Mohamed Talaat Abdel-Aziz: A medical vision
When it comes to medical biochemistry, Mohamed Talaat Abdel-Aziz is the man to talk to. Over 120 biochemists have obtained Masters and PhDs under his supervision. His major research papers have been discussed at scientific conferences at home and abroad. He is a member of several societies, including the Egyptian Society for Nutrition in the Middle East, the Egyptian Medical Society, and the Egyptian Society for biochemistry. He has written several authoritative books, including Basics of Biochemistry (two volumes) and Chemical Alterations in Hepatic Disease . The Unit of Biochemistry and Molecular Biology which he founded at Qasr Al-Aini has published over 126 papers and is at the forefront of stem cell research -- this week the topic of much debate in the media. "One of our latest research projects focuses on the transplant of stem cells to the liver to treat cirrhosis," Abdel-Aziz says -- a vital objective.
Interview by Riham Adel
"I spent more than 50 years in this place," says the physician. "Now it can only feel like home." We are at his office in the Unit of Biochemistry and Molecular Biology (UBMB) at Qasr Al-Aini, but he gestures as if to indicate the entire -- gargantuan university hospital complex. "I came here to study in 1952, graduated as a surgeon in 1959 and got a job as an assistant teacher in the Department of Medical Biochemistry in 1961. I became a teacher in 1967, an associate professor in 1972, and head of department in 1985. I still work here," he adds with a proud smile, shrugging off dissatisfaction with present educational standards, "and I intend to do so till the last day in my life." Yet he has much to say about such dissatisfaction.
"Medical education has been deteriorating year after year. Likewise, medical services have also gone downhill." Indeed the number of students admitted into medical studies totalled 13,000 this year alone, whereas the local market needs no more than 3,500. Only three years ago, the number of students was 7,500 -- an indication of the rate at which pressure on Cairo's medical faculty is rising; the number of patients is increasing at a slower rate, but though there is an excess of doctors to look after them, neither the skill these doctors manage to gain nor the funds required for facilities are in any way sufficient for adequate care. Abdel-Aziz gets into rather more detail.
Like any other, he explains, medical education has three sides to it: curricula, teachers and campus. "We're having trouble with all three. Parts of the curricula are outdated. Teachers are underpaid and under-trained. Because of the harsh economic conditions under which they operate, they see teaching as a secondary career. They cannot give it their best. And there's another thing that disturbs me at the personal level. I see teachers running around trying to make money by several different jobs. As for the campus, it certainly has no room for the huge increase in the number of students. The state has failed to deliver on the promised expansion that was needed as new students were admitted. All these problems have exacerbated the problem of medical education."
Abdel-Aziz believes that the state encouraging the establishment of private universities is not a bad idea in itself. Had it not been for the poor execution of such plans, it would have been very positive. "We always wait for a crisis to develop before we decide to take action. At first, the private universities were not subject to adequate supervision, nor did they have a system for admission. The only criterion for admission was money. Later on, happily, the state intervened; a special coordination office was created to handle admissions. In my opinion, private education has become a better option thanks to the enhanced capabilities of private universities."
What about education being free of charge, however? "My opinion hasn't changed over the years. I still strongly believe that free tuition in university and higher studies has produced an excess of jobless people with university degrees. Unemployment is a serious problem. We have created a time bomb and it is ticking. Unemployment is the worst humiliation one can suffer." While on the topic, Abdel-Aziz recalls a discussion that took place some 20 years ago with, among others, Rifaat Al-Mahgoub, then prime minister, Hussein Kamel Bahaaeddin, Mahmoud El-Sherif, Hassan Hamdi (before he became president of Cairo University) and Fathi Sorour, then dean of Cairo University's Faculty of Law: "I invited them to lunch in my house. After the meal, we started discussing free education. Al-Mahgoub, God bless his soul, was an ardent supporter of free education. But my opinion hasn't changed since then. I still support free education at the pre-college level, but not at the level of university."
