Bassem AlSawwaf


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American Article about Fighting Tuberculosis in Egypt with mention of Dr.Bassem AlSawwaf

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Bassem AlSawwaf

  1. 1. Africa Health 33March 2011TB treatment in Egypt: business as usualCivil unrest can severely affect TB management if drug supply lines areinterrupted. But a strong infrastructure ensured minimal disruption duringEgypt’s recent upheaval.This article has been written by the CommunicationsDepartment at the Global Fund headquarters in Geneva.Throughout recent tumultuous events in Egypt, thecountry’s hospitals and clinic services worked to main-tain business as usual. Services for tuberculosis (TB)patients remained open andalthough attendance at timesdropped sharply, those mostin need, particularly foreignmigrants or those sufferingfrom a drug-resistant strain ofTB, were able to access ser-vices financed through GlobalFund programmes.Social media like Facebook,which earlier played its partin coordinating mass protestsand informing the world ofevents, are being used as asource of public information,with blogs helping to spreadhealthcare messages.The greatest obstacle tothe success of Egypt’s TBprogramme used to be alack of public awareness.Most people knew about thehistorical significance of thedisease, evidence indicatesthat hospitals forTB existedin Egypt as early as 1500 BC.But many Egyptians thoughtTB was a thing of the past. Thefact that TB never went awaywas brought to general atten-tion most recently by a 2008Global Fund-financed publicinformation campaign. Initially consisting of TV spotsand radio programmes, with the spread of social media,TB messaging has taken on a life of its own.Bassem Al Sawwaf, a respiratory therapist at Cairo’sbusiest chest clinic keeps the clinic’s Facebook page up-dated with postings about drug availability and satelliteclinics, which currently close earlier than usual becauseof the curfew. ‘Our team faced challenges to keep ourwork of a high standard, continuous, stable. To seemlike ordinary times,’ says Sawwaf.In Egypt, Africa’s second most populous nation, TBtreatment is provided free and is generally successful.But a serious problem until recently was that only halfof TB patients were properly diagnosed. The GlobalFund has helped to renovate diagnostic facilities andbuild 80 new centres and thecase detection rate has goneup to around eight out of ten.It is also now easier to keeptrack of patients thanks to anew e-register. Patient recordspreviously only existed onpaper and it was very difficultto follow up on patients ifthey moved. The new com-puterised system financed bythe Global Fund helps medicstrack patients making it veryeasy to spot defaulters. EveryTB patient in the country isregistered so even during therecent social upheavals, treat-ment can be regularised.TB is difficult to treat be-cause the necessity of takingregular medication meansdisruption can spoil thechances of getting cured. TheEgyptian health system wasable to cope with demandssays the head of the RegionalStop TB Partnership, Dr AwadTag El Dine: ‘Centres arewell equipped; there was noproblem getting essentials.It was impressive; Egyptianswere so cooperative and clearwith each other, supportive. It was a good time. No onecomplained they did not get treatment.’Good drug and laboratory management meant thatsupplies were adequate at a time when it was practi-cally impossible to make new deliveries. A large chunkof two Global Fund TB grants totalling US$14 millionhas helped to improve facilities and strengthen healthsystems so TB services were strong enough to withstandthe crisis.Under the internationally endorsed DOTS (directlyobserved therapy – short-course) programe of TB treat-ment, a combination of TB drugs must be taken all atthe same time. If one or more drugs are missing froma dose it could lead to drug resistance in the patient, acondition easily transmitted, even to someone who hadNo longer a lack of public awareness inTB: the GlobalFund-financed public information campaign in Egypt©TheGlobalFund/JohnRae
  2. 2. March 201134 Africa HealthSee page 61 to test yourself on this articleCPD Challengeno history of TB. Prior to Global Fund financial assis-tance there was very little control for multidrug-resistant(MDR) TB. Two grants have helped establish manage-ment of MDR-TB through procurement of second-lineanti-TB drugs. ‘The Global Fund is able to support themost expensive and difficult part of TB control’ confirmsDr Awad.The average cost of a full course of TB treatmentin Egypt is US$60 whereas a full course of MDR-TBtreatment is around US$6000. Treatment of MDR-TB isnot only more costly it is also more complex and curerates are low. Last year the World Health Organization(WHO) released their most comprehensive report todate on MDR-TB calling it a ‘serious threat to globalhealth’. The disease is associated with cramped livingconditions and poverty and has the potential to spreadat deadly rates in prisons – and beyond if not properlycontrolled. In February 2010, Egypt’s Abu Zaabal prisonhospital opened a new TB ward, with the possibility totreat MDR-TB patients in isolation from other inmates.Further centres followed and by October two prisonersfrom Alexandria completed the complex, lengthy treat-ment and were cured of MDR-TB.©TheGlobalFund/JohnRae‘No-one complained they did not get treatment’: the Cairo Chest Clinic©TheGlobalFund/JohnRaeTB and MDR-TB are notoriously difficultto diagnose. Global Fund-financed pro-grammes have renovated diagnostic facilitiesand established 80 new centres. Throughprofessional training, the Global Fund assiststhe Egyptian National Reference Labora-tory, the regional specialist in case detectionand cure by reliable diagnosis and effectivetreatment. Highly accurate diagnosis bymicroscopy for TB bacilli requires externalquality assurance.The National Reference Laboratory sup-ports a network of governorate referencelabs with training and quality assurance to ahigh level of technical proficiency. Through-out Egypt, the Global Fund has also beenable to pay for the provision of training tohealthcare providers, particularly on howto administer DOTS. Training has also beengiven to conduct awareness activities fortargeted groups; and enhance the follow-up and counselling of TB patients and theirfamilies. As a result of corruption allegationsidentified in certain Global Fund grantsoutside Egypt, all training in Global Fund-financed grants throughout the world is cur-rently on hold – pending a thorough review.A new training plan has being submitted byEgypt’s Global Fund grant implementers tomeet the tighter regulations.Egypt has the highest population densityin the world in its urban areas, – with 2000inhabitants per square kilometre. Migrantsmake up a small but growing part of Egypt’spopulation. With migrants flocking to thenation’s capital and other cities in searchof work or fleeing repressive regimes, liv-ing conditions have become increasinglycramped and prone to the potential for dis-ease spread. The increase in centres means90% of the population can be reached with TB services.In order to access those most at risk, the GlobalFund finances two mobile clinics to target economicallydeprived areas. Outreach activities support refugeesmainly from Palestine, Southern Sudan, Somalia, andrecent arrivals from Libya. The mobile unit has a com-partment for clinical examination of the patients andanother equipped for diagnosis through microscopy.Experienced medics and nurses partner up with socialworkers and members of civil society organisationsalready working within the targeted communities. Thecombination of these different kinds of expertise andexperience ensure that the mobile units reach thosemost at risk with prevention messages as well as deliver-ing treatment for TB patients who would otherwise havegone untreated. The clinic was not operating during thecrisis but will be back on the road in March.