25 February - 3 March 1999
Issue No. 418
|Published in Cairo by AL-AHRAM established in 1875|
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Sun, sand and psoriasisBy Gihan Shahine"There is no place like it," is how a friend of mine described Safaga only a few days before I went there. Safaga is located 60km south of Hurgada on the Red Sea coast. "It is so beautiful, so relaxing and also very healthy."
The seven-hour trip was exhausting but enjoyable. On one side of the narrow road, high mountains puncture the skyline, while on the other, gentle, crystal-clear waves lap at the shore.
Closer to Safaga, however, the waves disappear, and the mountains draw closer. The air is pure, dry and warm. The area is extremely calm -- even the sea seems silent. Only a few days after our arrival, we were beaming and rosy-cheeked. Cairo's polluted air seemed light-years away.
Can climatotheraphy help those suffering from rheumatism and psoriasis? Some say the sea, sand and sun are not to blame -- but services are not yet up to par
photo: Khaled El-Fiqi
Safaga's potential health benefits were recently in the media spotlight when a group of scientists from the National Research Centre (NRC) found that it helps in the treatment of psoriasis (a chronic skin disease of which the cause remains unknown) and rheumatoid arthritis (a chronic, progressive form of arthritis causing inflammation in the joints). According to the NRC research team, there are several natural factors in Safaga which make it so appropriate for therapy. The high mountains act as a natural barrier against wind and sand storms. The air is thus free of any suspended grime that could divert and absorb ultraviolet rays -- essential in treating psoriasis. The curve of the bay accounts for the calm sea, which reflects UV rays further.
Due to the abundance of coral reefs, the water is 35 per cent saltier than in other seas, which greatly helps in psoriasis treatment. More salt, as evidenced in the Dead Sea, also means less gravity -- thought to improve blood circulation. The balance in saline concentration inside and outside the body also affects the therapy positively, according to the NRC.
Sand in the area has also been found to contain radioactive elements and minerals effective in rheumatoid therapy. Analysis also showed the soil to contain black sand, which is useful in curing acute and chronic arthritis, rheumatism and skin inflammations.
Those suffering from rheumatoid ailments are buried in the black sand -- with the exception of the head, stomach and chest -- twice a day, after sunrise and before sunset. Treatment lasts about a month.
Psoriasis patients, on the other hand, bathe in the sea and lie in the sun, also twice a day. The duration of exposure to the sun is prescribed by the therapist and a patient should see rapid improvement in about a month, depending on the case. In acute cases, patients are asked to repeat the course of treatment.
Is climatotherapy an effective alternative medicine? Physicians disagree. Both rheumatism and psoriasis are chronic diseases caused by a disturbance in the immune system. No therapy has been found effective so far, other than sedative drugs that relieve the symptoms, rather than curing the disease itself.
According to Dr Hani El-Nazer, professor of dermatology at the NRC and the supervisor of Safaga's medical programme, the NRC study conducted at the resort showed enormous clinical improvement in 85 per cent of psoriasis cases. Over 65 per cent of the patients did not have a recurrence of the disease.
"Psoriasis medications, however, have harmful side effects," El-Nazer said. "There is also a high incidence of recurrence. In Safaga, on the other hand, the recurrence rate is mild."
According to El-Nazer, the NRC started studying climatic therapy in Safaga when a tourist village there informed them that a group of German tourists, several of whom suffered from rheumatoid arthritis and skin ailments, said their symptoms had improved markedly during their short stay in Safaga. The NRC set up a team to conduct a survey of the climatic effects of Safaga on skin and rheumatoid diseases.
The study showed that the percentage of rheumatism patients living in Safaga is only 0.014 per cent, compared to the international average of 1.5 to two per cent. Similarly, psoriasis patients represent only 0.008 per cent of Safaga's population, as against the average of one to three per cent for any given population.
Two sample groups of rheumatism and psoriasis patients were sent to Safaga to spend four weeks under medical supervision. The results were announced at a 1995 international press conference, held under the auspices of Mrs Mubarak and attended by the ministers of scientific research, health and tourism.
A marked clinical improvement had occurred in 85 per cent of psoriasis patients, while 70 to 75 per cent of rheumatoid patients responded positively to the treatment, and found their suffering alleviated considerably. Follow-up studies indicated that 40 to 45 per cent of rheumatoid patients remained in good condition until six months after climatotherapy.
"A total cure, however, is not an option for rheumatoid diseases, which are chronic diseases associated with rheumatic pains and arthritis," conceded professor of medicine Dr Maher Youssef, supervisor of the rheumatoid therapy project in Safaga. "Climatotherapy, however, improves the patient's response to medication and helps reduce the doses prescribed."
Not all rheumatoid patients can benefit from climatotherapy, Youssef warned. Such therapy, in fact, can be dangerous, for instance in the case of cardiac patients and diabetics.
El-Nazer, on the other hand, assures that most psoriasis patients do not suffer relapses. The Dusseldorf-based German Egyptian Association for Climatotherapy was founded "after some German doctors visited the area and were convinced of the excellent effects of the environment on skin diseases," notes El-Nazer, who is vice-president of the association. "One German insurance company even covered the expenses of clients who were staying in Safaga in 1998."
