Fellow Since 2006
This description of Mohamed Shaalan's work was prepared when Mohamed Shaalan was elected to the Ashoka Fellowship in 2006.
Breast cancer is a leading cause of death among women around the world, and survival rates among Egyptian women are extremely low. Mohamed Shaalan is spreading information and awareness, improving early detection and other services, and helping women to confront the illness from an informed position, so they may consider the best options for their care.
The New Idea
Mohamed is changing the perceptions about breast cancer to eliminate the barriers that impede breast cancer detection, education and care. His aim is to create and institutionalize a culture that equips women with knowledge and empowers patients with confidence and self-respect. He is correcting the myths, misconceptions, taboos, and stigmas surrounding breast cancer, commonly known in Egypt as the "bad disease." A master organizer, he is bringing citizenship to patients with breast cancer and face systematic discrimination as a result of ignorance on the part of society, doctors, nurses, and the government. He is creating institutions to document the problems and provide information, counsel, subsidized screenings, and post-operative care. In addition, he is creating an advocacy committee whose members are patients, doctors, celebrities, and decision makers who will lobby for the creation of a governmental body to secure quality medical care. This body is responsible for accrediting breast-related health services and facilities, monitoring doctors' diagnoses and operations and reporting professional misconduct and malpractice to the national Doctors' Syndicate. It will also lobby for comprehensive medical care for breast cancer, including coverage by medical insurance. While focused on breast cancer, Mohamed’s efforts are strengthening the health care delivery system in Egypt, and raising awareness of patients’ rights.
Mohamed is addressing two important problems: The first is the culture of denial about breast cancer—the most common cancer among women in Egypt. (Without a national cancer registry, the prevalence is not known.) Survival rates are very low, with only 30 percent of women surviving after five years with the disease. The second problem is the lack of accountability and transparency in the medical profession. There is a common misconception in Egypt that cancer is contagious, a notion that has caused the husbands of many diagnosed women to seek a divorce. If a young woman is diagnosed with breast cancer, she is considered unmarriageable. Egyptian women do not usually come forward until the late stages of the disease, when it is often too late to assist. It is difficult to address the misinformation and fear around cancer, when Egyptians still do not refer to it by name, but as the "bad" or "cursed" disease. Many women are terrified of being diagnosed with breast cancer and are unaware of the treatment options. In Egypt, there are virtually no screening programs and usually long waiting lines in cancer centers. Lacking support and compassion, many women go to cancer centers and leave with their breasts removed, without having a doctor prepare them for the surgery, discuss other treatment options or secure their consent. For women who have had their breasts removed, there are few if any, post-operative support groups, psychological support or counseling offered to them and their families. The cultural taboo and ignorance surrounding breast cancer is also expressed among doctors and nurses towards patients. Accreditation for diagnostic centers is not necessary and no regulatory agency exists to keep a physician from unnecessarily operating on a patient without being held accountable. Unknowingly, the patient and her family will not consider or suspect malpractice. During these unnecessary surgeries, patients may lose parts of their bodies, be subjected to great pain or die. The government does not have the resources to address such widespread issues and patient poverty and lack of information about cancer means the community and citizen sector must play a significant role in developing solutions. However, even in the citizen sector there are no advocacy or lobby groups campaigning for the right to knowledge, health provisions, or exemptions for breast cancer patients.
