For almost three months, I have been gathering as much data and information about the current health system and practices here in the Iraqi-Kurdistan region. I am nearing the end of my journey and am expecting to return to the states within the next several weeks.
Prior to my departure, I would like to share with you some of the knowledge that I have been able to gather throughout my journey to heal Kurdistan.
For over four decades, general public health education, medical education, and health care were oppressed by the regime of Saddam Hussein.
Iraqi-Kurdistan has suffered since long-before the war on terror. The concepts of healthcare and general public education were hardly humanitarian due to political interference. The Kurds were dealt with poverty of basic medical resources, and alienation from the international medical community from 1968 to 2003, under the rule of Saddam Hussein.
The first medical school in Kurdistan, Iraq was a branch of the University of Sulaimany and opened in 1978. Students would be taught English and learn the medical terminology that is used in the UK and the United States; the medical terminology in the Kurdish language is incredibly underdeveloped.
Until this medical school opened, Kurds that wished to pursue medicine as a career would do so in other parts of Iraq, including Baghdad, Mosul, and Basra as prominent regions for their programs in medicine at the time. However, few Kurdish doctors would return to Iraqi Kurdistan post-graduation due to the residency that they established elsewhere. The first batch of doctors from the medical school in the University of Sulaimany graduated in 1984.
For easier political and military access, and by the direct order of Saddam Hussein, the Iraqi government decided to move the University of Sulaimany to Erbil in 1983 and renamed it the University of Salahaddin. This made it more convenient to remove any health care and academic professionals, as well as newly-graduating doctors, that Hussein didn't consider loyal followers.
Regardless of credibility, merit, or academic standings or achievements, Hussein appointed his own academic staff. This new staff would have more opportunities to grow in the field, with countless scholarships all across the world in more developed nations, including the UK and the United States of America.
In addition to pulling a switch on the employees of the medical school, courses that encouraged the Baath party's doctrines were incorporated into the curriculum. Furthermore, courses were now taught in Arabic.
Needless to say, there was constant discrimination between Kurds and loyal members of the Baath party. Hussein appointed agents to pose as staff and fellow students to maintain order and distinguish loyal versus 'seditious' students.
With the reputation that Saddam Hussein created for the medical school and in his international relations; books, publications, and assistance from more developed programs overseas stopped coming into Iraq. There were no longer opportunities to interact with the international medical community and scholarships were no longer offered. Graduates were not permitted to attend conferences, meetings, or postgraduate medical education outside of the Iraqi borders.
After the Gulf War came to an end in April 1991, Saddam's army headed for the Kurdish region, forcing hundreds of thousands of Kurds to flee to the mountains on neighboring Turkey and Iran. At the time, there was a lack of adequate drugs, if adequate at all. There were limited medical resources and basic surgical supplies.
Many doctors ended their professions as health care workers due to the extreme decrease in their salaries; these doctors would move to be employed with local aid organizations as translators and interpreters.
In October 1991, Saddam withdrew his administration from the region and the Kurds established the Kurdish Regional Government (KRG) and elected the first members of Parliament in 1992.
Since the removal of Saddam Hussein from power, there have been many efforts to stimulate the population here to implement a new healthy policy and system by both Kurdish and non-Kurdish professionals and non-professionals within the Kurdistan region and overseas. These efforts have been made by both government officials here in Kurdistan and in more developed nations as well.
For example, the United Nations Security Council initiated resolution 986, the 'oil for food program,' which allocated 13% of the total allowed sum of Iraqi oil export money for purchasing medicine and necessary humanitarian needs to the Kurdish administration. In addition, salaries have risen since the exporting of oil has began again.
The medical education here approaches educating prospective students through the British system, irregardless of British standards. Degrees in medicine and surgery are awarded in six years. Clinical education usually begins after the first two years. The last year is completely practical training.
Over the last few years, numerous dentistry schools, nursing colleges, medical schools, and technical schools for qualifying pharmacy assistants and lab technicians have been established and incorporated into the Kurdish medical education system. Kurdistan is currently one of the very few stable and secure regions in Iraq.
In the public institutions that are open to everyone and government-funded, there is an incredible lack of sanitation. Blood work and other lab testings are done in an unorganized manner.
Sixty percent of current medical practitioners have had little-to-no health related training in the past five years.
Doctors don't follow-up with their patients, regardless of the degree of severity in their illness. There is no official registry of patients. When in doubt of the diagnosis, doctors will make a 'good judgment' and prescribe what they feel might help, in the dosage of their choice.
If you were to pull 10 doctors at random, you are likely to find one that is honest in the way he treats his patients. If you're lucky.
Most doctors, in fact, will worsen your situation because they will usually cure every case with antibiotics and pain relievers, rather than diagnosing where the pain is coming from and why. That being said, your illness is most likely going to return. Furthermore, if they don't have the medication you need, they will prescribe a substitute.
There are times where patients will wait months to see a doctor for their condition; frequently, you will find a patient requesting a visa to Jordan, Turkey, Iran, or Syria to see a professional that can help them because there are no qualified doctors for their condition here.
Do not be surprised if you visit 100 doctors with the same symptoms and find that you have 100 different diagnoses.
The doctors that commit fatal mistakes are rarely punished, prosecuted, or acknowledged.
There is no insurance system if your doctor has made a mistake. You will be searching for a better cure at your own expense.
My conclusions, thus far, are that the health care system requires urgent attention from both domestic and international support. The current health policy in practice is in need of immediate review and reconstruction. Furthermore, our focus should not only be on rebuilding from the implications of the war on terror, but from the wide-ranging epidemics of the previous dictatorships regime.
Each year, there is an average of 2500 newly qualified doctors in the Kurdistan region, with only about 300 going into practice. In response to the removal of the embargo that was placed with the international community, Kurds have had the opportunity to utilize power and resources that would prove beneficial to the entire population. Aside from political or religious bias and affiliation, it seems that this power has been abused by those placed in positions with authority.
Through my interviews and the data that I have gathered, I have come to the conclusion that, first, many of the leaders that have been put into power into the ministry of health are incompetent and have expertise in non-health-related fields. They are unqualified, unskilled, and inefficient.
Any means of reformation would need to begin with the political sector.
Second, allocation of government funding stated by UN Resolution 986 needs to be strictly monitored.
Third, we need to reinvest in public health. Although there is very little research-based and valid data in regards to the currently populations health and the health services that are offered here, I stress the importance of gathering this data from here on out.
The new health policy needs to emphasize the legalities in doctor-to-patient services, insurance options for patients, and follow-up degree requirements and updated examinations for medical professionals in order to continue practicing.
I am in the process of reviewing the current health policy in practice. I look forward to presenting to you my final proposal for the 2012 health policy to be implemented in the Iraqi-Kurdistan region.
I am honored to have had the experiences that I did in Kurdistan this summer and I look forward to continuing with this research in the future. Updates in the future will be posted on the Journey to Heal Kurdistan's blog at www.healkurdistan.blogspot.com. Thank you.
[Photo Courtesy of Andrew Brehm]
