Lebanon has long been known as the Switzerland of the Middle East for its banking sector. These days, the Levantine country is claiming another proud nickname.
“Lebanon now has the reputation as being the Brazil of the Middle East,” says Lebanese plastic surgeon Dr. Roger Khoury.
When Khoury founded the Beirut Beauty Clinic 12 years ago, he recalls that less than one percent of his patients came from abroad, compared with 15 percent today.
Other doctors in Lebanon report a similar rise in patients coming from outside the country. They attribute this to high quality healthcare and hospitals, relatively low prices, a liberal health sector free from government oversight, and of course the attraction of Lebanon as a travel destination.
Most of Lebanon’s medical tourists are Lebanese expatriates, with the most popular procedure being rhinoplasty, more commonly known as a ‘nose job’. There are also a growing number of patients who come from the Gulf for the healthcare, and then often stay on for the sun, sea and sand.
“When you come from abroad, you get the complete package — the reception at the airport, the hotel, the clinic and people to help during the recovery period. And everyone loves to visit Beirut,” says Khoury.
Depending on the procedure, a vacation along with medical treatment in Lebanon can cost less than the medical bill alone in a Western country. For example, rhinoplasty in New York City can cost $20,000, while the same procedure in Lebanon typically costs $3,000.
This fact has not been lost on Lebanon’s tourism sector and travel industry — in the Ministry of Tourism’s 2009 Yellow Pages, approximately a quarter of the book includes contact details for Lebanese medical professionals.
Dr. Marina Hajj, medical director at the American University of Beirut Medical Center says, “We have contact with all the carriers and we coordinate with them. It’s booming.”
Middle East Airlines, Lebanon’s national carrier, has a link on its web site about the benefits of medical tourism. Here it boasts that, “health tourism has endless opportunities and benefits, and it ties extremely well into Lebanon’s reputation as a rejuvenating place and a healthy state.”
Lebanon’s place as a healthcare destination dates back more than a hundred years, back when AUB’s hospital was known throughout the Middle East for its medical treatments and its faculty of medicine. The hospital gained acclaim in the mid-20th century for being the first in the region to perform a kidney transplant, as well as open heart surgery. Lebanon’s place as a regional healthcare destination continued until 1975, when the country’s 15-year civil war began. Now, Lebanon has slowly regained its place on the medical tourism map.
“After the war, it took time for us and other institutions to come back,” notes Hajj. “In the late 1990s, we again became a magnet in the region. When medical tourism here restarted, we saw some of the same patients that had been treated before 1975.”
The appeal of a Lebanese scalpel
Whether they are returning patients or longtime Lebanese doctors, many people seem to believe that there is an intrinsic understanding doctors here have with their Arab patients that sets them apart from their colleagues outside the region, be it because of their education or their bedside manners.
Nasri Holloway, a 56-year-old British-born businessman of Lebanese origin, splits his time between Lebanon and his residence in Sierra Leone. But he always returns to Lebanon for medical treatment, even though he has spent most of his life abroad. This summer, he came to the AUB hospital to get a cancerous kidney removed.
Holloway doesn’t think twice about returning to his native country for medical treatment.
“I think the doctors are better here,” he says. “In Europe, doctors tend to be much more automated. I don’t know if they’re not allowed to take risks for legal reasons. They work very much by the book. But the book isn’t always the same for two people.”
Khoury also believes that many Arab patients from abroad choose Lebanon because they feel more comfortable with doctors of the same cultural background.
He recalls one patient who requested the he make an incision for a breast augmentation on the side of her breast right below the armpit. Khoury reminded her that “we’re Mediterranean people, and we like to raise our arms when we dance.” He was able to convince her to get the incisions closer to the center of her breasts.
For other patients, an important aspect of getting a medical procedure done in Lebanon is the privacy of being treated abroad.
Noor, a Kuwaiti who wished not to give her real name, underwent breast augmentation surgery at the Beirut Beauty Clinic while on vacation in Lebanon this summer. For her, the most important issue was privacy.
