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edical Student Journal

edical Student Association isr University of Science & Technology

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Editor’s Note Perhaps the greatest experience of my life was inside the operating theatre of an ongoing, offpump coronary heart surgery being performed by Bassam Fareed Akasheh, a true pionnering master of cardiac surgery, in the Middle East and the world. Another noteable gentleman would have to be Dr.Marwan Akasheh, one of the top Hematologist Oncologists to ever grace the Jordanian armed forces, right now he is revolutinizing Cancer therapy in Jordan through his deep hyperthermia system. Last but not least, Dr. Fareed Akasheh who was the Jordanian Health Prime Minster during his earlier days, he was known to have been the most humanitarian govermental health offical to have ever taken this chair. However, I would have to say, this publication is dedicated to the most important man of all, my father, Ghassan Akasheh. By supporting me through medical school you have given me the ultimate gift of all, the pleasure of attempting to disect this beautiful universe from inside out. I can never thank you enough for what you have taught me about space and time and more importantly for letting me grow and take root in such a special family.

-Hani Ghassan Akasheh Editor in Cheif Head of MMSA Publication Team

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IFMSA – Egypt: IFMSA – Egypt is a non-political, non-religious and non-profit organization which is studentrun. It represents more than 90,000 Medical Students all over Egypt. IFMSA – Egypt is represented through 2,311 Medical Students in 18 Local Committees. The goal of the Federation is to serve society and medical students all over Egypt through its member organizations.

MMSA: MUST Medical Students’ Association (MMSA) is a non-profit organization run by volunteer medical students founded in April 2011. It is an associate member of the IFMSA-Egypt. MMSA is concerned with increasing the knowledge of medical students to help them become better physicians, to improve the quality of medical education. By extending medical education beyond classic lectures through extracurricular activities including conferences, workshops, courses, clinical trainings and through passing down experience from older medical students to younger ones.

“It is my pleasure as CEO of SKMHC to work with the finest doctors, nurses and medical students Egypt has to offer. It is inspiring to see the MUST Medical Student Association employ such initiative, creativity and dedication in speaking out and highlighting important issues in their medical journal. Everybody has to start somewhere to eventually get where they want to get. Healthcare is a highly complex and dynamic field and I am confident that the efforts these students are committing will serve as a catalyst for advancement and innovation in health care quality in our teaching hospital, Egypt and beyond.” Lance Beus -CEO of MSKMC

American Hospital Management Company (AHMC), is a Washington, D.C., U.S.A. based diversified international healthcare system whose focus is on the management, and development of world-class hospitals and healthcare systems. Founded in 1998, AHMC’s successful track record includes collaboration in nearly 40 hospitals, spanning 5 continents and in 24 countries around the world. The AHMC Network includes 28 hospital projects that are in various phases of development; among them 12 operational facilities totaling nearly 2,000 beds in which AHMC has invested or currently manages.

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Amer Jarrar Team Leader Former President of MMSA

Hani Akasheh Head of Publication Editor in Chief

Meet the Team

Fadi Zumot Research/Co-editor Trama Room Drama

Design and Copyright by: Zein Akasheh This Magazine is in collaboration with SMKH association, MMSA, IFSMA Images extracted that are left uncredited are Copyright to Google and Shutterstock.We do not claim ownership to any uncredited images.

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Fatma Khater Member of the Student Council Bionic Ear

Abdelrahman Taher Medical Education Officer/Co-editor Robotic Heart Surgery

Marina Nader Reproductive Health Officer Vision 2020

Khaled Jabaiti Vice President of Internal Affairs Dark History of Beauty

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MMSA President A few years ago, my dream was to get into medical school, become a doctor, and ultimately help people. I am now, almost graduating, almost a doctor but I never felt like I was helping or healing my society. As I grew up in this school, I was thinking to myself, that this couldn’t be it, the seven year journey couldn’t only be about textbooks and lectures. I knew there was something special missing from my medical experience. It was the Winter of 2011 when I stumbled upon the Must Medical Student Association on their first breast cancer awareness campaign. I immediately signed up as a member as I felt that this was going to be an opportunity to give back. All the events, the campaigns, the lectures and now this publication! I watched myself grow and mature in a two year period from a member to president, and along that special road, I found out what was missing. Choosing medical school isn’t exactly like choosing a career, it is rather like choosing a lifestyle, MMSA made me see that, and it helped me to live life through medicine. My role model, fiancé and best friend showed me how to benefit from being in MMSA, in being a better person and therefore a better doctor.Since that day, I have been taught by our former President -Amer R. Jarrar- how work should be done with passion.

“Living Life Through Medicine”

W

elcome

-Bassant Adel President

Bassant Adel

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Introducing the Iknife Intelligent Technology

Great minds always referred to technology as an approach for humans to extend their senses and their consciousness. Think of technology -whether being your car, your watch or even your iPhone- as being your exoskeleton. An extension of you, allowing you to reach new dimensions in space and time, to do tasks beyond the limited nature of your biology. When you think about it, perhaps we may have taken this force for granted. As a doctor watching technology conquer and integrate into the world of medicine so rapidly on a large scale, I can’t help but feel a great deal of appreciation to what we have achieved as humanity altogether. The accumulation and aggregation of knowledge and so many failed experiments got us where we are now. This article is about one of the most innovative and bizarre new technologies in the world of surgical oncology today; a new breed of equipment that is revolutionizing the way cancer surgeons can extract tumours from living healthy tissue. In 1920 the discovery of electrosurgical blades -which substituted the simple blade or scalpel- transformed the way surgeons presently dissect and get through tissue. Electrocautery is a technique that uses an electric current to rapidly heat soft tissue so that surgeons can cut through it with minimal loss of blood. It’s used in all types of surgeries these days and it has majorly displaced the old cutting methods with blades and scalpels.

