Click image for larger view

"It's a balance between education and a duty to your country," Abeer said, grinning.

Abeer was talking about why she volunteers so much time to SHE, the Student Health Education Group. It is a program where medical students, like Abeer, explain health matters to people throughout Egypt.

I first learned about SHE when I attended the One Hundred Years' Liberation of Women conference in Cairo. Dr. Salma Galal, a professor from the El-Azhar University Faculty of Medicine (Girls), spoke with pride about the program, which was formed entirely by volunteers in 1984.

Afterwards, I went to Dr. Galal's office to meet with some of the SHE volunteers. I wanted to hear first-hand what they had to say about their medical curriculum, as well as how they integrate their class work with hands-on work in their communities.

Vocabulary Box clinical - hands-on hygiene - cleanliness natal - something that relates to birth; pre-natal or ante natal is before the birth, post-natal is after the birth infant mortality - the death rate during the first year of life consanguinity - when people marry from within their own family; for example a male might marry a female cousin from his father's side fetal - of or relating to being a fetus or unborn baby chromosome - a strand of DNA in animal and plant cells that carries genetic blueprints hypertension - high blood pressures

Women from all over the country attend El-Azhar, with about 35% of them coming from rural areas. The Faculty of Medicine (Girls) is the only medical school for women in all of Egypt, so I felt like it was a special opportunity to meet with these students. Dalia El-Sayed Gad, Abeer Abed El All El Miligy, and Enas Hamdi Yehia were from Gharbia, midway between Alexandria and Cairo. Amany Shakir Hassan and Eman Mohammed Ahmad were from Helwan, in the outskirts of Cairo at the end of the metro line.

Amany, Eman, Dalia, Abeer, and Enas are five women who have attained the honor of attending medical school in the hope of becoming physicians, five young people who have hope and the spirit of unity. Studies on medical students' attitudes show that female physicians are more likely to return to their homes than male physicians. Because these female doctors go back to their communities -- villages, towns, or cities -- more than male doctors, Dr. Galal figured that her students would benefit from a clinical component early on during their academic work.

Click image for larger view

SHE supports students who pursue health education activities in their hometowns. This can be as simple as first aid classes and blood pressure checks or as complicated as encouraging all young children in a village to practice hygiene. "It's like a chain reaction. It builds and builds," said Dr. Galal. "When people have the feeling, they go with you," she continued, about the movement towards taking individual and collective responsibility for one's health.

I invite you to listen to some of these five SHE volunteers' comments now.

Objectives of SHE To understand the integrated primary health care approach in order to be better prepared as physicians To build relationships between students and the community and increase the potential for future roles To educate groups in the community and promote health conditions To release individual capacities and build character through volunteering

MONICA: What exactly are you doing now?

EMAN: I'm working with 3rd year primary school students, ages 8-9 years old. I also work with young females from 17-25. I go to the mosque after gom''a (Friday afternoon prayer) and talk about breastfeeding, ante-natal care, and transmission of diseases like pneumonia and bronchitis.

ENAS: I work with mothers in my village.

ABEER: My program focuses on older men and women, and people with disabilities at El Wafaa al Amal (a center with services for people who are deaf, mute, or whose mental growth has been retarded).

DALIA: I work with children. They are the leaders of the future, and they must be prepared to be aware of our health education.

AMANY: I do health education with women 20-24 years old, in a sewing collective. I teach about the value of nutrition, especially when they are young, as well as the importance of pre-natal care.

MONICA: Tell me, what is your greatest challenge with SHE?

The students all answered that the production of their newsletter is one of the most actively challenging aspects of their work, but then it came down to personal challenges.

ENAS: It's not easy to change customs. For instance, there's the daya custom.

Dr. Galal explained that the daya is the traditional birth attendant. Dayas are not usually trained in standard medical care, but their skill, especially in villages, has been relied upon for a long time. There are 37 infant mortalities per 1000 births in Egypt, and dayas assist in about half of all births on Egypt.

ABEER: Customs for the treatment of disease are hard to change. For instance, it's difficult to convince somebody to build their house, not too far down (below the street level), but in a healthy manner, to have the sun's rays shining in, because they've already built their house!

DALIA: With the old customs, they tend to do things with no change. There's consanguinity, which leads to fetal abnormalities and chromosomal problems.

EMAN: That's right, like after gom''a, the women don't want to listen to me, because they have to go home, to prepare the food, or to take care of the children. So I tell them, if they stay and listen to me, I will measure their blood pressure. It works! Also, the children in primary school, if they are noisy, I have to talk with them about good behavior. Then I have competitions, where they can win small prizes, like pencils, if they pay attention.

Dr. Galal interjected that, because of SHE's low budget, students like Eman often have to pay for supplies, like the pencils, out of their own pocket.

AMANY: The young adults are more interested. It's easier to teach them. But the older people have many problems like hypertension and diabetes. Sometimes it's too late to change their minds.

Click image for larger view

The five women go through the standard SHE program when meeting with people. To see what effect they are having, they do a pre-test and a post-test of people's knowledge, attitudes, and practice. They teach and perform problem-solving, planning, and analysis. If they can, they also do urine, stool, and blood tests. For example, one volunteer was trying to teach children not to swim in the river since it is bad for their health. To see if her teaching was effective, she measured kids' bilharzia before and after speaking with them. The volunteers are also social workers, bringing together community needs and solutions. Dr. Galal commented on the full year commitment she asks of volunteers. "I don't want to train people who aren't interested. It's only for those people who have a clear idea of what they want to do."

The students expressed to me how much they enjoy and believe in what they're doing. "Our aim is to provide health education to the lower socio-economic classes in Egypt," they chorused. They "love communication with a special group." Further, as Abeer emphasized, their aim is to change the entire face of Egypt through work like this. Already they are organizing students from different colleges to focus on a clean, healthy environment by disposing of litter properly, and paying attention to sanitation and water supplies.

For more information about the state of women's health in different places around the world, check out the World Health Organization. They have a special section devoted to this very important issue.

Want to know what you can do to help? SHE is in need of health education materials. Please send anything you might have to: heea_egypt@yahoo.com or c/o 23, Sharia Abdel Kader El-Maghrebi, Heliopolis, Cairo, EGYPT. Visit http://www.geocities.com/heea_egypt for more information.