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“We’re kind of breaking even,” says Michel Mawad.
For most institutional leaders, this statement probably wouldn’t be cause for celebration. But when the president of the Lebanese American University (LAU) says that things are starting to look up for its two teaching hospitals, there is both relief and pride in his voice.
Since taking the helm of the institution in October 2020, Mawad has faced one setback after another as Lebanon’s economy went into freefall and the country tumbled into a constitutional crisis. The hospitals’ diesel generators are a daily reminder.
“There’s no electricity…so we have to produce our own power, maintain the lights 24/7, the intensive care unit,” says Mawad. “I look at that every day, just to...make sure I don’t run out of diesel.”
It’s a far cry from the well-heeled US institutions where his career took off. Born and raised outside Beirut, Mawad left to finish his studies in 1982 as the civil war broke out. He spent the next 40 years in the US climbing the career ladder, before a brief stint heading a medical centre in Abu Dhabi and then joining LAU as dean of its School of Medicine.
Mawad credits his time spent in the US – first in New York City, then in Houston, Texas – with teaching him many lessons.
“There’s this desire to always innovate and do better, and then innovate again…there is a check and balance, quality control. You make mistakes, but you pay for them, so to speak,” he says.
In the mid-1990s, Mawad was a professor across several departments: neurosurgery, neurology, radiology and ophthalmology. In 2001, he was appointed chair of the radiology department at the Baylor College of Medicine in Houston and, in 2005, director of the neurovascular service at St Luke’s Episcopal Hospital. By 2014, it was time for a move. “Frankly, I was getting to a level of seniority in the US where there was not much else to come,” he says.
The following year, he moved back to the Middle East, taking up the directorship of the Stroke Centre at the Cleveland Clinic in Abu Dhabi, a luxury hospital just taking shape in the United Arab Emirates. Then he was tapped for a role that would test him, becoming dean of LAU’s medical school in 2017 and the institution’s president three years later. The return to Lebanon – where daily operations are a matter of “constant struggle”, he says – was a sharp readjustment.
Ethical treatment for patients comes first for Mawad – it’s something he’s worked to instil in medical education at the university. But sometimes doctors could do nothing for them.
“The average [monthly] salary today across the board in Lebanon is about $150 (£120)…How is this person going to afford surgery when only implantable [devices] cost $15,000? So that’s a huge dilemma.”
In addition to sharing the concerns of university presidents the world over – raising tuition revenue, paying salaries, benefits and overheads – Mawad has another significant source of headaches: keeping two hospitals afloat.
“Here, the socio-economic situation is very different. You start thinking about who can afford what, whether this patient can afford this treatment…there are a lot of additional burdens that are directly related to the fact that the resources are very scarce,” he says.
Responding to these and other challenges has become “routine” – as have other parts of running the university. Take financial aid. Three years ago, when Mawad took over, the Lebanese pound plummeted and families’ purchasing power “completely disintegrated”, with parents left choosing between buying food, healthcare or paying tuition fees.
In response, LAU discounted tuition for roughly 85 per cent of students – by 65-70 per cent per student, on average. To do so, the institution had to borrow against its endowment, driving up its deficit to $72 million in 2022.
“It was a huge hit for us,” Mawad concedes. But he does not regret it. “We said: ‘We’re facing an existential threat here; if these kids start leaving, there’s not much left to keep an endowment for.’”
Everywhere possible, LAU cut costs. Its computers, previously replaced every three years, are now swapped out every five. The university also faced tough choices, such as whether to reduce library services. Doctors accepted base pay so patients could afford surgeries. In the meantime, routine maintenance costs on foreign equipment such as CT scanners skyrocketed. It was like a game of whack-a-mole.
But even as LAU scrambled to run basic infrastructure amid surging energy costs, it was dealing with another serious threat to its existence: brain drain. In the past few years, it has lost roughly 20 per cent of faculty to institutions abroad, says Mawad.
“Those who have good degrees from American, UK or French universities, they remain employable elsewhere…Unfortunately, most of those who came from overseas have left,” he says.
While he notes that this “doesn’t mean those who stayed were not as good”, he believes they were at a different stage in life. The young talent – early career researchers with young families – often opted to go. LAU also lost many of its IT staff. The institution quickly started recruiting lecturers to take the place of those who left, but this too affected the endowment, with new hires often demanding higher salaries than their predecessors.
“We suffered tremendously with that, and that all added to the deficit,” says Mawad.
After constant tumult, the situation, he hopes, is starting to stabilise. “We’ve gone through at least two or three very lean years, very painful years. But somehow, I think, we’re on the track of survival and recovery.”
Adversity has also brought a silver lining, he believes.
“We’re becoming more creative, stretching the dollar as much as we can. We’re becoming more thrifty in our expenses. If something is not necessary, we just cut it. We have become more resilient…we work harder, accept less [pay] for our work.”
Families and students are also coming to recognise the value of a good education, with those of better means increasingly willing to pay slightly more for quality, he says. As time passes, he and his team will consider this in LAU’s fee model.
But while the university’s budget situation appears to be stabilising – if far from ideal – other, weightier concerns keep Mawad tossing and turning at night.
“Somehow, with God’s grace I’m able to navigate all this, but there are things I have no control over,” he says.
“The presidency is vacant. We have no prime minister, no governor of the central bank…I worry about the continuity of the country as a free country where human rights are preserved, freedom of speech, gender equity are preserved…and yet…that’s my neighbourhood. I’ve got to live with what’s going on and provide education.”
These worries weigh heavily. But, despite them, both Mawad and LAU have no intention of giving up.
“Like Frank Sinatra used to sing, if you can make it in New York, you can make it anywhere,” he says. “If you go through what we went through, nothing can take you down any more.”
pola.lem@timeshighereducation.com
This is part of our “Talking leadership” series with the people running the world’s top universities about how they solve common strategic issues and implement change. Follow the series here.
