On 14 November 2019, Wessam Alieddine, an intensive care physician with close to ten years of experience, had arrived to London from her hometown of Suez. She was moving from the Suez Canal University Hospital to the reputable St Mary’s Hospital in London.
Alieddine was joining the team of leading Egyptian-British ICU consultant Ahmed Haddad – a team of around 15 physicians, seven of which are of Egyptian origin, or freshly arrived Egyptian medical doctors.
“It was such a big and massive change from my hometown hospital — which is a university hospital and that does make it better equipped than the average public hospital — to St Mary’s of Imperial College, which impressed me on the very first day, being so much better equipped,” Alieddine said.
“And for a doctor at the ICU, an equipped unit could make a difference between a doctor’s chance to save a wounded patient or his inability to help this patient battle for his life,” she added.
Despite the strong support Haddad is known to offer his team, Alieddine’s introduction in the system was somehow challenging. This, she explained, was not about clinical experience, given that the responsibilities given to a newly arriving Egyptian medical doctor at one of the UK's National Health Service facilities (NHS) are usually below those of their years of experience in Egypt.
However, a few months down the road, with the huge challenge that the newly emerging Covid-19 pandemic posed to health systems all over the world, Alieddine dropped all the inhibitions of a newcomer and was fast integrated into the life-saving system, working around the clock to help patients overcome an aggressive new virus with no clear means of treatment.
“The coronavirus was really a very decisive moment. I was there at the heart of the ICU units of a key London hospital and patients were coming in fast, and really ill, and there was no time to hesitate or think twice,” Alieddine said.
According to Alieddine, it did not take long for her or for the other younger Egyptian physicians who had joined the team to impress with their clinical skills.
“We come from hospitals where intensive care physicians perform under much more challenging conditions – more patients, less equipment and even at times less medicine stocks and items. This meant that given better working conditions our performance would inevitably pick up even higher,” she said.
Moreover, Alieddine added, most Egyptian physicians, especially those of younger generations, are used to long working hours given the fact that every doctor has to do at least two to three shifts a day in no less than two hospitals to be able to make a semi-decent living. This was a big asset and the team members of Egyptian descent impressed with their ability to maintain their poise under pressure and during long working hours.
Some days were both hard and long. However, it would take Alieddine only a couple of scrolls down her social media groups with doctors back home to shift from the stress she was working under to the much bigger challenge that her colleagues back home were facing, despite the fact that the number of cases recorded in Egypt from March to June was considerably less than those in the UK.
Today, with the worst of the new coronavirus hopefully over, and with plans in many countries, including the UK, to expand and improve healthcare services, Alieddine is confident that many of the young Egyptian doctors and fresh graduates of schools of medicine in Egypt could easily compete for the many new openings that will follow.
“It is not a matter of skills or a matter of training, but a matter of easier or more challenging working conditions,” she argued.
Haddad, a lead neuro-critical care consultant at St Mary’s, who has been working non-stop in the NHS since 2013, is convinced that the “incredible inspiration that one gets in the formative years in Egypt leaves one with an invaluable ability to want to work and deliver”.
Having graduated in the early 2000s from the renowned school of medicine at Ain Shams University, Haddad’s early clinical experience was at Al-Demerdash Hospital – a place where thousands are treated every week.
It was at this school and this hospital that Haddad learned what it means to be a physician, especially in looking after patients who have limited financial means.
“When I joined the school of medicine in 1993 I just thought that it was an impressive thing to be a medical doctor and I was thinking that I wanted to be like the iconic Magdi Yaccoub. But throughout my university years and during subsequent five years at Al-Demerdash, from 2002 to 2007, I saw leading medical doctors going way out of their way to help patients make it – no matter the limitation of resources and no matter the volume of work,” he said.
It was in the early 1960s that Yaccoub, who had graduated from the school of medicine of Cairo University in 1958, went the UK to pursue his studies at Guy’s Hospital, where he later started his medical career in the UK, briefly interrupted with a few years in the US. After he retired as a professor of cardiothoracic surgery at Imperial College, Yaccoub came back to Egypt where he started his reputable heart hospital and foundation in Aswan.
Haddad is convinced that the reputation of “this generation of many extraordinary medical doctors who came from Egypt” has been an asset that many hard working physicians of later generations benefited from as they joined the UK's NHS.
