Poverty, Health and Hope: Cairo

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936048_555279231177118_239356447_sA tender heart and caring face stares at me in Cairo deep in thought about a question I just posed to him – Are the slums as dangerous as everyone says?Dr. Osama Abdalla takes a deep breath and then we begin our very important discussion.“No, they are not,” he begins, “everyone is afraid of the slums and the Cities of the Dead. Spend some time in there are you find that they are people just like you and me, but they have nothing.”

This only begins our story of human tragedy.

Poverty Cairo is a city of 22 million by day and perhaps roughly 17 million by night. Yet Cairo is not one city, it is many cities with their own unwritten governments and rule. In Cairo you have the sanctioned part of the city connected to government services and then you have the other Cairo. The unsanctioned areas, squatter areas that operate illegally. That is they steal city services and build homesteads without permits. These prominent areas are the various slum areas and the well known Cities of the Dead. Both of these areas are regions where criminals released from prison live as well as the large migrations of people from the countryside abide. Cities of the Dead are famous. They are large cemetery spaces full of mausoleums and graves. Caretakers of the mausoleums began building habitations around the graves they watch over, eventually constructing multistory apartments as their families grew. Some of these buildings could be five or more stories high. Like the favelas of Brazil the passages are narrow, barely wide enough to drive a car through and the crime rate against outsiders is high. My guide drove me through one of the 5 Cities of the Dead, he was visibly nervous. What I saw were little shop, local artisans makes items needed by the locals and lots of people, people everywhere. Populations in these areas could range from 600,000 to 1.8 million. Exact numbers are not known as no one particularly care about knowing anything about the spaces. Just whispered claims and warnings. “If you need to buy a gun or an human organ, go there.”In the hierarchy of the Cairo you have the sanctioned city space, neighborhoods and square, then you have the Cities of the Dead and then you have the slums. Slum estimated populations are nearer to those of the Cities of the Dead, a difference is that they are even poorer. One slum of 600,000 may have one school for the children and completely lack services. Electricity has to be stolen and strung into the area, sewers have to be dug by community members, crude but they make due. Structural violence and the conditioning of poverty has created and kept these ever growing spaces.In Egypt, once a criminal always a criminal. The prison system has no method of reform or transitional help back into society. The crime of murder or the stealing of a loaf of bread might as well be equal in the stigma of criminality. Condemned to a life of a marginalized life.

Health In this visit to Cairo, I’ve had the extreme luck to spend time with passionate public health advocates, most notably Drs. Osama Abdalla and Ahmed El Metwally. These gentlemen hope for a different future for Egypt as dialogue of social justice is in the air. Public Health is by design a human rights philosophy – rejecting the unacceptable. Pioneers in the practice of Public Health Paul Farmer, Jim Yong Kim and James Orbinski to just name a few as there are many, have made the advocacy of health a common charge for human rights. One does not need to practice medicine to be active in public health. Health care opens a Pandora’s box related to culture, history, economy, education, structural violence, politics and education. Over a coffee, El Metwally explained how after his medical degree when he began his first posting he had a deep revelation based on his experiences – the bulk of people are not sick because they just came down with something, they are sick because they are poor. A powerful statement. Health inequity is arguably the number one problem faced by world populations.Linking health inequity within a failed state is an important step towards understanding the nature of poverty. Abdalla described how in the slum areas in Cairo before the revolution the regions were controlled by corruption, and sadly in this moment in the post-revolution is still. The transition to justice takes time. The hollowed out institutions that before controlled the illegal areas have succumbed to individual bribery under the Muslim Brotherhood to further impoverish these people. This phenomenon is not just an Egypt problem; it is a world problem. Regions of Latin America after dictatorships deteriorated into this ‘era of new violence’ of bribery and extortion, crime upon crime in void of corruption. Civil society has yet in these areas been able to regain control to protect and lift up dignity.  However, just as the public health profession is changing from the top down so too are populations beginning to realize this as a violation to their human rights. I believe these changes are directly tied to this long moment of riots, this global spring. The marginalized are awakening, not just the poor in the slums, but the youth who have entered into markets without promise of a future. There is hope on the horizon as inspiring young professionals are finding their political voice and in turn are recognizing the myriad of injustices around them. This is promising because it will be those individual who reach out a helping hand to help others, to pull them forward.

Hope The triad of poverty, ignorance, and disease are tied closely together. Abdalla working as a volunteer with Action for Hope volunteered in a Cairo slum and it changed the trajectory of his ambitions, and changed him as a human being. All peoples who work in this fashion go through this personal transformation. Abdalla directed our conversation back to the slums. He told me, “You would be amazed by the openness and hunger the people have to learn, to have someone care about them.” They live lives like mice in hiding, but you see that they have tightly knit kinship and community foundations. This he argues is where social justice begins and democracy is born. Bringing these people, people who have denied education and a chance, bring them into the fold and an enormous power of dormant ingenuity and creative with flourish in the streets of Cairo. In a serious tone, Abdalla tells me “You cannot judge them until you’ve given them an opportunity.”Abdalla lived for 12 day in a community along with a group of Action for Aid workers, who were artists, teachers, filmmakers, and community builders; he was the only doctor. Abdalla acknowledged that it took a little while for community members to trust the group, but then they rapidly opened up. What he found was that the people didn’t necessarily need a doctor, they could make their way to a clinic if need be, what they needed was public health education. The group brainstormed and then asked the community what do you want to learn about and from there they gave workshops on hand washing and basic hygiene, on maternal health, on community organizing, education, and most importantly security. The people have no sense of security in the form of policing or services. Unpacking all of these issues is what public health is all about and its weapon for the weak. Abdalla reflected on many memorable moments, one when he spoke about hygiene to a group of over 500 children. He said they were unruly at first but quickly settled down and were mesmerized. An unbelievable experience as he recounted it. Afterwards they had a community party for over one thousand people where the children taught their parents what they learned.  Inspiring.Both Abdalla and Metwally have worked in slums and will continue. This is the hope, offering a different tomorrow and today.

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