A team led by the surgical innovator Dr. Zoltan Takats from Imperial College London, knew that smoke that comes out of the electrical burning process, is always sucked away from the operating theatre because of its toxic nature. The real intelligence in his invention, is the realization that smoke rising out of burning cancer cells is different, in terms of chemical composition, from the smoke that comes out of healthy tissue. The I-knife is a new surgical blade that has been developed by the Imperial College London and funded by the National Institute for Health Research. Now the team at Imperial have developed a modified and intelligent electrocautery blade. The Iknife sends the smoke into a mass spectrometer, which gives a rapid readout of the chemical composition of the smoke. A super hi-tech digital nose, if you may, that is attached to the knife and lies directly above it. When a surgeon is removing a tumor, it is not always possible to tell by sight which areas of the tissue are cancerous and which parts are healthy. Due to that reason, sometimes excess tissue is taken out, or the cancer is not completely excised. The spectrometer analyses the

chemical signature in the smoke coming from the hot blade burning through soft tissue, as well as automatically updating the surgeon -within one second or even less- whether his blade is cutting through cancer cells or healthy cells. Delivering such bimolecular diagnostic techniques to the operating theatre for the benefit of the surgeon and the patient is one of the major innovations to improve surgical decision-making live in real time during surgery. Dr. Zoltan Takats who invented the system at Imperial said “the new technology has been tested on ninety one patients and showed that the knife was fully capable of accurately providing the surgeon with information as to what kind of tissue it was cutting and as a result if it was cancerous”. He also went on by saying that “its ability in providing a result almost instantly within parts of a second, which ultimately guides the surgeon on a very specific course of dissection, thus affecting the rate of survival of the patient. As this technology, clearly decreases the chances of cancer relapse by making sure no bits and pieces of the tumor, are still laying inside after surgery”. 13


The Dark History of Beauty

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lastic Surgery... The first thing to pop in your mind dear reader is either the image of botched facelifts or breast enhancement surgery. The patient you imagined is probably, an aging women in desperate need to find beauty under the blade. Perhaps its the image the media has constructed for us, all the rich and famous customers scavenging for beauty at all cost. The real picture behind plastic surgery, is one with ancient origins. Ironically, it was presumed that the only physical feature you take with you to the afterlife was your face. King Ramses II had a characteristically large elongated nose, funnily enough this was a sign of grace and beauty back then. Consequently to make sure he was recognized, he had bones inserted into his nose, after his death as well as a wooden stick, to support his long upright neck. A number of historians refer to that, as the earliest form of plastic surgery. He lived as a king and he surely wanted to die as one. Truth be told our concern with outer beauty is probably as ancient as we are. We as organisms tend to recognize beauty from facial asymmetry and other physical characteristics. Even if you choose to deny it, your brain will ultimately reveal the truth. The brain actually evolved to have a very specific area for facial recognition, thus it’s safe to say that we initially judge people by their looks. Unfortunately we are all victims to the relationship between our eyes and our brains. This was proven through a study aimed at

finding the real response, we have to other faces and how our minds interpret them. A series of photos were displayed on a small screen, to a person inside a high resolution CT scan machine bed, a group of specialists monitored the level of electrical activity inside the brain in respect to different areas of the brain. The experiment started by flashing images, of average, to good looking, healthy and cheerful faces of random people. As the person’s brain adjusted to these images, and the experiment went on, a sudden twist in the nature of the images occurred. A metamorphosis from the healthy and symmetrical faces to a series of disturbed and damaged faces. Even though the person tried to feel empathy to these distorted faces displayed, the brain imaging study showed the truth in the matter. The amygdala, is a primitive and evolutionary area of our brain, that is involved in the instincts of fear and disgust. The study revealed that the activity in the amygdala was almost 15 -25 times more electrically stimulated, when the disturbing and traumatized faces appeared in comparison to the normal faces. This simple, yet conclusive experiment shows you the truth and the magnitude of negative response, the human brain has to a disproportionate and damaged face. Once you get a real sense of this natural reaction people have, I imagine it becomes easier to comprehend why people with damaged faces, will eventually seek the help plastic surgery has to offer.

600 B.C - Location: India. This is where everything truly started. An ancient tale of a beautiful woman who committed an unspeakable act of adultery is often told. The punishment for this was extremely severe; her very nose was cut off, thus losing her beauty and her grace. Permenantly disfiguring the center of her face seemed like a fitting punishment. It would certainly discourage her from ever doing it again. Sushruta, an Indian doctor, in an attempt to encourage forgiveness and reduce public shame, came up with a technique that could actually rebuild the nose. By making an incision in the forehead and dragging the skin flap downwards to the nose, while the skin flap still attached to its original site at the forehead, thus allowing the new skin to receive continuous blood supply in its new place. This was the first known technique used to grant someone their nose back. You can probably visualize how the skin was grafted as a pedicle from the forehead to the nasal area. The Indian textbooks refer to it as the ‘pedicle flap’, more or less like an island of tissue, that is left to hang detached from the body.

by what is called a stalk. The stalk is what feeds this island of cells that are about to be transported, it keeps them viable and alive even though they are seperatedfrom their original place. It’s hard to imagine how they thought of the idea and how painful it must been to operate without anaesthesia on a screaming patient. Before I continue my story about the history of plastic surgery and the birth of a new procedure that enabled surgeons to manipulate tissue on a brand new level. I think an article about history wouldn’t really be an article about history, if I failed to mention the real ancient origins of surgery in a civilization that lived before us by 5000 years. I was truely astonished by the great deal of information the ancient Egyptians had acquired about the human sciences. Their almost conclusive surgical techniques, that really set the stage for the birth of modern surgery. I feel I could go on and on writing about the ancient Pharaoh, but honestly I’m probably not the most suited person to do so. For that reason I asked a very special person to write a few words about the rich history of medicine in Egypt. Professor and

Doctor Fawzy Gaballah, -the Dean of Medicine at Misr University for Science and Technology-, one of leading figures in human anatomy and historical medical anthropology as well as his role of being a specialist in human evolution. Quite honestly he is also one of my favourite professors as I was a student in his anatomy course and now in his history of medicine course. The always smiling and always helpful Dr.Fawzy, with his brief take on the rich and ancient history of medicine in Egypt.

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As many of you know, the first medical records available to this day came from the ancient Egyptian civilization. Imhotep (who was an architect, engineer, as well as a high priest of the sun god Ra) was considered, to be the first figure of a physician known to date. Due to his medical skills and knowledge, he was identified as “the great God of Medicine”. The Egyptian medical papyrus stands as evidence of our knowledge of medicine in ancient Egypt, the most notable being the Edwin Smith Papyrus and Ebers Papyrus, the later is concerned with medical science rather than surgical. Both papyruses are written in heriatric language and dated back to 1550 B.C (debated to be 3000 B.C.). The oldest surgical tools in the world were discovered in Egypt, our ancestors used knives, hooks, drills, forceps, scales and saws. The extensive mummification done by the Pharaohs as a religious exercise gave them a vast knowledge of the body’s morphology, and even a considerable understanding of organ function. The basic physiology of most major organs was correctly presumed, for example, blood was correctly guessed to be a transpiration medium for vitality and waste which is not too far from its actual role in carrying oxygen and removing carbon dioxide, but it seems that the heart and brain functions, were indeed still a mystery to them. It is worth mentioning that in ancient Egypt there were branches in medicine, where doctors specialized in orthopaedics, ophthalmology and gynaecology.

