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Pediatric Nephrologist facing War Chebl MOURANI

Pediatric Nephrologist facing War Chebl MOURANI. ESPN Lyon Septembre 2008 Ass. Professor Hotel Dieu de France Pediatric Hemodialysis & Kidney transplant unit Beirut- Lebanon- Hotel Dieu de France. Overview. 12 July 2006 Military conflict started between Lebanon & Israel , In 48 hours:

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Pediatric Nephrologist facing War Chebl MOURANI

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  1. Pediatric Nephrologist facing War Chebl MOURANI ESPN Lyon Septembre 2008 Ass. Professor Hotel Dieu de France Pediatric Hemodialysis & Kidney transplant unit Beirut- Lebanon- Hotel Dieu de France

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

  3. Consequences of War • Schools and Universities :closed • All civil activities stopped. • Embargo on Fuel: Electricity shortage • Fuel distributed only for Hospitals and Doctors • Dangerous circulation for citizens especially for children coming to Beirut for dialysis

  4. Direct Actions • Decision: gather children in a secure place near dialysis centers till the end of the war • Problems to solve : • Housing of 30 Pediatric HD patients with their families in secure place? • Ensure beds, food, water, access to sanitaries, showers, electricity, security?

  5. Solutions • Using public school for housing : opened after the authorization of security forces • Food: delivered by humanitarian associations • Electric generator donated by City Mayor. • Access to hospital showers for the families. • Beds and covers donated by the National Committee for Disasters.

  6. After 2 weeks of war • New Problems: • Factory for Hemodialysis solutions bombarded • Filters for pediatric use: shortage • Same problem for Peritoneal Dialysis • No possibility of delivery from outside Lebanon: maritime embargo, roads to Syria are closed.

  7. Temporary Solutions • Transfer of Pediatric patients outside Lebanon • Help asked from ISN • Meanwhile: • Reducing number of HD sessions • High Diet restriction • Resonium for everybody.

  8. Major Problem • We can not continue Hemodialysis to children • Parents were informed about problems in a general assembly • Parents: Ready to leave the country with their children. • Hope: Marmara center for HD in Turkey ready to accept them.

  9. Problems • Diplomatic problems: no possibility to give visas for 30 families (150 persons) no similar situation before. • Impossible to leave Lebanon : nobody can provide guarantee to secure their lives during travelling. • Efforts of ISN, Minister of Health, Baxter, Prime Minister, Lebanese Army

  10. New Hope • Filters and Solution for Adults and Pediatric Patients in Turkey: Ready for shipment. • Problems: • How to bring disposable materials to Lebanon? • Materials blocked in Turkey. • Who will guarantee the security of the ship?

  11. Solutions • Personal contact with Ambassador of Turkey • Target: save life of more than 50 children • Intensive Negotiations during 48 h allowed • Turkish war Navy to embark to Lebanon through a safe naval passage

  12. Arrival of materials • Engagement was respected by belligerents. • Turkish navy arrived to Lebanon with dialysis disposable. • Material received in presence of CNN and local TVs, the Turkish Ambassador and Minister of health. • Filters transferred out of Beirut Port to dialysis centers in Beirut.

  13. Out of Beirut • 20 children out of Beirut in need of material • How to send them filters and solution in War? • Red cross- Lebanese Army delivered HD materials to centers. • All children on HD were saved.

  14. Problems of Peritoneal Dialysis • 2 children refused to leave their homes • UPS was not recharging because of electricity shortage • No HD available • 2 infants on PD died at home • Impossibility to communicate with them

  15. Recommendations for HD • We recommend after experience of July 2006 in Lebanon for hemodialysis, in situation of war: • Gather children in same hospital or in a place very near to a dialysis center • Ensure facilities for their family to continue to live a decent life. • If not enough materials: reduce number of dialysis – Diet restriction + Medication + monitoring BP and Potassium. • Ensure electrical generator : provide fuel

  16. Recommendations for PD • In situation of war PD: • Ensure electricity for Homechoice machine. • UPS efficient for small period of electricity shortage. • Force them to come to the center in case of prolonged war • CAPD should be taught and material assured.

  17. Role of IPNA • Create a committee IPNA for catastrophic situation(disaster and war) to help pediatric nephrologists during war • Cooperate first with ISN (good experience in Turkey) • International recommendations : symposium on pediatric nephrology during disaster or war

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