However, unlike the doctors of today who might find it easier to join medical services in Western countries, including the UK, Haddad had to work hard on getting his chance at the UK. It took him four years in a Dubai hospital after his five years at Al-Demerdash to eventually land in London in the spring of 2011.
“It was not easy, especially that as I was graduating the UK was turning into a place that prioritised European Union doctors,” he recalled.
Haddad’s job offer that took him to St Mary’s Hospital a little under a decade ago seemed very promising for this inspired and ambitious intensivist. However, it was in a matter of weeks that he had to head to Canada for family reasons where he spent a little under two years before coming back to Egypt, also for family reasons.
When he landed at Cairo International Airport on 3 July 2013, Haddad was not sure about his next steps. He was then able to regain his “dream job”.
During the subsequent seven years, Haddad established himself as a prominent medical doctor in the NHS. And when the new coronavirus hit he joined the tireless efforts of doctors there to step up to the moment of a grave global health emergency.
Haddad would not wish to say that Egyptian NHS doctors necessarily stood out. What he would rather say is that those doctors did prove that they are no less capable than anyone else amid the tough challenge of an aggressive pandemic.
“I guess it has always been the case that the graduate of Egyptian schools of medicine could fit well in the UK medical service. What happened after the Covid-19 crisis is that the UK government decided to expand its medical services, and that this is happening at the time of Brexit means that the prioritising of EU doctors is over, and that chances are there now for keen and clever Egyptian doctors who wish to join under regulations that are being eased in view of the need to fill medical posts,” Haddad said.
The pursuit of an overseas career is something that many medical doctors would normally entertain in Egypt; not just because of the need to upgrade medical education, but also to pursue better rewards for hard years of study and very demanding work. Both Haddad and Alieddine agree.
According to Amr Dawoud, also an ICU consultant, who has been working in the UK NHS since the early 2000s, it is becoming increasingly the case that doctors want to work in countries like the UK in pursuit of more supporting working conditions. “Of course, it is perfectly legitimate for young doctors to want to have a decent living standard after long years of hard work, but there is also the factor that a doctor wants to be enabled to help his patients. This is especially the case if we are talking about doctors who work with critical conditions, or surgeons; both need highly equipped ICUs and ORs. The same applies to all other doctors, but I think in these particular cases the difference between the well-equipped and not so well-equipped hospital become very significant,” Dawoud said.
During the tough coronavirus influx at his hospital in Lancaster, Dawoud had some very challenging moments, including those where he needed to decide which patient had a better survival chance, to get him or her admitted into the ICU, over other patients who needed a miracle to get them back on their feet. However, during the toughest and thickest moments, Dawoud, a leading ICU consultant, knew that not at any moment would he be without basic essentials, nor would he face the sad destiny of over 160 medical doctors who died after having contracted Covid-19 while on duty.
Dawoud added that despite concerns sometimes raised over the quality of medical education in Egypt, with the increasing number of students and limited resources to improve the education system, the “incredible clinical skills that Egyptian doctors, even the younger ones, acquire through long hours of practice and large numbers of patients does put Egyptian doctors in a very good place, clinically speaking, especially if given a fair chance.”
Sometimes being denied a fair chance is a good enough for some young doctors to pursue their careers overseas. This, during the past two decades, has been the concern of some graduates of the school of medicine who complained that they were denied a fair chance to join the university staff because of questionable practices of nepotism.
Haytham Rabie, a pulmonologist who graduated in the late 1990s from Ain Shams University, had to go to court to rectify the unfairness done to him on a university staff assignment.
Despite this unfairness Rabie managed to pursue a successful career path both in the private sector medical service and later at the university hospital. And two years after getting his PhD, he decided to move to the UK.
With a father who had for long practiced at Austria, and degrees and experience that would have allowed him a chance in the US, Rabie still preferred the UK – perhaps for a certain compatibility that he and other doctors who are working there, or have worked there for a while, often talk about between the Egyptian and British systems.
The move was essentially prompted by family reasons, but also by awareness that his chances to have a stable life and significant medical career would probably be more in the UK rather than in Egypt.
As a leading pulmonologist at William Harvey Hospital, Rabei is in a privileged position to be well acquainted with the attempts of Oxford University to develop a vaccine against Covid-19.
