Tuberculosis — How Our Associations Fight It

No one denies the dark role that illness plays in a person's life, and the grave repercussions that ravage the patient and those around him alike.

I shall not go into the scientific theories, where we find what may save the patient — nor into any answer from the moral side, which is capable of making illness appear as an instrument of good.

The one matter to which I shall give my attention is the social side.

I shall therefore try to study the important issues that cause the many diseases here in our country, where there is nothing to protect a person from disease or to work at shielding him from it; and I shall try, in particular, to set before you some important cases, private and public, which I encountered in the course of my training in the fight against tuberculosis.

We ask first: does not the first problem arising from cases of illness stem from the family's income budget?

An ample, steady budget works like magic in these families that we must care for.

How do these families eat? How do they dress? Where do they live? How do they raise and bring up the little ones, whose number in a single home ranges between six and eight or ten, and perhaps more, while the father often earns no more than two or three liras a day?

The family rents a wretched room to live in, without water or electricity, renting it for ten or twelve liras a month.

The hardship of living for these people is doubled by the problem of total and partial unemployment. Many workers work two days against three days of idleness. Add to that the high cost of living and the paltry wages.

How, then, is one to escape the crisis of illness that besets these human beings?

We find no way out except in redoubled nourishment. And in this troubled material condition, the disease runs rampant in surroundings neglected in matters of health. These cases become alarming and frightening when tuberculosis infections begin to creep among the members of a family. And what happens then?

Sometimes the patient goes and consults a charitable physician; if he has tuberculosis, the physician directs him to go to the dispensary to be treated against tuberculosis. Very often the patient is taken to a neighboring or nearby dispensary, where he is directed to a social welfare office that cares for him and treats him. But his family — to what fate does it fall? At the outset it faces an additional expense added to the necessities of life. Want multiplies little by little, and often the parents seek the necessary food in vain. The matter is graver still if the patient was helping the family manage its affairs: the family is then forced to keep the children from school, if they were attending, ceases to renew their clothes, and lowers their level of nourishment. The tragedy grows sharper if the patient was the family's helper and its sole breadwinner — then it is truly a catastrophe.

It is necessary to pause over the cases of certain mothers who are hurled back into pain at a sudden parting, or into a state of no assurance about what is to come. Allow me now to introduce you to some of these families.

J. S., a workman for twenty-three years, unemployed for six months, father of five children. We were asked to go quickly to look after the family, at the direction of the social service for the fight against tuberculosis.

After great effort and an exhausting walk through the sands of Musaytbeh, under the burning rays of the sun and amid flying dust, we found J.'s home. And what misery we saw there!

A small room, damp in winter, scorching in summer, with a single opening, rented at 15 Lebanese liras a month. The owner of this room is trying to throw the family into the street, because it has not paid the rent for seven months. The furnishings of the room consist of an old bed and a child's bed, two or three chairs, and a small table on and under which are heaped a mass of things without order or arrangement. In a corner are piled the wretched bedding and a few threadbare clothes.

We found J.'s wife in the room with her little boy on her arms, her gaze distracted, her features miserable. The moment we entered the room, the terrified little girls took fright and clung to the hem of their mother's dress. The children are five: the eldest no more than seven years old, paralyzed in his left hand; the youngest not past his first month, born after his father entered the hospital. The fourth child suffers the pains of a racking illness; he weeps and twitches continually; and another has been crying and troubling his mother for an hour, because he is hungry.

The wretched woman spoke to us with warmth of her misery and her suffering. When my husband was in the prime of his youth, strong and brimming with vitality, he squandered the greater part of his earnings on gambling. They were quickly blessed with this large number of children... and they were forever in need of the necessary daily bread. She added: my family could have helped us, but they are poor like us.

This family of J.'s lives on the charity of the neighbors: one sends them a little flour, another a little rice and sugar, a third some chickpeas and beans... And very often the mother finds nothing to give her little ones.

Her husband has left her, and she has no source of livelihood. He is now dying in a sanatorium. Perhaps her only hope is that we shelter one of her children in an orphanage when the father dies.

Here is a second, similar case: the family of A. S. This man is thirty-three years old — strong, extremely vigorous, energetic, skilled in his trade as a builder; the employers who pay a daily wage of six to seven Lebanese liras are always asking for him. He lived in comfort and ease with his family, made up of his wife and three small children of seven, five, and two. Thanks to his prudence and thrift he saved some money.

Then suddenly illness struck him, and he was treated at home for four months. The savings ran out... He sold a piece of land he owned in the mountains at a trifling price, and this money too was quickly gone. What was he to do?

A. was moved to the Quarantina, where his treatment began free of charge. But how is his family to live, what is to be done, and what source of livelihood remains to him?

Here the crisis was met: A.'s cousins did everything in their power for their sister and her three children. The eldest brother, thirty years old, performed a heroic act: he broke off his engagement to a girl he had loved for three years, because her family insisted on his marrying her quickly — and this in order to go on contributing to the help of his family.

But what happens if the illness drags on?

In the face of these painful, distressing cases, what can we do? On what effective element can we rely?

On the medical side we have the free examinations at the dispensary for the fight against tuberculosis, and the devotion of the doctors and the social workers — the succor of them all is valuable and great. Free hospitalization in a sanatorium likewise has its effective influence, and the credit for that belongs to the Ministry of Health.

But on the social side, how are we to help these poor people mired in misery?

We sought help from the houses of charity — as numerous as the rites and communities of Lebanon — and it was generous. It was begging on our part, but an honorable begging. The charitable associations have concerned themselves with the social side, and one of them gives us a monthly assistance of ten Lebanese liras, granted to a family so long as one of its sick is in the sanatorium. Besides the help of the charitable associations there is individual help. And we must rely on this individual help alone when the patient is a stranger to Lebanon, for there exists in Lebanon no free sanatorium for strangers.

We petitioned the Ministry of Health and Public Assistance — and our request was granted — for the creation of assistance cards in the orphanages for the children of the sick. We could also wish that a government budget enabled one child of each tuberculosis patient to enter the orphanage at the government's expense; but alas, it is a mere wish.

The labor insurance law, when it is applied, will resolve a large part of the crisis. We had occasion to look after the case of a working girl of twenty who works at the Régie for a weekly wage of fifteen Lebanese liras. She entered employment in October 1949 and began to cough in October 1950. She was treated by the Régie's physician for a time, and was afterward admitted to the sanatorium once it was known that she suffered from this disease. She entered the hospital in January 1951.

We were overjoyed to learn that the director of the works where she was employed comes to visit her constantly, which heartens her, and that he paid her the salary of her three months of illness.

In some official departments an employee is helped if struck by some illness, provided he is on the confirmed staff.

We greatly hope that the project of prevention of disease and insurance of the sick will be realized in Lebanon. It is essential to create an official body to care for these poor unfortunates, so that fate does not fling them into beggary, and so that they are not left prey to the disease which strips them of their strength and of the means that would help them secure the life of their families.