Introduction

Magda is creating the profession of home health care in Egypt and training a cadre of providers who offer high-quality, affordable services to the elderly and others who are home-bound

Traditionally, younger members of extended families cared for the elderly, but in recent years the responsibility has shifted to inefficient, expensive private hospitals and nursing wards.  Madga, who is a doctor, sees that important aspects of care—companionship and love—have been lost in this shift. Many older people are made to feel like a burden, their potential for contribution somehow spent. To provide high-quality care and assistance to the elderly and others who are home-bound, Magda is creating a new professional niche: home health care. She selects smart, compassionate recruits and teaches them, motivates them, and gives them a respectable job and an important chance to contribute positively to those in their care. Her idea is clear, efficient, and appealing to everyone: it creates jobs without burdening the government, provides a desperately-needed service at an affordable cost, and sets a professional and compassionate tone for care-giving. To support and spread this new profession, Magda arranges partnerships with private hospitals, which offer an institutional shelter to home health care providers, and secures such employee benefits such as insurance

Of Egypt’s seventy million people, about 6 percent are sixty or older. Of these, an estimated 10 percent, or forty-two thousand, need or will soon need some form of assisted living or home health care. Others, such as people with disabilities and patients recovering from injury, could benefit from such services as well.

The services presently available to the home-bound are few. There are no nursing homes or assisted living facilities in Egypt. Older people sometimes squeeze into the homes of their children, but living spaces, especially in cities like Cairo and Alexandria, are cramped as it is. Long-term hospitalization is an option for some, but most Egyptians agree that medical care here is a disaster. Egypt’s spending on health care (private and public) is 3.8 percent of its GDP, significantly less than in most other countries: 8.3 percent in Brazil, 6.8 percent in Hungary, 13 percent in the United States. This means that doctors are scarce, nurses scarcer, all are paid very little and stretched thin on the job.

There’s also a misunderstanding about what and who is needed to meet the demand for care. As Madga points out, trained doctors and nurses are not best equipped to help the elderly and others who have difficulty leading completely independent lives. After all, many of this group are in stable health and don’t require on-the-hour monitoring of heart rate changes, blood glucose levels, white blood cell counts. Reliability, security, companionship—these are the things that home-bound patients most need. They need to feel confident that their caregiver will show up on time, want to spend time with them, provide for their comfort, and make sure everything is in order before leaving at the end of a shift.

Magda offers a comprehensive curriculum for training home health care providers and teaching the best of them to train others. The heart of her curriculum is a four-month certification course which draws together fifteen to twenty students—20 percent men, 80 percent women—from all walks of life and age groups. Many are unskilled and generally considered unemployable. Most come looking for a job, and find a career, a profession, a life’s purpose. The curriculum offers a well-balanced mixture of theory in the classroom, lab training where the trainees are coached to acquire and practice needed basic skills, and practical field experience where they apply what they have learned and can gain confidence and hands-on experience. Primary subjects include public health and nutrition awareness, body systems, communications, daycare skills, first aid, and common diseases.

Magda believes that a deep, personal commitment to caring for another human being must underlie health knowledge and technique in order for care to be effective. Trainees, who are Muslims and Christians, are taught to render care with love, using the basic value system of their religions in their interactions with patients. Magda teaches her students that people are born free, that they are free to make choices throughout their lives, and that each choice bears a price. She inspires students to offer always their best for those in their care, and teaches that if students find their job unsatisfying, they should get out of the profession and do something else. Magda says that 60 percent of students are transformed by the course; 20 percent do fine; and 20 percent demonstrate through their behavior and attitude that they simply don’t belong in this field. She cuts the latter group from her program: in her view, a new profession can’t afford to include the unconcerned, uninterested, or inept.

Prior to certificaiton Magda arranges one-month internships with seasoned home health care providers, who offer guidance, close and supportive supervision, and evaluation. In fact, evaluation by more senior providers and by clients is an ongoing part of Madga’s effort, not only to ensure mastery of technique, but also to monitor and provide helpful feedback on maturity, personal growth, and adjustment. Following completion of the course, students take an exam, and the 80 percent who pass don graduation robes and attend a formal ceremony recognizing their achievement. For most graduates, this is an important moment of personal transformation. But Madga sees that emphasizing this moment of passage is about more than acknowledging personal achievement. Importantly, this emphasis enhances the image of the profession she is building. To date all graduates have been employed and are earning a very good income. The first graduates received degrees in 1997; there are now six hundred certified home health care professionals serving home-bound clients primarily in the Greater Cairo area, but a few working in other areas as well—Alexandria, the North coast.

Madga also arranges professional supports that will stablize this new profession long-term. She has arranged for health institutions where the graduates will work to cover the cost of training or offer loans to students, to be retuned in installments upon graduation. She has secured an offer from the Ministry of Health to provide an institutional shelter for home health providers, granting them full insurance and employment benefits as hospital employees. She hopes to get the Office of Labor to acknowledge home health care providers as well.

Magda was born in a village in the south of Egypt, a child of parents who believed that girls should be independent and think critically. She was raised to understand that helping out—caring for older people, the sick, and others in need—was simply part of what you did. It was no great act of charity or display of self-sacrifice.

At eighteen, Magda desperately wanted to study music. Unable to pass exams for admission to the music faculty, she settled on medicine and found in radiology a fascinating new science. After studying for a period in the United States, she returned to Cairo in 1984, and found that ultrasound, by this time widely used in some other countries, was not yet available in Egypt. She brought the technique home with her, and set about the task of setting up training centers in Cairo-based hospitals. This first experience appending something new and useful to the Egyptian medical system would prove useful to her efforts, years later, to introduce and institutionalize home health care.

When her sister broke her leg, Magda had an opportunity to see, from the patient’s perspective, the inadequacies and dysfunction of the national health care system. Rather than keep her sister in the hospital during her two-week recovery, Magda hired a trusted house worker to take care of her, and gave this worker a brief but thorough tutorial on what she would need to do. Everything worked out perfectly. This experience, coupled with Magda’s daily encounters with elderly patients in the hospital, contributed to her resolve to build a home health care profession in Egypt.

Madga’s organization is based in Cairo.