-Dr Fawzy Gaballah

Former Dean of Medicine at MUST Faculty of Medicine

“The Egyptians were skilled in medicine more than any other art.” - Greek historian Herodotus

Edwin Smith Papyrus is an ancient textbook, on surgery and detailed anatomical observations in the “examination, diagnosis, treatment, and prognosis” of numerous ailments. Written in black heriatric ink, the cursive form of hieroglyphs , with inbetween explanatory glosses in red ink. The vast majority of the papyrus is concerned with trauma and surgery, with a short sections on gynecology and cosmetics on the verso. On the recto side, there are 48 cases of injury. Each case encapsulates, the type of the injury, examination of the patient, diagnosis and prognosis and treatment. It is estimated to be written around 1600 BC, but is regarded as a copy of several earlier texts, that date from as early as 3000 BC. Imhotep in the third dynasty is credited as the original author of the papyrus text, as well as the god of medicine in ancient Egypt.

P lastic Surgery is an ancient art. 17


The ancient Indian tale told us, that 2,600 years ago the concept of skin grafting was practiced by the surgeon Sushruta samhita. Skin grafting procedure is performed on an area of skin which requires reattachment to another area. The transported piece of tissue is the skin flap and its remains nourished with blood, through what is called a stalk. This ensures viable circulation to avoid tissue hypoxia, in the new home designed for the transplanted skin. As wonderful as it seems, reconstructive surgery and the idea of grafting, was still an immature concept and it would not be mastered until many years To imagine what a person had to go through, touch the back of your head with the palm of your hand, while having your nose touch your arm. Now imagine being fixed in that position constantly and without moving for two to three weeks.

Mummified head of Pharaoh Ramses II, with artificially enhanced nose.

Indian surgeon Sushruta performing the first nasal reconstructive surgery.

This is when Italian pioneer surgeon, Gasparo Tagliacozzi, attempted to make his mark in history. It was a time of renaissance in Bologna Italy, not only there was an outbreak in art and science, but also disease. A hideous Syphilis outbreak, infected patients were considered to be moral degenerates, out casting them as social pariahs due to the disfiguring bacterial infection, clearly labeling the sufferers, as syphilis usually caused the nose to alter its shape in a horrific and distorted way.

Doctor Tagliacozzi at the University of Bologna was experimenting with all types of plastic cosmetic surgery, but he had a certain interest when it came to reconstruction of the nose. He devised and practiced a new method to rebuild the nose, without scarring the rest of the face and forehead, like in the case of the old Indian way (that left the forehead with an obvious and repulsive scar). He finally did it, this time there was no need to scar the forehead for the tissue transplantation, this time the graft would be taken from the arm! Like in the case of the old Indian method, the graft would remain attached to its original site, which is the arm, until the new nasal tissue was viable to be cut off. To imagine what a person had to do, touch the back of your head with the palm of your hand, while having your nose touch your arm. Now imagine being fixed in that position constantly and without moving for three to four weeks. That was the price people were willing to pay to have their faces back. Wouldn’t anyone? It’s in our nature to love beauty, and what defines beauty more than our faces? Plastic surgeons up to this point in history were seen as “beauty surgeons” not as real ones, but all this was about to change. Plastic surgeons would be seen as heroes, and the one place all heroes are born is in the battlefields of war.

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World War I changed the way reconstructive surgery was seen. It delivered slaughter on an epic level. In the United Kingdom one million soldiers died and more than two million came back home injured. Soldiers on the frontline would often suffer brutal and horrific injuries to their faces, from bullets or burn injuries, due to the merciless advances in weaponry during that period of time. Explosive trenches left soldiers wounded in the most horrific of ways. It was up to the “beauty” surgeons, to give the men who fought for their country, a chance to fight for their life.

hospital with a thousand beds? Early in his career he knew nothing about plastic surgery and when he was just a junior red cross officer, he was horrified by the type of injuries on the faces of the soldiers. His past experience from France and the on-going ugly war, gave him the opportunity to become the greatest plastic surgeon in the history of surgery. He gave back the happiness, the quality, and even the comfort of life to the damaged and torn survivors of war. Sir Harold Gillies went down in history as the father of plastic surgery; he was truly an angel of war. Plastic surgery continued and continues to evolve; we now have microsurgery, where there is no longer the need for a pedicle. A skin graft may now be taken from an area, and reattached by microscopes in a totally different area. Plastic surgery is a different kind of medicine, instead of fixing broken bones, surgeons mend broken souls. Instead of giving medicine, they give hope. Instead of only working on a person’s physiology, they also work on the psychology. That is indeed a noble goal; plastic surgeons literally draw on a smile, on the outside as well as on the inside.

Surgeon Harold Gillies who performed the renowned surgeries on the opposite page

Surgeon Harold Gillies was in his thirties, when war broke out. He originally worked as medical assistant to a French-American dentist, who was attempting to develop jaw repair work. Dr.Gillies, eager after seeing his senior experimenting with skin grafting techniques, he then decided to leave for Paris, to meet the renowned surgeon Hippolyte Morestin. He saw him remove a tumor on a patient’s face, and cover it with jaw skin taken from the patient himself. Gillies became extremely enthusiastic about this kind of work and on his return to England, he persuaded the army’s chief surgeon, that a facial injury ward should be established at the Cambridge Military Hospital where he originally graduated. Little did he know that this small facial injury unit would turn into his own purpose built 21


Dr Amr Bastawisy

Robotic Heart Surgery “...Dr. Bastawisy is one of the leading heart surgeons and the early pioneers of robotic heart surgery in Cairo...”

