Medical students in an Egyptian university are packed into a small lecture room. A grainy presentation is projected on to the wall. The lesson, taught in English, is entirely theoretical – much like most of the medical-related courses – and demonstration equipment is also faulty.
Dr Rami Said is a product of Egypt’s tertiary education system.
“That’s what happens in medical school. We finish our studies and are supposed to be doctors. That’s our dream,” he says. “Six years of study plus a year of residency and we still don’t know anything.”
Said’s view is shared by many others. Dr Nadia al-Ansari works in the Faculty of Medicine at Ain Shams University in Cairo.
She says that “today, professors don’t have the time to teach the way they used to. University teachers are not dedicated or keen to teach any more. Medical students take private lessons, as in the humanities, engineering or business faculties. No one is dedicated the way they used to be.”
A lack of government funding is not only undermining health provision and affecting the quality of doctor training, it’s also spawned a black market in the sales of human organs – and a bizarre trade in “patients for hire”.
In the Qasr al-Aini Hospital, a familiar face walks the corridors, seen most frequently during exam season. Ahmad al-Saed Ahmad is a professional patient, more commonly known as a “consultation subject”.
In return for treating his chronic chest complaint, Ahmad – who is on the books of an agent organising similar cases for this kind of work – is paid by students at the hospital, to allow them to examine him in preparation for their final medical exams.
He uses his cut of the money to pay his own medical bills. The rest is pocketed by the agent and universities taking part in the back-door process.
But Ahmad’s role – and that of other consultation subjects like himself – doesn’t end there.
“I started memorising the medical terms until I knew the cases by heart,” he says, “We learned them so we could teach them [the medical students].
“Sometimes the student doesn’t know anything at all, so we explain everything, like how to measure blood pressure, take a pulse. The things they should have learned in medical school, we teach them.”
Some trainee doctors choose to leave Egypt, to take advantage of greater opportunities and better education abroad, in Germany, for example, but most have to make do with the situation at home.
“The number of medication companies has grown recently. They distribute medicines but need doctors to prescribe them to be sold, so doctors get money from these companies to prescribe a medication for their patients,” says GP Reda Harbi.
Dr Nihal Majdi works in general medicine and is calling on the Egyptian government for more rights and better support, claiming that doctors’ conditions verge on the inhumane. She says this is the heart of the problem and is threatening patient care.
“They [doctors] are asked to work extra shifts without getting paid or working in a humane place and without the proper resources. Without a lot of things. A big part of our job is humanitarian. How can you expect a doctor who’s been dehumanised to be humane with patients?” asks Majdi.
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