DR SAMI TRAD'S ORIGINAL "PROGRAMMED METHOD OF PAINLESS CHILBIRTH"
BY INJECTION OF TAC (TRAD ANALGESIC COCKTAIL).

What is TAC analgesia?
This is a method of obstetrical analgesia devised in the year 1961 by Dr Sami Trad in Trad Hospital.
It became popular under the name "إبرة طراد"
Why did this Trad Method become quickly popular?
It was easy to administer and very efficient. Overall it appeared at a time when no other successful method of obstetrical analgesia was available in Lebanon or abroad.

What other methods of obstetrical analgesia were in use at the time Trad Method was started?
There were the psychological methods (Read, Vervovsky, Lamaze) which enjoyed a great popularity around 1940 and by 1960 had shown their limits and started to fall in discredit.
Of the pharmaceutical methods in use at this time such as the paracervical block, the pudendal block, the injection of opioïds or of Gamma globulin, none had proven satisfactory.
As for the epidural analgesia, it had just started in the USA and was practically unknown in Europe. Even in 1988, only 7% of deliveries in France were made with peridural analgesia.

What does Trad method of obstetrical analgesia (the TAC algesia) consist of?
It consists simply in the administration during the course of labor of a specially devised lytic cocktail given by means of 1 or 2 intramuscular injections followed by 3 to 5 intravenous injections during the course of labor.

What are the components of this cocktail?
There are several components given in varying proportions, basically potentiating their effects and suppressing their side effects: Opiates, Phenothiazines, Scopolamine, Ephedrine, respiratory analeptics (Nalorphine and Vectarion). Hyaluronidase is used as a vector for the IM route.

Why did epidural analgesia progress nowadays so much at the expense of other analgesia methods?
After 1960, epidural analgesia started to improve and spread from USA to Europe and Lebanon. Although keeping in mind its limitations: 20% of failures, definite contraindications for its use (obese women, women with spinal problems, women with coagulation problems or with skin infections in the back). And also its side effects (chronic back pain, temporary bladder paralysis and other neurological symptoms).

In spite of all these drawbacks and disadvantages the peridural became very popular because it favored and facilitated the enormous increase in the rate of cesarean sections (from 10% in 1960 to over 60% today reaching even 100% with some gynecologists). The reason for the increased success of epidural analgesia among obstetricians was that it could be used as analgesic to soothe labor pains as well as an anesthetic for C-sections. So the patient, if already motivated by her obstetrician was practically and psychologically ready to undergo a cesarean section. Statistics show that for parturients receiving peridural analgesia the c-sections rate is three times bigger than in women receiving other kind of analgesia or no analgesia at all (French statistics).

Did the Trad Analgesia continue its expansion in Lebanon and outside?
It was welcome in Europe and especially in Germany where, among others, professor Semm, Chairman of Kiel University, acknowledged the method and wished to adopt it there. Also, International conferences were held with success in Berlin and Saarbruck. In London a book was published at Barker Edition entitled: Painless Programmed Childbirth. In Lebanon, because of the Lebanese Civil War, the momentum of the method was broken, since Dr Trad was busy defending his hospital situated in the no-man's land between warring East and West Beirut and was cut from his patients mainly from East Beirut.

What is the future of Trad Obstetrical Analgesia?
Aside from its intrinsic qualities and its obvious advantages over peridural (no limitations or restrictions of the analgesia results, no contraindications, no side effects) the one tremendous advantage of the Trad analgesia over epidural consists in the simplicity of its use, no anesthetist being needed for its IM/IV administration, which makes it the method of choice in all small maternities mainly in rural areas where no anesthetist is available. It is also the method of choice for women who wish to deliver whenever possible in the Sanapa way, that is safely and naturally (without a much greater risk of having an operative or instrumental delivery) and an easier and surer painless childbirth since there is no need for an anesthetist - often unavailable - to achieve that purpose.

It is besides the ideal method for anxious women, some suffering from anxiety neurosis and who for this reason cannot even bare the experience of delivery but it is also fair to admit that for some women on the contrary it is important to stay completely awake during childbirth and to "participate in a way" in the process. I do not agree with this view for the simple reason that a very painful childbirth cannot be considered as a joyful experience. On the other hand, choosing a peridural analgesia, will lead in 60% of the cases to a cesarean section, in which a woman cannot "participate" in the process.

 

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Affiliation

Affiliation

On September 10th, a Gala Dinner was held at the Hotel Phoenicia on the occasion of the signing of a Memorandum of Understanding (MOU) between The George Washington University Hospital in Washington, D.C., and our institution, Trad Hospital and Medical Center in Beirut.

