Before his surgery and the placement of a hearing aide cochlear implant, the boy Salah, 6, had been deaf. On a desk in front of him, some random plastic toys are arrayed: a bus, a plastic apple, and a miniature aeroplane.
“Car,” his counsellor says. “Give me a car,” she repeats, with an enthusiasm and attention that hides the monotony and repetition of her task.
It takes the boy a few seconds to recognise the sounds around him. He appears lost, but after practice, he grabs the car.
“Here you are”, says Salah. He receives a high five and is proud of his success.
The child’s treatment is only the beginning of a long and consistent process, which will include exposure to different types of sensory and environmental stimuli, as well as basic speaking and concentration.
Treatment is provided free of charge at the Helm Tefl Center for Special Needs, which loosely translates to “the kids dream,” located in the rural village of Kafr Hakim in Giza.
“The ultimate goal for us is to give the child the ability to depend on himself/herself as much as we can,” said one of the doctors at the clinic, Banha Ali.
Salah is one of 160 children with either a mental and physical disability being treated at the Helm Tefl centre, which offers treatment to not only those within Kafr Hakeem, a town in the Giza district west of Cairo, which has a population of around 10,000, but also sixteen surrounding villages of approximate size.
“We find that it is widespread in all Egypt, but it widely appears in Kafr Hakim, especially in Helwan, due to the pollution in the air and in the water,” said the organisation’s director, Hassan Abas Ramadan.
“Particularly amongst children, the village has its share of health concerns. Physical impairments range from cerebral palsy and dyslexia, to speech impairment and Down syndrome. There are children with the inability to walk, hear, or go to the bathroom properly,” he explained.
“You can find this in every house in Egypt,” said Manel Ahmed, whose daughter is undergoing physical therapy and is unable to walk properly. She herself knows at least 20 or 30 people who also have disability problems with their children.
On the first day of the clinic’s opening back in March 2011, the founder of the Helm Tefl centre, Kamel Hammam Ahmed, who is from Kafr Hakim, made an announcement at a local mosque, soon after, 38 children were brought to the clinic. The number of patients increased exponentially. The next day, there were 150, then 170 on the third, and 200 on the fourth.
The assistance Helm Tefl offers comes in the form of physical therapy and motor skills development. There is also a psychological section and occupational therapy section. Doctors at the centre also provide medication, which many of the families would not otherwise be able to afford.
Ahmed and the staff are quick to note that the disabilities many of these children face have a lot to do with the poor government hospitals and subpar private medical centres located in the area.
Ahmed himself had been motivated to start the centre, during his time at Abou Reash hospital when he came across a child who could neither speak, or walk and who didn’t have the ability to drink water or go to the bathroom.
“She couldn’t keep in her excrements,” he continued. Upon asking the girl’s mother why, she said it was a type of brain damage.
Staffed by unlicensed doctors with fake certificates and lacking ventilators and incubators, many of these centres take advantage of the villagers’ situation and ignorance.
“Doctors allow for normal delivery to take place when a mother is supposed to have a caesarean,” said Ali, who also added: “a child shouldn’t remain in one of these centres for more than 24 hours because they lack licensed paediatric care.”
Many villagers visit these clinics because of the close proximity to where they live. “[The staff] make a lot of mistakes with delivering children,” said Helm Tefl’s head psychologist, Shimet Abdul Al-Koda. “So, the kids are born with disabilities.”
“Poor people believe what they say and they pay money with no results. After they take the money, the centres close without informing the community. There is no qualification. He might as well be a real estate agent,” Manel Ahmed said.
One can imagine gaining trust is paramount and Helm Tefl is careful to test the waters between staff and the local population. Much of the work Ali does breaks the ice between the patients and staff and “wins the child over”. He said: “You have to manage through tantrums, especially if the child is not familiar with the doctor.”
“I work on developing the full range of his/her abilities and try hard to do so efficiently so we can compensate the disease in other ways of adaptation.
“Still, one of the hardest parts of their work,” explained Abdul Al-Koda, “is dealing with patients who are ignorant towards certain health responsibilities needed to care for these children.”
Much of this goes back to the customs and traditions of rural Egypt and lack of awareness, which the centre is trying to rectify.
One of those customs and traditions is endogamy, which is the practice of marrying within the family through cousins, which often contributes to disabilities in children.
“Relative marriage here is very common, and sometimes seen as a necessity,” said Ali.
The centre is trying to spread knowledge about the health issues that surround relative marriage so the family can be aware that the practice should be avoided due to its relevant health hazards. Sometimes, particularly with medical tests, many families take the advice of the clinic. Even still sometimes, the families say “if they will be married, they will be married” said Manel Ahmed.
Although the centre is often flooded with patients and hosts a lengthy waiting list of 600, many parents are hesitant to even bring their child in for regular checkups.
“It might be strange to an outsider,” explained Manel Ahmed, “but amongst the villagers there can be a taboo to admitting a physical handicap.” She stressed: “There is even more of a social stigma for those who have mental handicaps whose parents tend to bring them in less frequently.”
“They are afraid of people talking about their child,” noted Manel Ahmed.
Even as they instruct families and instruct them on the steps of proper healthy behaviour, the staff at Helf Tefl are not too quick to preach.
“We don’t attack them” said Abdul Al-Koda, who also added that they speak to them in a simple language they can understand. “No one wants to admit their kid is sick.”
One thing that they make sure to do when introducing their programmes and gaining parents trust is to take them on a walkthrough of the facility. By letting the parents see they are not alone in facing a common problem, they too can confront the issues of shame and embarrassment and look on with joy when seeing a father talking about improvement in their children from the village.
“We support and listen to them carefully, and we try to calm them down by telling them we’re going to solve this problem with you,” said Abdul Al-Koda.
When asked why she wasn’t afraid, Manel Ahmed replied: “Allah is the best healer. If your kid is sick it is better to get help.”