Rashad Fahmy nervously taps his sandaled foot on the shiny waiting room floor, wincing each time he hears his wifes screams cut through the air.
Beneath framed prints of Jesus, the Virgin and St. Thérèse, his extended family sits around him on folding chairs. In the next room, his wife, Noor, clutches the small of her back as she walks in a slow circle, her pregnant belly stretching the rough cotton of her dark gellabiya, the traditional ankle-length robe of Egypts rural poor.
Neither Mr. Fahmy nor his wife has ever set foot inside a hospital before; nor have any of the assembled siblings and cousins who have come with them to wait for the birth of the couples first child. For such a milestone, they did not want to take any chances. As Mrs. Fahmys due date approached, the family decided to take her to St. Thérèse Hospital near their home in Imbaba, a sprawling Cairo neighborhood.
According to staff members and patients, St. Thérèse is the best hospital in Imbaba, and thanks to its commitment to serving the poor, the cheapest.
The Fahmys are Orthodox Copts from the Upper Egyptian city of Assiut, an ancient river center some 200 miles south of Cairo that is one of the most heavily populated Christian centers in Egypt. The family is new to Cairo, having moved to the nations capital in search of a better life.
We came here about a year or two ago, says Mr. Fahmy, looking down at his feet as a ceiling fan spins loosely overhead. Imbaba is nice, we like it here. All of our family lives here now and our work is here. My brothers and I found work on construction sites, spreading plaster on walls.
While construction work pays modestly, the family still wanted to give the young mother and her new baby the best care they could afford. They asked around the community and were directed to St. Thérèse.
A relative of ours delivered a baby here, and we decided to come here too because she said the doctors were good and the people were nice, says Gad Fahmy Shehata Morqos, Rashads older brother, his rough hands folded tensely in his lap.
Mr. Morqos is an imposing barrel-chested man with a hard, weathered face. He leans forward in his unsteady chair as he listens to his sister-in-laws labored moans in the next room. He is a force in the family. When he speaks, everyone listens intently. He says his family is grateful for the good work St. Thérèse Hospital does and the low fees it charges, but worries that the price may still be too high for many of Egypts poorest.
This hospital is beautiful and the people are so nice and respectful to us, but the fees are high, he says. There are other people who are poorer than we are. Thank God we can afford it, but it would be nice if they could lower their fees.
His family paid 500 Egyptian pounds ($86) for all of Noor Fahmys obstetric care far less than what such treatment would cost at other hospitals in the city, which probably would be less clean and more crowded. But for Cairos poor, even 500 pounds is a lot.
Egypt has witnessed unprecedented economic growth in recent years. According to figures released by the government in September 2007, the economy grew by 7.1 percent and saw direct foreign investment top $5 billion.
The benefits of this growth, however, have not been spread evenly among the population. In recent years, the countrys already significant gap between the rich and poor has widened even further.
This economic boom has fueled an explosion of conspicuous consumption among the Egyptian elite. Shopping malls and gated communities with names like Beverly Hills and Dreamland have sprouted like mushrooms along the outskirts of the capitals dirty, overcrowded and crumbling center.
Inside these outposts of wealth, children grow up speaking English in pricey private schools. Residents enjoy lives of material comfort, in which Gucci headscarves and Swedish cell phones are the latest craze at chic neighborhood cafes serving skim milk lattes.
Theirs is a world far removed from the crowded streets of Imbaba, where St. Thérèse sits crammed halfway down a narrow, unpaved alley.
The neighborhood is a maze of dusty, claustrophobic lanes shaded by a canopy of bed sheets and gellabiyas hung from clotheslines strung high above the street. Imbabas alleys and dirt paths spill out into Luxor Street, one of the areas main drags, which buzzes with the darting and weaving of rickety, three-wheeled micro-taxis called tuktuks. They speed across the pavement in swarms, cutting across lanes and veering into oncoming traffic. On the side of the road, children walking home from school pass underfed donkeys listlessly grazing in great piles of rotting garbage.
At one end of Luxor Street sits the parish church of Our Lady, which serves the neighborhoods 500 Coptic Catholic families. About 200,000 Egyptians belong to the Coptic Catholic Church, which despite its small size administers numerous clinics, schools and other social service institutions. Most Egyptian Christians, who make up to 10 percent of Egypts 76 million people, belong to the Coptic Orthodox Church.
The parish pastor, Father Abram Morgan, is a tall, soft-spoken man with kind eyes and an easy smile. He is a native of the Fayoum, a lush agricultural oasis famous for date palms, late Roman wax burial portraits and early Christian monasteries. Committed to a life of service, he has been working in Imbaba ever since he completed his theology studies in Rome in 1997. Father Morgan also directs St. Thérèse Hospital, which he helped establish in 2005 and for which he has big plans. Unfortunately, the countrys fragile economy has foiled them, for now.
The same economic boom that has made some residents of Cairos posh suburbs rich has also generated a dangerous riptide of inflation, which makes it nearly impossible for the poor and social service providers to keep their heads above water.
According to studies done by the American Chamber of Commerce in Egypt, inflation has crept to almost 8 percent in the past year, though some costs have skyrocketed beyond that figure. On average, the price of basic foodstuffs has spiraled upward an estimated 30 percent since last year.
The patients who come to St. Thérèse Hospital feel squeezed by these economic pressures. Father Morgan says the hospital also suffers.
Inflation has had a serious effect on us here at the hospital. It is a big problem in our country, he explains.
