Rural Egyptians seeking medical treatment often face an ordeal just getting to the nearest clinic or hospital. But when they finally get there, they are unlikely to find the equipment, medicines or even doctors they need.
The Arab Spring may have brought radical changes to Egyptian politics, but medical practitioners say little has changed in the undersupplied health system used by the poor.
“Our government needs to revolutionize health services, particularly in the countryside,” Ahmed Lutfi, a senior member from Egypt's Medical Association, told IRIN.
“There are few hospitals and clinics outside the major cities, and the few medical institutions available in these areas offer no services whatsoever to the patients. These medical institutions are cut off [from] whatever it takes to serve these patients.”
Last month, Health Minister Mohamed Mustafa Hamed said that 20 percent of hospitals in the rural south have no doctors, and that only 40 percent of necessary medicines are available in government hospitals and clinics.
Pharmacy students from Mansura University recently treated 400 patients during a trip to Samanoud, in the Governorate of Gharbia, 126km north of Cairo, the capital.
“We discovered that the few clinics that existed in this area were only about the walls and the doors - no medicines and no service at all,” said Aly Kishk, one of the pharmacy students.
“The doctors of the clinics, if there are any, ask the patients to bring the medicines with them, although most of these patients are very poor.”
Patients told to look elsewhere
Donkeys and cows wander past the gates of the Abul Nomros Central Hospital, 25km southwest of the capital, Cairo.
As IRIN arrived, a doctor shouted out for a sling, but the hospital had run out.
Suddenly, an old French Peugeot screeched to a halt outside, and four men carried in a man with a bullet wound to the chest.
A staff member told them the hospital lacked the equipment needed to save the man’s life.
The group erupted in anger. “God will take revenge on you,” said one of men.
“He'll die,” said another.
Mohamed Al Laban, the hospital director, tried to reach Kasr Al Eini Hospital, Cairo's largest teaching hospital, to request it admit the gunshot patient.
Al Laban had to use his cell phone to place the call; his hospital does not have a landline.
“The conditions of my hospital are just a reflection of the conditions of Egypt as a whole,” he told IRIN. “We do our best to serve the patients in the absence of everything. What else can we do?”
Abul Nomros Central Hospital receives between 1,000 and 3,000 patients every day. Its 130 doctors struggle to compensate for the deficiency in equipment and medicine, but with a high workload and low pay, morale is poor.
“My doctors do miracles every day,” Al Laban said.
Many are unwilling to work in such conditions.
Kawthar Mahmud, head of the health ministry’s nursing administration, said her ministry was dealing with a shortage of 40,000 nurses in the nation's hospitals and clinics. The Medical Association says as many as 230,000 doctors are registered with them, but around 30,000 have left to work in other countries.
“There is mass migration of doctors from Egypt because of the lack of money and the tough work conditions in this country's hospitals,” said Mohamed Hassan Khalil, the head of the Right to Medicine Centre, a local NGO that defends the rights of doctors and patients to better work conditions and services.
“A doctor in this country earns less than a craftsman does,” Khalil said.
Doctor’s salaries in the public sector start at less than 500 Egyptian pounds ($73) per month. Even after decades on the job, some doctors earn less than $300 per month.
Rashwan Shaaban, a cardiologist in his early fifties, says the salary of an Egyptian doctor is not enough for him to buy a pair of shoes.
“This is why doctors have to do more than one job to put food on the table for their families,” he said. “Some people have even left the medical profession altogether because of these difficult conditions.”
The consequences of staff shortages have been dire.
When a group of religious radicals stabbed a young man in the Governorate of Suez in June 2012, he was rushed to a hospital where there were no doctors.
“My son could have lived if they had rescued him,” the young man's father said. “This is why I accuse the Health Ministry of contributing to his killing,” he told the private channel On TV.
Egypt's state-run hospitals and clinics treat the majority of Egyptians because they offer cheaper services. Public hospital admission fees range from 1 to 5 Egyptian pounds (14 to 73 US cents), and medicines, when available, are often dispensed without charge.
But this subsidised care frequently breaks down, particularly in rural areas.
When Mohamed Ragab, a farmer in his early forties, experienced strong chest pain, he hurried to Abul Nomros Central Hospital. There, he was advised to have an electrocardiogram, but the machine was not working.
“I had to have the electrocardiography at a private clinic,” Ragab said. “But I paid 70 pounds ($10.24) for this. God only knows that I borrowed this money from a neighbour.”
This week, Health Minister Hamed said that to deal with the problems in Egyptian hospitals, the government would invest in infrastructure and equipment - but mainly in Cairo.
“There is no logic in putting new beds in hospitals where there is no staff,” the minister told local media. “We do not want to repeat the mistakes of the past. Some hospitals in the other governorates have equipment, but they do not have staff to operate them.”