SELECTED STUDIES

Community Genetics 
in the 21st Century (Part II)

By Prof. Talaat I. Farag MD, FRCP(Edin), FACP
Dalhousie Univ., Halifax, NS, Canada

  • Community Genetics Courses
  • The Egyptian Model of Community Genetics
  • An Interview with H.E.Prof. Ismail Sallam
  • My Personal Observations
  • International Symposium on Community Genetics in Developing Countries
  • Pan-African Environmental Mutagen Society 4th International Symposium
  • Further readings

 


Prof. Ismail Sallam, Egyptian Minister of Health & Population

 

In May and October 2001, I was honored by H.E. Prof. Ismail Sallam to join the distinguished professors of medical genetics from the five Egyptian centers in teaching and training courses on Principles, Philosophy and Practice of Genetic Counseling to medical specialists, family doctors, psychologists, social workers and nurses. Seven courses were held with the collaboration of geneticists from Alexandria, Ain Shams, Cairo and Mansoura medical colleges in addition to the Medical Research Department of the National Research Centre (Dokky).

Prof. Sallam mentioned to me that "there is a definite change in the disease profile in Egypt. Only three cases of poliomyelitis were ascertained in 2001 and the prevalence of bilharziasis has dropped to only 3.5%." The plan is to completely eradicate bilharziasis in Egypt before 2005. I was pleased to find out that the average life expectancy in Egypt exceeded 70 years. 

Community genetics courses

In the early 70s, the late Prof. Jim Farquhar, with his colleague Prof. John Forfar established the first school of community pediatrics in the world in Edinburgh University. I was fortunate enough to attend the birth of this college. Interestingly, the first international Symposium on Community Genetics in Developing Countries will be held in India (January 2002) and the 4th International Meeting of the Pan-African Environmental Mutagen Society to be held in Egypt (March 2002). Data about these conferences will be presented in the end of this article. Community medicine and pediatrics focus on the prevention of both genetic and environmental diseases. Both these conferences to be held in early 2002 give an important meaning to the preventive approach. There is increasing interest in studying preventive techniques to eradicate genetic problems, major congenital anomalies and mental retardation.

Genetic disorders can lead to: (1) chromosomal abnormalities, (2) monogenic disorders, and (3) multi-factorial disorders.  This latter group includes psychiatric disorders, essential hypertension, ischaemic heart disease, peptic ulcer, cancer, major congenital anomalies, diabetes mellitus, asthma etc., which are called "modern diseases." In Western societies, around 10% of the population complain from them.


The late Prof. Jim Farquhar, founder of community pediatrics with Prof. Bayoumi Gharib (Alexandria), 
Prof. T.I.Farag (Canada), Dr. Mohamed Yehia El-Khalifa (Sudan), Dr. Mahmoud El-Banna (Egypt) and Mr.Dahabra (Jordan).


The Egyptian Model of Community Genetics

It seems to be, that Prof. Sallam's model of community genetics has many objectives.

  1. It aims on making genetic services reach all provinces - from Alexandria to Aswan - as part the goal of providing equitable health services to all citizens.

  2. It aims to include the family doctors as partners in these services. I personally witnessed their interest in participating in seven genetic courses held in May and October 2001. Prior to these courses, some of them had attended courses presented by Prof. Ikram Abdel Salam (Cairo University).

  3. It aims at establishing a new diploma or board of genetic counseling for family doctors who successfully completed three courses in community genetics and counseling in collaboration with the international Euro-American authorities and the National Society of Genetic Counseling (NSGC).

  4. It aims at giving specialists with Masters degrees in pediatrics, medicine, gynecology and so on the chance to join in Masters courses on medical and human genetics in Ain Shams University (Prof. Rabah Shawky) or in Alexandria University (Prof. Suzan Roshdi Ismail).

  5. It aims at establishing integrated community genetics services by creating  a "Tetra-step pyramid model":

    1. the well-trained and knowledgeable family doctor, nurse and social worker will receive the patients in their area, construct family pedigrees, and refer cases to the provincial genetic clinic.

    2. the provincial genetic clinic, with a qualified clinical geneticist with 2 masters degrees (one in any medical branch and the second in medical genetics), will study cases referred from the family doctors.

    3. the liaison consultants (ophthalmology, cardiology, orthopedics, radiology, dermatology, etc.) will receive cases from the genetic clinic for further review.

    4. each of the five medical genetic centers in Egypt will be responsible for around 12 million people, and will supervise the other three levels to help in applying the Penta-axial SETRR model in their region. This model includes Services, Education, Teaching, Registry and Research.