“In Egypt, I worked with the best of pulmonologists, including Awad Tagueddine and Tarek Safwat, and I would have been in a good place had I stayed in Egypt. But here I am now working in the NHS and, being one of many good doctors who came to work in England, can either to stay for good or stay and then go back to Egypt after having had a worthwhile medical experience here,” he said.
For now, Rabei is anticipating a lot more doctors, especially pulmonologists, coming from Egypt to the UK, among other Western countries that are planning to expand their medical capacities.
“At the moment we think that around 12 to 14 per cent of patients who contracted Covid-19 could develop in the long run some lung problems, and as such the demand for pulmonologists would probably be one of the highest among specialisations,” he argued.
Psychiatry is another branch that is likely to gain more practitioners coming from Egypt. According to Mohamed AbdelGhani, a psychiatrist who has established himself in the NHS and started a successful private medical service in London, psychiatry is a place where cultural differences might be rather challenging for both patient and physician at the beginning, but not for long.
According to AbdelGhani, the UK has during the past decade seen a considerable successful presence of psychiatrists who studied and worked first in Egypt. And they have been doing well enough to encourage the NHS system to further integrate bright and smart young psychiatrists who wish to pursue their studies and careers, partially or fully, in the UK.
AbdelGhani himself is a good example of a success story. Upon his graduation in the early 2000s, AbdelGhani went off to the UK for a job that he got after he forwarded his application to 12 job openings. He started in Birmingham, then moved to Liverpool, before settling in London. In less than 15 years, as a consultant psychiatrist, AbdelGhani established the first NHS clinical TMS Service in London, in 2016.
AbdelGhani was successful enough that in 2017 he became the first British doctor to be elected as a director of the Clinical TMS Society and he was re-elected to this position in 2020.
AbdelGhani explained that TMS (Transcranial Magnetic Stimulation) is a treatment that can primarily help people who suffer from depression, especially those who did not respond to medication.
During the lockdown that came with the crisis of Covid-19, AbdelGhani noted, there has been a rise in the cases of depression, whether first time diagnosis, "perhaps as a result of the sense of lack of control, lack of certainty or lack of exercising entitlement, such as stepping out any time to buy something,” or those who had been treated and relapsed with “the decline of communication with their medical teams at a time where their treatment was not optimised.”
The restrictions imposed on socialising during the tough months of the coronavirus crisis, or the economic consequences and the psychological repercussions thereof, have been responsible for an increase of cases of anxiety and depression. “I guess we are up to see a post-coronavirus mental health pandemic,” he argued. This would perhaps mean more jobs for psychiatrits, “although it is still not clear how much of the funds that would go to expand the health service will be allocated to mental health trusts and psychiatric services,” he argued.
According to medical doctors who voluntarily administer the Facebook page ‘Doctor Nabatshi’ (Doctor on Duty), whatever the branch and whatever the destination, there will be a lot more medical doctors taking the opportunity of increasing demand for physicians in Western countries.
They argue that the NHS will inevitably be a prime attraction, because of the long established tradition of Egyptian doctors going to the UK and because of the respect that prominent medical doctors who made successful careers in the UK keep inspiring.
Today, the admins of Doctor Nabatshy say there are a little over 4,000 Egyptian doctors working in the NHS, and around 30 percent of those arrived there in the past four years in pursuit of better working conditions and better living standards.
Working conditions, they argue, include a wide range of things, starting from the availability of required medical equipment to the safety of medical teams. During the past five years, the Doctor’s Syndicate of Egypt has been repeatedly demanding the introduction of measures to protect medical teams who work under challenging conditions from the angry reactions of families devastated by the loss of loved ones.
According to the admins of Doctor Nabatshy, if a new physician has to spend over LE150,000 during his years at the school of medicine to get a little over LE2,000 monthly during his early years of practice, where he has to work at times over 18 hours, then it makes perfect sense for these doctors to wish to pursue their careers elsewhere.
Currently the number of graduates of the school of medicine in Egypt is around 9,000 a year. The estimate of Doctor Nabatshy is that around 40 per cent of those will seek jobs overseas – either in Western countries or Arab countries.
To stop the exodus of medical doctors, the admins of Doctor Nabatshy argue there needs to be a shift up in the working conditions and levels of salaries that doctors get.
“Every physician knows that they have a very noble job to do, but at the end of the day those doctors need money to continue their studies, to provide for themselves and their families, and to get treatment if they fall ill,” according to Doctor Nabatshy.