3:23am , Tuesday 27th July 2021

White Cheese: A Cancer Spreading in Egyptian Homes

4 December 2013

Umm Mohammed wakes up in the morning, and tries to make a quick breakfast for her 11-year-old son. She almost always goes for a white cheese sandwich, as it is cheaper than other kinds of cheese, while still containing the nutritional benefits of milk, which he does not like to drink every day. She looks at her watch and sees that it’s late, and that it’s time for him to go.

Like thousands of mothers and families in Egypt, Umm Mohammed relies on cheese as a main source of sustenance. Many people prefer to buy generic cheese available in bulk from shops and street vendor stalls, because it costs only a few Egyptian pounds, compared to other kinds of processed cheese that is being sold for more than 24 pounds per kilo. But little do they know that the cheap cheese contains formalin, a substance that could lead to cirrhosis of the liver, tumours, and kidney failure, and which is known scientifically as formaldehyde.

In this investigative report, which took two months to complete, al-Yawm al-Sabei  found that many backdoor unlicensed creameries are adding formalin to the milk that goes into white cheese, in order to extend its shelf life.

The report’s author collected 13 random samples of this cheese in the governorates of Cairo and Giza, from grocers and street vendors in areas like al-Manial, Sayeda Zeinab, Sayeda Aisha, al-Badrashin, Imbaba, Imraniya, and Bab al-Shehria to test them for formalin, in addition to a sample obtained directly from one of the factories producing the cheese. The tests we conducted showed that 7 out of 13 samples contained formalin, according to the results we got from the National Research Centre.

The investigation focused on illegal cheese factories, which number more than 4,200 spread across all the governorates of the republic, according to a recent study by the National Centre for Criminal and Social Research. These unregulated factories produce 80 percent of cheese in Egypt, while major companies produce only 20 percent.

In addition to analysing the samples to establish whether they contain the substance in question, we witnessed what goes on inside one of these cheese-producing facilities, which fails to meet all standards applicable to factories producing these kind of foodstuffs, in accordance with the specifications of the Egyptian Organisation for Standardisation and Quality stipulated in its Manual No. 3393 of 2005.

In addition, we observed that workers were violated health and safety requirements meant to prevent food contamination, by not wearing protective clothing and gloves, or notifying management of medical conditions such as flu or infectious skin diseases, and other regulations relating to food safety. We also observed the stages that milk undergoes from collection to conversion to cheese, and distribution to shops and street vendors.

Homemakers make cheese for personal consumption, while unlicensed creameries distribute carcinogenic products in the markets

The governorates of Dakahlia, Beheira, Gharbia, Tanta and Minya are heavy producers of dairy products, including milk and cheese. There are several stages in processing white cheese, which vary according to the environment in which the process takes place, either at a home, a facility run by a major company, or the creameries we described above.

In households, homemakers produce cheese for personal consumption. In the second and third cases, cheese production passes through almost the same stages, except for minor differences relating to additives introduced to the cheese, which are not stated in the standard specifications for the processing of white cheese set forth by the Egyptian Organisation for Standardisation and Quality under No. 1008-1/2005, which specifies limits for protein, lactose, calcium chloride, fat, and salt content, as well as permissible food additives.

Making white cheese at home, according to O.M., a cheese maker in the governorate of Dakahlia, begins by straining milk “according to the quantity available” using a strainer with fine holes to get rid of dirt after warming over low heat. Rennet, or a complex of enzymes from an animal source, is then added, either in liquid or dry form, extracted from the stomachs of calves.

The mixture is then stirred well in a deep dish to thicken the liquid. After that, it is covered for half an hour and left to cool. The cheese is then cut into two parts, and left for another half an hour. Next, the cheese is placed in a plastic colander and pressed well to get rid of excess water, and then left overnight after being covered again using a cheesecloth. In the morning, the cheese is placed in a large platter and sprinkled with salt. For storage purposes, it can be placed inside salted milk and covered well.

In major cheese-making companies, the white cheese production process is different, according to Ahmad Yahia, an owner of one such enterprise in the Cairo governorate, and head of the Foodstuffs Division at the Chambers of Commerce.

The process begins by collecting milk in agreement with owners of certain farms. The milk is delivered to the factory or plant in chilled and sterilised tanks (factories and plants are different in that the former are more modern than the latter). After that, the milk is placed on heating stands, where salt and rennet, which helps in the conversion of milk to cheese, are added. The resulting curd is then poured into mixing trays, to be drained from the whey, or the water present in the mixture to make concentrated cheese before it is packed in containers. The milk base of the cheese must be pasteurised or heat-treated, i.e. heated and then cooled at a certain temperature to kill harmful bacteria.