The Memorandum of Understanding signed on this occasion will serve as the roadmap for a wide range of collaborative efforts. These include:
- The exchange of visiting faculty for teaching and research
- Access for qualified medical students planning to pursue their international clinical electives
- Mutual cooperation in the field of breast diseases, ear-nose-throat (cochlear implantation), obstetrics and gynecology, orthopedics (navigational systems) through planning and development of joint conferences and seminars of mutual interest, training programs, program planning, and the development of technology of the above clinical areas
- The promotion and exchange of scholarly publications and other materials
- The development of substantive educational and research programs and conferences, seminars on topics of mutual interest and to encourage and strengthen communication and cooperation between members of both institutions

The MOU was signed by Dr. Stanley Knoll, MD, FACS, "Clinical Professor of Surgery, Department of Surgery and Medical Director, International Medicine Programs" and Ms. Huda M. Ayas, "Executive Director, International Medicine Programs, Adjunct Professor, School of Public Health and Health Service", representing Dr. John F. Williams, MD, EdD, "Provost and Vice-President for Health Affairs" at the University of George Washington. Dr. Sami Trad, Chairman General Manager, and Dr. Karim Trad, Medical Director, signed on behalf of Trad Hospital.
"This is this kind of mutual collaboration that can only enhance the research, education and clinical care goals of our respective institutions," said Dr. John F. Williams, provost and vice president for Health Affairs at GW, in a message prepared for the signing ceremony. "An exchange like this one will ensure that the entire country of Lebanon benefits from the value of the partnership."

Dr. Williams singled out the efforts of Trad Hospital Medical Director Dr. Karim Trad in making the collaboration possible. After completing a residency in general surgery at GW in the 1980's, Dr. Trad returned to GW as an assistant professor of surgery and director of endoscopic surgery in 1992. He moved to Lebanon three years later to become medical director at Trad Hospital; he remains a Clinical Assistant Professor of Surgery at GW.

Dr. Sami Trad, Chairman and General Manager of Trad Hospital and Medical Center, reminded in his speech at the signing ceremony that Trad Hospital was founded in 1940 as a one floor maternity hospital . It was later expanded to cover a wide range of specialties in a multistoried building complex which still features carefully preserved traditional architecture . Today the Hospital stretches over 9000 M2 housing 70 beds and a Medical Center well equipped with a cutting edge modern medical environment.

"This agreement is a major stepping stone in Trad Hospital's ongoing pursuit to deliver high quality medical care" said Dr. Karim Trad in his speech. "We feel particularly proud and fortunate, especially that GW, through its International Medicine Programs, has been extremely successful in establishing similar collaborative efforts worldwide".

The dinner grouped around the representatives of George Washington University and Trad Hospital, prominent members from Beiruts' Medical and Academic Communities and was honored by the presence of His Excellency Mr. Jeffrey Feltman, Ambassador of the United States, who wished to be a witness of the signature. Mr. Feltman delivered on this occasion, a big speech stressing the importance of this partnership, which beyond its pure medical benefit to Trad Hospital and the whole country, will no doubt reinforce the long standing tradition of friendship and collaboration between the USA and the Lebanese people.



Affiliation

Affiliation

Entre Le Professeur Salim Daccache s.j.
Récteur

Et Le Docteur Sami Trad
Chairman de l'Hopital Trad

Désireux de contribuer à promouvoir la collaboration scientifique et pédagogique sur la base des relations d'amitié qui unissent les deux institutions, l'Université Saint-Joseph, représentée par son recteur, le Pr. Salim Daccache s.j, et l'Hôpital Trad, ont conclu une convention de coopération scientifique et pédagogique. La convention a été signée par le Pr. Daccache et le Dr. Sami Trad à la Villa Sursock, en présence du Pr. Roland Tomb, doyen de la faculté de médecine de l'USJ. 
Dans un mot de circonstance, le Dr. Trad a affirmé que l'affiliation avec l'USJ « représente pour l'Hôpital Trad une nouvelle étape dans notre marche vers une institution toujours plus performante, et surtout vers sa consolidation dans le temps». 
Pour sa part, le Pr. Daccache a remarqué que «les institutions sans les hommes n'ont ni âme ni volonté. Aujourd'hui, c'est grâce à la conjonction de volontés clairvoyantes et décidées, sages et engagées que cet accord a vu le jour ».


Agreement

Agreement

La Caisse des Français de l'Etranger est une structure originale spécialement créée pour les Français résidant à l'étranger. Elle leur permet d'avoir, quelle que soit leur situation, la même sécurité sociale qu'en France à des tarifs très compétitifs.
Les salariés, peuvent en plus, bénéficier d'une couverture accident du travail et cotiser pour leur retraite Sécurité sociale.
L'adhésion à la CFE se fait individuellement ou par le biais de l'employeur.

- l'Admission à l'Hôpital
[Formalités]
Après décision de votre médecin traitant, vous avez choisi l'Hôpital TRAD pour une intervention médicale
Pour faciliter vos démarches d'admission et pour que votre séjour se déroule sans surprise, nous vous recommandons de prendre contact avec le service administratif de l'hôpital pour connaître la date possible de votre intervention. Cette démarche est souvent faite par votre médecin traitant.

- Instructions aux patients C.F.E.
Le patient doit se présenter à l'Admission de l'Hôpital TRAD au moins 48 heures avant la date d'hospitalisation, muni d'un rapport du médecin traitant, de sa carte d'identité comportant une photo et de son numéro d'immatriculation à la C.F.E. (numéro de sécurité sociale). L'Hôpital se charge alors d'envoyer par fax la demande de prise en charge. Dès que la C.F.E. faxe son accord, le patient en est avisé et peut être admis à l'Hôpital.
Dans les cas urgents, le patient sera d'abord admis à l'Hôpital et la demande de prise en charge sera envoyée à la C.F.E. après son admission.

 

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