Pediatric Nephrologist Pediatric Nephrologist facing War facing War

Chebl MOURANIChebl MOURANI

ESPN Lyon Septembre 2008ESPN Lyon Septembre 2008Ass. Professor Hotel Dieu de FranceAss. Professor Hotel Dieu de France

Pediatric Hemodialysis & Kidney transplant unitPediatric Hemodialysis & Kidney transplant unitBeirut- Lebanon- Hotel Dieu de FranceBeirut- Lebanon- Hotel Dieu de France

OverviewOverview

12 July 2006 Military conflict started 12 July 2006 Military conflict started between Lebanon & Israel , In 48 hours: between Lebanon & Israel , In 48 hours: • International Airport of Beirut: out of service International Airport of Beirut: out of service • Beirut Port is closed: EmbargoBeirut Port is closed: Embargo• All Highways & Principal roads bombarded All Highways & Principal roads bombarded • War in South of Lebanon.War in South of Lebanon.• Air Strikes: Beirut, North and East of Air Strikes: Beirut, North and East of

LebanonLebanon

Consequences of War Consequences of War

Schools and Universities :closedSchools and Universities :closed All civil activities stopped.All civil activities stopped. Embargo on Fuel: Electricity shortageEmbargo on Fuel: Electricity shortage Fuel distributed only for Hospitals Fuel distributed only for Hospitals

and Doctorsand Doctors Dangerous circulation for citizens Dangerous circulation for citizens

especially for children coming to especially for children coming to Beirut for dialysis Beirut for dialysis

Direct ActionsDirect Actions

Decision: gather children in a secure Decision: gather children in a secure place near dialysis centers till the place near dialysis centers till the end of the warend of the war

Problems to solve :Problems to solve :• Housing of 30 Pediatric HD patients Housing of 30 Pediatric HD patients

with their families in secure place?with their families in secure place?• Ensure beds, food, water, access to Ensure beds, food, water, access to

sanitaries, showers, electricity, security?sanitaries, showers, electricity, security?

SolutionsSolutions

Using public school for housing : opened Using public school for housing : opened after the authorization of security forces after the authorization of security forces

Food: delivered by humanitarian Food: delivered by humanitarian associationsassociations

Electric generator donated by City Electric generator donated by City Mayor.Mayor.

Access to hospital showers for the Access to hospital showers for the families.families.

Beds and covers donated by the Beds and covers donated by the National Committee for Disasters. National Committee for Disasters.

After 2 weeks of warAfter 2 weeks of war

New Problems:New Problems:• Factory for Hemodialysis solutions Factory for Hemodialysis solutions

bombarded bombarded • Filters for pediatric use: shortageFilters for pediatric use: shortage• Same problem for Peritoneal DialysisSame problem for Peritoneal Dialysis• No possibility of delivery from outside No possibility of delivery from outside

Lebanon: maritime embargo, roads to Lebanon: maritime embargo, roads to Syria are closed.Syria are closed.

Temporary SolutionsTemporary Solutions

Transfer of Pediatric patients outside Transfer of Pediatric patients outside LebanonLebanon

Help asked from ISNHelp asked from ISN Meanwhile: Meanwhile:

• Reducing number of HD sessions Reducing number of HD sessions • High Diet restrictionHigh Diet restriction• Resonium for everybody.Resonium for everybody.

Major ProblemMajor Problem

We can not continue Hemodialysis to We can not continue Hemodialysis to children children

Parents were informed about Parents were informed about problems in a general assemblyproblems in a general assembly

Parents: Ready to leave the country Parents: Ready to leave the country with their children.with their children.

Hope: Marmara center for HD in Hope: Marmara center for HD in Turkey ready to accept them.Turkey ready to accept them.

ProblemsProblems

Diplomatic problems: no possibility to Diplomatic problems: no possibility to give visas for 30 families (150 give visas for 30 families (150 persons) no similar situation before.persons) no similar situation before.

Impossible to leave Lebanon : Impossible to leave Lebanon : nobody can provide guarantee to nobody can provide guarantee to secure their lives during travelling.secure their lives during travelling.