Finally, there is the process of cheese-making in small creameries that use primitive methods in the production process: first, milk is collected from rural areas and farmers. But these shops don’t have the capabilities to pasteurise milk or heat-treat it to kill harmful bacteria, even though milk is one of the foods most prone to contamination, and no more than two hours must elapse from extraction from cattle to processing, according to Yahia. Instead, these cheese-makers use chemicals to kill the bacteria, including formalin, which is used without any awareness of its hazards to human health. Formalin is also added because these cheese-making shops neglect to cool the milk, even though the purchased dairy would have traversed a long distance before arriving at the dealers and distributors.

These crude creameries, which are present in all regions of the republic, produce up to 800 out of the 1,000 tons of white cheese manufactured daily in Egypt, according to a study by the National Centre for Criminal and Social Research. This would be sufficient to meet demand in the conurbations in which these cheese factories operate or in other governorates.

During our quest to collect samples from markets in Cairo, we observed that some stores and street vendors sourced their cheese from the governorate of Tanta. In the market in Giza, we found some women who had bought white cheese from a factory on October 6. They said that a van belonging to the factory in question distributes cheese to them each Wednesday. These factories use formalin in their products as well, without knowledge of their hazards and adverse health effects. We thus decided to continue our search for the places where formalin-containing cheese is sold, and enquire about their exact hazards and the available alternatives to formalin that serve the same purpose of food preservation.

Used to Preserve Corpses, Formalin Could Lead to Liver Cancer and Renal Failure

For only six Egyptian pounds, one can buy a litre of formalin from any chemist. All one has to do is ask for the “cheese solution,” which is the common name used by dairy producers for formalin, and the chemist will respond, “You mean the preservative?” before rushing to get some. But one chemist we went to wanted to get some clarification, and we told him we wanted to buy formalin to add it to cheese. The man asked us to verify whether we were sure we wanted to use it in food, but in the end, he did not mind to sell it to us either, in return for a few pounds.

This is what happened when we tried to buy formalin from a chemist in the governorate of Cairo. A litre may be sold anywhere from 4 to 6 pounds.

Formalin 

It is a colourless and flammable substance with a pungent odour, which dissolves quickly in water. It is used as an embalming liquid, to preserve dead animals and humans from bacterial decomposition, and also in adhesives, carpets, fabric, and plastics. Although it is permissible to use formaldehyde or formalin as a preservative in some industries at a concentration of no more than 3 or 4 percent, it is banned in foodstuffs, according to the Codex Alimentarius issued by the Food and Agriculture Organisation (FAO) of the United Nations, in collaboration with the World Health Organisation (WHO), given its long-term detrimental effects on human health. However, in Egypt, this is ignored, and formalin has been used by unregulated factories since the 1990s, without any regard for its hazards.

Dr. Hisham al-Khayat, professor of gastroenterology and hepatology at the Theodor Bilharz Research Institute, spoke about the dangers of formalin, and said:

“[Formalin] can be credited for raising the number of patients with kidney failure and hepatitis, which are increasing in incidence in Egypt annually, according to recent data by the WHO and the Egyptian Ministry of Health. [Formalin] is a highly toxic substance, and when it enters a patient’s body, it causes ulcers and severe inflammations in the esophagus, and could even perforate the latter in high concentrations, or cause cirrhosis of the liver over the long run, as well as narrowing of the esophagus resulting in an inability to swallow, weight loss, and deficiency in vitamins and proteins needed by the body.” Khayat added, “The substance can also cause renal failure and tumours in the liver, because it is a terrible toxin used without awareness as a preservative to extend the shelf life of foodstuffs for as long as possible, while its health effects appear in the long run.”

He continued, “Formaldehyde is highly toxic, even with exposure in very small amounts. It is considered a strong carcinogen, and it also causes damage to the skin and the eyes with direct exposure. Inhaling it also causes irritation of the mucous membranes in the nose, inflammation of the trachea, and shortness of breath.”

In 2011, the U.S. government added formaldehyde to the list of substances known to cause cancer, warning against consumption of, or exposure to, the substance. A report submitted to the US Secretary of Health and Human Services (HHS) at the time warned that those exposed to the substance could face increasing risk of cancer of the nose and pharynx, cancer of the blood, and various other types of cancers.