When you first hear about “Robotic Heart Surgery” it may sound like some kind of futuristic advanced surgical technology, but in reality robotic heart surgery has been around for quite some time. Our very own Dr. Prof. Amr Bastawisy, who is the chief of cardiothoracic surgery at Misr University for Science and Technology (MUST) and the Memorial Souad Kafafi Medical Hospital Center (MSKMHC), was one of the pioneers in utilizing robotic heart surgery. Personally having attended Dr. Bastawisy’s classes and surgeries was indeed a huge learning experience. His lectures were very educational and his teaching methods kept me focused and interested at all times. With various surgical videos to aid and explain procedures and his own stories from his medical career as a surgeon. I was always left satisfied but somehow even more curious after each lecture, waiting for that next video or that next surgical case to understand more about the science of heart

surgery. After reading about what Dr. Bastawisy had achieved with robotic heart surgery in the (MSKMHC) monthly newsletter, I was encouraged and compelled to write this article, with the support and help of our professor. Robotic heart surgery is a type of minimally invasive cardiac surgery “Minimally invasive” means, that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter inch incisions or ports. Robotic surgery can be divided into 3 subcategories depending on the degree of surgeon interaction during the procedure: In a supervisory-controlled system, the procedure is executed solely by the robot, which will act according to the computer program that the surgeon inputs into it prior to the procedure. The surgeon is still indispensable in planning the procedure and overseeing the operation, but does not take part directly. The shared-control system has the most surgeon in-

volvement; the surgeon carries out the procedure with the use of a robot that offers steady-hand manipulations of the instrument. This enables both entities to jointly perform the tasks together. Finally, the third type is the telesurgical system, also known as remote surgery requires the surgeon to manipulate the robotic arms during the procedure, rather than allowing the robotic arms to work from a predetermined program. Using real-time image feedback, the surgeon is able to operate from a remote location using sensory data from the robot. The robot is still technically performing the procedure; thus it is considered a subgroup of robotic surgery.

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The da Vinci® Surgical System, the current leading device in this field and the world’s most advanced surgical robot, belongs to this section of robotic surgery. The original telesurgical robotic system that the da Vinci® Surgical System was based on, were developed at SRI International in Menlo Park with grant support from DARPA and NASA. Although the robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The minimally invasive robotic heart surgery provides surgeons and patients, with what may be the most effective and least invasive treatment alternative, for even the most complex cardiothoracic procedures. The reason that this robotic approach is so attractive to our heart surgeons and patients is that, these surgeries do not require an opening of the chest with a large incision. Traditionally, open heart surgeons have reached the heart through a sternotomy, a full incision of the breastbone that averages 9-10 inches in length while this robotic approach offers complete access to the heart, through quarter inch port holes that give the robot the window to insert its

Furthermore, robotic heart surgery has the potential to expand surgical treatment modalities beyond the limits of human ability. Whether or not the benefit of its usage overcomes the time and cost to implement it remains to be seen and much remains to be worked out. Although feasibility has largely been shown, more prospective randomized trials evaluating efficacy and safety must be undertaken. Further research must evaluate cost effectiveness or a true benefit over conventional therapy for robotic surgery to take full root. With the huge transitional changes, that we have all witnessed at our university hospital, including the development of a new state of the art cardiothoracic surgical unit. It makes me wonder about the bright future of our new cardiothoracic department and knowing that our chief is one of the pioneers of robotic surgery. His hunger and ambitiousness combined, may be the keys for opening the door for robotic surgical technology to arrive and proceed in our hospital.

arm. Heart surgery usually extends the post-operative recovery period since the patient’s sternum must heal along with large scar. However, in robotic heart surgery, surgeons reach the heart through smaller incisions that provide access to only the section of the heart being operated upon. Thanks to robotic arms, the surgery is done with precision, smaller incisions, less scarring, minimal blood loss, no splitting of the sternum or rib and less postoperative pain. All this by avoiding the trauma of sternotomy, keeping the sternum intact reduces the chance for post-surgical complications and infection. Instead of a long chest scar, only a few tiny scars remain.

Due to these techniques there is a reduced duration of hospital stay and faster return to normal activities with shorter recovery time. All these advantages are not only better for the patient, but also for the healthcare team as they reduce the number of staff needed during heart surgery, nursing required after surgery, therefore the overall cost of hospital stays.

“...the most effective and least invasive treatment alternative, for even the most complex cardiothoracic procedures...”

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Breaking News in the World of Heart Surgery December 18 2013: French Patient Is The First To Receive World’s Most Advanced Artificial Heart. The new innovative artificial heart - powered by watch-style batteries that can be worn externally, was put into a patient at Pompidou Hospital in Paris. It includes sections of cow tissue and weighs three times heavier than a human heart, it can beat for up to five years and is designed for patients suffering from end-stage heart failure. This brilliant piece of engineering, will be literally saving humans across the globe, it could help thousands of people who die each year while waiting for a donor. The company claims its device should enable hospitalized cardiac patients to return home and possibly even resume work. Alain Carpentier, the surgeon who performed the implant, said: “It’s about giving patients a normal social life with the least dependence on medication as possible.

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Vision 2020

MISSION: To eliminate the main causes of avoidable blindness by the year 2020 by facilitating the planning, development and implementation of sustainable national eye care programs. This campaign surveys the major causes of preventable eye diseases in Egypt as well as providing free treatment for patients with reversible blindness conditions.

As the bus drove through the narrow and dirty road we reached to our destination, a poverty stricken village in Cairo. A sense of fear and anxiety started to build up silently inside me, everything around me seemed so chaotic and out of place. The bus kept driving further and further, deeper into the alley ways of this exile rural village. I realized the looks the local people have been giving us, I remember my colleagues feeling as if they were aliens from another planet. As we came to a stop beside what looked like an old medical building complex. I stepped outside the bus, the people gathered around us in surprize. At first it was concerning but I tried to remain calm by reminding myself that the locals here are not used to buses this size full of medical student. When our senior doctors saw our anxiety of being somewhere so different from the city, they immediately did a good job of reminding us of our mission and why we have been sent here as medical students representing Misr University of Science and Technology and its Medical Student Association. The younger kids started circling and enclosing on us, laughing at first and staring in wonder with their eyes full of innocence. That look in their eyes was more than enough to quickly wash away all my fears. Vision 2020 is a global initiative for the elimination of avoidable blindness; a joint program of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) along with the help of several other NGOs (including IFMSA-Egypt), professional associations, eye care institutions and corporations. There have been very few surveys of blindness in Egypt. The largest survey, consisting of 11,000 rural and urban residents of the Nile Delta, were carried out starting in 1965 near Alexandria. Blindness in Egypt (presenting vision <6/60) was detected in 2.1% of men and 3.2% of women (all age groups). For both sexes, the rural prevalence were about three times higher than the urban prevalence.

