March 7, 2018

My most recent trip to Egypt

Egypt January 2018

I am fortunate to return to Egypt for a fourth visit.  I am returning to al Maadi Hospital to work with Dr. Eziz in his excellent Physical Medicine and Rehabilitation Department.  Dr. Eziz has an very wide ranging physical space, with physical therapy, aqua therapy, exam rooms and a very high grade interventional suite.  My role is to help teach the residents interventional pain management.  The focus is on diagnosis and the application of interventional techniques.  To this end, I have brought along several, many, lectures dealing with the basics of interventional pain management.  The focus is on specific techniques, such as epidural injections in the neck, chest and low back, whether interlaminar or transforaminal, facet injections, regardless of whether in the neck, chest or back, whether into the joint or to the nerve supplying the joining and regardless of whether local anesthetic or radiofrequency injections.

The physicians and physical therapists at Al Maadi are very intelligent, well trained and enthusiastic.  I am very much looking forward to seeing them again.

30 Jan 2018.   I am in day 3.  This is our best trip to Egypt so far, this being number 4.  The first trip was the day after Benzi and Ambassdor Steeven’s death.  What a difference 5 years makes.  We are, for the first time, going to a restaurant in the, this one called Zulu, in Maadi, where the hospital is located, started by a South African.  Yesterday, we returned to the Cairo Museum,.  Perhaps what I like best about the Museum, even more than the artifacts, are the University educated guides, whose education, enthusiasm and depth a knowledge alone are worth the trip.  The best news is that about 150 King Tut artifacts will be coming to the US, starting with Los Angles in the Spring of 2018.

Yesterday, we returned to the pyramids.  One would think, this being our fourth visit, that it would get old.  Never!  Their granduar overwhelms.  And, for my first time, I went inside the burial chamber.

Last night, we had some shisha, or, in English, a hooka, grape flavored.  I objected, as I do not smoke, but the pleasure of sitting on the banks of the Nile, even though the night was brisk in the middle of the winter, with good company, was reward enough.

But I am not here for vacation or a travel guide. Dr. Abdel Aziz has created a dream, which is a well run, modern, rehabilitation facility, with a staff who works together smoothly to the end of high quality patient care.  The renovation of the space is complete, so that previously unused spaces, large spaces, are function rehabilitation, facilities, water and land based, adult and pediatric.  Dr. Abdel Aziz is occasionally called away by his other duties.  My busy clinic, which consists of about 30 patients per half day, continues to work smoothly.

We are seeing a wide variety of patients from all walks, from the highly educated to the extreme poor, who have been sent to the clinic specifically for evaluation by experts.  The problems seen are typical with what is seen in any pain clinic, with a large dose of spinal stenosis, but also a significant dose of young meaning with disc herniations from playing advocational soccer (football).  Madrid Real is a popular team, by the way.  In addition to injections, there is a huge role here for physical therapy, followed by a self directed home exercise program.  My impression is that there is an increasing acceptance of exercise, which is the foundation for health everywhere.

3 February 2018

We have finished the clinic.  Egyptian military hospitals serve both military and civilian patients; our breakdown was about 50/50.  The bulk of the problems were spinal, as would be expected in a physiatry clinic.  I performed over 30 procedures.  Most of what we did was what I would call bread and butter procedures, primarily interlaminar epidural injections, cervical and laminar.  This emphasis on the basic, rather than the more esoteric procedures I might do in my practice at home, is very appropriate, as it reflects the local need.  I am impressed by the duration of relief I am seeing.  I have been to Egypt often enough now that I am getting repeat patients.  It is very common for people to get a year’s relief from the injections.

As everywhere, the issue after procedures is a home exercise program.  The nurses at the hospital, however, work out 90 minutes a day, so the ladies are leading the way!

Speaking of the nurses, the staff at Al Maadi are excellent.  The patients flow in the clinic and in the procedure room is excellent.  I am dependent upon the skill of Entissar here in Cairo as much as I am on the nurses and staff with whom I work at home.

Dr. Ehab Abdelaziz has done a remarkable job in upgrading the Physical Medicine and Rehabilitation Clinic at Al Maadi. There is a consistency and enthusiasm amongst the staff which is delightful.  The physical plant is open and bright.  I had the pleasure of touring the physical therapy clinic when some patients were there.  In particular, there was a young family who had been involved in a car accident. The father shattered his femur; his wife showed me the x-rays, which showed a very nice femoral rod.  The two-year-old son, who was busy scampering around the equipment, had broken his tibia.  They were a delightful family, getting good care and well on the way to recovery.

One of the nicest things about the trip was the consistency of the physiatry clinic staff.  In particular, we spent a lot of time with Drs. Mohamed  Abdelrahman, Harony, Shahin and Abdelkader.   They are energetic, well-trained and fun to be with.  Because of them, we saw Cairo as we had never seen it before.  Best trip ever.

At this point, I am waiting to  return home to figure out my schedule so that I can set up my next trip back to Al Maadi Hospital, with it wonderful staff and patients!

One final point, to show what wonderful people the Egyptians are.  On our last trip back to the hotel, we were stopped in traffic on the University of Cairo bridge.  We heard a wailing and saw a feral kitten under the next car.  Several Egyptians got out of their cars, including our own Dr. Haruny, and got the kitten out of traffic, safely onto the sidewalk.  Try stopping traffic for a kitten in Los Angeles or New York  City!

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