Although there have been studies published in Egypt decades ago by the faculties of agriculture at Cairo and Ain Shams universities, in collaboration with the Ministry of Interior, and in Alexandria in cooperation with the Chamber of Food Industries at the Federation of Industries, which all warned against using this substance in dairy products, some cheese-making factories still use such traditional methods to avoid the cost of using modern equipment to kill bacteria. “Formalin is a banned, unhealthy and illegal substance,” according to Dr. Munir al-Abed, professor of dairy processes at the Faculty of Agriculture, Cairo University, adding that cheese and dairy producers started introducing such substances without any knowledge of their properties and effects.

Dr. Marsa Soda, professor of dairy science and technology, Faculty of Agriculture, Alexandria University, explained how formalin might be detected in cheese. He said, “Take 3 ml of milk and add to it 3 ml of water from the tap. Then carefully add 5 ml of concentrated sulfuric acid to the tube, taking care to hold the tube at an angle, and slowly pour the acid onto the inner surface. If formalin is present, even in small quantities, a purple ring will form. If the milk is free of formalin, the colour will be light green and will gradually revert to brown.”

Regarding the available alternatives to eliminate the harmful bacteria found in milk and dairy products, chemical expert Bahaa Jaheen said that there are other chemicals that can be used instead of formalin, such as benzoic acid and its salts, and sorbic acid and its salts, which are all permissible preservatives in accordance with the specifications of the Organisation for Standardisation and Quality at concentrations less than 3 percent, saying that they are not harmful.

Jaheen went on to say that some cheese-makers do not have sufficient knowledge and awareness, reckoning that their craft is usually dictated by conventions inherited from their fathers and forefathers. He called on chemists selling the hazardous substances to ask customers about the intended usage and to educate them about the hazards, as well as inform themselves using scientific references that explain the dangers of certain chemicals and notify customers accordingly before making a sale.

Jaheen said that sorbic acid and salts are more expensive than formalin, which is why the owners of the crude cheese factories prefer the latter despite its hazards. “Formalin is completely forbidden as a food additive, given its harmful effect on human health, even in small amounts,” he emphasised.

To see what happens away from the eyes of the regulatory bodies, we had to observe the stages of cheese production mentioned above, as well as distribution and violations that take place inside crude creameries.

Al-Yawm al-Sabei Spends 8 Hours Inside a Creamery in Imraniya

Al-Yawm al-Sabei spent eight hours inside a white-cheese factory in Imraniya in the governorate of Giza, after establishing that formalin was present in a sample taken from cheese produced by the factory. The purpose of the visit was to monitor the stages of the cheese production process, and witness whether this factory, as well as similar establishments, were following mandatory health and environmental requirements.

Queuing with the women workers in the morning begins at 7 am, outside the factory that is no more than a few square meters big, no bigger than the first floor of one of the adjacent buildings. A metallic sign sits on top of the entrance, bearing the name of the factory and its specialisation.

A few minutes later, the person in charge of personnel at the factory ordered the women to enter, and they all went into a small room where insects were crawling everywhere. The room was separated from the refrigeration room used to preserve cheese and other dairy products, before they are distributed to shops and street vendors, by means of a metal door.

In the room, the women began to change into abayas [traditional cloaks], and then went to their respective post. Some went to pour cottage cheese into wicker baskets to drain the whey and allow the curd to set. Others went to heat the milk and afterwards to cool it, while others still went to pack the cheese left from the previous day, and stack it in plastic buckets. Three of the women finished cleaning the place and tried getting rid of the waste from the previous night shift.

As soon as we entered the factory, we started to compare the reality there to the requirements set forth by the Organisation for Standardisation and Quality and the Ministry of Health regarding conditions at the workplace, specifically in factories producing these type of foodstuffs, since dairy products are among the foods most susceptible to contamination and therefore require a special environment for their production. We found that the irregularities began with the internal structure of the creamery itself, such as the flooring, the drainage, all the way to the workers and their behaviour, and the packaging and distribution of the cheese produced.

First, the factory floor: the requirements set forth by the Organisation for Standardisation and Quality, the Ministry of Health, and the Self-Monitoring Manual of the Dairy Industry issued by the Ministry of Environment stipulate that the surfaces of walls, partitions, and floors must be made of impermeable, smooth, and non-toxic material, while floors must be built in a way to allow adequate drainage and cleaning.

However, things were different at the factory in question. The floors were covered with a layer of rust, and although they are made of ceramic tiles, they were not level. There were channels to drain water on both sides, but hoses from reservoirs used to wash buckets and clean the floors were scattered everywhere, in addition to piles of workers’ shoes. There were also all sorts of flying insects that landed from time to time in the containers used for the milk base.