Health ministry officials claim eyes disease and blindness as one of the major problems in Egypt. Research done on the steep rise of eye blindness reported that the lack of proper sanitary conditions and a vicious socioeconomic state of the country as the root of all evil. The same research also concluded by saying that just by simple education and eye hygiene protocol, people of suburban rural areas in Egypt can start understanding the preventive measures needed to slow down the rates of blindness and eye infections. With instructions specifically given to us from senior eye consultants on our team, we divided and stationed ourselves, eager to start our special day of helping these poor strangers. People of all ages, came rushing in through the doors eager to have their eyes checked as they all fought their way to our clinic set up in the building. It made me realize the gravity and size of the poverty in this area of Cairo. The fact that really blew me away and left me astounded is that many of these elders and even youth came

to us without any clue of how old they were when asked about their age in the patient history sheet. This issue reflected the extent of chaos these poor Egyptians suffer from. Many of these people are known to have come out of the slums, under bridges and farms without any proof, documentation or birth papers. Nonetheless, Egyptians are known for their kind hearts and sense of humor, I recall this sweet old lady who was also born in a farm, she appeared to be in her late fifties, but when i asked about her age, she laughed and joked about being twenty-two. We spent the next five hours rotating in five different stations. There was a station for the history and information gathering. Another station tested the peoples visual acuity using a Snell chart. A third station used to test the dilatation of the pupils to detect if there were any eye problems like cataract, glaucoma and so on. The fourth station gave important information for methods of prevention to most eye diseases. As for the last and fifth station, it took other

systemic complaints related to their eyes and automatically referred to the doctors if needed. One of the greatest things offered by these doctors is their granting of free treatment and check-ups to those suffering from serious health problems affecting their quality of life. Another detail that I noticed throughout the day is how thankful and how simple these people were. As they are isolated from the city and trapped in their own misery, it was easy to sense their sincere appreciation to who we are and why we do what we do. That feeling essentially drove us to work and we were determined to provide them with the best we could. None of us were bored or even tired that day, we all put our hearts and minds to giving it our all, through this wonderful opportunity we had been granted. As our mission was coming to an end, I was heading back to my seat on the bus ride back home, I couldnâ&#x20AC;&#x2122;t really determine who was more grateful, us or them? They touched our hearts and taught us a lesson we could never forget. That day not only opened my heart, but opened my eyes to the future. Aside from the great amount of medical information that we gained in only a couple of hours, I personally understood the true meaning of medicine. I realized that it wasnâ&#x20AC;&#x2122;t only about diagnosing diseases and prescribing drugs, but is about dealing with human souls and how they look up to us as healers. I finally comprehended and recognized why I studied medicine and why God chose me to travel down this noble path.

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Q&A The

Dr Hussam Ahmed Mowafi The Internal Medicine Giant

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lease doctor if you may start by stating your name to the readers who are unfamiliar with you and who your biggest inspiration is?

Hussam Mowfai Ahmed Mowafi, born in Giza on the first of January 1945. I went to Omran school as a child, I am now married to a professor in medical college and she has blessed me with three children, who I watched grow up to be doctors just like their parents. I remember my childhood hero and inspiration definitely has to be my beloved father may his soul rest in peace. He passed away when I graduated from the School of Medicine in 1968. Tell us about your journey in the medical world. How it started and where it took you? I graduated from Kasr il Aini medical college in 1968 then reached my way to assistant teacher after few years of experience as a resident. Actually during my residency, I was always pursuing my studies in cardiology. After many hard years with god’s help and my families support I was appointed with a title of Professor of Internal Medicine

On your return, as an experienced Internal Medicine Doctor fresh from Harvard, how did Cairo welcome you?

in 1987. After that I traveled to Boston U.S.A, where I was privileged to find Harvard University as a home for my extended study and research. During my time of stay, I remember being interested in a new department I never heard or seen in my life. The critical care unit, caught my attention and captivated me, because of its emotional nature and the great rewarding feeling a doctor experiences. After saving someone from a clinical near death situation. I only hoped that I can bring back what I have seen in the United States to my beloved home and people in Egypt. It became my calling to establish a home for critical care science in my country.

Like they say, you can do anything you set your mind to. After lots of hard work dedicated to my vision of bringing critical care medicine to Egypt the ministerial decision number 982 during the year 1991 finally granted the permission for the development of a new critical care unit during which I became the Professor and Head of the Critical Care Department in Cairo University Hospital on the 27th of October 1992 until this present day. What other positions have you held during your career as a Doctor in Cairo ? I am a current active member in other associations like the American Critical Care Society, American Renal and Heart Association and the Egyptian Cardiac Association, Egyptian Cardiac and Renal Society as well as the head professor in critical care in Egypt. I also had some managerial positions as the past dean of medicine at MUST, Manger of Cairo Hospital and the head of Medicine at the police and army hospital.

How did you come to write so many papers and how many papers do you have in your name? I don’t think quantity matters, as I recall my research papers and articles where special in terms of the quality of science I tried to expose. Admittedly, I have published a total of 132 research papers 100 of them lean towards critical care science and the remaining 32 were dedicated to internal medicine. One of the things I really appreciated, about the research I did inside the university as opposed to the ones outside. The research inside the college, involved young master level doctors and their help and creativity always helped me, the team leader, to also learn from them and add to my study. Many aim to reach the level of professionalism you attain, Do you feel being a member and a part of so many associations and societies has been part of your success? Yes, ofcourse it is the only way a group of scientists can excel and push beyond the boundaries of modern medicine.The purpose is for us to all work together, to inflate the library of human knowledge. Doctor you always dedicated a day from your weekend to come and give us free lectures of our choice, why? My daughter, we are the sole carriers of what we know and we can’t carry this information to the grave. When you treat a patient you help one person, but when you teach a student you are treating more than a thousand patients. If you also think about it you wouldn’t have asked to in-

terview me if it wasn’t for those free lectures, it’s because you respect this person whom you take knowledge from,without any financial return, thus the real incentive behind teaching appears. I think private courses and private classes that doctors do for money, destroys the personality of the doctor before the personality of the students. I lived my whole life and my ambition at any moment was never financial, because a good reputation and a golden legacy in the eyes of my family, friends and paWhen was the first time you cried over a patient? One day a patient came to me complaining from chest pain and shortness of breath. The patient looked really angry and irritated, I asked him about the reason for his obvious discomfort; he pointed towards his son who was accompanying him to my clinic. The father pointed at his son and said “he is the reason why I’m angry.” The man murmered obscenities towards his son as he opened up to me and spoke of their conundrum. It seemed that his son acted impulsively and did not consider his family before making decisions. The father was hurt from his son for insisting and fighting for the wrong girl to be his wife. As the man was giving away the reasoning behind his anger, his son lashed out at him with an explosive manner of speech insisting that he should keep his mouth shut because his wife is all that matters to him now. With the height of the moment his son insulted his father with a single hurtful word, within the next second the father fell on the floor with his hand on his chest! All my attempts to resuscitate his heart failed, the dad died in my clinic from a heart attack. As I went

back home that night, the image of the father’s pale face haunted me in my bed. He couldn’t bare to handle the insult from his son that he loved unconditionally. That was the real reason I cried, because as a father the only person you wish to be better than you is your own son, but sadly enough his son never understood that and never will. Thank you dear Doctor, myself and the readers really appreciate you giving us your time for this interview.

