Poisoning exposure is an increasingly global public concern due to the progressive flooding of chemicals, pharmaceuticals and natural toxins in the international markets. Factors enhancing this poisoning epidemic expansion are multiple and complex in any country. Since the beginning of the 20th century technological advancement has resulted in an exponential growth in the number of chemicals introduced into environment, workplace and home. These include medications, cleaning substances, pesticides, fertilizers, petroleum distillates, intermediates in chemical processes, and drugs of abuse leading to increased exposure to potential poisons with an unavoidable result of increase in the number of poisonings. EG in particular is a rapidly economically growing country with extensive wide-spectrum use of chemicals. While there is high population density in the cities, a significant proportion of the population lives in rural areas where agrochemicals are extensively used. Toxic chemicals are also widely used in a multitude of small-scale workshops and cottage industries, such as textiles, tanning and metal working, found in every town and urbanized areas throughout the country. A growing number of chemicals are used in the home and surrounding domestic environment. Chemicals are inappropriately handled and often poorly labeled. There is poor awareness among the public about toxic risks of chemicals. Some four million tons of chemicals and chemical products are imported per year into EG, representing about 95% of manufactured chemicals found in the country. These chemicals include a wide range of toxic substances such as pesticides, amines, solvents, heavy metals, acids and alkalis. With general lack of effective control on emissions of chemicals to air and water and no adequate toxic waste disposal, there is a potential for major problems from environmental exposure of populations to chemicals. There exist 5 poison control centers in EG located in major cities. In 2013, the one located at ASU reported over 30,000 incidents, 63% of which were in the 15-40 age group, while 24% were less than 7 years old. Alarming as it sounds, this is by far less than the actual number of poisoning incidents due to the unreported cases in rural areas outside the greater Cairo area and the incidents attended at local clinics. Despite continuous update of information on poisons and intoxications by the poison control center, several problems have yet to be resolved: a) there is still insufficient awareness regarding the potential hazards of poisons, b) physicians and pharmacists are still not adequately trained in clinical toxicology, and c) keeping pace with the increasing amount of information has not always been possible due to its huge volume, limited availability and insufficient clinical exposure.
Development strategies in clinical toxicology and project compliance with national priorities:
As a developing country with vast human resources and a rapidly-growing economy, the Egyptian
government has realized this increasing threat in specific and in the health care sector in general
affecting the nation’s wellbeing with a direct impact on the productivity and economy. Ambitious reform plans have been developed with government expenditures reaching beyond 3 Billion Euros in 2013.
Coordination between different authorities (Ministry of Health, Ministry of Agriculture, Ministry of
Industry and Ministry of Environmental affairs) has been initiated to identify the threat, increase
awareness and control usage of toxic chemicals and substances. Despite the tremendous efforts by the Egyptian government, the availability of qualified professionals in health-related domains (Medical, Pharmaceutical and Nursing) is by far a major threat affecting those plans. There is not a single integrated academic program in EG that targets the clinical toxicology domain in EG that consolidates the different threats and provides clinical and implementation practices to physicians, pharmacists and nurses to be able to effectively cope with the government strategies in managing and treating poisons cases. The dilemma of cost of establishing poison centers all over EG is huge due to cost and shortage of qualified human capacity. Proximity and remote education using IT and e-laboratories support is by definition due to overcome these limitations.
It is therefore the wider objective of the current project to introduce a new line of qualified professionals in health-related domains to manage, attend and deal with increasing threat of natural and synthetic poisons and poison agents in various disciplines such as agricultural, pharmaceutical, industrial, petrochemical as well as domestic and home usage to complement Egypt’s health care strategies, who are outreached in large cities as well as nomadic and less privileged areas in EG using up to date technologies and knowledge whose qualifications are internationally recognized.
