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Egypt, officially the Arab Republic of Egypt, is a country in North Africa famous for its ancient civilization and some of the world’s most famous monuments, including the Giza pyramids and Great Sphinx. With nearly 75 million inhabitants, Egypt is one of the most populous countries in Africa and the Middle East. Most of the population lives near the banks of the Nile River, in an area of about 40,000 square kilometers (15,000 sq mi), where lush and fertile agricultural land is found. The large areas of the Sahara Desert are sparsely inhabited. About half of Egypt’s residents live in urban areas, with the majority spread across the densely-populated centers of greater Cairo (Africa’s largest city), Alexandria, and other cities in the Nile Delta. At 1,001,450 square kilometers (386,660 sq mi),Egypt is the world's 38th-largest country and is more than half the size of the US state of Alaska. Rich in culture, Egypt has more than 5,000 years of recorded history and boasts an enormous array of ancient and modern architecture and artwork. Egypt's economy depends mainly on agriculture, media, petroleum exports and tourism.
The Kybele Team Arrives
On April, 2 - 12, 2008, 13 members of the Kybele medical team made their first official visit to Egypt. The team included: Terrence Allen (Blackpool Victoria Hospital, UK), Sabri Barsoum (Hillcrest Hospital, Cleveland, USA), Ferne Braveman (Yale School of Medicine, USA), Adel Bishai (Hillcrest Hospital, Cleveland, USA), Vicki Clark (Royal Infirmary, Scotland), Ken Cummings (Cleveland Clinic, USA), Ron George (IWK Health Centre, Canada), Ashraf Habib (Duke Medical Center, USA), Ali Kamani (BC Women’s Hospital, Vancouver, BC), David Levy (Queen’s Medical Center, UK), Sashi Ratnasabapathy (Royal London Hospital, UK), Susan Kay Stein (Brattleboro Memorial Hospital, VT, USA), and Nader Helmi (Cleveland Clinic, USA). Drs. Habib and Barsoum served as trip coordinators. The group spent several wonderful days sightseeing in and around Cairo gaining an appreciation of the local culture and becoming acquainted as a team. On April 5-6, Kybele members lectured at a special “Obstetric Anesthesia” symposium in conjunction with the Egyptian Society of Anesthesiology. Following the meeting the team split into three groups with two staying near Cairo and the third traveling to Ismailia.  
The Egyptian Society of Anesthesiology Meeting
The lectures were very well attended and stimulated a lot of interest and discussion. Topics included: labor epidural analgesia, team work on the labor ward, anesthetic implications for pre-eclampsia, the pregnant cardiac patient, major obstetric hemorrhage, what is new in obstetric anesthesia, ASA guidelines for the practice of obstetric anesthesia, regional anesthesia for cesarean section and post-dural puncture headache.
There were many positive comments following the symposium, including one from Dr. Mohamed Abd El Raouf Nasr, Professor of Pain and Anesthesia, Cairo, University, “I would like to thank you for the great effort done by all of the team. The obstetric day (Sunday, April 6, 2008) was really a beautiful day in the conference and it was full of scientific and educational contents that added to the attendants a lot.”
“Team Cairo”
Cairo boasts 2 of the most prominent university hospital systems in the region, Kasr Al Eini and Ain Shams. The obstetric units are very busy with delivery rates of more than 18,000 per year. The use of spinal anesthesia for cesarean section has been increasing over the last several years due to the recognized mortality and morbidity associated with general anesthesia. Labor epidural analgesia is uncommon in the large government hospitals, but it is performed to various degrees in smaller private hospitals. Nine members of the Kybele team spent three days observing and working in the clinical areas of these large hospitals. Lecture sessions were conducted and techniques were demonstrated including the use of small pencil point needles for cesarean section and labor epidural analgesia. It was a tremendous experience for the team to learn about the issues in such busy maternity hospitals. The Kybele team was very impressed with the hard work that everyone put in to running such busy units with so many high risk patients.
Dr. Susan Stein shared, “I thoroughly enjoyed my visit to Cairo and can not express in words how much I appreciated the hospitality shown to us. Not only was I able to impart some of my knowledge, but I felt the experience was equally enriching for me. A special thanks to Drs. Habib and Barsoum for their leadership and planning as well as the entire team of wonderful and inspiring colleagues and new friends. Finally, Dr. Nesrine Refai, thank you for everything, not in the least your smile.”
“Team Ismalia”
With approximately 1 million people, the small city of Ismailia lies at a very strategic spot along the Suez Canal, midway between the Mediterranean and the Gulf of Suez, the entrance to the Red Sea. Four members of the Kybele team visited Ismalia General Hospital (IGH), one of two large government owned and operated health care centers in the city (the other is the University of Suez Canal). Opened in 2004, IGH is a well equipped facility occupying an area of 17 acres. The Anesthesia Department at IGH has been a pioneer in the country in the use of regional anesthesia for cesarean section. The Department of Obstetrics and Gynecology at IGH is one of the largest and best staffed departments in the entire Hospital, if not the city. The current Chief of Staff of the hospital is the previous chairman of the OB/GYN department.
The Kybele team of 4 anesthesiologists conducted a successful workshop between both the OB/GYN and the Anesthesia Department. The team was humbled by the extent of the warm welcome received at IGH. It was clear that much preparation and work had gone into setting up the workshop. From banners all over the hospital corridors to an official welcome session including a guided tour of the hospital, there was a clear atmosphere of excitement and anticipation of the group’s visit. Following brief talks and introductions, the media was brought in to provide coverage on the local TV station for this important event.
Daily lectures were followed by assigned groups comprised of one Kybele team member with one or two staff anesthesiologists and at least two junior residents. The work consisted of scheduled Cesarean sections and normal vaginal deliveries, when available. Kybele members provided discussions and advice related to protocols and basic standards of care. On the last day, an hour long open forum for feedback and mutual recommendations was conducted. By weeks end, the team took care of approximately 40 patients, the majority having Caesarian Sections. The highlight of the team’s visit was meeting with the Governor of Ismailia for a special dinner. There was extensive media coverage from the local TV channel clearly demonstrating the city’s interest in establishing this hospital to be a role model in the area of health care.
Comments following the program
“Many thanks for your wonderful performance, continuous teaching effort, encouragement and support for us in Egypt. I really enjoyed working with you. We are all looking forward to meeting you again and benefit from your knowledge and experience.” Nesrine El-Refai, Assistant Professor, Cairo University
“I would like to take the opportunity to thank you deeply for allowing me the privilege and the honor to represent Kybele on this historic mission to the different hospitals in Egypt. It has been an honor to work side by side with such a variety of excellent clinicians from all over the world and be involved in this remarkable opportunity.” Adel Bishai, staff anesthesiologist, Cleveland Clinic
The Kybele team is very grateful to Dr. Yehia Khater, president of the Egyptian Society of Anesthesiologists; Dr. Nesrine El-Refai, Dr. Bahaa Ewais, Dr. Nazeih Refaat and Dr. Magdy Ghattas (our hosts) for their hospitality and hard work in organizing this program.
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