- by Razan AlBakry

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Trauma Room Drama I remember pretty well how excited I was that summer, I spent attending and volunteering at the emergency room, in the trauma unit at a local hospital beside my home back in Amman Jordan. I spent the month with my two dearest friends Mohamed Omar and Hani Akasheh, as we attended the night shift every other day. I would grab my most comfortable scrubs and sneakers and head to the night shift, known as shift C, which started at 9 pm and ended at 7 am. Throughout these hours, we roamed and rotated in all the emergency departments the surgical ward, the internal medicine ward and the most dramatic the Cardio Pulmonary Resuscitation room. It was truly one of the most memorable experiences of my life and from that I thought to myself, if I was able to write about one of those nights or about one of those patients. Then maybe I could give you a sense of what it really feels like to be a doctor and how it feels to affect peopleâ&#x20AC;&#x2122;s lives in such a positive manner. Even as a volunteer or a medical trainee I truly got to experience firsthand the real power and beauty behind being a doctor. My name is Fadi Zumot and I finally made it through medical school, after all the years of confusion and hiding behind a wall of insecurities and lack of self belief. When I had the least confidence in myself as a medical student, I guess I was lucky to have met those two friends at such a time in my life.

Dr Mohammad Omar & Dr Fadi Zumot Students at Misr University for Science and Technology

Friends who helped me focus on the bigger picture when I was living far from my family, they showed me the way to be calm and collected in an emergency setting or even when am alone. They made sure I realized that I was destined to do this exact job, and that the path I chose as a doctor, was a self-sacrificing and a noble one indeed. Therefore, It was definitely worth all the hard work, dedication and years and years of study. From the various cases we assessed and assisted with during our time at the emergency unit, I chose to share this particular story because, it was one of the most emotionally charged cases of CPR we experienced. Normally, people discuss their accomplishments and their triumphs, when they want to mention their life experiences but I would rather do the opposite in my article. I would like to share our mistakes and missteps because what I discovered is that people tend to learn more from disappointment rather than-

from achievement. I now realize that we made a mistake while dealing with our patient that night and we truly have learnt from it the hard way. I must say this story is not for the faint hearted. Normally ambulance drivers alert the E.R, as they approach the hospital by a special siren sound, that allows the trauma ward doctors to distinguish the arrival of a critical patient, that needs resuscitation from a normal emergency situation with a conscious patient. That dreadful sound is the initial warning, we as doctors get, to leave everything in our hands and rush outside to help in the resuscitation of the patient. Our arrested patient that night was Abeer; she was a 38 year old Jordanian working mother. The ambulance signaled the emergency siren as it was rushing through the northern districts of the city in attempts to save Abeer, who just minutes ago, collapsed at home and showed no heartbeat or spontaneous breathing. Upon arrival we rushed her to the CPR unit and signaled the 33


blue code alarm, which meant the patient had no pulse and was in need of immediate cardiovascular intervention. As we started the advanced life support protocols with the team, my colleagues were trying to gather all the information about the patient’s history, why she had collapsed? Why her heart stopped suddenly? Our leading internal medicine specialist, Dr. Shroof noticed that she had a huge collection of fluid in her abdominal cavity known as ascites. Ascites are accumulation of bodily fluids in the peritoneal cavity. Some of the many causes are cirrhosis, heart failure, constrictive pericarditis, nephrotic syndrome, hypothyroidism, liver cancer, pancreatitis, bacterial infection of the peritoneum and hepatic failure. It was the Holy month of Ramadan and during ‘Iftar’the time of the day when all fasting people gather around to eat their first meal of the day. Apparently people tend to over eat, during such a meal, as was the case with Abeer. Her originally existing abdominal fluid was further compressed and distended by her then extremely full stomach. However that was not the main trigger, after that meal Abeer did what all religious people do and she went on to pray. The sudden cause of her heart arrest was the overload of fluid falling back on her heart as she crouched down in the praying position. The mass of water collapsing on her pericardium forced her heart to give out as she remained collapsed in the same position. In the cardio pulmonary resuscitation room, doctors automatically started the life support measures and protocols and as adrenaline was being forcefully pumped into her system, in an attempt to re-

start and restore her pulse. The doctors slowly started realizing the gravity of the situation as the cries of the family echoed louder and louder from the waiting area. Dr Shroof luckily realized that Abeer’s heart monitor was showing irregular waves of ventricular fibrillation, which is known to be a sign and a window of opportunity to restore the normal heart beat by D.C shock. The first attempt to synchronize the heart failed, Dr Shroof immediately asked to up the doze of the adrenaline before the second and final attempt of D.C shock . At this point Abeer has been asystolic for over four minutes, which means her life hangs in the balance, as we now enter the stage of brain cell ischemia. Her brain was hungry for blood but her compressed and weak heart wouldn’t bother to beat. What happened next was to some extent unbelievable, I still recall

this moment as one of the most astonishing feeling of awe to beset me. It was the first time, I witnessed a patient come back from the underground as the second DC shock delivered to the chest brought Abeer back to life and her heart started beating again. After experiencing this emotional rollercoaster, a profound sense of appreciation and respect arose towards Dr.Shroof, who just saved a mother for the sake of her children. I was walking out with Hani and Omar, leaving the rest of the team to continue with intensive care preparations, I recall walking through the hall as I was still struck with awe and joy, I had the most genuine and pure smile on my face as it was my first time to witness such a turn of events. While leaving the emergency room, to my surprise, her family members were standing right outside the door. They quickly surrounded us with

faces full of sorrow and fear, in attempts to understand if their family member is alive and well. I felt like they wanted to understand why we showed so much joy in our eyes? How could we possibly, be smiling and looking so content, at such a time of tragedy? As the anxious family approached me and my friends and bombarded us with questions, I personally couldn’t help but tell them what we have just witnessed inside, I acted on impulse and told the family that Abeer was fine and that her heart was restored to normal. We left the family with tears of overwhelming joy, we left them stunned in the ecstasy of knowing someone you love is alive after such a close encounter with death. We walked outside to the car park to get some fresh air after that emotionally draining experience. Dear reader, at this point, I still didn’t know about the huge and

