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Cogs in the wheel: A day in the life of a community doctor

Egypt is a massive living organism — a web of ticking clocks, each set to a slightly different millisecond. With approximately 80 million in the country, 18 million of whom are woven into the streets and buildings of Cairo, the traffic of the city may crawl but many would say it is only by the will of God that it continues to flow at all. People are everywhere — driving, jumping off buses, walking, bicycling … ticking minute by minute through the days and nights of the city. Doctors, valets, belly dancers and beggars … Cairo keeps 18 million cogs in one of the world’s busiest wheels. This series takes a magnifying glass to one person, a representative of a job that keeps the city ticking — an eye-level shot that takes you through a day in the life of a cog in the wheel of Cairo. —Nevine El Shabrawy

Men and steel dominate the streets of Sabtia. Workshops line the street and each shop has an unofficial claim to several meters of road. Steel rods, car parts, nuts and bolts spill over and the busy traffic weaves just inches away from the metallic overflow. Men — young and old — are outside, working with their bare hands in grease-stained clothes. Others sip tea and smoke shisha outside.

Rounding Sabtia Square, a humble building comes into view. The facade is empty with the exception of a workshop on the ground floor, one blue-painted shutter and one heavily dust-coated sign for Dr. Mohsen Khalil’s general surgery clinic. They’re hard to notice, but similar signs for private clinics can be found on almost every street in Cairo. This clinic opened in 1954.

The doctor, who commutes from 6th of October City, arrives at 2 pm after eating lunch, watching the news and relaxing at home with his family. Patients have been calling his mobile phone since the morning and are already waiting when he arrives.

Bikhatirha, who has been cleaning and assisting at the clinic since the mid-1950s, lights up when Mohsen enters.

“Dr. Fadel’s blessings linger here, may he rest in peace,” she says nostalgically about Mohsen’s father-in-law, from whom he inherited this clinic. In many ways, the history of the clinic and Sabtia rests with Bikhatirha. Most nights, she sleeps here.

A young girl is the first to walk up to Mohsen’s open office door. She looks up at him and smiles; she’s come alone. She’s here to change the dressing on a motorcycle burn. She covers her face while Bikhatirha, in her oddly colorful green galabeya, pretends to poke the wound. The doctor sprays some betadine and antibiotics on the exposed skin.

“What is this? What are you spraying on me?” the little girl sasses. “Oh, a little hot sauce, some lemon juice and pepper,” he teases back as he dresses the burn. He pats her on the back and she runs out.

A few patients stream in and out with the flu, food poisoning and kidney stones (from too much shatta, hot sauce, on their koshary, Mohsen says).

A large group of men rush into the clinic. One man is holding a bloodied work rag to his hand. He’s ushered in; the smell of cigarette smoke leaks in from the waiting room where the worried party puffs away anxiously.

Mohsen peels off the rag slowly, and sees exposed tendons under shredded skin: a work accident. “There is one cut tendon,” one of the men says as the patient rests his head and looks like he might faint. The din in the waiting room gets even louder as word of the accident spreads around Sabtia. The men are on their second or third cigarettes while the women utter comforting prayers.

“Al-Hamdulillah [Thank God], it only came to this,” they all repeat.

“Two cut tendons, and a third that needs repair,” says Mohsen. The surgery will cost LE5,000.

The cigarette smoke hangs still in the air. Bikhatirha turns on the fan. One of the men finally steps forward.

“Can’t you give us a better price? It’s too much for us, but we don’t want anyone else to do the surgery but you.”

“Okay, LE4,500,” the doctor gives a slight nod of the head. The man, satisfied with his bargaining, steps outside to collect the money.

A minute later, a different man walks in and hands the doctor a wad of bills. It’s a few hundred less than promised. Mohsen gives the man, now smiling sheepishly, a quick stern look before he pockets the cash with a chuckle and ushers them all away so he can apply the anesthesia.

The surgery takes three hours, and the hand is stitched up cosmetically.

“I always try to leave as small a scar as possible,” he says.

“What a beauty,” the doctor says about the wound as he invites the whole party into the small operating room to admire the work. They leave, but not before many kisses, firm handshakes and confessions of loyalty to a doctor who is always keeping an eye out for them.

Mohsen holds a sort of celebrity status in Sabtia, but word of mouth has carried his reputation far and wide. A man who fought with the Libyan rebels came to him recently, as well as a man who traveled by train from Aswan so that he could re-attach a severed finger. Patients often come in and proudly declare: “I’m this clinic’s child,” meaning they were delivered here.

“You know what they say,” one of the patients tells me as he takes his prescription. “Genies tell Mohsen what to do — that’s why everyone heals when they come here.”