The Kuwaiti Ministry of Health has also decided to cover the medical expenses of psoriasis patients' cure in Safaga, El-Nazer adds, while this year, the Russian Medical Insurance Authority has decided to send psoriasis patients to Safaga at its expense. "Today, Safaga is accredited as an international centre for psoriasis therapy," El-Nazer says. "About 7,500 patients from all over the world have been treated here so far."
To meet the local demand for climatic therapy, the NRC has also established a public health spa where patients pay reduced fees of LE400 per month, including food and medical care. The centre, established under the auspices of NRC president Dr Sherif Eissa, has an annual occupancy rate of 100 patients. It cost a total of LE100,000. The Ministry of Tourism contributed 50 per cent of expenses.
Karam was 11 when he got psoriasis and went to Safaga to receive medical treatment at the NRC-subsidised health spa.
"My son suffered a lot," says Amani Mohamed, Karam's mother. "We tried different medicines, but nothing worked. Then we came to Safaga. He started getting better after a week, but we were amazed when he was completely cured in 28 days. That was three years ago. Since then he has been doing very well."
Not all patients, however, are happy. Most of those interviewed had suffered severe relapses. The effectiveness of climatic cure has also been hotly debated among specialists.
Ferial, who has had psoriasis for 25 years, spent a month in Safaga, but started suffering the same complaints upon her return to Cairo.
"Very few people there responded to the treatment, and those who did were mostly very mild cases. I wish I had spent the money doing something else," she complained.
According to Dr Ali Abdel-Fattah, former minister of health and renowned dermatologist, the recurrence of psoriasis after climatotherapy is very likely. Although dermatology guru Mohamed El-Zawahri praised the NRC project for promoting curative tourism in the area, he adamantly refrained from expressing his medical opinion on the effectiveness of climatotherapy in treating psoriasis.
"The recurrence of disease is probably due to the abrupt change from the pure climate of Safaga to the densely polluted environment of Cairo," Abdel-Fattah explains. "Recuperation in Safaga is also very expensive. Many patients are unwilling to risk spending money without being sure that they will recover. That is why I stopped sending patients to Safaga."
Abdel-Fattah concedes, however, that climatotherapy can be very effective in some cases. Field research he conducted during his tenure as minister of health proved that some patients recover completely. The research proved that in certain areas, like Safaga and Oyoun Moussa, climate therapy can be effective for skin and psoriasis patients.
Apart from the NRC public spa in Safaga, neither tourists nor middle- and upper-class Egyptians have access to climatotherapy only in a few relatively expensive tourist villages. "The establishment of an international health spa in Safaga would therefore be both useful and profitable," says Abdel-Fattah enthusiastically. "Psoriasis is a very widespread disease, especially in colder areas like Europe, and no medication is known to cure it."
There are 900,000 psoriasis sufferers in Egypt, as against four to five million in the US and a staggering total of 25 million psoriasis patients in Europe. The popularity of health spas where the painful symptoms of this skin disease can be alleviated is thus understandable. Thousands of patients visit climatotherapy centres on the Dead Sea every year. El-Nazer, however, insists that Safaga is superior in every respect. The Dead Sea, he explains, is 400 metres under sea level, which makes it inappropriate for patients suffering from heart, liver, and kidney diseases, high blood pressure, epilepsy and a number of other ailments. The water of the Dead Sea, furthermore, contains a high concentration of bromine, which can cause allergies and severe skin infection, El-Nazer added.
Mohamed Osman El-Guindi, head of the Safaga Local Council, also believes that great profits can be made from the Safaga project: "Every year thousands of tourists come here from all over the world for a cure. The profits from this tourism should go to the government, which should include climatotherapy in medical insurance schemes. Many people have been denied medical assistance for climatotherapy, but apply the treatment on their own at Safaga's public beaches and suffer health complications due to the absence of medical supervision."
El-Guindi deplores the fact that tourist villages are not medically qualified to provide climatic therapy services. "Many tourist villages also refuse to take patients because tourists may think that their diseases are contagious. And many new tourist villages are advertising climatotherapy but are not subject to medical supervision from the Ministry of Health," El-Guindi maintained.
Salwa El-Enani, a journalist at Al-Ahram, received treatment for her rheumatoid arthritis at Safaga. "I did feel better there, but that was only because of the weather, not because of any medical services," said El-Enani. "And of course, rheumatism is a chronic disease."
In a two-part article published in Al-Ahram, El-Enani explained that, apart from the weekly visits conducted by the medical staff of the NRC, most tourist villages offer very inadequate medical care. "We were a group of 30 rheumatoid arthritis patients and 30 psoriasis patients, and there was no organised medical care. The doctor had no first-aid equipment, no medication, not even a thermometre. Nursing, which is essential for rheumatism patients who may have mobility problems, was significantly lacking," she wrote.
Soad, a psoriasis patient who spent a month at Safaga, also suffered a relapse. "The problem is that the cure in Safaga is very expensive and one may need to follow it several times," Soad complains. She spent about LE4,000 during her stay at one of the tourist villages.
"Normal vacationers used to stare at us and make offensive remarks," she adds. "Patients need a secluded, specialised centre at reduced fees to receive their treatment. This way, I can't even contemplate going back."
If Safaga is to attain the status of an international health spa, clearly, something must be done. Abdel-Fattah suggests that the Ministry of Health establish a health centre with sophisticated medical facilities as well as restaurants and means of entertainment. He is ready to provide medical assistance and staff to such a "national project".