Treasure in the Rubbish
“One man’s rubbish is another man’s treasure.” How very apt this old saying is in Cairo! Here the rubbish that we throw out on a daily basis is not only potential treasure, but also the basis of a living, both in terms of employment and providing housing.
In rural areas subsistence farming can no longer support families or village communities and as a result many people have been forced to migrate to Cairo in search of work. This has resulted in over-population of the city and the creation of areas with crowded living conditions and limited employment. Many of these areas are not recognized by the government, and basic utilities such as roads, sewage, power and water are not legally supplied.
Even the seven collection points for rubbish have become places to live and work. Ezbit el Nukhl is one of these rubbish dumps, and it houses over 15,000 people. The people who live here literally live in houses or huts built from the rubbish that surrounds them. Dwelling in absolute poverty and squalor, inhabitants earn their living by sorting through the rubbish brought in for recycling. They then sell on the plastic, tin and other recyclable commodities to local companies. Food waste is used as feed for the pigs and goats that share the same living quarters as the families themselves.
It is an incredibly humbling experience walking along the dirt roads – inaccessible by car – where the main form of transport is still the donkey and cart. In this community built on layer upon layer of rubbish, the flies and the stench are unbelievable, and sheep, goats and dogs wander the streets. And sitting amongst all the rubbish are people, sorting it into sellable and recyclable products, while children play all around them.
Conditions are hard here; the area is affected by chronic overcrowding, pollution, unemployment, illiteracy, high infant mortality, and a lack of basic health, hygiene and welfare services. There are many stories of preventable infant deaths or disabilities. Education is a low priority for many children, whose parents see more benefit in them labouring in low-paid jobs that at least provide some additional financial assistance to their families.
Within the rubbish and dirt is a school trying to provide basic education to these poorest of the poor. It operates in a run-down old building, with the first two floors for general education. Up another two flights of narrow stairs is a centre in which we are trying to establish a project to improve the plight of disabled children and their families. There are only limited resources in this centre and most of the youngsters need to be carried up the four flights of stairs by their mothers.
Disability and disabled children are not well understood in this part of the world. Often the condition brings shame not only on the child but on the whole family, and they are poorly treated by the entire community. Many of the children are kept hidden away from the outside world and neglected, as the families’ limited resources are given to their healthy siblings.
The causes of disability are also poorly understood - blame is placed on the doctors, mothers and anyone else involved in their care. Doctors are reluctant to provide accurate information or to tell the families anything they may not want to hear. Instead they will say, “Inshallah (God willing), everything will be fine,” so that parents expect that the right medication or medical operation will make their child suddenly normal. Or the family will be told, “Malesh (sorry/never mind), there is nothing to be done.” Either results in a rather passive approach to the children’s care, anger at a lack of improvement in their condition, and lack of acceptance within the family and community.
Common therapy practice here is to provide the same basic stretching and exercise programme for every child, regardless of the condition or presentation. In the home there is no equipment such as wheelchairs, standing frames or walkers to help the child be more independent. In almost all cases the care of the child is left solely to the mother. Secondary complications are common, such as contractures (tightening) of muscles, especially the leg and arm muscles. This can lead to further loss of function, pain, hygiene problems and, in severe cases, even dislocated joints.
It is in response to these needs that I have been working together with a locally trained physiotherapist to provide basic therapy and equipment for the disabled children of Ezbit el Nukhl. We also focus on providing accurate information to the staff and families about what disability is, how it is caused, how to minimize secondary complications, and how to work towards the children becoming more functionally independent.
When families bring their children to the centre we assess them, then provide a therapy programme and advice on things that can be done at home. Where necessary and possible, basic equipment is provided, such as foot orthotics and leg splints. Recently, with the help of a visiting therapist, we were able to build a wheelchair with a specialized seating system for a child with two dislocated hips. This has enabled her to sit up while at home, instead of having to spend all her time lying down (which aggravates her condition). It has also provided a level of freedom, in that she can now leave the house with her family.
Progress is slow and often disheartening. Parents often come in expecting cures or, at least, instant results. Even though we provide education on disability in order to empower everyone involved, we also have the challenge of changing cultural mindsets. Then there are the added challenges of finding - or adapting - basic equipment, and having to fulfil multiple roles, such as physiotherapist, speech therapist, occupational therapist, orthotist, doctor and teacher.
Despite such challenges and setbacks, the big picture of changing the potential outcome and quality of life of these children and their families - and the daily joy of seeing a smile on their faces - make it definitely worthwhile. ♦
The author, a physiotherapist from NZ, has been working in Egypt since 2006.