At the Cairo University branch at Qasr Al-Eini a group of medical students had set up a table with pamphlets and literature to raise HIV/AIDS awareness. The students were from the Student Scientific Society (SSS), an international student organisation whose mission is to offer future physicians a comprehensive introduction to global health issues.
Hisham Mohamed Said, one of the coordinators, had already rehearsed an activity that had been used around the world to incorporate a personal reaction to open a dialogue concerning tolerance of people with HIV/AIDS.
A curious student approached the table, and after a brief introduction of hellos, Said told the young man “One of us has HIV, would you still be interested in shaking hands with us?”
Disconcerted, the student immediately took a step back, turned around, and sprinted. Surprised and maybe a little shocked at the response, Said said: “Oh my God, it’s not like he has Ebola.”
Though the student’s reaction had been extreme, such strong responses have been common when talking about issues related to reproductive health in Egypt.
HIV/AIDS, sexually transmitted diseases, erectile dysfunction, masturbation, Female Genital Mutilation (FGM), virginity, puberty, changes in body organs, love/relationships, awkward adolescence, child marriage, use of contraceptives, abstinence and intimate relationships, all are issues tackled regularly by health specialists under the umbrella of reproductive health.
“People don’t like to learn about certain words like sex or sexuality but words like reproductive health are more palatable,” Ahmed Malah, the Youth Programme Officer for the United Nations Population Fund (UNFPA) in Egypt, when speaking of typical attitudes in Egypt.
According to educators, the lack of education and a deeply conservative society have all contributed to a general ignorance towards sexual health and have hindered attempts at raising awareness.
Nourane Aref Khoweiled, a medical student at Qasr Al-Einiand SSS coordinator, said if the information is presented in class it is usually glossed over quickly.
“We get education from friends and porn sites, and all of these sources aren’t correct ,” said Moustafa Sheik, a counsellor trainer for YPEER, a network of NGOs working to increase awareness of reproductive health among youth.
Questions confronting peer educators have been varied. Among the most common questions were: Will masturbation affect my sexual performance? Will it make me go blind? Will I lose my sperm? How do I know if my fiancé is really a virgin? I rode a horse, am I still a virgin? I missed my period is something wrong? I have an unusually amount of fluid discharged is something wrong? What should I do on my wedding night? Is what I’m doing haram [forbidden by religion]?
Though the discussion has not been easy in Egypt’s highly conservative society, creative methods to spread knowledge and education has been as varied as the questions themselves.
The SSS found meandering around the stigma of HIV, which can be associated with homosexuality or “playful behaviour”, can be as simple as making a comparison to hepatitis C “or any other blood born disease” said Said.
“We have to frame our stance in a cultural context,” added Malah, who mentioned that teaching reproduction health can be as much about the delivery of knowledge as about presenting factual information.
Theatre games and workshops have been an integral tool of YPEER and UNFPA. The performances have included themes, such as girls’ lack of education opportunities, unrequited love due to economic issues, and harassment.
Theatre scenarios have revolved around young girls dealing with the fate of circumcision and characters realising what it is to live with HIV.
In one particular skit presented in a quick pace, a man in drag portrays a female life, from being a toddler to growing elderly. There is even a scene where the actor gave birth to a child, which Malah mentioned with a chuckle.
“Interactive theatre games engage young people to talk about their experiences. They become more comfortable,” Malah added, saying that theatre plays a big role in changing attitudes, and offers live experiences to give an outside perspective.
The performances often involve of a role play between audience and actors with an open ending for discussion, helping the audience to view different issues with different attitudes and opinions.
How would you do in this situation? Does the girl have a right to go to school? How would you live with HIV? The audience are then confronted with such questions after the performances or workshops.
“What you’re trying to do is influence them to have more healthy practices,” Malah says by provoking to have a dialogue.
Mona Mohamed Nada, an YPEER coordinator and medical student, said: “It’s easy to forget a lecture. We are doing energising plays and dances. We do things between sessions. We do media skits. We don’t just give them information. We share our experiences. We make it fun”.
Though all those disseminating information came from such diverse backgrounds as student activists, to doctors, to online web coordinators, and United Nations health specialists, they all emphasised an attitude of non judgment.
“We don’t tell them not to do this or that. We tell the information in a simple easy way. We have confident resources from the World Health Organisation”, said Nada.
Khoweiled mentioned cases in Egypt of doctors breaking medical ethics, “doctors cannot refuse to treat or report the case without the consent of the patient” she said. She mentioned one particular case where a patient died of appendicitis with complications that resulted from HIV, because a doctor refused to treat her.
Hassan Shoier, another medical student with SSS, said: “It is not the doctors duty to judge. We just have to make them feel better.”
Still Nada added the act of talking about reproductive health, even with a medical professional, can be a cause for embarrassment.
Enter Ma3looma, where anonymity for those with reproductive health questions is guaranteed, and the identities of doctors and medical professionals answering health inquiries is undisclosed.
Ma3looma, whose name means “information” utilises information technology, mobile phone SMS messages, clever YouTube videos animations and various social media outlets to raise awareness amongst reproductive health in Egypt.
The organisation, which was a project by One World UK in conjunction with the UNFPA, made a serious attempt to understand the cultural needs of the society they were serving, careful wording is chosen and shocking language is avoided. Instead of saying sex, the organisation uses the term intimate relationships. The organisation also directs their outreach more to those less aware of health issues than the open minded crowd.
With the use of safe language, an ensured privacy policy, and cultural sensitivity the response has been overwhelmingly positive with over 700,000 likes on their Facebook page, though many fans are hesitant even to click the like button for fear of their friends seeing. Coordinators were even surprised that beneficiaries were posting prayers and mentioned that a religious leader had even shared one of their videos. A fan even mentioned that they had saved his marriage.
At an auditorium presentation at a university in Cairo, Khoweiled and several other members of the SSS had prepared a lengthy and informative presentation on the dangers of Female Genital Mutilation (FGM), the surgical practice of partial or total removal of the external female genitalia.
Khwelied mentioned that engagement was an effort to combat the medicalisation of FGM. Though the practice was outlawed in 2008, the procedure still continues with many doctors undertaking the surgery under a false sense of belief or for a cash incentive.
In 2008, the Demographic and Health Survey, estimated that 91% of Egyptian women between the ages of 15 and 49 had been circumcised, with the practice occurring mainly in rural and low economic areas.
The presentation had met with a positive reaction, but as she had finished a young woman approached her and said she had gotten circumcised as a child and as Khowelied can see, she wasn’t suffering.
“You can’t teach them comprehensive sexual reproductive health for everyone without tacking the root cause which is gender norms,” said Malah.
Though on the decrease, the practice continues in many communities out of a traditional belief in protecting the girl’s virtue, decreasing her sexual desire, and a satisfaction “in a society always seeking virtues to satisfy their ego of being pure”, said Shoeir.
As well as funding and implementing programmes to combat FGM, YPEER and the UNFPA have worked with religious entities who have influence over traditional communities. Malah mentioned that religious institutions like Al-Azhar prohibits FGM.
“There is no contradiction between science and religion,” Nada added.
Members of the communities are recruited to spread knowledge which is shared with them concerning the repercussions of FGM.
And though she maintains an acute attitude of non judgment when delivering health information to the community, on a personal note she added “If anyone does this to a child, they be should be punished. Doctors should know better than this” said Nada.
Mohamed Essam the networking and partnership officer in YPEER Egypt said: “We are facing wrong beliefs from lack of information. Young people have questions without answers and in YPEER we are training the young to deliver the right information. The right information doesn’t conflict with taboos in societies – wrong beliefs do.”