Eihab Boraie heads out to visit the essential paediatric hospital in the heart of Cairo, and speaks with the doctors to find out how the largely-free facility manages to operate in a country like Egypt despite endless obstacles.
Not too long ago Prime Minister Mahlab paid a visit to a public hospital and was shocked by its conditions. In jest, Egyptian across the nation started a Facebook group posting horrific pictures of the ugly state of public health care. In an attempt to quantify just how bad the health care system is, I decided to visit The Cairo University Specialized Paediatric Hospital (CUSPH) better known as the Japanese-donated Abu El Reesh Hospital, which not only shocked me but left me pleasantly surprised and looking to donate.
Public hospitals in Egypt range from the good, the bad, and the dreadfully ugly. Looking to dismiss the misconception that all Egyptian hospitals are the stuff of nightmares, Deputy Director of CUSPH and co-founder of Tabibi 24/7, Dr. Khalil Abdel Khalek, graciously invites me to take an exclusive carte blanche tour of their facilities. “Everyone picks up on the bad and no one ever picks up on the good. I want you to show the bad stuff and I want you to help people understand why that it is,” a frustrated Dr. Khalil says.
As we began the tour, just days after seeing the photos posted to Facebook, I expect to find a barrage of filthy bathrooms, overcrowded rooms, unhygienic operating rooms, and a variety of stray animals. Given access to the whole hospital I randomly picked rooms to expose the dirt, but found that the conditions were far from the horror stories we’ve seen. Obviously different hospitals have different conditions, but the Abu El Reesh Hospital was easily a great example of a medical institution doing all that it can with the limited resources provided.
Entering a room full of patients, Dr. Khaled Bahaaeldin doesn’t hesitate to point out the problems in each room we visit. “This room is originally designed for three beds, and you should find an outlet for each bed. We have these outlets just in case we have a child who need oxygen support. Ideally each child should have chance to receive the oxygen support he needs as soon as he needs it, but we are renovating the ICU of the hospital, and so we had to add more beds in here. Three outlets and four beds… Conditions are not so bad but this is not the ideal,” describes Dr. Bahaaeldin.
Deteriorating conditions in Egypt’s healthcare system are not a result of laziness but rather insufficient resources. The Abu El Reesh hospital treats 900 patients per day and an estimated 25,000 every month, over 90% of which are pro bono cases. With the government contributing only a portion of what is needed, the hospital largely relies on donations. Giving a rough estimate of government contributions, Dr. Bahaaeldin estimates that “they allocate for about 19 to 20 million EGP to us per year. On paper this is a good amount to run 300 beds, but in fact we have to handle double or three times the normal load of patients so that’s when the donations become very important.” In fact this hospital wouldn’t have been possible without a 30 million USD donation from the Japanese government who graciously funded it’s opening in 1983. Since that time the hospital has expanded, building two extra floors, and also functions as a teaching hospital taking in roughly 1000 undergraduate students a year. Without donations, the hospital would barely be able to provide effective healthcare let alone teach the next generation of doctors.
According to CUSPH Professor of Paediatric Surgery Dr. Bahaaeldin, “It’s simply a mismatch between the amount of demand on the service that we provide and the actual input given to the service. For example I manage unit surgery coordinated ICU, it’s different from any other ICU because it offers a baby who were born with a congenital anomaly the ability to have an operation to cure their disease and provide chance to live. I have 29 incubators available, but I can only operate safely on 15 to 17 at any one time because we don’t have enough nurses. People often give me private money to get a third party nursing help, but we struggle to find them because there aren’t enough nurses in Egypt.”
The lack of nurses in Egypt is common problem rooted in society’s degrading perception of the profession. Often Egyptian parents will encourage their children to become doctors, but look at nurses as a second class job despite the fact they are in high demand. “Nurses are really vital. This is something we need to teach to residents and talk to them to stop treating nurse as if they are lower than them, .as everyone in the health care, nurses and doctors work side by side and sometimes senior nurse teach junior doctor how to do and how to manage things. Machines are important but not as important as nurses, Machines are not being used because I don’t have enough nurses to operate them,” admits Dr. Ranya Hegazy, Professor of Paediatrics and Director of CUSPH.
This sentiment seemed to be widely shared amongst all the doctors I speak with, and in a country with a generation struggling with massive unemployment, it’s baffling that this noble profession is overlooked. According to Dr. Bahaaeldin, “When we try to get third party nurse we offer her 120 LE to 160 LE per shift and this is very good money because the highest paid doctors in the best private hospitals make like 400 LE per shift. Some of the nurses can make up to 300 LE per shift.
Running a hospital is a team effort that depends as much on its janitors and nurses as it does on its doctors. Each has their own duties and together they provide the conditions to give patients the best chance for recovery. Sadly, the Abu El Reesh Hospital faces a myriad of problems outside of their control which effectively results in their in their less than ideal success rate. “The success rate worldwide is 97.9%, so they only lose very few babies in paediatric wards. Right here it’s about 70%,” explains Dr. Hegazy. This number may scare a lot of people, but the failures at Abu El Reesh Hospital have less do with equipment and management and more to do with the time it takes patients to reach the hospital. In terms of paediatric care, time is of the essence, and the sooner the problem is diagnosed and dealt with the higher the probability of recovery. “Some of the babies we treat arrive three hours after their birth, but for a baby born in Aswan it takes about two days until we learn of the case, then another two days to give the proper diagnosis. After that they then have to travel so by the time they are in our facility it has been six days. That is entirely too much time to pass for a baby to go without treatment. So when I look at the 30% difference between us and the world wide statistics, I can see that improvements need to be made, but I cannot blame the people working as they are doing their best.”
Egyptians have no trouble pointing out problems, but often fail to propose solutions. It’s as though everyone expect some magical leader to fix all systemic issues holding the nation back for decades. If Egyptian wants to see improvements in public healthcare, then they need to get involved and be part of the solution. Sharing photos on Facebook of dreadful hospital conditions won’t fix the problem, however donating your time by volunteering can help. From helping to repaint rooms to cheering up children there are plenty of ways to help and with Ramadan being the season of giving, one can easily help by giving a simple cash/equipment donation.
As it stands, the hospital has raised around a million EGP this year, but need to find a way to raise another 25 million EGP to meet their goal. Four of the six elevators in the hospital need to be repaired, and a single medical device can cost millions, however if I learnt anything on my trip is that a significant amount of money donated will be used to tackle the biggest problem facing all Egyptian hospitals; recruiting nurses.
If you want to be part the solution then please send donations to account number 4667/3 at Nasser Bank.
If you want to volunteer send an email to firstname.lastname@example.org
Follow their progress on Facebook here.
Photography by Christina Rizk.