and disastrous mistake I have just done. On our return to the emergency corridor, we saw what we least expected to. Abeer was covered in a plastic bag and was on her way to the basement floor, down at the fridge department. During our time of absence she had lost her pulse again and at that point the doctors knew there was nothing more to do. Only then did it weigh down on me, what I have told the family! I shouldn’t have said what I said and I should have known that the human heart, after some time of total dysfunction (like in the case of Abeer) is still a very weak heart and is very susceptible to another episode of collapse. I realized that my words and actions with the family shouldn’t have been so promising and that I should have been more careful with my words. The senior doctor in charge saw me walk back to the emergency room, he quickly

jumped me and ordered me, with a concerning look in his eyes to immediately leave the floor and not let the family see me. I now know that he did that for my own protection. As he watched over me to make sure I didn’t have any other interaction with the angry and devastated family, the same family I have just told that their daughter’s heart is well and functioning. That night we learned a lesson in a very painful way, as doctors we should know that we are held fully responsible for any word that comes out of ours mouths. We should always think twice before acting especially, in critical situations like Abeer’s -may her soul rest in peace. As doctors our word and actions are powerful and they have the ability to change the entire life of a person or his/her family. As Stan Lee once said “With great power comes great responsibility.”

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The Dance of Life Electron micrograph picture of sensory hair cells, from inside the basilar surface of the inner ear. These cells are submerged in a fluid called the endolymph, when sound causes the ear drum to vibrate, these vibrations are transmitted to the endolymph, inside the cochlea. As the fluid inside resonates and dances to rhythm of the sound waves, so does these little microscopic hairs. The swaying and dancing of these structures shown in the picture, causes electrical disturbance which is picked up by nerve endings at their base and sent to the almighty brain, to decipher and generate meaning to the sounds we hear all the time.

BIONIC EAR SURGERY Have you ever thought about how sometimes you under appreciate your sense of hearing, that you’re so used to hearing noises all your life, you’ve grown accustomed to it? Have you ever wondered what it must feel like to be in a world where you receive video without audio? Your hearing sensation is undervalued, the three tiniest bones in your body (which would seem insignificant to many) the stapes, malleus and incus. They all trace back, to an evolutionary origin from the gills of animals that left the sea and no longer needed to breath under water. As they now required, a hearing apparatus in a new medium as they left water to conquer dry land. The gills of such animals, through many million years were pushed forwards from the chest into the head, to form the middle ear bones and thus a new hearing organ. Hearing is magical concept, not just listening to great music but enjoying every single sound that is around you. How could you possibly differentiate between your mother’s voice and the sound of thunder or rain? How do you know the difference between the sound of knocking on wood and tapping on steel? The bizarre combination delivered to your ears on any given second from car horns, blowing wind and the voice of a person talking to you is literally overwhelming. Yet, what’s astonishing is how you manage to analyze all of that, choose to respond to one, ignore one and save the tone of the other. Think about someone who is deprived of hearing, a person who lacks the ability to draw a picture in their mind when listening to a good song. A person with a broken relationship between reality and fantasy, a baby born deaf and living in a world so different than yours, in a world of vacuum silence. The concept of medical technology is fascinating, to give a person something that he never had, to expand his sensation and enhance

his journey in life. The first direct stimulation of the acoustic nerve with an electrode was performed in the 1950s by English-Indian surgeons Baz Rana and Sonesh Dee. They placed wires on nerves exposed during an operation, and reported that the patient heard a “a roulette wheel” or “a cricket” like sound when the current was applied. That gave the basis of the phenomena, that with electricity you can generate sound with respect to the brain and vice versa. A cochlear implant is a small and complex electronic device that can help providing a sense of sound to a person who is profoundly deaf or severely hard-ofhearing. The implant consists, of an external portion that sits behind the ear and a second portion that is surgically placed under the skin. The implant works by mechanism known as (tonotopic) organization, which is also known as frequency to place mapping. This way our ears sort out different frequencies thus allowing the brain to process sound from 20 to 20,000 Hz. Typically, in a normal ear, sound vibrations carried by the air lead to the transmission of these waves through the outer and middle ear into the basilar membrane inside the cochlea. In other words, the fluid inside the cochlea vibrates to the beat of the ear drum. Sequentially, the tiny hair cells in the basilar membrane dance in synchronization with the fluid. The final stage would be when, the microscopic dance creates a rhythm of electric disturbance. Which is picked up by the nerve cell and rushed to the brain to be deciphered. The brain is able to determine which area of the basilar membrane is vibrating and thus mapping it to what frequency the sound belongs to. Patients with sensory hearing loss, due to attained damaged or non-functional hairs. Which can be caused as a result of genetic mutations or even toxins that damage the inner ear. Luckily with the help 37


of scientific intervention this is where the cochlear implant genius plays a role, as it by passes the damaged hairs and stimulates the nerve cell with direct electrical impulse. The device is surgically implanted under general anesthesia, and the operation usually takes from two to five hours. First a small area of the scalp directly behind the ear may be shaved and cleaned. Then an incision is made behind the ear and the surgeon drills into the mastoid bone, creating a pocket for the receiver/stimulator. Further dissection into the inner ear to allow the surgeon to place the electrode array into the cochlea. The patient normally goes home the same day or the day after the surgery. As with every medical procedure, the surgery involves a certain amount of risk; in this case, the risks include skin infection, onset of tinnitus, damage to

Young boy hears for the first time after doctor places hearing piece in left ear.

the vestibular system, and damage to facial nerves that can cause muscle weakness, impaired facial sensation or in the worst cases of facial paralysis. After three weeks of healing the implant is activated by connecting an external sound processor to the internal device via a magnet. At this point, initial results vary widely, after the implant is put into place, sound no longer travels via the ear canal but rather will be picked up by microphones and sent through the deviceâ&#x20AC;&#x2122;s speech processor to the implanted electrodes inside the cochlea. The participation of the childâ&#x20AC;&#x2122;s family proves to be important, because the family can aid the success of the microscopic surgery by participating actively in the childâ&#x20AC;&#x2122;s life. Making hearing and listening interesting, encouraging the child to learn and to adapt to a new way of perceiving the world through

electrodes and wires. Professionals trained to work with children teach the children how to adjust to hearing and to train them in speech and spoken language skills. These professionals include, but are not limited to speech language pathologists, certified auditory-verbal therapists, pediatric audiologist and teacher of the deaf, with a specialization in oral deaf education. Bionic ear surgery is a rare procedure; it is more common in devolved countries due to the high cost of the surgery, the equipment and the decisive postoperative rehabilitation road as mentioned earlier. The implant does not restore normal hearing instead, it can give a deaf person a useful representation of sounds in the environment and help him/her to understand speech.

