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By Robert Ross The sound of mortar fire outside grew louder. The professor paced the room, nervously glancing at his watch. Before him, a group of students bent over their desks, straining to concentrate on their final examination. When time was up and they had left the room, comparing answers as students everywhere do, the professor set about correcting the exams at once. As he worked, he felt the building shudder from the shock of explosions. Moments after he had left for home, an explosion sent window glass shattering into empty classrooms and offices. Another academic year of the Lebanese University School of Pharmacy in Beirut had ended successfully - on time. For Anwar Bikhazi, PhD'70, the school's director, things like that count as small victories. Every morning at seven, Dr. Bikhazi, a Christian, leaves his home in the Moslem sector of west Beirut and crosses into the eastern sector to work at the Lebanese University. At three o'clock in the afternoon, he shuttles back across the heavily guarded dividing line to the American University, where he teaches medical students and has a research laboratory. He returns home at seven in the evening. When asked how he goes about the daily business of being a university professor, researcher, and administrator in the midst of the fighting that has torn Beirut for so many years, he shrugs it off. "I can cope with anything," he says stubbornly. He would rather rail against sloppily written prescriptions than the shelling that twice has shattered his office windows and toppled his bookshelves. He prefers to talk about his students' research projects than the days nobody shows up for class out of fear for their safety. In a place where hopes have been dashed so often before, he takes the future seriously. Dr. Bikhazi was born to immigrant parents in Accra, Ghana in 1942, when it was still a British colony, and four years later moved with his family to Beirut. After graduating from high school at the American-run International College, he enrolled in the American University of Beirut School of Pharmacy, where he got a BS in pharmacy with distinction in 1965 and an MS in pharmacy in 1967. He chose the University of Michigan for graduate study because, "to be honest, I wanted to work with Dr. Bill Higuchi who was there at that time." When he got his PhD in pharmaceutical chemistry in 1970, he stayed on another year for post-doctoral training with Drs. Higuchi and Simonelli. In 1971, he joined the AUB as an assistant professor of pharmacy. When the pharmacy school closed in 1975, he was transferred to the physiology department in the medical school. In 1986, he also became director of the Lebanese University's newly established school of pharmacy. Like many Lebanese, he doesn't like to call the fighting a civil war, referring to it instead as "the present situation" or "the military situation." Salim Jarawan, PharmD'87, who worked with Dr. Bikhazi at AUB as head of hospital pharmacy services before leaving the country for good, agrees: "The place has become a battleground for everybody who wants to fight their own battles there." Whatever it is called, its effect on a country whose hospitals and universities were once the envy of the Middle East has been a gradual erosion of the quality of health care and education. Dr. Bikhazi says an exodus of nurses and pharmacists from Beirut's hospitals is increasing. "There is a group of American recruiting agencies that travel to the Middle East to call on our nurses. They offer immigration status in the US and close to $40,000 a year salary." He adds that it is difficult to replace hospital pharmacists, who can nearly triple their starting salary by going to work for a drug company. The shortage of pharmacists threatens the hospital's ability to set and enforce drug policy and reduce dispensing and prescribing errors. He's proud that he, a pharmacist, chairs the hospital's pharmacy-and-therapeutics committee, instead of a physician, but is concerned about the errors that come to its attention. "Either the nurse is giving the wrong drug or dose or the doctor has prescribed the wrong drug to the patient," he says. Enforcement of health standards and regulations by higher authorities has broken down, as well, according to Dr. Bikhazi. "Walk into a community pharmacy in Beirut without a prescription and ask the pharmacist for a drug and he'll sell it to you - except narcotics," he laughs. "Ask for an insulin injection and he'll give it to you. Ask for digoxin tablets, he'll give it to you. Ask for aspirin, he'll give it to you." He adds that it's not uncommon for a physician to write a prescription "on a very simple piece of paper, without his name, without the name of the medical center, without the name of the patient, without even signing it. "It's a loose way of running the profession. We think it's part of the duty of the school of pharmacy to push for strict control," he says, "but with the present situation in the country we cannot do that. There's no ministry of health, nothing at all forcing anybody to follow the rules." With war has come an inflation that has devalued the Lebanese pound to 600 to a dollar, from three to a dollar, according to Dr. Jarawan, and driven up the cost of medications tremendously. "We'd love to shift somewhat to generic drugs," Dr. Bikhazi says, "but because our market is open, many companies in Lebanon are buying these products and selling them with no control over them. The ministry of health doesn't have strict control over drug procurement. They have regulations, but they're not implementing them 100 percent. We in the AUB hospital have freedom to buy products from outside markets without going through the ministry of health. This is very bad. We're facing problems with some of the products that are not PDA-controlled, which we do not approve of prescribing to our patients. To illustrate, he tells of recently serving on a government drug procurement group that was "looking into buying good products through the World Health Organization, then flooding the market with them in order to reduce the price." They got burned instead when the drugs they ordered turned out to be "lousy products, really lousy products, from unknown European companies." He has since proposed strict regulations to the AUB pharmacy and therapeutics committee for procuring generic products. The war's effects on the Lebanese University School of Pharmacy have been more than broken windows. For one, it has frustrated Dr. Bikhazi's efforts to recruit "the outstanding faculty" he dreams of. "As a matter of fact, if it wasn't for that war," he says angrily, struggling to control his breathing, "already we would have had a medical center and already we would be implementing a PharmD program." The school's nearly 200 students get their training in various private hospitals in Beirut. Of the forty students who graduate each year, some continue their education in the US and some work in community or hospital pharmacy. Most, however, happily take positions in drug companies in Lebanon, where they earn more than the assistant professors who taught them. The BS degree he now offers "is better than the degree which I had taken twenty-five years ago," he says. "The program is very efficient, very up-to-date, and I'm proud of it, but my dream is a much better school. I'm expecting better times and I will grasp the first opportunity to build a better school." "We are building up a school to the whole Lebanese community," he says. "In my laboratory I have students from all factions. I accept them in on the basis of their credentials." He visits the U.S. and The University of Michigan every few years, yet still he remains in Beirut. Why? Maybe he still holds dear what many young professionals of his generation were telling each other before one by one they left the city: "This country is not a hotel that you leave when things get bad." This article first appeared in the Spring 1990 issue of INTERACTIONS, published by the University of Michigan College of Pharmacy. |
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