Visiting scholarship recipient describes a revolution

Amgad Haleem, MD, an orthopaedic surgeon in Cairo, was planning to travel to California in January to attend the annual meeting of the Orthopaedic Research Society, which had accepted two of his abstracts. But a stunning uprising in his home country meant he had to cancel his trip.

As his countrymen protested against long-time president Hosni Mubarak, Dr. Haleem found that his surgical talents were needed for treating those injured in the demonstrations. He and his colleagues at the Cairo University hospitals volunteered for duty during the most intense protests. All 15 orthopaedic surgical theaters at the hospital were put to use, and Dr. Haleem says the physicians saw “gunshots, lots and lots of gunshot wounds,” along with many lower limb fractures.

Dr. Haleem recounted the events of the historic democratic Egyptian revolution—which culminated in the ouster of President Mubarak and a vote on reforming the nation’s constitution—during a visit to the Academy’s headquarters in Rosemont, Ill. As the 2011 recipient of the AAOS–Stetson Powell Orthopedics and Sports Medicine Scholarship, he was attending a team-training surgical skills course at the Orthopaedic Learning Center.

The scholarship is sponsored by the Stetson Powell orthopaedic practice in Burbank, Calif., named after William B. Stetson, MD, and Scott E. Powell, MD. After finishing the course at the Learning Center, Dr. Haleem travelled to Burbank to study under the guidance of Drs. Stetson and Powell for several days.

Dr. Haleem said the mood in Egypt has been transformed from one of grim resignation and repression to jubilation and optimism. He said the turning point came when the December 2010 parliamentary elections were held and people sensed that Mr. Mubarak’s son would take over as head of the regime, a prospect that ignited mass anger.

“That was the straw that broke the camel’s back,” Dr. Haleem said. “Personally, I said if he is going to take over, I am going to leave the country.”

Instead, the Mubaraks were ushered out, changes in the constitution were overwhelmingly approved in an open election in March, and for now Egypt operates as a republic under military rule until parliamentary and presidential elections take place later this year.

Indeed, Dr. Haleem said, the military played a key role in preventing the government from brutally crushing the revolution, acting as a broker between the people and the government and maintaining some sense of order at the massive gatherings at Tahrir Square in Cairo.

“It was amazing,” he said. “It was a very civilized action from the standpoint of the people. We had casualties, but if it weren’t for the army, the casualties would have been in the thousands. It was a blessing.”

He smiled as he reflected on what has happened in his country. “In the election for the constitutional reform, the voting numbers were amazing,” he said. “I voted for the first time. It didn’t make any difference before. I had never experienced my political rights before. Something like 50 percent of people cast ballots, whereas before the numbers were like 3 or 4 percent. Once people are politically aware and know that their votes do count, progress can be made.”

Now, he said, Egypt must tackle social and economic challenges. “There is a very high mood of hope among all of us,” he said. “Still you need to change the culture of the country and educate the illiterate.”

Dr. Haleem, who is an associate lecturer at the Cairo University, performs a variety of procedures in his daily hospital practice, but he plans to focus on sports medicine after he completes his PhD and a fellowship in the United States. In Egypt, aspiring physicians enter the track to medical school after high school and complete a 7-year program. Dr. Haleem served a 1-year internship and a 3-year residency, although now the total residency term is 6 years.

In a typical week, Dr. Haleem sees patients both from the Cairo University hospital and in his germinating private practice. “As junior faculty, I see all sorts of patients, so I treat whatever comes. This is typical for younger surgeons trying to build careers. As time passes, you gradually shift into becoming more specialized.”

Sports injuries that he commonly sees include anterior cruciate ligament tears, knee cartilage defects, and shoulder problems, especially in basketball players; Dr. Haleem is the team physician for Egypt’s top basketball team, Al-Ahly Club, which won the 2011 National Basketball Cup of Egypt.

Healthcare in Egypt is government-sponsored but funding is insufficient, and patients in need of joint replacement or other expensive procedures may be undertreated. Patients who can afford a form of private insurance may end up paying about two thirds of the cost of a procedure.

Dr. Haleem has a keen interest in research and has twice spent time in the United States completing research fellowships. At the University of North Carolina–Charlotte, he studied orthopaedic bioceramics and biomaterials. Later he spent 18 months at the University of Pittsburgh, in the Cartilage Restoration Center. There, under the guidance of Constance R. Chu, MD, he studied mesenchymal stem cells in the treatment of cartilage injuries and coordinated research in equine models.

Asked about differences he noted about orthopaedic surgery in the United States versus Egypt, Dr. Haleem named the wide availability of implants here, as well as how the U.S. system operated. “The level of research dazzled me,” he said. “The amount of data for retrospective and prospective studies, the gathering of it all—the U.S. system is very well organized. We are trying to establish that. At Cairo University, each surgeon is doing his own data.

“I was also struck by the approach to diagnosis and treatment. In the United States, you go by steps from A to Z with a systematic way of thinking.”

Before Dr. Haleem pursues his fellowship, he will have to yield to the educational progress of his wife, a geriatric physician. This summer, she will begin a 3-year residency at St. Francis Hospital in Chicago, while he remains in Cairo to complete his PhD and take his orthopaedic board examinations.

He will continue to celebrate the changes in Egypt and looks forward to more improvements. “I think there will be a dramatic change,” he said. “Mostly we have sailed very smoothly through these events. We have passed the tough times.”

Terry Stanton is senior science writer for AAOS Now. He can be reached at tstanton@aaos.org