Certain kinds of education should be made available for free, he goes on: "one has to be able to read and write to a point where one can educate oneself further if one wanted to. But college education and post-graduate studies: no, thank you. I don't understand why we should favour quantity over quality? How can we boast that we're a country that sends its citizens to university free of charge only to end up with jobless, poorly educated people? I can't understand why the country should spend LE10,000 or so on a masters or a doctorate in medicine? The current situation has led to a drop in the level of scientific research. We have an immense unemployment. Wouldn't it have been better for them to be trained as skilled workers or technicians? If they were, the country's income and production would increase, and unemployment would go down."
Abdel-Aziz has numerous memories to share of his own education, when conditions were infinitely more positive. He was born on 1 August 1935 in the village of Aghour Al-Kubra, near Tokh in Qalioubiya, and he waxes polemical about pre- revolutionary times. As a student at the secondary school in Qalyub in the late 1940s, he remembers life as a continuous protest: "we often participated in demonstrations against the monarchy, calling for the fall of the king and his entourage. We wanted to bring down the walls of injustice and corruption. We kept demonstrating until the revolution took place in 1952, when our dream finally came true." That generation had to struggle to have a decent education, Abdel-Aziz says: "I had to travel 12km to school. It was hard to make it to school and back every day. I recall clearly the private buses that were operating at the time; we knew their numbers by heart, and the names of the drivers. But the buses often broke down and we had to walk the rest of the way, come rain or -- burning -- sunshine. Education was hardship."
Becoming a doctor had been Abdel-Aziz's dream for as long as he could remember. "As provincial people, we had great respect for the medical profession. We had only one doctor in the vicinity, and he treated all kinds of medical problem. When I was 15, Dr Henry was the village doctor and he was everyone's friend. I will never forget him treating me when I came down with typhoid, a disease that killed many of my contemporaries. This doctor had a great influence on me. I had great respect for him and his noble mission. I saw how everyone loved him and dreamed of being just like him. At the time, medicine was a truly great profession, a philanthropic public service -- not a way of amassing money. Those were gentler times. And when I came out eighth of my class in the entire country, I went straight to Cairo University to study medicine. You can imagine what an honour this was when I tell you that, at the time, the dean of the faculty in person received every new class. It was Abdallah El-Kateb, too, the greatest surgeon of his time."
None of which undermined Abdel-Aziz's initial support for the revolution -- which he still believes was inevitable. He particularly admired Abdel-Nasser, who "revived Arab nationalism". Alas, Abdel-Aziz says plaintively, the revolution turned into something else. The mukhabarat (General Intelligence) practically took over and many innocent people, including honest patriots, ended up in political detention. "I saw this unfold before my own eyes. Great professors from the Faculty of Medicine were dismissed because of their patriotism and set on less prestigious career paths in the Ministry of Health. Detention orders were issued on circumstantial evidence alone. We were afraid to talk to each other about public affairs, even in Qasr Al-Aini and even at home. Informers were everywhere, ready to sell their friends and family to get ahead."
After obtaining his doctorate in medical biochemistry, Abdel-Aziz immediately embarked on his long-standing career in research. "I was lucky," he says, "to get a fellowship to study in the US, signed by Gamal Abdel-Nasser in person, one month after the 1967 defeat. Three months after I arrived in the US, I managed to finish a scientific research project I had been stumbling over for a few years. Driven in part by the shock of defeat, and wanting to make an achievement for my country in those difficult times, I worked feverishly. The outcome of my research was published in the best scientific magazine of the time. That was a quite something; it led to better treatment of atherosclerosis and blood clots. I discovered a new hormone, at first extracted from lab animals and pregnant women, then manufactured artificially, and this hormone brought down cholesterol levels in humans. I returned to Egypt in 1970 and placed the results of my research at the disposal of the medical establishment."
Abdel-Aziz soon became acutely aware of the problems facing the scientific community at home. "On my return I could sense the change the country was undergoing. The time of El-Sadat was a time of political and intellectual as well as economic openness. He was a great man, a seasoned politician, and he definitely made history in 1973. But as far as scientific research was concerned, the obstacles, by contrast, were immense. Funding for research was meagre and that impeded our work as researchers as well as our lives as ordinary citizens. We couldn't enjoy the fruits of our endeavours nor feel that we were making a difference. Scientific research was so removed from real life, it ended up having little or no impact on life in the country as a whole."
