The poor, the sick, and the vanishing in Egypt’s class-divided healthcare

When it comes to health and illness, the odds of recovery depend heavily on the quality of care available, on access to diagnostic tools, and on how easily a patient can obtain treatment. So-called “free” hospitals and clinics are a crucial factor in determining how a disease unfolds, in controlling outcomes and improving prognoses, especially for the lower classes, who can barely scrape together their daily bread and would rather endure pain and symptoms than pay for treatment, saving what little income they have for expenses that seem more pressing and more worthwhile, like their children’s education.

Organic illnesses and psychological disorders have known statistical rates. Their prevalence within a particular class, social group, or age bracket can be charted and graphed, made available to specialists and to anyone with an interest. But what happens when the picture changes, for one reason or another: when economic conditions deteriorate markedly, say, and the distances separating people from one another widen into gaps and chasms? Such a shift is bound to leave behind glaring marks that brand the image of society and disfigure the harvest. These signs may not be noticed early on, but they grow quickly in the shadows, and before long they swell, tear through the veils concealing them, and announce themselves with brutal clarity.

A nearly real, imagined scene

The clinics whose doctors have long treated patients of modest means are changing beyond recognition. In the old scene, poor mothers scraped together bus fare, or borrowed it, to bring their children in, and were granted a few precious minutes in which they might get a sound diagnosis. They would make a second trip to collect the medicine, then leave grateful, hoping to mend the damage, catch the illness in time, and see their children grow up healthy: moving, talking, and behaving like the neighbors’ and colleagues’ kids.

The new scene is entirely different. Mid-range cars now pull up outside the very same clinics, cars that seem almost embarrassed, ill at ease with themselves. They carry passengers, but this time these are not the lower-class families the place has always served. They are people newly arrived to poverty, unsettled by their own sense of need, no longer able to keep up habits and rituals they once took for granted. They can no longer afford a doctor in private practice, so they have turned to the “free” services, which have themselves, in turn, become services one has to pay for.

The building is the same, the service is the same, even the number of tickets sold is the same. But the scene is different, and sadder. Without meaning to, it reveals the disappearance of one class of people from the picture and the arrival of another in its place, both wretched, both mourning their luck, both searching for relief.

In rooms whose walls seem eaten away by destitution sit mothers who could not scrape together a bus fare, or the cost of a tuk-tuk or a microbus, and who have therefore been unable to bring their sons and daughters in for treatment, unable to afford the sessions that might help these children live something closer to a normal life, keep up with school, and claim even the smallest share of opportunity and advancement.

And here, in front of the doctor’s desk, sits a father ashamed of his own presence, and a mother hiding her flushed face, bowing her head, staring off into the distance, cursing the day she was forced to swallow her pride and knock on the doors of the subsidized and the free.

The ache of the mind, the ache of the body

On the horizon, one can also find indirect evidence that certain organic illnesses are becoming rooted among the neediest and poorest classes. Over recent years, the long-running social announcements page of a well-known state-owned newspaper has emptied of engagement notices, birth congratulations, and celebrations of success.

Instead, it teems with notices addressed to those willing to donate a kidney, complete with blood type and contact details. Beneath the word “donate” here, one should draw a thousand lines and add a cluster of question marks.

The pleas the newspaper carries are a mirror, reflecting a frightening process of class stratification within illness itself, in which certain afflictions take root and become, in effect, the exclusive property of one miserable segment of the population. Whoever can afford to place a costly ad, and whose money, if it works, spares them the burden of repeated dialysis and its expected complications, is undoubtedly a person of means. Whoever is driven to give up a kidney, on the other hand, is certainly the poor man who has nothing else left to give.

Perhaps the first man is cured, and the second carries on with his life, teetering on the edge as usual. As for the third, the poor man who also happens to suffer from kidney failure: he is quietly excluded from the scene, as the factors and causes that make his disappearance more likely accumulate.

It is worth noting here the effect of the degraded environment around him, which ultimately entrenches this state of division and distance. On one side sits the complete absence of a clean, drinkable water source, used by a considerable share of the population; on the other, the clear bottled water that undergoes elaborate purification, filtration, and refinement to be bought by a select few. Between the one and the other, the gaps widen until they tear apart the shared ground the whole of society once stood on, and each class or segment ends up with its own separate footing, going its own way, cut off from the rest.

Distribution and redistribution

It is understandable, and expected, that the lower classes should turn into fertile ground where afflictions grow and flourish. It is likewise understandable that rates of certain organic illnesses, the kind that adverse conditions provoke and sustain, should rise, especially as food quality declines in favor of whatever merely fills and silences hunger.

As for the psychological disorders that affect children, many arise without any definitive environmental cause, and rates of incidence are often roughly equal across social strata and classes. But the response, the attempt to deal with symptoms, to have the child examined and assessed, departs entirely from any notion of equality; its course bends according to one’s economic position.

While it is scientifically possible to limit the consequences that might befall a child — consequences that hold him back in every field and disable his capacities indefinitely — failing to seek help in the early stages lowers the odds of a positive outcome and raises the likelihood of a poor one. It adds to the burdens of an already overwhelmed family, doubling its tendency to neglect the whole difficult situation, to set aside the child and his intractable problems, and to direct its attention instead toward whatever seems more urgent and easier to address.

In any case, the signs and telling markers keep multiplying, and within them grim scenarios take shape that are difficult to look past: the sense that they are poised to worsen and erupt, unless they are given the attention they demand, and unless something is done to pull back into view those who have fallen, unnoticed, out of the picture.