The current program includes One-year diploma divided into fundamental and two track-specific
modules; the first is for physicians and the second is for pharmacists. The program is planned to target inter-disciplinary health-vital issue that is considered a cross-platform domain, in which nursing, medicine and pharmacy heavily interact. The program is planned to be EU and EG accredited to ensure development quality and quality sustainability as well as visibility across EG, the region and EU. Globally, there is only two clinical toxicology programs for pharmacists, the first is at Cardiff University and the second is at the University of Florida, which makes this the third in the world. The fundamental courses are covering all domains simultaneously, while two specialization tracks, each targets a different target group (medicine, pharmacy). In addition, four one-month professional certificates shall be designed to strengthen practical and applied skills for the participants in specific domains. These certificates include specialized topics on emergency management of poisoning, industrial poisoning, biosafety and microbial forensics as well as medication errors and patient safety. Moreover, this program provides e-based education that offers knowledge and expertise in different specialties of clinical toxicology to enhance
emergency management agencies and healthcare organizations. This shall be the first clinical toxicology education program in EG that implements e-labs as an integrated part, which crosses the physical labs barriers and expands the practical benefits to remotely located participants in an informative and interactive manner. These online courses may provide opportunity for professional advancement of health care providers to a wide range of audience including students in other countries up to the level that will guide them through an informed decision making process and affording specific skills in management of specific poisoning.
Aims and Objectives
The project wider objective is to introduce a new line of qualified professionals in health-related domains to manage, attend and deal with increasing threat of natural and synthetic poisons in various disciplines such as agricultural, pharmaceutical, industrial, petrochemical as well as domestic and home usage to complement Egypt’s health care strategies, who are outreached in large cities as well as nomadic and less privileged areas in EG using up to date technologies and knowledge and whose qualifications are internationally recognized.
The objectives of the project is:
- Develop a comprehensive gap analysis of Egypt’s exposure and impact of poisonous agents in various domains and professional training programs in clinical toxicology.
- Establish a multi-disciplinary diploma program for practitioners with medical and pharmaceutical backgrounds.
- Develop professional certificates targeting practical and hands-on skills for professionals in clinical toxicology domain, who are targeting specific expertise.
- Design an ECTS system for the developed diploma to match with EU academic regulations and seek EU accreditation through a subcontracted EU accreditation body.
- Gain EG academic accreditation and government recognition through MOHP to be recommended for professionals enrolled in poison centers and emergency related domains.
- Establish up-to-date facilities serving the targeted domain.
- Establish first-of-its-kind Establish e-labs and e-learning management system for the developed diploma to expand labs and practical exposure of diploma participants and to widen the diploma outreach to remote and nomadic areas in EG.
- Establish an exchange of knowledge and individual’s mechanism among teachers, practitioners and students between EG and participating EU institutions.
- Implement the diploma and professional certificates. As implied in Part E, the poisons exposure in EG is a continuously increasing threat to the national growth and more importantly to the nation’s health due to the dramatic increase in usage of chemicals in all aspects of production and home use. Poison literacy is very little in a community with about 35% illiteracy. With the development of the planned program, a new line of professionals (Physicians, Pharmacists, Nurses, Emergency operators …etc.) qualified with up to date knowledge and experience in managing and handling poisons shall be developed. Those shall be able to raise the awareness of these dangers and provide effective means of treatment and management to minimize the dramatic effects of poison exposure on the different levels. From one point, this shall develop preventive measures and from another point this shall provide corrective and effective management actions. Continuous flood of chemicals is not expected to stop, however health and safety counter measures manifested in well-educated generations of practitioners is expected to limit and reduce the hazardous effect.
Cairo University – CU (Project Co-coordinator)
Alexandria University – AU
Assiut University– ASTU
Ain Shams University – ASU
Ministry of Health – MOHP
Egyptian Medical Society for Detox and Environmental Diseases – EMS
Ministry of Communication and Information Technology – MCIT
University of Malta – UOM
University of Newcastle upon Tyne – UNEW
Royal Institute of Technology – KTH