He wasn't about to give up. He had inherited the determination of his father, he says. "My father was the one who implanted in me a sense of belonging to the country as well as to my small village. He was a teacher and used to wake up early to go to school and give the students extracurricular tuition for free. He also founded an agricultural cooperative despite opposition from the mayor, and I got to see him turn this cooperative into something impressive. I learned from him that one has to remain true to his objective, and I stayed loyal to my village all those years: it remains a dream of mine to turn it into a model village. Unlike so many others, I never severed the link. I started practising medicine in the village immediately after I graduated, dedicating Thursdays and Fridays to [gratis] visits and arranging for hospitalisation of patients at Qasr Al-Aini when needed." At the time, Abdel-Aziz replaced his simple old home in the village with a larger one so he could stay there more frequently, bringing his children along with him to help them, too, stay in touch with their roots.
"Egypt is full of great scientists in all fields," Abdel-Aziz goes on, "and they want to serve the country. The government can co- opt them and help them produce applicable research. But it also has to take care of them. So far this isn't happening." The UBMB, he says in response to my questions, took him years to put together, largely because of red tape and limited funding. "We neglect our best minds, hence the brain drain -- our loss. This is how the idea of this unit first emerged. At the unit we try to provide the right climate for scientific research. We conduct the necessary tests to diagnose various diseases, especially in cases referred to us from other hospitals, cases that need special methods or equipment that may not be available in traditional labs. We also give researchers working for various scientific centres the opportunity to use sophisticated equipment in their work. Periodically," he continues, "we hold training sessions in molecular biology and biochemistry. We also organise seminars and scientific conferences on various types of chemical analysis and modern molecular biology. And we implement research projects that are funded by the Academy of Scientific Research and the Ministry of International Cooperation."
Abdel-Aziz is eager to acknowledge the contribution of all who helped him, including doctors Nader Abraham, Nagui Habib and Yassine Abdel-Ghaffar: "in general, we look for solutions to common health problems in Egypt. We have formed a scientific society under the name of the Medical Egyptian Society for the Application of Genetic Engineering and Biotechnology [MESAGEB], and we publish a scientific magazine in the field." To set up the UBMB, Abdel-Aziz solicited the help of the late Hassan Hamdi, then president of Cairo University. Hamdi agreed instantly to allocate space for the unit within Qasr Al-Aini. "My colleagues and students helped me put together a programme. After the unit was built with funding from Cairo University, we had to import the latest equipment from abroad -- we managed to, thanks to international cooperation and a LE5-million grant."
It was not long before the unit became involved in US- Egyptian exchange, largely through MESAGEB, obtaining "rare chemicals" necessary for research. "Our latest work focussed on an enzyme that rejuvenates the sexual functions of males. We have also uncovered the process by which drugs such as Viagra work in the human body. This topic opened new horizons in scientific research. We are currently working in collaboration with Egyptian medical and pharmacological departments and some pharmaceutical companies to produce a nature-based Egyptian alternative to Viagra. The unit is also cooperating with Egyptian scientists living and working in the UK." Many parties are helping, besides: the Ministry of Communications and Information Technology, for example, has made a gift of high-speed Internet connections and modern computers to the unit. Nor is the work it produces limited to the medical establishment.
In the UBMB information booklet Abdel-Aziz hands me, I glimpse a recommendation to the Ministry of Health to add zinc to bread; the mineral, it says, has been proved to protect the liver against cirrhosis. Abdel-Aziz takes particular interest in hepatic diseases, which affect some 20 per cent of the population. Among the unit's achievements, too, is the discovery of a previously unknown type of leukaemia that is apparently confined to Egypt, as it results from an abnormal genetic malfunction not common abroad. The UBMB has also experimented successfully with the genetic treatment of animals with liver cancer. It is currently involved in research involving transplants not requiring the use of human organs, and its findings have been published in major scientific magazines abroad. Abdel-Aziz has asked Ali Abdel-Rahman, president of Cairo University, to help him form a scientific committee on stem cell studies. The committee is already functioning and has submitted proposals to the Academy of Scientific Research for the funding of various projects. It has also asked for permission from the Committee on Research Ethics to conduct research on the terminally ill.
