Doctor and women’s rights activist Omnia Sweidan likely never imagined the scale of the reaction that would follow the testimony she posted on Facebook Monday detailing a series of abusive incidents faced by women in the obstetrics and gynaecology ward at Alexandria’s Al-Shatby Hospital. The post went viral within hours. Tens of thousands of people shared and commented on it. Many said the abuses she recounted reflect a common and pervasive reality in public hospitals. Others were shocked by the brutality she described. Twenty-four hours after posting, Sweidan was arrested from her home in Damanhour, Beheira Governorate. She was forcibly disappeared overnight. Sweidan’s arrest only added fuel to the fire. The controversy intensified, particularly in the absence of a response from medical or state authorities to investigate the incidents she described or the growing number of similar testimonies that have surfaced or resurfaced in response to hers. The sole exception was a single statement issued by Alexandria University, which said it would be “following up on what has been raised with the utmost seriousness and responsibility” to try and “verify” the reported incidents. Should the claims remain unsubstantiated, however, the university reserves the right to refer the matter “to the relevant authorities” in the interest of preserving “the reputation of this prestigious institution,” the statement read. The university is yet to comment on the results of its own investigation. But when Sweidan was brought before prosecutors in eastern Alexandria on Wednesday morning, it emerged that a lawyer representing Alexandria University’s hospitals had already submitted a complaint against her to the Public Prosecution, according to lawyer Mohamed Ramadan. After attending the hours-long interrogation sessions with her, Ramadan said in a statement on Wednesday evening that Sweidan had been released on LE20,000 bail after being questioned on charges of publishing false news and misusing social media. A series of deflationary news reports claimed that Sweidan’s answers during questioning had cast doubt on the veracity of the incidents she had described online. But the university’s litigation threat does nothing to stem the torrent of similar testimonies and recollections that have been published and republished by social media users and by women’s advocacy organizations this week, echoing the routine and dehumanizing abuse Sweidan’s frank testimony unmasked. The growing body of testimony belies any attempt to cast the incidents as isolated “bad apple” cases, pointing instead to systemic negligence in public sector hospitals, especially in obstetrics and gynecological wards, and to normalized and routine violence against women, ranging from verbal abuse to physical and sexual assault. The accounts describe women’s symptoms being ignored, minimized, dismissed or ridiculed. They detail fatal admission delays in cases that require urgent care and instances where women were asked probing questions about their marital status and personal lives as a prerequisite for treatment. And for the healthcare providers and health advocates who spoke to Mada Masr, these types of incidents are not unfamiliar. What Sweidan described is “something we’ve all heard about,” says Mahmoud Fouad, the head of the Right to Medicine Foundation. This is partly due to a severe shortage of doctors and nursing staff in the public health sector, especially in labor wards, Fouad and other healthcare professionals and advocates tell Mada Masr. They explain that this strain and pressure on capacity, paired with the awareness that women who give birth at government and university hospitals often lack the means to pursue alternatives or press for accountability, creates an institutional culture that allows, and even normalizes, a standard of care that is rushed and minimal at best, and abusive and dangerous at worst, particularly for women in their most critical and vulnerable medical states. Though there is a corps of professionals in the public healthcare system who push for and deliver better standards of care, a more comprehensive change would be required to address these systemic issues. However, despite acknowledging existing issues, the health officials who spoke to Mada Masr had little to offer in the way of remedies. Instead, one suggested that, without a serious change, these practices and the growing conversation around their painful and often fatal consequences threaten to stoke public distrust in the medical establishment. *** Mohamed Hassan Khalil, the founder and chair of the Committee for the Defense of the People’s Right to Health, told Mada Masr that he personally witnessed such behavior during his time as a medical intern. He recalled observing an obstetrician in a natural delivery ward treating a woman who was screaming in pain and responding with shouting and cursing. Reproductive health researcher Nana Abouelsoud agrees that this type of mistreatment is widespread in public hospitals. “There is nothing fantastical about what Omnia wrote,” she says. “It matches the things I’ve heard from doctors engaged in reproductive rights and reproductive health in Egypt. Whenever I asked what first drew these physicians to reproductive rights advocacy, the answer was always what they’ve witnessed in delivery rooms, and what women — and patients more broadly, but especially women — are subjected to in public hospitals. Because when women express pain or cry, they are mocked and treated violently.” Fouad adds that across hospitals, these types of complaints about maternity wards exist. The knowledge that the abuses take place does not mean that anything is done to remedy them. For both Fouad and Khalil, part of the problem is a prevailing set of attitudes toward women, and especially lower-income women seeking care in the public healthcare system, that permit this kind of mistreatment. Complaints are often “silenced,” says Fouad, because they typically involve women who are economically disadvantaged. Khalil attributes this to the assumption that women who seek care at free public hospitals often lack the means to challenge the way they are treated. “You came here to give birth in a free public hospital. You have no rights. You’re poor and powerless, so suck it up,” he says, describing the mindset of medical professionals responding to these patients. The advocates and doctors also note that, amid low capacity in public health wards, labor and obstetric care tends to get pushed to the bottom of the pile. An OB-GYN who trained at a public hospital says there is a shortage of doctors relative to the volume of births. “Naturally, the less experienced physicians tend to [end up] assisting women during natural childbirth, while those with more experience perform more complex gynecological procedures, such as hysterectomies,” they say. “These doctors and residents don’t have extensive experience, and we also lack a midwifery system to support women through natural childbirth.” Abouelsoud points to an exacerbating problem in the public healthcare system: the low salaries paid to doctors in public and university hospitals. While this may help explain the lack of patience and declining quality of care across the system, she said the issue becomes particularly visible in pregnancy and childbirth services because women need extended care, which public sector hospitals struggle to accommodate. The result of these factors is immense pressure on medical staff and limited time to manage deliveries properly. It is under these pressures, the OB-GYN acknowledged, that doctors do sometimes shout at women in labor. But they, along with Ayman Salem, a member of the Doctors Syndicate board, insist that this is an almost intentional form of bedside manner, a clinical attitude adopted “in the mother’s interest,” as the obstetrician put it. A doctor raising their voice in certain situations may be intended to reassure the patient, Salem adds. But many of the testimonies shared online describe the experience of being shouted at or verbally demeaned as dehumanizing and traumatic, denting their trust in medical staff and making them less likely to clearly signal pain or communicate symptoms mid-childbirth. For example, one woman, who shared her testimony with the Speak Up platform, describes being reprimanded and belittled by a doctor when she presented with early contractions over a week before her scheduled C-section. The doctor ridiculed her appearance and downplayed her condition because she was wearing make-up, she recalls. She only received medical attention when she was already half way through labor, she writes, saying she ended up with a major wound that could perhaps have been avoided “if the doctor did his job instead of ridiculing me.” And given the normalization of this approach toward women in labor or seeking obstetric and gynecological care, there is little political will for change. Alaa Ghannam, the Right to Health Program director at the Egyptian Initiative for Personal Rights, says that strengthening governance within the healthcare system is the essential starting point for addressing such crises. “What’s happening now is a farce,” he tells Mada Masr. Ghannam called for the implementation of ministerial decree 470, which provides for the establishment of patient rights committees in all hospitals. These committees, he said, should include community representatives and be tasked with monitoring both the quality of care and service standards, noting that respect for patient rights is among the most important indicators of a healthcare system’s performance. However, he stresses that implementing such a big organizational shift would require genuine political will. And based on comments from some of the health officials who spoke to Mada Masr in the wake of Sweidan’s testimony, the will to change is not there. Speaking to Mada Masr on condition of anonymity, one deputy health minister says the testimony in its entirety “hurt the feelings of Egyptians and doctors,” categorically denying the “existence of any form of obstetric violence in Egypt” and criticizing instead the language used by Sweidan, which they say is “unbecoming of the medical community.” House Health Committee Deputy Chair Magdy Morshed acknowledges that the incidents described in the testimony are “maybe” and “most likely” true and do occur. But the MP was nevertheless critical of Sweidan for speaking out about the issue, warning that it could undermine confidence in the healthcare system as a whole. The controversy comes at a time when public faith in the Egyptian medical establishment is already being eroded, with officials expressing alarm at the rise in popularity of alternative medicine and health regimens, such as recently deceased Doctor Diaa al-Awady’s controversial Tayyebat diet. Morshed fears that many women would begin to refuse treatment from male obstetricians and gynecologists and that husbands would forbid their wives from seeking healthcare. “We’re heading into a hell of a crisis,” he tells Mada Masr. Yet the anger and concern around Sweidan’s arrest — with over 20,000 engagements with Mada Masr’s news on the incident alone and hundreds of thousands more across the internet — shows that concealing the problem or refusing to speak about it is not good enough. Maybe the Alexandria University hospital’s intervention to silence Sweidan does something to reassure its management’s confidence in its legal standing and restore the reputation for which it expressed concern in its statement responding to her testimony. But a lack of political will to take serious steps toward change of the kind that Ghannam recommends risks a loss of faith in the public health sector that will take much more than an arrest or two to restore.The post The care that’s missing from Egypt’s maternity wards first appeared on Mada Masr.
