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September 7, 2004
Salam lends hand to Egyptian medicine

Lailee Mendelson is communications coordinator for the Office of International Affairs.

(Editor’s note: This begins a series of columns by the Office of International Affairs highlighting faculty members’ international work.)

In 2001, the Egyptian government awarded vascular surgeon (and Emory medical professor) Atef Salam the Shield of Medicine for being one of the 10 most outstanding Egyptian doctors in the world. The award recognized Salam’s contributions to advancing medicine in his native country, where for more than 30 years he has returned annually to perform charity surgery and train Egyptian physicians in the latest surgical techniques.

Salam’s lifetime mission to improve Egyptian medicine took root in the mid-1960s. A junior faculty member at Cairo University’s medical school at the time, he found himself treating peasants and poor farmers who worked in fields along the Nile. They had developed liver cirrhosis, a complication caused by an endemic parasite contracted from the river.

“I was doing the traditional operation on them, and we were correcting the problem, but the side effects of this operation were too much to accept,” Salam said of effects that included tremors and forgetfulness. “If you’re not 100 percent, you cannot work in the fields. There was no welfare, so these people would just shrivel and die.”

Salam wrote to a doctor in Miami (Dean Warren, former chair of surgery at Emory) who he had heard struggled with similar issues. Thus began Salam’s journey to the United States, where the two collaborated and developed a new operation for cirrhosis that avoided the debilitating complications. In 1971, Salam followed Warren to Emory, where he has worked since.

“It became my mission,” Salam said, “to introduce this new technique to doctors around the world.”

That same year, following Egyptian president Abdul Nasser’s death, Salam returned to Egypt for the first time after several years of exile (his move to the West in the 1960s had branded him a deserter in Nasser’s highly nationalistic government) and was saddened by what he found: a medical system deteriorating from state rejection of anything considered a vestige of Western imperialism, which included the British-built medical centers in which Salam had been trained.

“When I left Egypt in 1965, the level of medicine in Egypt was pretty good,” Salam said. “But after that, three things happened simultaneously that were very damaging. One was the nationalistic sentiment. Second, technology exploded. So there was a movement toward isolationism while the world was changing, and Egypt was left out.

“Third,” he continued, “the population exploded. Modern medicine became technologically driven and expensive, and the ‘haves’ in Egypt got good treatment, but they are a minority. The poor and the middle class could not afford modern medicine. And this is a major socioeconomic and political problem, much more so than in the United States.”

Salam traveled several times a year to academic centers in Egypt, Kuwait, Saudi Arabia and Mexico to train medical teams to perform his new operation. Since then, his service to Egypt has extended to several other activities, including bringing promising young Egyptian surgeons to spend two years researching and training with him at Emory; organizing an annual international surgical meeting in Cairo with 600–1,000 participants from the Middle East and Mediterranean; and writing the first book in Arabic on vascular surgery.

He also is consulting with the Egyptian government on plans to construct several modern hospitals.
But one of Salam’s most rewarding activities remains the two weeks each year he spends performing vascular surgery pro bono in Egypt, something he has done for the past decade.

“During those two weeks, I perform surgery from seven in the morning to seven in the evening. There is so much to do,” he said. “There is no money changing hands. There is no trail of paperwork, no insurance companies, no lawyers. Just a doctor helping a patient. Sometimes wives bring me meals they have prepared themselves in appreciation for helping their families. It is very touching. It reminds me of the way medicine used to be.”

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