  6. It aims at establishing a National Board for Medical Genetic Services (NBMGS), which includes the following distinguished geneticists (alphabetically listed):

  7. It aims at establishing a liaison genetic services board including the following distinguished specialists/consultants who participated in May and October 2001 genetics courses. This board will work under the management of the NBMGS:


    H.E. Prof. Ismail Sallam with Profs. Adel Mattar (USA), T.I.Farag (Canada), Wagida Anwar (Ain Shams), Mokhtar Gomaa (Al-Azhar), Wael M. Fahmy and Mahmoud El-Banna (Cairo)

In an interview with H.E. Prof. Ismail Sallam, he mentioned to The Ambassadors Magazine:

  1. Egypt is currently establishing the Cairo Medical Genetics Center (CMGC) in Nasser Medical Institute, which has an international reputation. A new clinic is in progress in Alexandria under the supervision of Prof. Suzan Roshdi Ismail, the founder of medical genetics in the city. In Giza province, a genetic clinic is being prepared to be named after Prof. Zoheira Abdeen, who funded the building of  the province's pediatric hospital. More genetic clinics are currently in the making, two of which will be in upper Egypt, one in Luxor and another in Aswan.

  2. Several courses will be held in 2002 for medical specialists, family doctors, sociologists, nurses and psychologists in order to acquire knowledgeable personnel.

  3. The ministry of health and population will establish medical genetic libraries in all provinces. The distribution of both the Egyptian Medical and Human Genetics Journal and the Eastern Mediterranean Health Journal.

  4. He emphasized that several techniques for family planning are available in Egypt, except for abortion and sterilization.

  5. He acknowledged the contributions of previous ministers of health, in particular Dr. Abdelwahed Al-Wakil Basha and Dr. Nabawy El-Mohandes and described how much he learned from the late Prof. Anwar Mofty and Prof. Fouad Mohieldeen in the area of community medicine. He also sent his condolences to Prof. Esmat Ezzat for the passing of her husband, the late Prof. Zuhair Nomaan, the founder of Suez canal medical college and one of the international pioneers in the field of community medicine.

  6. He commended the work done by the medical college at Alexandria University regarding the diploma for family medicine. 

  7. He thanked all Egyptian experts who practice around the world for contributing to the training of Egyptian doctors and providing exceptional medical services to their country. Egypt will not forget the kind contributions of these specialists who traveled throughout 2001 and came from Canada, France, Netherlands, UK and the USA. He also acknowledged the contribution of all the professors and consultants that assisted in the training courses and the establishment of the National Genetic Counseling Program and the implementation of services in all Egyptian provinces.. 

  8. The strong cooperation between the universities and the ministry of health and population with the support of international organizations is the key to the success of community medicine programs in Egypt.  

               

My Personal Observations


Prof. Mokhtar Gomaa

During the seven courses on community genetics entitled, "Principles, Philosophy and Practice of Genetic Counseling" I noticed and enjoyed the following:

  1. The enthusiasm of professors to contribute in teaching and training the young generations. Three former deans of medical colleges did an excellent effort. Prof. Mokhtar Gomaa (Al-Azhar University), Prof. Mohamed Hafez (Mansoura University), and Prof. Ihab El-Mansy (Alexandria University).

  2. The excellent contribution of the WHO office for the Eastern Mediterranean region by distributing their journal for free to all participants and attendees. Also, Prof. Abdelmoneim Abdel Aal (Dermatology & Venereology) distributed his books free, including "Moneim's Dictionary".

  3. I enjoyed the scientific visit to the medical genetics center at Ain Shams University with more than 50 doctors attending the courses. The efforts of Prof. Rabbah Shawky, the chair of the pediatrics and genetics departments, and her colleagues must be commended.

  4. The meeting that was held to discuss the diseases of Ancient Egyptians that brought together a multidisciplinary team of doctors and Egyptologists was truly exceptional and unique.

  5. Dr. Esmat Mansour, the undersecretary of the Ministry of Health and Population, who oversaw the primary health services, neonatal screening program and the "Healthy Child, Healthy Mother" project, and all her colleagues must be congratulated for their great effort they are doing.

  6. The effort done by Dr. Azza El-Husseini, under-secretary of the ministry of Health and Population, plus the effort of Dr. Mohamed Sherif, director of Nasser Institute were great factors to the success of the courses.

  7. I admire Dr. Salah and his colleagues in the Horus programs.

I have to note however, that some of the sessions needed to be recorded and distributed to all doctors in Egypt. For example, the workshop on "Genetics of Cardiovascular Diseases" presented by Prof. Mokhtar Gomaa and 10 distinguished cardiologists, the workshop on "Neurogenetics" organized by Prof. Bayoumi Gharib, the genetic lectures by Profs. Samia Temtamy, Suzanne Roshdy, Mohammed Hafez, Ikram Abdelsalam, Samia Kotb, etc. would have been a very valuable educational tool. Hopefully, such accommodations can me made in future workshops and conferences. 

In the next issue, I will tackle the issue of the coordination of the National Board for Medical Genetic Services (NBMGS), the liaison genetic services and how it can be successful, with reference to other models applied in other parts of the world. 