“If it was in a hospital, I wouldn’t have done it,” she says. “But at the clinic, I had my own room. I’m a veiled woman from Kuwait, so I wanted my privacy.”
Ahmad Zaatari, medical director at Hamoud Hospital in Sidon, agrees that privacy is often a reason for patients getting procedures done away from home — especially when it comes to cosmetic treatment. Zaatari, a plastic surgeon, says, “Sometimes people will request to be treated on a certain floor, worried that someone they know who works at the hospital will see them.”
But as plastic surgery has become less taboo in recent years, so too has the desire for patient secrecy. Zaatari points out that it’s not uncommon to see people walking down the streets of Beirut with nose bandages during their recovery period following rhinoplasty.
“It’s become a status symbol,” he says, referring to post-plastic surgery bandages.
Free-wheeling medicine
From what Zaatari can see, a key reason many people are increasingly choosing to be treated in Lebanon — aside from doctors’ well-known medical expertise and competitive prices — is the country’s relatively liberal medical laws and an absence of a thick government bureaucracy.
For example, with a surplus of doctors, patients report a much shorter waiting period than at most hospitals abroad.
A notable example is kidney transplants. Along with India and Egypt, Lebanon has some of the most liberal laws for kidney transplants in the world. Many of the kidney transplant patients at Hamoud Hospital, one of the largest centers for such operations in Lebanon, come from Syria and Jordan.
Zaatari explains, “In most of the world, the kidney donor has to be related to the patient. Otherwise, people go on a waiting list to receive a kidney from a brain-dead patient. In Lebanon, kidney donors and recipients have to be of the same nationality.”
Still, Zaatari emphasizes that Lebanon’s rules on kidney transplants are not nearly as lax as those in India, and that there are regulations in place to prevent a black market in kidney trade.
Women’s health
Another important part of Lebanon’s liberal medical sector is that of women’s health. Of all the countries in the Middle East, Lebanon has the easiest access to abortion, emergency contraception and birth control. Like many Western countries, birth control and emergency contraception can be bought at pharmacies without a prescription.
Many women also seek gynecological surgical treatment in Lebanon, including hymoplasty, which replaces the barrier in the vagina so women can “regain” their virginity, so as to ensure bleeding on the wedding night.
“I think if Lebanon is coming back as a major tourist destination for Arabs, people say, ‘Let’s get medical services while we’re here,’” says Beirut-based gynecologist Faysal Elkak. “It’s not like anyone’s going to say, ‘I went to Lebanon to get my hymen repaired.’”
Another common request from gynecologists is the “virginity test,” an exam to determine if a woman’s hymen is in place. Elkak refuses to do such tests because, he says, “I respect women’s rights.” Instead, he hopes people will become more educated about women’s health, and learn that the absence or presence of a hymen is not always an indication of sexual activity.
Knowing that much of Lebanon’s medical tourism has to do with cosmetic procedures for women, Elkak says he hopes that the country’s increasing medical tourism market will not mean the “commoditization of healthcare in Lebanon.” He hopes Arab women won’t be pressured by society to undergo surgeries they would not have wanted otherwise — creating a demand for the appearance of Haifa Wehbe, for example. The large-breasted, pouty-lipped Lebanese pop star openly boasts of having undergone more than a dozen cosmetic procedures.
While the Ministry of Tourism is glad to promote its country’s health services, they are well aware of the responsibility of the sector.
“We have to be careful when talking about medical tourism,” says the ministry’s Director General Nada Sardouk Ghandour. “We don’t want to promote it as a product, [or] a culture. It can’t be too commercial, because it’s something delicate and fragile. If someone needs to see a doctor or wants to have plastic surgery, our main concern is the patient’s privacy.”
As for the need to organize Lebanon’s ever-growing medical tourism industry, Ghandour says she hopes the Lebanese government, including the tourism ministry, can work with foreign governments to facilitate their visa and medical requirements.
At the moment, such steps would seem premature, as most of the country’s medical tourists are Lebanese expatriates.
“Hopefully one day there will be real medical tourism — people who come here for healthcare who have nothing to do with Lebanon,” Zaatari says.