Secondly, most of the irregularities we observed within the factory concerned worker conduct, sometimes in complete violation of the regulations. Workers were not wearing the required protective clothing, and did not notify management of their medical conditions.  Instead, all the women wore abayas or robes, took off their shoes, and walked around barefoot or in slippers, without wearing gloves. One of them was observed coughing into the exposed food containers, as she was congested and showed signs of a fever.

Failing to wear gloves is in fact a gross violation of the mandatory health requirements. We observed that the workers did not hesitate to wipe sweat from their foreheads with their hands, before inserting their hands into the milk to check its temperature, taste the resulting curd, or verify the consistency of the cheese, all in violation of the requirements that state that workers who do not maintain a certain level of personal hygiene, display certain symptoms or health conditions, or behave inappropriately can cause food contamination and transmit diseases to consumers.

We saw one of the workers use a cloth drenched in soap and bleach over the tip of the hose connected to the milk-draining machine. She did not rinse the cloth after washing it in soap to make sure it was suitable for use,  but only squeezed it.

Third, the receipt of milk for cheese production: A large vehicle stopped outside the factory at 7:30 am. With agility, the foreman and deputy director of the factory poked a large hose from a window inside the building to syphon the milk collected from nearby vendors and cattle owners  into a machine used to filter the milk of any impurities. However, there was no person present adequately trained on inspecting the milk to verify its quality before adding it to the older milk inside.

Next, the milk is separated from the cream, and then transferred to another machine that heats the milk to 50° C.  After that, the worker responsible for this stage transfers the milk to a cooling machine, and then reheats the cooled milk once again to 70° C, before cooling it in the final phase to 40° C. Throughout all these stages, the worker sprays the milk from a canister containing a whitish substance, which the head of personnel gave to her at the start of the day. When we asked her about the sprayed substance, she said, “We spray it to reduce foaming in the milk.”

During the heating stage, the rest of the women were busy packing the cheese stored in the refrigerator after the person in charge of distribution to stores arrived. Others were cleaning plastic buckets before refilling them. The buckets are sent back to the factories from the distributors, and after they are washed, workers place each bucket under a printer which inscribes a new production date – the date of the day the cheese is packed, when in actuality it was produced days earlier. The foreman then instructs the workers to attach a label bearing the name of the factory, the type of cheese, and an expiry date of no less than one month. Another worker went to cover the metallic pans where milk is poured and rennet is added for the next day.

According to one worker, the factory distributes the cheese both inside and outside Imraniya. She said, “We distribute in many places, so much that the supervisors once called us at night to reopen the factory after the closing-time, to deliver an order of 200 cheese buckets to the airport.”

Mohammed Damati, managing director at Domty Foods and Dairies, and head of the Dairy Division at the Chamber of Food Industries, said that these crude factories hurt major dairy companies and their products, adding, “When there are reports about formalin being added to cheese by unauthorised factories, we find that consumers avoid buying dairy products in general. This has certainly caused us huge losses, not to mention that such factories do not abide by national insurance and tax regulations like major companies, and hence, competition in the market is unfair.”

Multiplicity of Regulators Weakens Efforts to Crackdown on Fraud in Foodstuffs

The multiplicity of regulators concerned with protecting the process of producing and selling cheese – ranging from the Ministry of Health, the Ministry of Supply’s Inspection Directorate, the Consumer Protection Agency, local administrations, and others – has undermined efforts to prevent these irregularities, due to a lack of coordination between these authorities over the normalisation of conditions in unlicensed factories.

In addition, there is a problem concerning the regulatory aspect as well, namely, the excess of unenforced laws enacted by Egypt to confront fraud in foodstuffs. A large number of these laws date back to the 1940s and 1950s. The most recent of these laws is the Anti-Fraud Law No. 281 of 1994, which punishes any person committing fraud or planning to commit fraud against a contractual party with a prison sentence of no less than one year and a fine of 5,000 to 20,000 Egyptian pounds, or the equivalent of the value of the goods or services in question.

The sentence increases to two to seven years, and the fine to 20,000 to 40,000 Egyptian pounds, or the equivalent of the value of the goods or services in question, if the latter are detrimental to human or animal health. The court may rule to close a facility found to be in violation for a period not exceeding five years in case of recidivism, and may also permanently revoke its license if the previous punishment is deemed inadequate, without prejudice to the rights of the workers in said facility.

However, all these sanctions remain ineffective without the efforts by the concerned authorities to protect consumer interests.

Dr. Mohammed Houfy, head of the Food Industries Division at the Faculty of Agriculture at Ain Shams University, said that laws should be passed prohibiting the sale of formalin in shops, while those who want to buy it must produce permits explaining how the substance would be used, in order to withhold formalin from cheese producers. A further problem, according to Houfy, is that the Ministry of Health labs in the governorates are not outfitted to deal with this kind of fraud in foodstuffs, whether in terms of equipment or qualified personnel who can identify the chemicals.