The bills for the electricity, water and phone keep going up all the time, Father Morgan adds. Each month our income is the same, but each month it buys less.
The most common service that the hospital provides is a basic checkup, which once cost 5 pounds (86¢). But due to rising costs on everything from water to medication, the hospital now charges 7 pounds ($1.20). Half of that amount goes to paying the doctors, who work evenings after a full day at for-profit hospitals elsewhere in the city.
Father Morgan says that the 2-pound (34¢) increase is as steep as his patients can afford, and he is loath to do it. However, if the hospital is going to make ends meet each month, he says it has no choice but to raise its fees.
The priest worries about how the facility will cover its operating costs if the countrys economic situation exacerbates inflation. Imbaba is a poor place and, if the hospitals prices go any higher, patients will stop coming. He is afraid he may be running out of options.
We are a charity, we cant increase the prices we charge by too much, he says. People here simply cannot pay more than 7 pounds for a checkup.
While inflation is causing similar problems for doctors and hospitals across the country, Father Morgan says that it poses a special threat to a charity like St. Thérèse.
Doctors and hospitals that do not offer charity work are not affected in the same way. When prices rise, they just raise their prices too, he says. In the end, the patients just end up paying for it, but the patients we treat here cannot.
Despite financial constraints, St. Thérèse Hospital has blossomed from a bundle of blueprints into a well-run and spotlessly clean facility that boasts high-tech equipment. It offers its patients services that rival those at much larger hospitals, but at a fraction of the price. (At one well-known private facility not far from Imbaba, a checkup costs 50 pounds, about seven times more what patients pay at St. Thérèse.)
The hospital wraps tightly around a stairwell four stories high. On a tour of the facility, Father Morgan points out each examining room and lab, proudly describing the different procedures performed inside.
There are rooms for ear, nose and throat specialists; an emergency room; a 24-hour blood lab and clinics specializing in womens health and pediatrics.
We have a group of the best doctors working here, and they are all specialists in their fields, he says, lingering in front of the dentists office, where a lone dental chair reclines.
In a nearby room, gastroenterologists treat stomach illnesses spread by the neighborhoods dirty water and poor sewage.
The most common problem I treat is gastroenteritis, with severe diarrhea and bad stomachaches, which people contract from eating unclean food, says one of the doctors.
After that, its street fights and tuktuk accidents.
Overall, the hospital employs 4 dentists, 3 nurses, 45 doctors and 33 nonmedical employees, most of whom live in Imbaba.
While the facilitys employees are all Christian, Father Morgan is quick to point out that the overwhelmingly majority of its patients are Muslim.
This hospital is interested only in the health of the community, not in peoples religion, he says. I would say that more than 85 percent of the people who come here are Muslims, and its no problem.
What patients care about most when it comes to health care, in his view, is not the doctors religion, but his ability. That is why people, Christian and Muslim, come from all over the country to receive treatment at St. Thérèse Hospital.
Once I asked some patients who had come from Luxor how they had heard about us, Father Morgan says, referring to an Upper Egyptian city 450 miles south of Cairo.
They were Muslims, but they told me that we once treated some Christian neighbors of theirs, who told everyone in the neighborhood about us.
When they got sick, they came to us too, he adds. Religion doesnt matter when it comes to taking care of your health.
Back in the waiting room, Rashad Fahmy has begun to tap his foot harder and harder.
His mother-in-law is pacing nearby, nervously adjusting her black head covering and exchanging small talk with the nurses.
Noor Fahmys screams have been getting louder and louder. When they reach a high pitch, she is suddenly joined by a second high-pitched wail. In a quick moment, Mr. Fahmy and his family exchange anxious looks before a nurse in a bloody white smock throws open the door.
Come on, celebrate! she cries out, her face beaming. The baby is here!
The family bursts into smiles and the men start clapping. The young mothers mother and the other women cup their mouths and joyous zaghrouti (a warbling sound that welcomes a guest or announces a grand family event) erupt from their throats.
Inside, Noor Fahmy lies dazed on a gurney. A nurse wheels her into another room while a second prepares a crib for her new baby daughter, Mary.
Dr. Mona Aziz is the attending obstetrician, a stately woman in a floral print blouse stained by the same blood as the nurses. Sitting at a table, she asks Mr. Fahmy to fill out Marys birth certificate. He smiles at his daughter, but says he cannot.
Dr. Aziz delivers more than 200 babies here a year; as with most of her patients, Mr. and Mrs. Fahmy cannot read. He cannot even write his own name, so she will sign the certificate on his behalf.
She writes his name and looks up, And what is your wifes name?
Noor, he replies.
Noor what?
Um, Mr. Fahmy looks sheepishly from the baby to the doctor. Um, I dont know.
You dont know? Dr. Aziz looks up at him in stern disbelief, her glasses sliding down her nose. What do you mean you dont know? Shes your wife, right? Are you her husband or not? Go ask someone what her family name is.
The young man runs into the next room and brings back his wifes brother to settle the matter. Bekheit. Her name is Noor Bekheit, he declares.
Dr. Aziz writes the name down. He didnt know any of his wifes personal information, not even her full name, she sighs, laying the paperwork on a table as the family left her and gathered around the baby. Dr. Aziz adds that most of her patients are very poor, illiterate and from the least sophisticated quarters of society. Truthfully, she concludes, the work we do here is charity.
Contributors Liam Stack and Shawn Baldwin live and work in Cairo.