Title:Bridging Cultures

Above: In the pediatrics ward at Butaro Hospital in northern Rwanda, Dr. Hanna works as a clinical advisor and researcher through Partners in Health, helping to implement a more intensive leukemia protocol.

As an orthodox Christian Egyptian growing up in Ballwin, Missouri, I was well aware of what it felt like to be an outsider. Until college, I had always been the only Egyptian student and the only Orthodox Christian in my entire school. Fitting in with my American peers was made more difficult by my parents’ decision to raise my brothers and me in an Egyptian microcosm. For a long time I struggled with how to reconcile these two very different areas of my life.

And this struggle played into most of my whirlwind Georgetown experience. I entered as a biology major in the College, but after my first semester transferred to the School of Foreign Service (SFS). The Science, Technology, and International Affairs (STIA) major was a great fit, allowing me to study international health from political, economic, and socio-cultural viewpoints through STIA’s interdisciplinary approach.

I started to look at my mixed cultural background as an advantage rather than a hindrance. It is a blessing and a skill to be able to understand two cultures so well. I saw that having to learn about American culture had increased my desire to learn about other cultures.

I continued to take pre-medical courses, and in my sophomore year became the first student from SFS to be accepted early to Georgetown University School of Medicine. As I could finally see the end of my international affairs undergraduate studies and the start of a medical career, I was continuously asked how I would merge these two seemingly disparate interests. My answer was always the same: global health.

I deferred medical school for one year to pursue a Fulbright Fellowship in Egypt. For the first time I was working and living in my parents’ country of origin, carrying out a research project to prevent tobacco use among urban street youth. Working youth are a rapidly growing population in Egypt, and they have an extremely high smoking rate. They have little access to health and other services provided to in-school youth, including access to behavioral health campaigns. I had spent months developing a questionnaire to determine the knowledge, attitude, and beliefs behind smoking practices, in an effort to discover population-focused interventions to prevent this vulnerable group from engaging in such risky behavior.

While my Fulbright experience had been driven by a belief in health as a basic human right, issues of gender inequality, censorship and religious intolerance presented themselves throughout my research experience. I felt overwhelmed by the bureaucracy, poor health infrastructure, and inadequate resources in Egypt. And I came face to face with the broader aspects of health and related psychosocial issues—poverty, abuse, and neglect. My questionnaire was lost amidst the din, and my sense of failure had never been more pronounced.

During a break in December, I sought refuge back home with family in the U.S. while I tried to refocus my goals for the fellowship. It was in the airport on my way back to Cairo that I stumbled across the book Mountains Beyond Mountains, which traces the work of Dr. Paul Farmer as he establishes the health and social justice organization, Partners in Health. His challenges with the Haitian health system resonated with me. I was captivated by his endless quest to cure infectious disease from country to country—Haiti, Cuba, Peru, Russia. I could see his efforts (including the missteps and failed attempts) to promote accessible and equitable health care without distinction as to race, national origin, gender, or income level. He was trying to transform health care globally by focusing on the poorest and sickest. And it was not far from the Jesuit mission of “men and women for others” that I had been imbued with during my time at Georgetown. In fact, it was the inspiration I needed to return to Egypt with a renewed sense of purpose.

As I began to build relationships with a small group of street youth in one of Cairo’s many slums, I engaged them in discussion about the issues that mattered to them and ways to address them. The focus of my project shifted from tobacco prevention to the identification and strengthening of the resiliency factors these children needed in their daily lives. At the Al-Darb Al-Ahmar youth center, run through the renowned Aga Khan Foundation, we used drama to engage the youth. This gave the children a voice—so important for youth generally and for vulnerable youth in particular. In their own words, through their own creativity, they linked their daily experiences with their health, their behavior, their lived poverty.

One of the boys worked for a dry cleaner who was notoriously abusive. He would be yelled at, hit, driven out of the store for his incompetence, and not allowed to take breaks. The boy’s mother had just died of breast cancer and he was supporting his siblings, which made quitting the job unthinkable even though he hated working there. He brilliantly channeled all this into a comical skit about a boy who would daydream of going back to school or finding another job, and one day he was day dreaming while ironing and burned an iron-shaped hole in a customer’s shirt. The embarrassed owner and the furious customer began yelling at the boy, who thought quickly and calmed them down enough to say that actually this style of shirt was the latest fashion in Europe. He put his head through the burned hole, slipped his arms through the sleeves, and wore the shirt like a poncho. The customer, not wanting to lose face, said he had heard of it and paid the owner for “updating” the shirt to a “trendier” look. The vignette was charming, funny, and shed light on difficult work conditions—showing both the necessity of the job and the ingenuity of the child.

Telling their own stories enabled the youth to expand their horizons beyond daily life. Seeing them proudly perform these small vignettes for members of their community was the moment I realized how to put Georgetown’s guiding Jesuit tradition of cura personalis—care of the whole person—into practice.

My experience in Egypt cemented my mission for serving the health needs of vulnerable and young populations in the United States and globally, linking curative and preventative care through community health. I have worked in South Africa, Costa Rica, Botswana, and Rwanda, where I am currently helping to carry out an intensive national pediatric leukemia treatment protocol with Partners in Health. I completed an internship with the World Health Organization, a Master’s of Public Health from Johns Hopkins University, a Health Justice Certificate from Georgetown and a combined Internal Medicine and Pediatrics residency from the University of Pennsylvania.

This was the path I envisioned when I made the decision to major in STIA, and a steadfast commitment to this dream over the last ten years made it possible. There were many moments when I was overwhelmed by the ambition inherent in the course of study I chose—moments when I was unsure about my ability to handle it mentally, emotionally, and even physically. My desire to become a good doctor, to affect change on the individual and population levels, and to focus on health justice and helping underserved and vulnerable populations has kept me going through the challenges.