In 2003, Mohamed created a citizen organization, The Breast Cancer Foundation of Egypt to introduce the first comprehensive breast cancer service in Egypt. He realized that understanding the scope of the problem is necessary to marshal the resources and public will to tackle it. He gathers statistical and biographical data to allow him to map out the problems, revealing the significance using numbers, and establishing local screening guidelines for Egyptian women. He pairs screenings with the provisions of information and resources.Mohamed understands that the most important group to reach is the medical staffs of hospitals because they can relay information and inspire patients. To increase the sharing of information and build the capacity of nurses and physicians, Mohamed approached El Galaa Hospital—the oldest women’s hospital in Egypt—to raise awareness about breast cancer. The physicians, nurses and technicians seemed to know very little about breast cancer, so he began by screening 600 female employees, gathering volunteers—including a breast cancer survivor— and started training the medical staff how to screen for breast cancer; the technicians to offer mammograms. Mohamed bought educational films (at his expense) and designed a questionnaire for epidemiological and risk factors—training at this hospital took one year. In Tanta City in Delta, Mohamed launched a free screening campaign directed at the families of diagnosed breast cancer patients because they are a high-risk group. He and his team trained physicians and nurses at Tanta Cancer Institute and in three months they had screened all the female members of families of previously diagnosed breast cancer patients. Nine women of the 500 screened were diagnosed with cancer. Mohamed produced and presented a report at a conference in Tanta to raise awareness about cancer and encourage its early detection and treatment. Community members, officials from MOPH, and the Tanta governor attended the conference. The 2006 campaign continues, offering its services to all of Tanta's residents.Mohamed launched a similar campaign at the Ministry of Housing to reach female employees. His campaign offered awareness seminars, self-examination classes, free physical exams with qualified physicians, free mammograms, and surgery. His team screened 300 women. As a result of successfully raising awareness about the importance of early detection and appropriate treatment for breast cancer the Ministry of Housing sold the Foundation land at a reduced price, enabling it to build the first comprehensive breast cancer center in the Arab World. Through ongoing fundraising activities, Mohamed has managed to cover the first installment and believes the center will be complete and operational in two years. In 2006, due to his relentless efforts in lobbying, Mohamed was invited by the Minister of Health to join in partnership with the MOPH, contributing his expertise and research to draft a national strategy to eliminate breast cancer in Egypt.To reach poor women lacking basic information about breast cancer, Mohamed also works in squatter areas with women referred to the Foundation by other citizen organizations. He has reached Ezbet Abu Qarn in Misr El Qaddima, Cairo; Farsis village, Delta Tanta; and Al Agami, Alexandria, distributing informational brochures at mosques, churches, and physicians’ clinics. He has lectured at Cairo University, Al Azhar University, and public and private factories and companies. He uses the lectures to teach self-examination techniques and publicize the services offered through his and other organizations. The Foundation is to serve as an information and resource center, equipped with outreach tools such as a website for women with breast cancer. Mohamed has created support groups for women with breast cancer and advocacy committees to lobby for the rights of women with breast cancer, while also holding a series of meetings for interested citizen organizations and the media to bolster advocacy and awareness. Looking ahead, he will encourage the Ministry of Health to adopt and apply his prevention, detection, and treatment strategy on a national level, supplanting the stigmas about cancer with information and options. He plans to conduct two highly-visible national conferences, inviting policy makers, donors and the media. The conferences will also function as an open arena for cancer patients and survivors to tell their stories and ask for needed policy changes. He has also published a book about breast cancer survivors for free national distribution. Longer-term, Mohamed aims to create community-based breast cancer centers that will offer subsidized screening as well as diagnosis, support to patients and their families, affordable post-treatment sessions, physiotherapy, prosthesis, and other services.
Raised in Cairo, Mohamed was born into an upper middle-class family. He attended private language schools and was a good student, excelling in the classroom and in sports. He enrolled in medical school in 1977 and received an appointment as a professor at the National Cancer Institute in 2005. Mohamed cites two people as having been especially important in forming him as a physician and social entrepreneur. The first was his uncle, Karim Shaalan, a surgeon who introduced a number of improvements to the medical system in Egypt. Following 23 years practicing medicine in the U.S., he returned to Egypt to become Director of Al Salam International Hospital in Maadi. He introduced procedural changes to raise the quality of care, build capacity among nurses, and foster ethics among the medical community. He founded the first one-day surgery center in the Arab World and introduced ambulatory surgery, laparoscopic surgery, and a host of other improvements. Initially, his peers thought he was a lunatic, and many resented his campaign for transparency and patients’ rights, but his improvements stuck. Mohamed learned from his uncle the value of teamwork, leadership, and integrity; to support innovations in health care. The other person who greatly influenced him was his grandfather; a judge who directed the Red Crescent of Egypt after retiring. Mohamed spent summers with his grandfather, learning the utility and importance of community work and that responsibility to the community should be an integral part of one’s life and identity. Mohamed returned to Egypt in 2001, after a one-year fellowship at the University of California followed by fieldwork in breast cancer centers in New York and Houston. He started working at the National Cancer Institute and realized that there was a real problem regarding the lack of awareness about breast cancer in Egypt. He began printing informational brochures and subsidized mammograms in diagnostic centers. Mohamed created the Breast Cancer Awareness Project, whose purpose was to raise awareness about breast cancer. He received assistance from dedicated professionals and survivors, and raised money through races at schools and clubs. He then thought of establishing a citizen organization and approached friends and colleagues for financial assistance. In 2003, Mohamed founded The Breast Cancer Foundation of Egypt.