Toxicology services in Libya: the present and the future

Toxicology services in Libya: the present and the future H ealthcare services in Libya are in need of major efforts to tackle the reconstruction challenges and to revitalize the whole system. The aim is to provide a healthcare system centered around people's needs and expectations, up-to-date with the latest medical advances, and capable of meeting rising demands (1, 2). In Libya, there is no robust poison and toxicology service. This was evident during the 'methanol crisis' in March 2013 in Tripoli (3). Though official data are lacking, it has been reported that up to 1,050 patients were affected, with fatalities as high as 100 (4). Some survivors suffered from permanent central nervous system damage (5). Medecins Sans Frontiers (MSF) launched a special humanitarian mission during the aforementioned crisis and sent a team to Tripoli. They reported that 'the health personnel at the various hospitals seemed to do a heroic job in trying to treat as many as possible. They did not have a lot of experience in the treatment of these poisonings, and so antidote was seldom given' (5). A poisoned patient admitted to hospitals in Libya will generally be treated on an ad hoc basis, with no clear guidelines or protocols. Furthermore, there is no toxicology laboratory in the entire country. Also, the mode of management of poisoned patients in Libya is outdated. For example, gastric lavage Á the routine use of which has been abolished long since in the rest of the world Á is still used routinely for treating poisoned patients (6). Most antidotes are not available, and if they were, they are often given in wrong doses and timing. In developed countries, there exists a standardized model for delivering toxicology services. It is based on a centralized national service providing expert advice on all aspects of acute and chronic poisoning. This ensures optimal care for patients in cases of severe poisoning, and where toxicity is low, it prevents unnecessary hospitalization. Such a model has proven its efficacy in reducing the number of emergency department visits for cases of poisoning and reducing the length of hospital stay (7Á9). In Louisiana, United States, the closure of poison control services resulted in a four-fold increase in the rate of cases of poisoning 'self-referred' to healthcare institutes (10). Data from the United States show that every dollar invested in the poison center system saved $13.39 in healthcare costs and productivity …