Featured Reference Site: El Cairo, Egypt

Our focus will be on citizen digital and health literacy, and on the implementation of the digital transformation of health and care to improve the outcomes of chronic diseases such as diabetes along the entire lifecourse.

To this purpose, the RS will take advantage of a new location that is being appointed by the Government in Eastern Greated Cairo region, to drain 4-5 million inhabitants from Cairo and nearby governorates. It is annexed to Ain Shams University Hospital campus, and is easily accessible, being on a main road Ramses road in Cairo.

Interview to prof. Emad Hussein, El Cairo RS Coordinator
Emad Hussein is professor of Vascular & Endovascular Surgery and past chairman of Vascular Surgery Department at Ain Shams University of Cairo. Clinical Fellow at USUHS – Bethesda; Visiting Professor of Vascular & Endovascular Surgery at Dammam University, Saudi Arabia, and at La Sapienza University, Rome. Prime Founder & 1st  Past President - Vascular Society of Egypt; Vice President ISVS & IUA 2009 – 2017; Founder of Vascular Surgery Dept &Vascular Program Director of Aswan University;  Founder of Afrochap of  IUA; Founding Member – Egyptian Venous Forum; since 2012 Advisor to the President – International Union of Angiology UA for N. Africa & Middle East; since 2018 Vice President MeFAVS Mediterranean Federation for Advancing Vascular Surgery. Coordinator – National Egyptian Endovascular Training Program & National Aortic Interventions Training Courses NAAD. He is Course Director of the Annual National Aortic Interventions Hands on Course & Workshop in Egypt since 2014. Since 2017 he is coordinator of El Cairo- Ain Ahams University Reference Site.

Interviewer: Maddalena Illario

Population Ageing is posing several important challenges to our societies, that overcome country boundaries and hence require concerted global policies aimed at implementing sustainable approaches to transform it into an opportunity for sustainable development. Health inequalities, public health emergencies, environmental factors affect high, medium and low income countries, where they hinder the achievement of human full potential.

Which public health challenges do you foresee as priority for your Country and for your Region?

The first priority now is fighting and containing the current COVID 19 crisis. Our ongoing containment measures are proving effective, as the number of cases is under control; however we will need to remain vigilant and continue our management and monitoring activities.  Other public health challenges we are facing in Egypt include: hepatisis,  diabetes, and a growing population. We undertook mass screening for hepatitis until 75% of susceptible categories were screened. We also provided immunization and antiviral drugs to all population as well as to residents from sub-Saharan countries. Our approach has drastically reduced morbidity from hepatitis.

We are also experiencing increased prevalence of diabetes and its associated complications for patients.. To address this we have developed a  largescale plan that includes establishing an excellence center for diabetes. This will allow us to carry out screenings, promote awareness about the causes of diabeters, and encourage screening of patients before complications such as diabetic foot, nephropathy, retinopathy arise. We see this as pivotal to lowering incidence of diabetes,  diabetic foot ischemic, and infective complications.

Uncontrolled growth of the population is also another challenge. This has cultural roots based on religious beliefs in birth control. But we need to consider the socio-economic impact of a growing population, as well asaddressing the health care challenges from an ageing population and facilitating the independence and autonomy of our elderly citizens.

Egypt is in the Mediterranean Basin, at the crossroad between two continents: which public health challenges do you share with Africa, and which ones with Europe?

There are several challenges we share with Africa, which can be addressed through collaboration between the countries, such as:

• Viral Hepatitis C - In Egypt we have promoted for the last 3 years a successful national awareness and treatment campaign which has an 80 % + cure rate and we have seen the eradication of the disease from several regions in the country
• Parasitic infestations - these are being progressively eradicated by improved access to water, and sanitations.
• Managing Diabetic complications
• Shortage of advanced technology and some modern equipment in surgical specialties

Some of the geographic and social challenges we also experience in Egypt include lower levels of health literacy and awareness amongst some areas of the population, which can have implications for the success of our public health campaigns, for example diabetes; remote locations of the population can make it difficult to reach people or for them to fully benefit from high quality proper services for diabetes diagnosis or management of complications. To address this we need to increase the number of community centers for health, providing specialised care focusing on diabetes, and provide simple awareness materials and information to citizens so that those developing complication would go to reference centers as soon as possible.

Some of these challenges, managing diabetes complications, we share WITH EUROPE, and Egypt Egypt could work as a bridge to share innovative good practices on the African continent.

With the availability of so many digital tools, we need to make an effort to develop and sustain High Quality Health Care, especially in facilitating active and healthy ageing. We could also look at other areas of health promotion e.g. disease prevention, and reducing Smoking prevalence of both cigarettes and Nargila.

What role do you think the digital transformation of health and care can play in addressing these challenges?

There are broadly 2 aspects to this. Firstly digital transformation can lead to more accurate, retrievable and sustainable data registers that could benefit patients, health care providers, and stake holders. Secondly, smart technologies can support clinicians by improving communication with patients, reaching out for those in remote areas, and providing efficient telemedicine programmes.

For example, greater use of digital solutions could help local health authorities, improve awareness and implementation of our Public Health policies.  However, there is a need to increase funding for digital transformation of health and care, so we can implement a plan for telemedicine, making greater use of mHealth apps. Everyone has a smartphone, so we need to train patients on how to use mobile health and care apps to help them engage with the health and care providers and better self-manage their health and well-being. For this to happen, we need to improve broadband connections countrywide, and there is strong determination from our authorities to do this, as well as allocation of necessary funding. Looking to the future a new center for excellence is being set up in Cairo University to work as a hub for digital health in Egypt, and there could be opportunities to explore the options for connecting this with European mHealth or Digital Hubs to further the scaling up of digital solutions.

Which enabling factors and bottlenecks do you see for implementing new solutions to improve health services in your RS?

There is the readiness and determination to bring together within the Reference Site local Academia, Government authorities, and NGOs to create within the a CENTER OF EXCELLENCE FOR HEALTH CARE. This Center could drive the Plan for Digital Transformation and become a hub for the health sector by political authorities. The Egyptian Government have already as part of their national plans provided the infrastructure to support this e.g. upgrades of the national electronic network and markedly increased internet speed. Furthermore, a large number of public services in Egypt already have digital hubs/platforms e.g. train transportation, traffic department, issuing and renewal of driving licenses, tax payments and issuing passports.

The hurdles or obstacbles to progress I consider are:

• Lack of awareness and proper training on Digital Transformation amongst many health and care employees
• Lack of certain new Technology resources
• Shortage of Funding to optimize our strategic plan

What kind of support do you expect from the RSCN?

The kind of support I am expecting from RSCN can be summarised as follows:

• opportunities to participate in relevant funding calls in order to achieve our mission (Better health care, awareness, education)
• Technology Transfer of innovative good practices to our Reference Site in Egypt
• Providing regular training for selected teams from Academia and administrative staff
• Capacity building & exchange visitor program.

Would you be available to be an ambassador for the RSCN in your area?

I would be definitely available to be Ambassador for RSCN in my area

Are you aware of the WHO Decade of Healthy Ageing (2020-2030)?

Yes I am aware of the initiative, and I am interested to find out more on its specific goals, policy,  and implementation plans, etc so that we can both collaborate with others in achieving these, and ensure they are reflected in the aims and objectives of our Reference Site.