Researchers from the University of Maryland -- who published a study three years ago in the Lancet linking the prevalence of hepatitis C in Egypt to actions of its government -- worry about discussing the disease's impact. The university has a Cairo-based hepatitis C prevention project, which has been examining the routes of transmission.

"When the paper originally came out, there were headlines saying, 'Ministry of Health infected millions with hepatitis C and dirty needles,'" says Dr. George T. Strickland, the director of the University of Maryland's international health division as well as a coauthor of the study. "It was embarrassing to them and unfair because it's retrospectively looking at something that was meant to do great good and ended up harming. The sensationalism has made everybody fearful."

Indeed, when a doctor who studies HCV learned that I met with patients suffering from the virus, he was panicked, and then tough. "Which hospital did you go to? Who let you in? You then went to the delta? Who did you go with?" he asked in a rush.

"People in Egypt don't want to talk about problems," says Dr. Frank J. Mahoney, director of the U.S. Naval Medical Research Unit No. 3's office in Cairo. "No one has been willing to step forward like the way [former U.S. Surgeon General] C. Everett Koop did in the U.S. [for AIDS]. It wasn't until Koop came in and said, 'This isn't a gay disease; it's a disease of everyone in America' that the debate changed.

"No one has done that here," Mahoney continues. "Someone needs to stand up and do that."

As Mahoney's comments become increasingly bold, he is interrupted several times by a colleague who wants to make sure that he is fully cognizant of what he's saying. He thinks about it and says he is.

"[Egypt] is the world's laboratory for studying hepatitis C," he says. "Unfortunately, it's not the laboratory for prevention. And it's frustrating because it should be."

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The same waterways that give so much life to the verdant Nile Delta are also home to a parasitic worm called the schistosome. Its underwater attack on the El Sayeed family members occurred on the most blissful of days -- when, as children, they would congregate at the Ferhashe canal for swimming and picnicking. The Ferhashe, which runs just outside town, is one of the only respites from temperatures that soar into triple digits.

The schistosome enters the body in the soft webbed area between the toes. It then infiltrates the bloodstream and lays eggs that settle in organs like the liver, bladder and intestines. A buildup of these eggs -- which causes the disease called bilharzia, or schistosomiasis -- can lead to bladder cancer and sometimes death. Bilharzia's most famous victim is Abdel Halim Hafez, a beloved singer who died from complications from the disease in the 1970s. These days, his music, which still blares on the radios of passing cars, serves as one of the few reminders that the disease was once a scourge here.

At the time that bilharzia was a problem, Egypt was the hardest-hit country in the world, and in agricultural areas like the delta, where residents rely on water for farming, bilharzia had infected 70 percent of the residents of some communities. Many members of the El Sayeed family, including Hamdy, fell ill. It was in response to this epidemic that the government launched a national campaign to treat those with the illness and prevent others from suffering.

"Schistosomiasis killed people -- they could not walk, they had bleeding from the mouth, they found really young people dying," says Dr. Mohamed Abdel-Hamid, in his Cairo office of the University of Maryland School of Medicine's Viral Hepatitis Reference Laboratory. "That's why people started this campaign. During this time, they didn't even know of something called HCV." Hepatitis C wasn't identified until 1989, at which time it was renamed, dropping the highly ambiguous "Non A, Non B Hepatitis." Blood wasn't adequately screened for HCV until three years after that.

When the government combated bilharzia, patients lined up to receive 10 to 12 shots of tartar emetic to kill the blood flukes. Although the anti-bilharzia campaign dates back to the 1920s, it ramped up in the 1960s. The delta's high prevalence of HCV may be explained by the fact that the campaign lasted the longest here, until the mid-'80s, when oral medication replaced the intravenous.

"[The swimming] was nice, but if I would have known that it would have caused me this illness, I would have thought differently," says Hamdy El Sayeed. The yellow cast of his skin and eyes, the result of cirrhosis, stands out in contrast to the white prayer cap and tunic that he wears in the hospital.

Hamdy first felt the pathogen's effects 25 years ago. A fatigue descended on him and, like a shadow, followed him everywhere. Then the color of his eyes changed. Someone told him that sugarcane, marmalade and honey -- whose healing properties are noted in the Quran -- could cure these mysterious ailments. And it seemed to work. Hamdy repeated this regimen for years, until the day when all this sweetness couldn't erase the ever darkening yellow of his limbs and torso. Simple activities like walking became a chore. When he finally sought medical attention and was tested for hepatitis C, it was positive. Three months later, he ended up at this Cairo hospital.

"What increases the death rate is people present themselves too late," says Dr. Hesham Dabbous, assistant professor of tropical medicine and liver diseases at Ain-Shams University. "I see it every day. You have a perfectly healthy life with no signs of disease or symptoms. The liver is damaged silently and the patients come in with end-stage liver disease like cirrhosis, digestive bleeding, liver cancer and liver failure."

Over the last decade, cirrhosis has increased substantially in Egypt, and liver cancer has risen in rank to be the third most common cancer. About six years ago, doctors at the Cancer Institute in Cairo used to see one case of liver cancer a week or every other week. Now they see one every day. By comparison, it is not even in the top 10 cancers in the United States.

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