A friend who is an epidemiologist called the other day: “Hey Maria, did you know you’re living in the middle of an epidemic?” he asked. Egypt has hardly been a fount of glad tidings, nor is Cairo known to be a healthy city. However, I was unaware that around one in every seven of my neighbors carries the liver-damaging hepatitis C virus – at least 12 million Egyptians – the highest prevalence for HCV in the world.
There is virtually no danger of infection, unless you share needles or other things allowing the transmission of blood. But part of the problem is that people who have contracted the virus may not know until it is too late. Out of every 100 infected, one to five will die of cancer or cirrhosis of the liver. Although not spread by casual contact, HCV carries a social stigma, with some Egyptian businesses and other countries (including Saudi Arabia and Qatar) screening job or visa applicants.
HCV is called the “silent epidemic,” because it has no acute phase, in other words those infected rarely exhibit symptoms, which is partly why it was able to spread unchecked. But in Egypt, it could be called the “‘I-told-you-so’ epidemic’” because it is both a consequence and constant reminder of proven failings that await correction. HCV was fueled in its early stages by poorly sterilized glass syringes used during a state-sponsored campaign to eradicate yet another liver pathogen, bilharzia, and today continues to spread via health facilities with lax hygienic practices, particularly regarding injections.
Since the virus can be disinfected with soap and water, washing hands and more careful use of syringes and multidose vials would go a long way toward containing the epidemic, which places a tremendous strain on Egypt’s health care system, rendering it even less effective in providing adequate services than it already is.
HCV treatment consumes $80 million, or 20 percent, of the Health and Population Ministry’s meager budget. Beginning in 2008, 23 treatment centers were established nationwide, and around 28,000 patients per year successfully cleared the virus after a 48-week-long therapy. Whether you take the official estimate of 100,000 new infections annually or the 500,000 arrived at in other studies, the virus is still winning by a stretch.
Yet only 1 percent of the Health and Population Ministry’s HCV budget is allotted to prevention, which is considered a touchy, indeed, politically toxic issue. Any serious prevention effort must begin with the frank admission that health care facilities (hospitals, clinics, dental clinics, and pharmacies) with substandard infection control practices are threatening instead of improving people’s health.
The Health and Population Ministry scored a vaunted success in the early 2000s by cleaning up kidney dialysis treatment centers, a major source of HCV infection. But the ministry operates 4,500 overburdened, underfunded hospitals, not counting all the other state and privately owned medical facilities, dental clinics and pharmacies where injections are administered.
According to Dr. Mahmoud Zalabany, an internal medicine resident at Cairo’s Ahmed Maher Teaching Hospital, “We have infection control programs but a lack of funding for supplies, lack of training for doctors and nurses and the whole health sector has the problem of low salaries.”
Medical professionals have in fact been striking for higher wages (currently $300 per month on average) since January. “Our best doctors are leaving the country,” Zalabany says, producing a brain drain that further undermines the quality of health care. Under the circumstances, it is particularly poignant that the latest, most promising treatment for HCV (a drug called Sovaldi) was recently developed in the United States by an Egyptian-born researcher whose Jewish family was exiled from Alexandria by the regime of Gamal Abdel-Nasser.
Right now, HCV is in the public eye owing to the Feb. 23 televised presentation by an army spokesperson of two remarkable inventions – one purportedly able to detect the virus without so much as a blood sample, and the other that allegedly cures it using a kind of blood dialysis. The science behind these devices is highly questionable, but the announcement that military hospitals would offer the revolutionary treatment as of June 30 (not coincidentally the first anniversary of the army-backed popular coup that ousted President Mohammad Morsi) has raised people’s hopes of a quick and easy cure.
Prevention, not treatment, is the way forward according to many experts, an effort that should start with an awareness campaign targeting Egypt’s health professionals (numbering at least 376,000) and focusing on simple steps to improve hygiene. The campaign would need backing from the incoming president, Field Marshal Abdel-Fatah al-Sisi in all probability, the prime minster (to coordinate the activities of the appropriate ministries), and the army to assist in the logistics of delivering the campaign’s message nationwide.
The army has cast itself as the savior of HCV-infected Egyptians (a triumph that is bound to be short-lived) and the Health and Population Ministry prefers dwelling on its accomplishments in the treatment department rather than its shortcomings in prevention. However, political posturing will not stop the HCV crisis from coming to a head and potentially taking Egypt’s bedraggled health system down with it.
Egypt is up against the wall on countless fronts, but HCV prevention is one where it could make significant headway. The tools – soap, water and basic techniques – are readily available; the concerned parties, including committed medical professionals, private sector and civil society stakeholders and probably donor agencies, would gladly dig into a campaign that would make a difference. The cost would be low and the gains high in the short and long term, for Egypt’s health and the state’s well-being, once the state has provided the essential and long-neglected service of infection control.
Far from being politically damaging, a successful HCV prevention campaign would be a political gold mine for whoever had the courage to promote it. So will it happen? A glance around a ravaged nation suggests the answer: When it comes to facing hard truths, Egypt’s leaders favor denial and self-promotion over self-critical action. And that’s the saddest reproach of all.
Maria Golia (www.mariagolia.wordpress.com) is an American author living in Cairo. She wrote this commentary for THE DAILY STAR.