Medical nonprofits face the pandemic
As COVID-19 crushes Egypt’s health care system, two nonprofits work to get care for more patients, regardless of need
 
 
 

Media narratives have focused on the supposed ignorance and indifference of the general public since the pandemic set in four months ago. But two social projects tell a different story.

Mersal and the January 25 Hospital are healthcare nonprofits that provide medical services to all. They had already been in operation when the pandemic hit. But the two socially funded operations have seen their workload swell several-fold during the crisis, as they swabbed suspected patients, provided treatment and secured intensive care for those with severe symptoms.

 

Discrimination-free medicine

Mersal is not the only organization providing medical services, but it is unique in that it does not take the nationalities of recipients into account. “The foundation has contributed to the treatment of patients from 40 different counties so far,” says Heba Rashed, the founder. “Mersal doesn’t turn anyone away, regardless of how severe, chronic or late-stage their conditions may be. They only need to be in financial need and not covered by the public health insurance system or eligible for the government-funded treatment program. If they are eligible but their place on the list would have them waiting too long, while their condition may worsen or their life may become at risk, Mersal would also welcome them and try to provide them with the necessary medical services for free.”

Rashed graduated from Ain Shams University with a degree in linguistics, then went on to earn a master’s degree and three certifications in project management. She worked as a project manager in the private sector for 13 years. For 10 years after that, she volunteered at various charitable organizations, particularly ones providing medical care to limited-income recipients. With that experience and a drive to start her own organization, she established Mersal — but not without having to overcome financial and bureaucratic obstacles on the way to legalizing it.

 

Courtesy: Mersal Foundation’s Facebook page

 

“It’s just a two-room apartment on a back street off of another back street, but I’m filled with hope that it can make a transformation in Egypt,” wrote Rashed on February 24, 2014 on her personal Facebook page about Mersal’s very beginning. The official launch came later in March 2015. At the time, the work was done entirely by Rashed and two other employees. Five years later, it has become one of Egypt’s major charitable healthcare foundations. It currently employs 160 people at five different locations around the country.

Mersal provides a wide range of care, including medications, prosthetic limbs, surgeries, infant incubators, and intensive care. A year ago, Mersal started operating outpatient clinics to serve a broader scope of patients. Three years before that, the foundation built a cancer center, where chemotherapy is provided free of charge. Additionally, it maintains an accommodation facility for out-of-town Egyptian patients as well as foreigners coming from abroad for treatment. Outreach efforts at Mersal also include medical caravans that go into remote villages and Upper Egypt provinces. The foundation’s most recent project, currently underway, is to equip a charitable children’s hospital.

The Mersal team launched an organized initiative to combat the novel coronavirus well before the hike in confirmed infections and deaths. Sterilization and cleaning supplies, as well as masks and gloves, were distributed early on as a preventive measure to patients at Mersal facilities. Awareness material was published on the foundation’s Facebook page, and used by medical caravans regularly dispatched to Egypt’s poorest villages. “We have 16,000 patients on the books who receive treatment through our foundation. Since the virus started spreading around the globe, and considering how financially hard-pressed they are, we decided to help curb the contagion,” says Rashed.

With the rising number of COVID-19 cases, Health Ministry-run ICUs were becoming increasingly inaccessible. So Mersal boosted its online presence to enable patients in severe condition to get in touch. “When a patient in need of intensive care contacts us, we contact the room to help us search for an available bed,” says Rashed. “If a bed is found, we immediately refer the patient … If demand is high and an available bed can’t be found, we refer them to a private facility until a spot is vacated at a public hospital or until they’ve recovered.”

“My friend’s father was isolated at home,” says Ahmed Nagy, a media professional. “He was hooked to an oxygen cylinder. But his condition deteriorated one night. A doctor instructed that he must be taken to ICU, because his breathing was irregular, and he has acute anemia.”

“We called every hospital we knew of,” says Nagy. “Either they were at capacity, or they didn’t admit COVID-19 cases at all. Private hospitals had beds available, of course, but for exorbitant prices: around LE20,000 per night, and you’d have to put down a deposit of LE30,000. It was nothing like the prices publicly set by the Health Ministry. By dawn, the ministry answered our calls. They said, ‘We’ll call back in two hours.’ We have yet to hear from them! An hour later, we called the Cabinet’s complaint line. They told us they would send an ambulance in two hours. We have yet to hear from them! Then, we called Mersal. They told us that they had no vacancies, but they would put him on the waiting list. Mersal were the only ones who followed up and kept at it. A few hours later, they managed to find a place for him and they called us back.”

Nagy urges people to donate to Mersal. “After 15 hours of searching and frantic calls, Mersal was the only organization that played an effective role, even more so than the competent authorities themselves. My friend’s father was admitted into intensive care. They offered to cover the expenses, entirely or partially, depending on our financial ability. This is why I think everyone should donate to Mersal — it would help shorten their waiting list.”

Beyond distributing cleaning and sterilization supplies, securing ICU beds and even buying ventilators, Mersal has also extended services to those whose condition does not require hospitalization. Through a Facebook group titled “Mersal support team for COVID-19 patients in home isolation,” a bevy of doctors provide consults to patients at home and recommend healthy nutrition to help their bodies battle the infection. 