Efforts of ISN, Minister of Health, Efforts of ISN, Minister of Health, Baxter, Prime Minister, Lebanese Baxter, Prime Minister, Lebanese ArmyArmy

New HopeNew Hope

Filters and Solution for Adults and Filters and Solution for Adults and Pediatric Patients in Turkey: Ready Pediatric Patients in Turkey: Ready for shipment.for shipment.

Problems:Problems: How to bring disposable materials to How to bring disposable materials to

Lebanon?Lebanon? Materials blocked in Turkey.Materials blocked in Turkey. Who will guarantee the security of the ship?Who will guarantee the security of the ship?

SolutionsSolutions

Personal contact with Ambassador of Personal contact with Ambassador of TurkeyTurkey

Target: save life of more than 50 Target: save life of more than 50 children children

Intensive Negotiations during 48 h Intensive Negotiations during 48 h allowed allowed

Turkish war Navy to embark to Turkish war Navy to embark to Lebanon through a safe naval passageLebanon through a safe naval passage

Arrival of materialsArrival of materials

Engagement was respected by Engagement was respected by belligerents.belligerents.

Turkish navy arrived to Lebanon with Turkish navy arrived to Lebanon with dialysis disposable.dialysis disposable.

Material received in presence of CNN Material received in presence of CNN and local TVs, the Turkish and local TVs, the Turkish Ambassador and Minister of health.Ambassador and Minister of health.

Filters transferred out of Beirut Port Filters transferred out of Beirut Port to dialysis centers in Beirut. to dialysis centers in Beirut.

Out of BeirutOut of Beirut

20 children out of Beirut in need of 20 children out of Beirut in need of materialmaterial

How to send them filters and solution How to send them filters and solution in War?in War?

Red cross- Lebanese Army delivered Red cross- Lebanese Army delivered HD materials to centers.HD materials to centers.

All children on HD were saved.All children on HD were saved.

Problems of Peritoneal Dialysis Problems of Peritoneal Dialysis

2 children refused to leave their 2 children refused to leave their homeshomes

UPS was not recharging because of UPS was not recharging because of electricity shortageelectricity shortage

No HD availableNo HD available 2 infants on PD died at home 2 infants on PD died at home Impossibility to communicate with Impossibility to communicate with

themthem

Recommendations for HDRecommendations for HD

We recommend after experience of July We recommend after experience of July 2006 in Lebanon for hemodialysis, in 2006 in Lebanon for hemodialysis, in situation of war:situation of war:1.1. Gather children in same hospital or in a Gather children in same hospital or in a

place very near to a dialysis centerplace very near to a dialysis center2.2. Ensure facilities for their family to continue to Ensure facilities for their family to continue to

live a decent life.live a decent life.3.3. If not enough materials: reduce number of If not enough materials: reduce number of

dialysis – Diet restriction + Medication + dialysis – Diet restriction + Medication + monitoring BP and Potassium.monitoring BP and Potassium.

4.4. Ensure electrical generator : provide fuel Ensure electrical generator : provide fuel

Recommendations for PDRecommendations for PD

In situation of war PD: In situation of war PD: 1.1. Ensure electricity for Homechoice Ensure electricity for Homechoice

machine.machine.

2.2. UPS efficient for small period of UPS efficient for small period of electricity shortage.electricity shortage.

3.3. Force them to come to the center in Force them to come to the center in case of prolonged warcase of prolonged war

4.4. CAPD should be taught and material CAPD should be taught and material assured.assured.

Role of IPNA Role of IPNA

Create a committee IPNA for Create a committee IPNA for catastrophic situation(disaster and catastrophic situation(disaster and war) to help pediatric nephrologists war) to help pediatric nephrologists during war during war

Cooperate first with ISN (good Cooperate first with ISN (good experience in Turkey)experience in Turkey)

International recommendations : International recommendations : symposium on pediatric nephrology symposium on pediatric nephrology during disaster or warduring disaster or war