians were busy and rushed, and Mrs. Zurayk was wheeled from one operation to the next with little advance notice or explanation. For a woman in her mid-90s, this experience was distressful for her and for her family who had nowhere to turn for help.
About a year later, Dr. Osman happened to meet Mrs. Zurayk’s daughter, Huda, who was then Dean of AUB’s Faculty of Heath Sciences and an old family friend. Huda was completely overwhelmed with the complications of her mother’s illness including surgery, emergency room visits, radiation therapy, and fielding multiple doctors’ opinions. Immediately, Dr. Osman took on the role as the go-between; she coordinated with Mrs. Zurayk’s physicians to arrange meetings with them and the family. At the same time, Dr. Osman talked with Mrs. Zurayk to include her in the decisions regarding the kind of care she wanted. What struck Huda was Dr. Osman’s holistic approach, she connected with the person, and managed the symptoms of the disease, rather than just the disease itself. However, Dr. Osman didn’t possess all the tools necessary to treat Mrs. Zurayk’s symptoms at home and when complications arose, Mrs. Zurayk would be subjected to yet another stressful visit to the hospital. While Dr. Osman was familiar with hospice care from her US-based training, this option was not available in Lebanon and the concept of palliative care was still an unknown.
After a particularly lengthy hospital stay, Mrs. Zurayk made it clear to Dr. Osman that she wanted to leave the hospital and go home. At that critical phase in her illness, Dr. Osman hesitated. But Mrs. Zurayk insisted and her wishes were respected. A few days later, Dr. Osman travelled to the US to attend a Family Medicine conference, where she found herself drawn to all sessions related to what she came to know was palliative care. In the middle of the conference, on May 1st 2008, Dr. Osman learned that Mrs. Zurayk had passed away at home in Beirut. Though Dr. Osman was hit hard by the loss of Mrs. Zurayk, she took solace in and gained strength from the knowledge that she had helped make Mrs. Zurayk comfortable in the last months of her life and that she had given invaluable support, guidance, and relief to Mrs. Zurayk’s family. Ultimately, this experience changed the course of Dr. Osman’s career. In August 2009, she left her position as family physician at AUBMC, set up her own private practice, and found her true calling in palliative care.
Balsam’s beginnings and growth
Backed with seed money from a generous donor, Dr. Osman paired up with like-minded people to found Sanad, the first palliative care NGO in Lebanon. Like many new experiences, at first things were touch and go, and soon after a difference in vision led Dr. Osman to leave Sanad and establish Balsam. Founded in the September 2010 and formally registered in March 2011, Balsam launched out on its own with a mission to relieve the suffering and improve the quality of life of patients facing life-threatening illnesses through patient care, advocacy, capacity building, and research.
Janane Hanna and Rebecca El-Asmar, award-winning palliative care trained nurses, joined Dr. Osman to form Balsam’s small team in 2010. From their first patient that fall, things moved very quickly. Indeed, since the end of 2016, Balsam has cared for over 633 patients. Between 2014 and 2016, patient enrollment numbers increased from 98 in 2014, to 159 in 2015, to 215 in 2016. Moreover, physicians increasingly recognized the benefit of palliative care for their patients such that referrals to Balsam came from only 8 different physicians in 2011, to 92 physicians by 2016. Perhaps the greatest indicator of Balsam’s success is the 71% increase in the number of patient days in 2013. This means that patients are referred to Balsam much earlier in the course of their illness and that they remain under and benefit from Balsam’s care for a much longer period. As a result of earlier referrals, some patients, in fact, have moved out of the category of being ‘high needs patients’ to the category of ‘stabilized patients’. Clearly, these facts and figures testify to Balsam’s success in the fulfillment of its mission to relieve suffering and improve the quality of life of those facing life-threatening illness.
Since 2010, Balsam’s team has simultaneously grown to meet the increasing demand for palliative care. Modelled after the interdisciplinary team approach of US palliative care centers, psychologist Dr. Michael Khoury and pharmacist, Dr. Dania Ghaziri joined Balsam’s team in 2011. AUB Master’s of Public Health graduate Loubna Batlouni joined the team as Outreach Coordinator in 2012, succeeded by Jinane Abi Ramia in 2014. According to Janane and Rebecca, both full-time nurses at AUBMC and part-time nurses at Balsam, Balsam’s first year was a balancing act of building working relationships with each other and handling what seemed like a constant stream of emergencies. During the first 2 years, Dr. Danielle Sara played a critical role in providing periodic support to Balsam nurses with patient care and nurse training. Then, in March 2012, the first full-time nurse, Mohammad Saab, joined the team and nurses’ patient load significantly stabilized. Since 2015, Balsam has supported three full-time nurses, Hiba Shami (2013-2015), Alia El-Tabsh (2014), and Chadia Fayad (2015). Also in 2015, Dr. Aline Zakhem and Dr. Karim Farah, brought their invaluable medical experience and expertise to Balsam’s service. In November 2013 Hiba Makke, a social worker, joined Balsam to support the team and reduce the psycho-social stress that patients and the team may encounter especially when dealing with the most difficult or painful cases, such as pediatric cases. Jinane Abi Ramia took on the role of Outreach Coordinator between 2014 and 2016, and in January 2016, Roula Doughan became Balsam’s Human Resource Manager to support the team while guiding Balsam’s future expansion and direction. Most recently, Dr. Joe El Khoury joined the team of physicians supporting the nurses and providing care the patients and their families at home. A team of one physician and two nurses in 2010, Balsam is now a formidable force of 13 specialists, who work together to anticipate, and more often than not, avoid emergencies. More on Our Team.