Dina, a housewife who contracted the virus through her husband, received assistance from one of the group’s doctors throughout the duration of her home isolation. “I didn’t get the swab,” says Dina. “But I did get lab tests and a CT scan, and I posted them to the group. About an hour later, a doctor got back to me. He told me that I had to isolate myself, and that it was okay for me to do the treatment course at home. I got a medication package from a Health Ministry-run hospital. But when it came to consultations, especially through the worst part of my sickness, I was entirely dependent on the Mersal doctors group.”

 

January 25 Hospital: A place for the poor

 

Courtesy: Facebook page of the January 25 Hospital Foundation

 

The January 25 Hospital was established in Shabrawin, Hihya in the Sharqiya governorate, as a place for patients with no money or connections to secure treatment. Home to over seven million people, Sharqiya is the country’s third-most populous governorate after Cairo and Giza. Mohamed el-Garhy, a journalist, first conceived of the hospital after the January 25 revolution as a place that would provide comprehensive primary health care free of charge. But he moved on the project with urgency after his young son, who suffered from health issues, died following a struggle to find him a place in a hospital.  

Since July 2011, Garhy has been tirelessly working to build the hospital and buy all the necessary medical equipment. Using Facebook and Twitter, as well as his “Charity Taxi” that drove around the country collecting money from donors, he raised enough funds to buy a plot of land and start construction. The hospital now has an admissions office, an emergency room, a pharmacy, a neonatal intensive care unit equipped with incubators, various specialized outpatient clinics, operation rooms, and an intensive care unit — all built gradually over the past nine years. The facility has yet to officially open, however, and most of these services remain inactive. Nevertheless, the foundation has been working to facilitate the provision of urgent services to COVID-19 patients at other establishments. An intensive care unit was set up at Hihya Central Hospital, one of the officially designated isolation hospitals, through the foundation’s efforts.

“The foundation currently takes on several kinds of activities in the fight against the coronavirus,” says Garhyl. “That includes, for example, home visits to take swabs from people in self-isolation and suspected cases in coordination with quarantine hospitals, running CT scans and chest X-rays, supplying basic medication packages to confirmed and potential cases under the supervision of fever doctors, sterilizing the homes of COVID-19 patients and those who have been in contact with patients in coordination with the Health Ministry … dispensing protective equipment sets to healthcare workers, and soon to paramedics all over Sharqiya, and mobilizing volunteers to organize crowds, such as people standing in line to cash their pensions and at vaccination drives.”

On whether the January 25 Hospital is able to serve as a quarantine facility for COVID-19 patients, Garhy says, “Our foundation was the first to offer itself, as an organization and as a facility, to the Health Ministry to use for isolating patients in Sharqiya. We also made Dr. Mamdouh Ghorab, the governor, aware of this proposal. Sadly, however, there is not enough nursing staff to operate the building. We’re ready to hand the building over at any time to the Health Ministry to use for treating confirmed cases; we’re also willing to incur any expenses.” Garhy adds, “Because the hospital has yet to be officially launched, it has no ICU. This is why we set up and equipped an ICU seven kilometers away, at Hihya Central Hospital.”

Doctors have raised concerns about the increased risk of contagion if people can only get tested at hospitals — a patient could go to a hospital to get a swab and be confirmed negative, only to contract the virus on that very trip, either from another patient or from a medical worker carrying the disease. In response, the January 25 Hospital Foundation contracted a medical lab and started a service in which technicians swab suspected cases at home and get the swabs tested. The program first launched as a pilot on June 7 only in Shabrawin, and later came to cover Hihya district then all of Sharqiya, with plans to expand further. CT scans are also provided as part of this service, and all costs are incurred by the foundation at no charge to patients. Priority is determined by a team of medical professionals, mostly volunteers.

The foundation’s efforts have been supported by the Health Ministry, according to Garhy. “We met with the Hihya director of health services. Before that, we had meetings with the administrators at Hihya Hospital and the Shabrawin Primary Care Unit. These are all representatives of the Health Ministry. We also met with the Sharqiya Ambulance Organization. There’s a good, cooperative relationship, and we hope to have more of that in service of the community.”

Garhy says the foundation’s board of trustees are all volunteers, who contribute time, effort, and even money. “Salaried employees are paid reasonable wages,” he says. “One of the things we at the foundation take pride in is our complete transparency with donors. Ever since we started, we have published every donation receipt on our official website. Our annual budgets are available there. We publicly account for everything, and regularly keep our donors apprised of new developments. Anyone who wants to check our payroll records or our ledgers is welcome.”

 

Courtesy: Facebook page of the January 25 Hospital Foundation

 

The foundation can only continue to provide people with free healthcare services as long as donations keep coming in and medical professionals keep volunteering. By Garhy’s evaluation, ventilators, protective equipment for medical teams, and tests, scans and medication for self-isolating cases are the primary expenditures, although he also discusses the need for better awareness of the virus and protective measures. “With low levels of awareness, one case could potentially cause a public health crisis in an entire village. That people view the diease as a stigma doesn’t help.

Both Mersal and January 25 Hospital are occasionally hit with harsh criticism, usually targeted at Rashed and Garhy, the two people in charge. Patients’ families voice their dismay at sluggish responses, long waiting lists and other shortcomings. This raises the question: How can these foundations satisfy the needs of an ever-multiplying number of patients and their families in the midst of a pandemic?

Community efforts and civil society organizations can play an integral role in helping us survive the coronavirus pandemic. But, at a time when so many people have fallen outside of the safety nets provided by the state — which is ultimately the responsible actor — Garhy emphasizes that the capacities of foundation employees and volunteers are limited.

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