Hands still powdery from the inside of his surgical gloves, the doctor leans against the door frame and checks the football game score. He motions for whoever is next.

“Doctor,” the patient sits down, his tone serious. “No one has been able to cure me.”

“Tell me,” Mohsen says calmly, accustomed to hearing patients’ frustration with other doctors’ ineffective lines of treatment.

Mohsen explains that he often sees impressive credentials written on blatantly incorrect prescriptions. Many poor patients struggle to see expensive doctors, only to walk away with dangerous misinformation, he finds.

The man holds his head.

“I can feel the headache coming, and it consumes the right side of my head. The pain is debilitating,” the man begins to raise his voice in frustration. “It lasts days. Nothing stops it.”

“Severe migraines,” Mohsen nods in understanding. “They can’t be stopped, only medicated, no one knows why.”

The man looks unsatisfied with the quick diagnosis.

“The last doctor told me it was my facial nerve.” Mohsen laughs and shakes his head no as he writes a prescription. “Your facial nerve is completely unrelated. What kind of doctor told you that?”

I take a seat in the waiting room and I count 13 people waiting. Most know each other. One man is sitting in white boxer briefs, calf wrapped in gauze.

“I tripped over a vat of boiling water,” he says in response to the curious stares.

“Al-Hamdulillah, it only got your leg,” I say. The whole room echoes in agreement: “Al-Hamdulillah.”

An old woman in a black abeya (traditional full-body covering) sits motionlessly to my left. Mouth open, face still, and eyes glazed over, she's been brought in by her two sons. The plastic green lawn chair she is sitting on does not belong to the clinic, and I notice that its legs are reinforced with wooden planks — it's how they brought her here, I realize.

The young man with no pants limps into the office and lays on the bed. Mohsen examines the damage — third-degree burns covering his entire leg — and says “cleaning and dressing will cost LE400.” “I live with those LE400,” he sighs. “I’ll go to Qasr al-Aini [Hospital].”

While government hospitals are always an affordable option and private hospitals almost never one, this clinic fits a socioeconomic niche: Patients, often hailing from nearby Boulaq and Imbaba, are willing to pay to be treated here instead of Qasr al-Aini and other government hospitals because of the quality of care. Although Mohsen’s net profits are marginal, some are still out-priced. However, the doctor has been working in Sabtia long enough to know when he should not charge for treatment.

The elderly woman on the plastic chair is carried in. It doesn't matter that she has come with no medical records; Mohsen has memorized his patients' histories. The two men struggle under her weight. “She’s been like this since yesterday,” one of them says, his eyes filled with fear. “Look, mama, it’s Mohsen! Your darling!” She slowly turns her head to the man who has been her doctor for decades but looks too tired to react. She is diabetic, and her blood sugar is at 593 mg/dL (145 mg/dL is the upper limit of normal). “We stopped giving her insulin a few days ago because she looked sick.” The doctor stares at them in disbelief.

“She is entering a diabetic coma,” he says. “She also has a severe kidney infection. She needs to go to the hospital.”

But they don't want to take her. “It's up to you, but the combination of a kidney infection and severe diabetes is very difficult. This is not a home case,” he warns.

Nonetheless, he explains how to give home care. One son carefully tries to tuck the silver strands of hair back under her hijab. She stares at the ceiling.

There is hardly a moment to reflect before the next man walks in, all smiles, wearing a galabeya and speaking with a heavy Upper Egyptian accent. The doctor quickly determines that he has kidney stones.

“Drink a ridiculous amount of water!” he tells the man. “Even when your mouth does not feel like cotton. Drink Birell, Fayrouz, water ––”

“­–– and beer!” the patient interjects. The doctor laughs. “Drink that on your own time,” he says.

Somehow ex-presidential candidate Hazem Salah Abu Ismail comes up.

“Where does the man live, anyway? America?” the patient asks. “In Dokki!” says the doctor. “May God damn Dokki!” Bikhatirha almost yells. The patient looks puzzled.

“Vote for Dr. Abouel Fotouh,” Mohsen advises. “We graduated from medical school together, you know.”

Finally, there are no more patients. He usually closes at 9 pm, but often stays late, especially if he performs a long surgery or delivers a baby. He goes to make himself some tea. Bikhatirha is storytelling, seemingly to herself, her voice echoing in the bare stairway. Mohsen’s driver brings the car around, and soon he's home. His 2-year-old granddaughter, whom he loves to play with, is already asleep.

“I get to see her on Fridays,” he says, smiling. He spends the rest of his evening sitting with his wife, eating dinner and watching the news.

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