Cessation service centers in Egypt
By Wael Safwat
Global Bridges is supporting several healthcare experts in Egypt and the EMR through King Hussein Cancer Center, among which Dr. Wael Safwat was included in different meetings and workshops in Egypt, Jordan and at the Mayo Clinic.
After receiving primary training in EMR Global Bridges meetings and online national smoking cessation training in the UK, Dr. Wael has been certified as a smoking cessation specialist through the Mayo Clinic Nicotine Dependence Center and has begun managing services in Sehaty clinics in Egypt. He has also been nominated to be the international committee chair of ATTUD and program coordinator of the Egyptian coalition of tobacco control.
Dr. Wael has established Sehaty smoking cessation service, which is provided in four clinics in different parts of Cairo, Egypt. The service consists of a smoking cessation unit in one of the big military hospitals, and a smoking cessation clinic in a cardiac rehabilitation center, in addition to two clinics in two small wellbeing centers in Cairo.
The service includes advocacy activities through the coalition of tobacco control in Egypt, which is coordinated by Dr. Wael. It aims to raise public awareness through the production of different communication materials, audiovisuals, training of healthcare providers in different medical conferences and participating in collaboration with medical associations. Advocacy efforts also include networking and collaboration with different clinics providing smoking cessation service, specialists working on smoking cessation and centers providing the service all over Egypt and the national quitline. The advocacy also includes collaborating on NCDs with medical associations working on DM, Respiratory problems, cardiovascular and cancer. One of the advocacy plans is to help the implementation of smoke-free hospitals and workplaces.
Tobacco control in Egypt is progressing in different aspects and MPOWER strategies are partially implemented through raising taxes, placing health warnings on tobacco products and bans on direct advertisement. However the “offer help” strategy is not well implemented and cessation services are very limited except for running of national help line, developing tobacco dependence treatment guidelines and very few clinics operating all over the country. Tobacco treatment is not widely available and there is no national system for providing help in healthcare facilities and training healthcare providers.
The smoking cessation unit of Wadi elneel (National defense military) hospital provides the service through a team of four physicians which include two psychiatry consultants and one pulmonology consultant beside Dr. Wael as the smoking cessation specialist and program coordinator of the unit. The service is provided two days per week for outpatient visits and on-call for in patient consultations. Bupropion and Varenicline are available in the pharmacy of the hospital, but NRT is not available, as it is not yet a registered medication in the Egyptian market. However, people can still purchase it from pharmacies outside the hospital being an imported medication.
The smoking cessation unit is collaborating with other departments inside the hospital and a transfer system is implemented between the cardiology, pulmonology, oncology and gynecology and obstetrics departments. Most of the smokers in those departments are provided brief advice through physicians or nurses as well as self-help material on smoking hazards and smoking cessation program in the clinic. The smokers are advised to consult the smoking cessation clinic where trained nurses can provide additional information about the program, examine vital signs and provide minimal intervention in the form of CO analysis and behavioral support to increase motivation for quitting. Smokers who are ready to quit meet the smoking cessation specialist who assesses the situation and provides behavioral counseling, then may recommend suitable medication. In some cases, the smoking cessation specialist seeks consultation of the psychiatrist or the pulmonologists in cases of drug addiction, mental illness or COPD. Clinic follow up is conducted through nurses and the smoking cessation specialist where the first follow up visit or phone call is after one week, twice during the first month, once during the successive three months, then after six months and one year if needed.
Follow up of cases for one year showed that consultations are with men more than women (76 to 24 %.) 67% are over 40 and middle aged and youth were 22 and 11%, respectively.
Programs and protocols used in the unit were adapted from different sources and have been incorporated revising cultural variations. Equipment for physical examination and carboximetry are available, and objectives tool of addiction and psychological assessment are prepared. The success rate is almost 23 percent at Wadi elneel hospital and 17 to 21% in the other three clinics.
- Offering an unprecedented service in the field of smoking cessation.
- Collaborating with similar projects to maximize benefit and spread awareness.
- Serve the statistical research concerned with smoking cessation.
- Provide capacity building and training for different levels of healthcare providers.
- Comprehensive advertising campaigns; aiming at raising awareness.
- Sufficient pharmacological supplies to meet the needs of underprivileged clients.