'The clinic is Therese' - the Lebanese mountain village relying on one retired nurse

Therese Comair likes to talk about herself in the third person. “Therese is clever and hard-working,” she said when explaining how the ministry of health granted her a permit to continue running her village’s clinic despite retiring three years ago. “Therese serves everyone, whatever party or religion,” she said, sitting in her cousin’s living room overlooking the dramatic mountain scenery surrounding the picturesque village of Tannourine, an hour-and-a-half’s drive north-east of Beirut. “A sick man is a sick man.” Most people in Tannourine, a historic Maronite Christian refuge close to 1,500 metres above sea level with a natural reserve of Lebanon’s famed cedar trees and deep waterfalls near by, agree with Therese. “She’s not like any other employee who goes home after their shift. She’ll come out in her pyjamas to get medicine for you,” said Norma Younes, a retired schoolteacher. For the tight-knit community of Tannourine, Therese, a short, energetic 67-year-old woman with bright blue eyes, has come to embody the local government-owned primary healthcare centre, where she has worked as a nurse and midwife for nearly 50 years. Though she retired in 2018, she stayed on as a volunteer, backed by the local government hospital and the municipality that provides her with a small monthly stipend. Villagers feared no one would replace Therese because of a government hiring freeze and the centre would close. Today, they rely on her services more than ever. Patients have tripled in the past two years as Lebanon’s devastating financial crisis drags on, according to Therese, who manages her stocks carefully. People have started calling from outside the village, as far away as Batroun, a coastal town a 45-minute drive away. “I can’t give everything to one person in one go,” she said as she listens to a voice note on WhatsApp from a man asking for a second dose of an antibiotic, Augmentin, for his baby, a few hours after a first request that morning. Drugs have become a precious and expensive commodity as shortages of basic goods, including pain-relievers such as Panadol, increase. Like in all primary healthcare centres in the country, Therese hands out medicine provided by the ministry to anyone – no questions asked – for a small fee of about 10 cents. Because public hospitals and clinics in Lebanon are widely viewed as subpar compared with the private sector, turning to a government-run clinic for medication used to be relatively uncommon among the Lebanese middle class. It is a new habit for Therese's cousin, 22-year old law student Carine Comair. The clinic is “normally a place for the poor. But we are all poor now”, she said. “If I go to the pharmacy, they say there’s nothing, or it’s very expensive. I come here and it’s free.” Rana Tarabey, another distant relative who has come to the clinic to pick up Panadol, described the primary healthcare centre as “better than 100 pharmacies”. “Habibeh,” answered Therese with a smile, gracefully acknowledging the compliment with a local term of endearment. She knows how important she is for the community. But she is also aware she cannot cater to their most urgent needs as the amount of medicine for chronic diseases delivered by the cash-strapped Ministry of Health dwindles. “Most people want medicine for diabetes but I don’t have it. They have to try their luck at hospitals or pharmacies,” she said. The doctor who normally sees patients in the clinic, which sits on the ground floor of one of the village’s traditional stone buildings, was absent the day The National visited because he could not get enough fuel for his car. Tannourine’s primary health care centre is part of a network of more than 200 centres across the country. Most of them are managed by NGOs, but a small portion, including the one in Tannourine, are entirely state-owned. Experts agree the centres play an essential role in keeping the population healthy and preventing the spread of chronic diseases such as diabetes, which, along with cancer, are the leading cause of mortality in the country. Yet decade-long underfunding is becoming increasingly apparent, much to the worry of the centres’ managers, who have to accommodate an ever-increasing number of patients. Serop Ohanian, the executive director one of the biggest primary healthcare centres in the country, said the network received less than 10 per cent of the health ministry’s budget, one of the country’s main expenses. “Demand has increased and the quantity of medication has decreased. I sometimes have to tell patients to return in two weeks,” said Mr Ohanian, who heads the Howard Karagheusian primary healthcare centre in the Beirut suburb of Bourj Hammoud. In the past decades, the Ministry of Public Health had responded to political pressure by building hospitals instead of focusing on preventing disease, said Salim Adib, a professor of epidemiology and public health at American University of Beirut. “Prevention has always been the weaker part of public health in Lebanon,” he told The National . Randa Hamadeh, the director of the primary healthcare department at the ministry, did not respond to a request for comment. In Tannourine, the government-run clinic is both a symbol of the state’s faltering presence and a testimony to the efforts of hard working individuals such as Therese. “It’s us, Lebanese citizens, who took the necessary steps to make sure that our institutions continue working,” said Walid Harb, chairman of Tannourine government hospital. Therese summed it up: “Without Therese, there is no clinic. With Therese, there is a clinic. The clinic is Therese.”

'The clinic is Therese' - the Lebanese mountain village relying on one retired nurse

Therese Comair has worked at a government-owned primary healthcare centre for close to 50 years. Today, the public health sector is collapsing