International Symposium on Community Genetics in Developing Countries 

The symposium will be held on 16-18 January, 2002 at the Indian Institute of Science, Bangalore, India. The local organizers of the event are Profs. N. Appaji Rao, H.S. Chandra, H.S. Savithri, M.R.S. and Dr. N.K. Ganguly. The international organizing committee is made up of Profs. A.H Bittles, R. Mueller, M.A. Patton, J.H. Edwards , B. Modell , Drs. R. Hussain, A. Darr, A.K. Saggar-Malik and Mrs. G. Karbani. Participants of this symposium will come from 11 countries: Australia, France, India, Iran, Jordan, Norway, Oman, Pakistan, Sri Lanka, UAE, and UK. For further information about the conference visit its website at www.consang.net/Bangalore2002

 

The conference is sponsored by The Indian Council for Medical Research and The World Health Organization. It is also supported by: Jawarhalal Nehru Center, India; The Council for Scientific and Industrial Research, India; Indian National Science Academy; The British Council; Birth Defects Foundation, UK; The Wellcome Trust, UK; Morrison Institute for Population and Resource Studies, Stanford University, U.S.A.; and International Union of Biological Sciences.

The symposium will tackle the following seven specific topics:

1. The prevalence and profile of genetic disorders in Developing Countries, e.g.: visual defects, hearing defects, haemoglobinopathies, familial cancers, and intellectual disability.
2. Health implications of endogamy and consanguinity with regard to fertility, and offspring morbidity and mortality. 
3. A community-based approach to the study of genetic disorders in countries with long-established social and cultural sub-divisions. 
4. The genetic contribution to mature-onset diseases in Developing Countries.
5. Practical approaches to genetic counseling, prenatal diagnosis, and screening for genetic disease in Developing Countries.
6. Advances in the development of computer-based genetic registers.
7. The role of the media in fostering public knowledge of genetic disease in Developing Countries.

The plenary lecture in honour of the late Prof. V. Ramalingaswami entitled, "Endogamy, Consanguinity and Community Genetics in Developing Countries" will be given by Prof. A.H. Bittles, Edith Cowan University, Perth, Australia. There will be three studies presented from the Arab world:

 

Pan-African Environmental Mutagen Society 4th International Symposium
CHILDREN'S HEALTH AND THE ENVIRONMENTAL MUTAGENS: 
AN AFRICAN AGENDA FOR PREVENTION RESEARCH

The 4th International Meeting of the Pan-African Environmental Mutagen Society (PAEMS 2002) will be held at Le Meridien Hotel, Cairo, Egypt between March 3-8, 2002 under the auspices of H.E. Prof. Ismail Sallam, Minister of Health and Population. The elected council of the society are: President Prof. Wagida Anwar (Egypt), vice-president Dr. Yogeshkumar Naik (Zimbabwe), Secretary-General Dr. El-Hussein El-Khatib, Assisten Secretary-General Dr. Soheir Korraa, and Treasurer Dr. Mohamed Al-Khafif. The International Advisory Committee of this organization consists of 24 distinguished scientists from Egypt, France, Japan, Netherlands, South Africa, UK, USA and Zimbabwe.

The 4th International Meeting of the Pan-African Environmental Mutagen Society (PAEMS) will be held in Cairo, Egypt between March 3-8, 2002 under the auspices of H.E. Prof. Ismail Sallam, Minister of Health and Population. The purpose of the symposium is to discuss the issues of children's health and the creation of a healthy environment in Africa, free from pollutants which are mutagens, teratogens and carcinogens. PAEMS was established 1983 in Kenya and has held three conferences since then in Egypt (1994), South Africa (1996) and Zimbabwe (1999). The elected council of the society are: President Prof. Wagida Anwar (Egypt), vice-president Dr. Yogeshkumar Naik (Zimbabwe), Secretary-General Dr. El-Hussein El-Khatib, Assisten Secretary-General Dr. Soheir Korraa, and Treasurer Dr. Mohamed Al-Khafif. The International Advisory Committee of this organization consists of 24 distinguished scientists from Egypt, France, Japan, Netherlands, South Africa, UK, USA and Zimbabwe. For further information regarding this symposium, you can visit its website at www.iaems.nl/paems.htm. 

Further Readings

Rasha N. El-Kharadly, Soha Kholeif, Samia  M. Kotb, Nagwa A. Mohamed, Mamdouh A. El-Ghandour (2001). Assessment of children with Down Syndrome receiving early intervention. Alexandria Journal of Pediatrics 15(1): 13-17.

AS. Ramalho & RB Silva (2000). Community Genetics: A new discipline and its application in Brazil. Cad-Saude-Publica. 16: 261

AA Elfituri et al. (1999) Role of health education programs within the Libyan community. EMHJ 5: 268

DS Chase et al. (1998) The North Cumbria community genetics project. J-Med-Genet, 35: 413.

H Skirten et al (1998). Recommendations for education and training of genetic nurses and counselors in the U.K. J-Med-Genet 35: 410

AS Teebi & TI Farag. (1997) Genetic disorders among Arab populations. New York: OUP

Editorial (1995) Egypt triumph with oral rehydration. Brit-M-J 291: 1249

B. Modell (1992). The need for a service in community genetics. Birth Defects Original Article Series 28: 131.

E Anionwu (1991) Teaching community genetics. Nursing, 4:37

G. Turner et al. (1991) Cystic fibrosis screening and community genetics. J-Med-Genet 28: 575

M Modell et al (1991) Community Genetic services in Europe. WHO Regional Office for Europe. Public Health in Europe Series. 

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