Houfy claimed that 80 percent of diseases in Egypt are caused by fraud in foodstuffs, and said, “We are a people that eat cheese rather than drink milk. It is not acceptable for simple citizens to spend everything they have on dairy products, of which Egypt produces 4 tons annually, barely enough to cover half of our needs, because they are cheaper than other foods; and yet, they receive poisoned food.”

He then added, “Instead of only conducting inspection visits, it is better to offer some guidance for those working at such enterprises, and help them develop their craft by using correct and healthy methods like those observed by the Chamber of Food Industries and the Dairy Industries Division at the Federation of Industries, and impose penalties on them in case they continue to violate health regulations that must be respected in making this type of foodstuffs, as set forth in the manual of the Organisation for Standardisation and Quality.”

Throughout 2012 and up until last month, the number of citations concerned with combatting the circulation of dairy products unfit for human consumption by the Ministry of Supply’s Inspection Directorate stood at 239. In 2012, 36,860 containers of cheese and milk, 1,500 boxes of cheese, 96 cartons of milk powder, 162,303 boxes of yogurt, and 79.750 tons of substandard production ingredients were seized. In 2013 so far, 6,739 cartons of milk, 403,386 portions of cheese, 68,362 boxes of yogurt, and 9,915 of substandard production ingredients have been seized.

Despite this, the role of the Ministry of Supply’s Inspection Directorate is limited to issuing citations, while the decision to close down a facility found to be in violation must be made by judicial authorities, after the seized samples are analysed.

As for the Consumer Protection Agency, one of the regulatory bodies concerned with this issue, Ahmed Samir, executive director of the Consumer Protection Agency explained its role. He said that the agency takes action based on complaints filed by citizens. For example, he continued, if a citizen complains about irregularities in a cheese product, a team from the agency goes to where the product was bought immediately, and seizes the cheese products there. These are then sent to the Ministry of Health or the Ministry of Agriculture, Samir said, which in turn analyses the samples and publicises the results. If they are free from any irregularities, they can be sold again. But if there are violations of the mandatory specifications, the necessary legal procedures are taken.

Samir explained that the total number of complaints filed by citizens regarding goods offered for sale in 2012 was 20,000, of which food items represented only 2 percent.

In spite of numerous studies submitted by various authorities regarding fraud in foodstuffs, the low number of complaints filed with the agency in this regard show that fraud in foodstuffs is a concern that ranks low with Egyptians. This is despite the fact that the annual conference of the Egyptian National Competitiveness Council indicated that 45 percent of consumer income was spent to food, that 20 percent of the Ministry of Health’s budget went to treating diseases resulting from food contamination, and that 99 percent of food trade outlets were unregulated.

As a solution to this crisis arising from the multiplicity of regulatory bodies and their piecemeal efforts regarding food-related fraud, there are voices calling for the establishment of a food safety agency, which would handle all these functions. These voices have also called for passing the unified law on foodstuffs, which has been in legislative limbo since 2007.

Apart from the supervisory role, there are efforts to raise awareness and offer guidance, with a view to bringing the unlicensed factories into the fold of the law, undertaken mainly by the Federation of Industries in Egypt. 

The Egyptian Federation of Industries Provides Guidance to Small Factories

The Federation of Industries, through its Dairy and Foodstuffs Industries Division, is working to raise awareness both among consumers and producers about the health risks of using banned substances.

Teams were formed to visit universities in various governorates to raise awareness of the need to implement standard specifications developed by experts at the Egyptian Organisation for Standardisation and Quality, including taking care of storing the milk at cool temperatures from the moment it is extracted from the cattle, all the way to the distribution phase; establishing milk collection and refrigeration throughout the republic; maintaining existing milk collection centres; abiding by health requirements; providing refrigeration equipment for the transport of milk to processing plants; pasteurising milk before processing into dairy products and urging unlicensed factories to follow contemporary, safe methods in their production processes.

Amid these alarming facts and figures, there is an absence of a sufficiently deterring law to combat food fraud, while efforts to confront the latter remain scattered across the many supervisory bodies, weakening their collective efforts. For this reason, this investigation sought to shed light on the dangers of this phenomenon, which is believed to be a major cause of a growing number of diseases afflicting Egyptians each year, and to call on the authorities concerned to unify and intensify their efforts to eliminate this by establishing a unified agency for food safety, and enact laws to criminalise the sale of certain chemicals to the public without prior authorisation that would be commensurate with the nature of the work of the bearer.


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