Egyptian Doctors Get Rx for Change in UCI Program

SANTA ANA —  In Egypt, whatever the doctor says, the patient does.

That’s not always the case here, eight Egyptian physicians have found out as they train with UC Irvine doctors in family medicine.

After seeing a patient at UCI’s Family Health Center challenge a doctor’s advice, one visiting physician asked whether the patient was permitted to say no.

“My reply was, ‘It’s a free country,’ ” Dr. Thomas Bent, UCI’s director of residency in family medicine, said, laughing. Whereas in Egypt a patient wouldn’t dream of disobeying a doctor, he said, “in the United States, we negotiate with patients because patients have a wide range of health beliefs.”

The Egyptian physicians are the first wave of eight teams of doctors visiting UCI’s College of Medicine and its community clinic to study family medicine. In two months, the Egyptian physicians will return to their country and teach other doctors there. A team of UCI doctors will fly to Egypt in May to help set up a family medicine education program.

Funded by a $510,000 grant from the Egyptian ministry of health and population, the program is designed to “train the trainers,” said Dr. Thomas Cesario, UCI medical school dean.

“I think this is the wave of the future,” he said. “If this succeeds, we will be changing how health care is delivered to an entire country.”

Since the doctors arrived here in February, the medical schools at UC San Francisco and USC have expressed interest in participating in the future, he said.

Until this program, family medicine has not been recognized as an important specialty in their country, the Egyptian doctors said.

Doctors in Egypt concentrate on treating the illness or injury, but they do not look for other health problems at the same time, the visiting doctors said. Nor do they work with patients to prevent medical problems.

For example, women do not receive Pap smears regularly, as they do in the United States, because the cervical cancer test is ordered only when the patient has a related medical complaint, they said.

Here, family medicine emphasizes preventive care, Bent said.

“In the long run, an ounce of prevention can save lots later by keeping people from developing more complicated health problems. . . . So [the doctors] are learning to be more proactive.”

Also, in Egypt there is no coordination or communication among a patient’s doctors when specialized care is needed, Bent said. “The patient simply goes from one specialist to another, drifting on his own. The family doctor is left out of the loop,” he said.

Dr. Rajab Manna of El Geza said his colleagues have “found that family medicine has the upper hand in the United States. We are anxious to make family medicine have the upper hand in Egypt and try to apply what we are learning here to medicine in Egypt.”

On Thursday, Bent escorted Manna into an examining room where Mary and Alan Foster, mother-and-son patients, waited. Their cases exemplified the prevention and health maintenance issues of family medicine, American style.

Alan Foster, 26, has Down’s syndrome and diabetes, which often causes skin problems. Bent and Manna discussed the antibiotic creams the patient uses and asked his mother about Alan’s skin care regimen. They also inquired about his blood sugar and insulin usage.

The Fosters have been Bent’s patients for 15 years. Good nutrition and preventive care have kept Alan Foster remarkably healthy, despite his chronic conditions, Bent told Manna.

“The reason why Alan isn’t an amputee or on dialysis [common diabetic complications] is because of Mary,” Bent said.

Then they turned their attention to Mary Foster, who was overdue for a visit to monitor her high blood pressure. A former nurse, she gave Bent her opinion of possible causes of her problem.

“Who is going to take care of Alan if you don’t take care of yourself?” Bent gently chastised her.

“You will!” she told him, laughing.

In addition to studies at the UCI clinic, each Egyptian doctor in the UCI program must pursue a research project upon returning home. One doctor plans to look into the possible correlation between the infestation of a particular parasitic worm and anemia, or iron deficiency. Many schoolchildren in rural Egypt seem to be afflicted with both conditions, he said.

Another said he will study the use of Depo-Provera, which is the primary form of birth control in Egypt, and resulting weight gain, to determine whether there are associated health problems.

“This is a thrill for me,” Bent said. “I never thought I’d be doing something global. I’ve just been practicing medicine by taking care of one patient at a time.”