Stem-cell research is the future, Abdel-Aziz says. The new technology addresses the root causes of an illness, not its symptoms. It also provides alternatives to organ transplants, especially the liver. Transplants are too expensive to address hepatic disease on the local scale; this is why Abdel-Aziz is interested in developing alternatives that are appropriate for wider use. And aside from various moral issues that surround its use, Abdel-Aziz says, genetic intervention is the only way to treat certain diseases. A few years ago, six scientists from his team spent time in the UK finding out about the latest discoveries in the field, including tissue implants. Genetic intervention, he adds, can help treat certain types of cancer as well as several complications of liver cirrhosis. Abdel-Aziz himself has done research on the creation of new blood vessels and his discoveries have been registered with the Academy of Scientific Research. His findings can be helpful in the treatment of heart disease and the complications of diabetes.
Recognition has not been as forthcoming as it might be. Still, Abdel-Aziz won several scientific awards, including the State Award for Medical Science in 1976, a State Medal First Class for Science and Arts, the State Award for Scientific innovation in 2000, and the Best Research Project Award by the International Society for Productive Medicine in 2005. Four of his team members won state awards for medical achievements. Although the number of patients in the country is rising, Abdel-Aziz notes that the general level of health is much better than before. This is mainly due to advances in scientific research, medical testing and the early detection of illnesses. "In the 1940s and 1950s, peasants in the countryside shared the same living space with their animals -- I saw this with my own eyes. Those peasants didn't have access to radio and television. Since then, things have changed. The media played a significant role in spreading health awareness."
At one point, Abdel-Aziz was hoping to become dean of the Faculty of Medicine but losing the elections put him on another track. "One night, the late Zaki Badr, then interior minister, visited me and told me to move beyond the confines of Qasr Al-Aini, to try to serve the public elsewhere." Abdel-Aziz took the advice. He successfully ran for membership of the Shura Council in Qalioubiya, winning the elections three times in a row starting in 1989. "Elected office gave me an opportunity to serve my people in more than one way. Before that, I could only help with medical expertise. Now I could help with education, sewerage, roads, etc. I formed a community-service society in my village. We started out with a capital of LE500 and now have LE2 million in assets." The building of this society cost about LE600,000, of which LE100,000 was a contribution from the state and the rest was made up of personal contributions.
As a politician, Abdel-Aziz bemoans the growth of Islamic fundamentalism in the country. "I don't know why and how the government let Islamic groups grow so much. Personally I cannot understand a slogan such as 'Islam is the solution'. What does this phrase mean? I believe that the Egyptian people are more politically aware than many others. But let's not forget that they are also very sentimental and quite susceptible to religion. I had my own encounter with Islamic groups and the Muslim Brotherhood. They are very well-organised and know how to implant their ideas in the heads of the young. When I was a teenager, a student in Quwesna, I actually joined an MB cell for a while..."
Is it hard to balance a medical career with the obligations of elected office? "My wife helped me a lot," Abdel-Aziz answers. "She took care of the children, raising them on traditional family values. She also saved while we were in America, making things much easier on our return. Although a graduate of the American University, she has never had a real job, preferring instead to dedicate herself to me and the children. This gave me the chance to work and excel in my career. She also played a major role in my political campaign for the Shura Council elections. She received members of my constituency and talked to them persuasively. And she's now an honorary president of many organisations in our constituency."
What worries him is the future. "Education is in trouble at all levels. It is not heading in the right direction, and it requires a complete revision. I am also concerned by lack of attachment to the country among the young, who feel alienated due to the spread unemployment. And I am worried by the way some people monopolise political power. I am not referring to the head of state. But I see people who are in charge of educating the young staying in office for too long. These people need to be replaced with younger ones, and so on..." But he will not give up.