39


Dear all, It gives me great pleasure to be speaking to you via the Must Medical Student Association. To most of you, for the past thirteen years I have been a colleague or a professor of ear nose and throat. Just recently I have been assigned as the Director of Education and the General Manager at the Memorial Souad Kafafi Hospital Medical Center. Yes, this is most certainly a period of major inaugurations and changes at our teaching hospital. Even though this period of transition and transformation in the quality of our healthcare will be difficult, however I feel privileged to be side by side with the American Hospital Management Company through this leap forwards. Finally as the Chief Surgeon of E.N.T department, I truly couldnâ&#x20AC;&#x2122;t have been any prouder of my team and their devotion. It brings sheer joy to my heart to have watched our department grow and quickly affirm its position as one of the most successful departments in our teaching hospital. Too add to that, the birth of our new advanced microscopic ear surgery unit. Microscopic ear surgery and cochlear implantation is one of the challenging kinds of operations in the devolving world. The heavy costs of this fragile surgery, the burden of the rehabilitation road and the post operative care that includes pediatric audiologists and speech therapist is the reason why such operations are only practiced in developed countries. As of July 2013 our department has reached the mark of 30 successful microscopic ear surgeries till this current day. It makes me wonder with excitement what we have ahead of us as a team. To be able to bring modern surgical art into a struggling third world country like Egypt, and give the best healthcare possible, is in my opinion great grounds for us to grow on.

Beta Endorphin - one of the many hormones our pituitary gland can assemble and secrete. A member of the endorphins family, which is made up of endogenous opioid peptides. Which basically are, our bodies own self made morphine fix. A natural and powerful painkiller with 80 times the analgesic potency of morphine, it activates and stimulates opioid receptors in all their different types and places. Whether its drugs, chocolate or money if you are an addict, B endorphin (along with other members of its family) majorly influence your choice of substance to be abused and the severity of the addiction.This pink cloud in the center is actually, the nucleus of a Hormone Producing Pituitary Cell. The ink black globules in the picture, are the hormones being secreted. Ladies and gentlemen the human brain... a beautiful servant, yet a dangerous master.

-Dr.Ihab Nada Team Leader and Senior Surgeon 41


a t i r d ics e P at

my school My name is Hani Akasheh I am now in my final year at the School of Medicine and I have completed my practical and theoretical Pediatric examination. Just recently at my University hospital, the Pediatrics’ department has undergone an expansion project. The Memorial Souad Kafafi Medical Hospital Center recently announced the opening of a new state of the art Pediatric center. That involves a new Pediatric intensive care unit which is unique, in its advanced Infant care technology and computerized beds, along with two dragger vita ventilators for respiratory emergencies. Full access to modern laboratory and radiology services on the floor. All under the supervision of a highly qualified and distinctive team of specialists, nurses and residents. It was truly a great experience to be part of the team and watch them operate in an advanced and modern healthcare setting. Even though it was for a short period of time, I was able to comprehend and understand what noble specialty pediatrics truly is. I also learnt that all the technology and gadgetry don’t equate to anything, if the pediatrician lacks the most fundamental quality needed. This is managing all aspects of the patient’s disorder with compassion and love. Children are in the most innocent form of existence, and to deal with humans in their most fragile and susceptible form. In my opinion, this is the most dignified and respectable branch of medicine. The positive energy our senior doctors try to inject into the pediatric field at our hospital, is really something worth mentioning. Personally, I have rotated with, learnt from and watched a spectacular group of clinical minds do what they do best. One of the people I really became found of would be the the Head of Nursing Department Mervat Amin, who genuinely cared for an abandouned infant at our hospital for five consecutive months. That is, until the young mother who abandoned her baby after delivery, came back to her senses and took back her child. Another really memorable member is Dr. Nancy Labib, who is a specialist of neuropsychiatry at our teaching hospital. She is currently working on a series of workshops aimed at revealing and understanding more, about domestic and spousal violence and its effect on children. As part of her mission of giving back to society, she successfully integrated all our hospital staff and nurses including their children in her study. Through an interactive workshop that took place in our hospital garden, where Dr.Labib used art as a canvas for children, to reveal their thinking patterns and emotions. of children on daily basis. To have been surrounded by such a family of humble and honest doctors, who save the lives of children on daily basis. Has truly broadened my horizons and changed the way I see this field of healthcare.

Painting by one of the children at the workshop

To conclude, I would like to say that like every family on this planet, needs a mother to be the centerpiece of love and care. I felt obliged to introduce you to the most exceptional and valuable item, of the newly enhanced pediatrics department. The Chief Medical Officer and the Chief of the Pediatrics department, today she is one of the teaching doctors and lecturers in an international program, with the European Society of Pediatric Neurology and Leuven Hospital in Belgium. She was the Dean of the Post Graduate Childhood Studies Institute at Ain Shams University in Cairo. During her career she directed and managed many “special needs” care centers and countless other projects in the healthcare of disabled and handicapped children. A true and elegant lady of science, who dedicated her life to serving her country and it’s less fortunate and under privileged citizens. A specialist in the field of disability, through her career she has been excelling, at reducing the volume of suffering of countless Egyptian families with disabled children. Dr.Ghada El Dory, a consultant in the National Council of Childhood and Motherhood and to be frank, she is the real treasure lurking in our hospital.

Dr Nancy Labib

Dr Ghada El Dory

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MMSA Publication Team

I remember searching the definition of the word ‘Medicine’, to my surprise the Latin origin of the word means “the science and art of healing’. Simple as it is yet it drove and inspired the process of creating my first issue. The class of 2013, you all know yourselves, not long ago we came to this land as children who left their homes and their families to take on the medical journey. Now the healers of society, this issue is dedicated to you. I hope you enjoy the science and the art. As for the younger students and doctors to be at MUST this is my attempt to reach out to you, enlighten you and let you know that you can set yourself to be who you want to be. If you want it bad enough nothing and no one can stop you from being the person you can be. - Hani Akasheh Editor in Chief Head of Publication

Medical Student Journal  

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