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SUMMER
2012
29
To Dr.
Ramzi Hajjar ‘83
every patient
who walks into his clinic is a friend. He
knows only too well, that at this latter
stage in life, his patients need to talk.
And he is willing to listen. He carefully
schedules his appointments to give each
patient a full 45 minutes. Even more if
they need it. Some only need to be there
for a few minutes really, perhaps just to go
over some test results.
But it doesn’t matter to Hajjar. He quizzes
them about their spouses, children, grand-
children, or anything that is bothering
them lately. Some burst into tears as they
talk about lost loved ones. Others impart
age-old wisdom to an eager listener.
It may seem like chit-chat. But actually
it’s the best therapy for the elderly. “Most
of them are lonely,” he said. “They may be
widows, single, childless, or have children
who live abroad.They need to talk.That’s
just as therapeutic as giving them medi-
cine for their arthritis.”
On his desk is a big bowl of colorful tab-
lets – easily mistaken for delectable candy.
“These are the medicines I confiscate from
my patients,” he chuckled. “You would be
surprised how much unnecessary medica-
tions are prescribed to the elderly. I just
tell them to hand them over.”
He has repeatedly noted that loneliness
and inactivity are the worst enemies of
the elderly.That’s when pain and aches
seem to increase. A big part of geriatrics is
to keep healthy elderly – healthy.
His patients need him to care. And he
does. He cares enough to follow up
patient visits with personal telephone calls
“to ease their burden of having to come to
the clinic all the time,” he said. He cares
enough to visit terminally ill patients at
home free of charge.
But, he sighs, it’s a lonely job.The need is
great but how much can one geriatrician
accomplish on his own?
Unfortunately, Lebanon’s care for its elder-
ly – which comprise 9% of the population
(among the Arab countries, Lebanon has
the oldest population) - is characterized
by a health care system which drops them
once they retire, costly private insurance
(completely rejected if over 70), lack of
retirement communities, gloomy nursing
homes, non-existent palliative care, and
a deficiency of community or recreation
centres for the elderly. Even simple things
like senior citizen discounts rarely exist.
Shockingly, there are only a handful of
geriatric physicians across the country that
care for an increasingly ageing population.
Having spent time volunteering in Pales-
tinian camps and other deprived areas in
Lebanon, Hajjar had already experienced
his country’s negligence in addressing
the plight of the elderly. However, it
was when he was living and working in
the US that he noticed the extent of the
medical community’s neglect. During his
visits to Lebanon, he was deeply con-
cerned by the comparison between his
active and productive patients in the US
and their somewhat discarded Lebanese
counterparts.
It was a difficult decision but he packed
his belongings and moved back to Leba-
non in 2010. He felt he could make a
difference here.
That same year, he established the first
geriatric medicine program at AUH. At
present, Hajjar operates almost indepen-
dently but he is intent on convincing his
employers for the need to expand the
department and - as Lebanon’s only board
certified doctor in hospice care - establish
an inpatient palliative care service for
terminally ill patients.
His other challenge is to convince medical
students to study geriatrics – or at the very
least change their perception of caring for
the elderly. With a rapidly aging popula-
tion and without a coherent program in
place or a viable recruitment strategy,
Lebanon’s medical establishment will find
itself considerably under-prepared and
ill-equipped to confront the issue.
“This is not about seeing as many patients
as you can in one day,” he tells them.
“And it’s not about finding cures. You
won’t.This is about managing symptoms
and improving the quality of life. This
is about knowing how to handle death,
how to talk to the patients and how to
prepare the family for that. It’s also about
going to their homes and being there for
them so that they won’t feel abandoned
if diagnosed with a terminally ill disease.
This is about caring and having a loving
attitude.This is not about making money
(you won’t!).This is a calling.”
Hajjar and Othman (previous page)
often coordinate their efforts to give their
patients the best care.
“Lebanon is where the US was 30 years
ago in geriatrics,” said Hajjar. “There is a
huge need here there’s no doubt. I am so
much more useful here than in the US.
There’s still a lot I can’t do here but we
are slowly filling in a gap. If we didn’t do
it, who will?”
It’s all about
caring