Balsam’s impact is not only felt through its life-changing patient care, but also in the multiple roles it plays in advocacy, research, and capacity building. Central to Balsam’s mission is the integration of palliative care into the Lebanese healthcare system. But because palliative care services are not reimbursable by health insurance companies in Lebanon, palliative care is not available or accessible to all, nor is there a real understanding across communities, health care providers, and policy makers of its benefits. By the same token, physicians and nurses are discouraged from choosing palliative care as a career option. However, through Balsam’s efforts, prospects for change are promising.
From its very inception, Balsam sought to partner with the Lebanese Ministry of Public Health (MOPH) to win support for the recognition of palliative care on policy level. Balsam played a critical role in the establishment of the National Committee for Pain Control and Palliative Care (NCPCPC) under the MOPH in May 2011. This was followed in June 2013 with the MOPH’s issuance of decree 1/1048 that recognized palliative care as a specialty in Lebanon. A few months later, in September 2013, the Medical Specialties Committee of the MOPH certified Dr. Osman as the first Palliative Medicine specialist in Lebanon. These vital steps go a long way towards the goal of the integration of palliative care in the Lebanese healthcare system that Balsam works tirelessly to push through.
One of Balsam’s most ambitious projects, that combines research and advocacy, is the ImPaCT study, supported by GlobeMed, a visionary third party insurance administrator. Launched in 2015, this two-year clinical trial is evaluating the impact of home-based palliative care on the cost of healthcare and quality of life of patients with advanced illness to produce research findings that will help inform policy makers and private insurance providers. Preliminary findings have already shown that Balsam’s services save healthcare costs (and the associated stress of emergency room visits) by catching patient illnesses early and treating patients at home rather than at the hospital.
Capacity building is more difficult to quantify because it is such a natural extension of Balsam’s outreach efforts. Since its very beginning, Balsam’s team members have given numerous public lectures, conference presentations, workshops, and university courses. At AUB, Dr. Osman taught courses in Public Heath and designed and taught a course on palliative care that has become a requirement for all second year medical students which Dr. Zakhem now teaches. At the same time, Balsam has conducted several capacity building workshops and projects. Of the many examples, the following three evince Balsam’s reach on local, national, and regional levels. In 2013, Dr. Osman trained a multidisciplinary team to launch the first hospital-based palliative care initiative in Lebanon at the American University of Beirut Medical Center (AUBMC). Though still in the beginning stages, this initiative has already informed views and approaches to palliative care. The following year, Balsam invited international palliative care specialist, Dr. Frank Ferris, to Beirut to conduct two courses, a leadership course in 2014 and an advanced palliative care course in 2016. Both experiences were especially noteworthy for bringing together medical professionals working in completely different hospital settings around the country for training, ultimately creating a more collaborative environment. In between these two courses, with the support of the World Health Organization (WHO) and in collaboration with the MOPH, Balsam launched an ambitious capacity building pilot project in 2015. This project developed a hospital-based palliative care model at the Ain WaZein Hospital in the Shuf region of Lebanon involving the training of medical professionals, nurses and physicians in palliative care. On a regional level, Dr. Osman has participated in training workshops in Kuwait, in collaboration with the WHO and the Gulf Federation of Cancer Control, and in Morocco, with the American Society of Clinical Oncology.
Balsam’s wishes for the future are clear. Nurses, Janane and Rebecca, would like to see the availability of a dedicated hospice in Lebanon. In the short-term, Dr. Osman would like to see Balsam have a sustainable source of funding. Financial stability is one of Balsam’s greatest challenges as its services are offered at no cost to ensure universal accessibility. Presently, Balsam is entirely dependent on individual donations and supporters. Dr. Osman would also like to see palliative care covered by insurance companies and integrated within the national healthcare system. In the longer term, Dr. Osman dreams of scaling up Balsam’s capacity building to train healthcare professionals in palliative care across the country. With the Lebanese life expectancy rising and hospitalization costs also rising, these dreams need to become reality.
Considering Balsam’s achievements on so many different levels, it’s hard to believe that Balsam’s story covers a short 7 years. With its seeds sown in a heartfelt personal experience, Balsam has grown into an organization that combines the immediacy of impact – through patient care, advocacy, research, and capacity building – and a far-reaching vision for the benefit of all.
In memory of W. B.
In memory of F. L.
In memory of R. M.
In memory of N. M.
In memory of L. K.
يعني ما بأعرف قدي بدّي احكي قدي بدّي قول وكان كل هيدا الشي بلا ولا ولا ولا مقابل. يعني ولا نهار... هي ع البرد كان اول الشتي ف التانت ع كتر ما تبرد يزرقو يبطل يمشي الدم، تقعد ربع ساعة تفركلا باجرا. ان يمكن لو ابنا كان زهق. ... عن جد انا كنت سميهم هدية من ربنا لحتى لقيتم بحياتي. انا باعتراف لو ما هني كانو انا ما كنت قدرت خدمت التانت بهل طريقة. كان وجودم كتير مهم بحياتنا. عن جد انا بس شوف اسمهم عن جد هيك بأحس أبدا مش تمثيل.
كل خبرتي مع بلسم كانت هيي دائماً صعبة وبلسم هيدي العصا السحرية اللي لاقيين لاقي هبة حدي يمكن لو بتليفون. أوقات اقعد ساعة بس احكيهم بشي ما خصو بالتانت بشي خصو بالتعصيب...