Medical teaching in war torn Iraq
The recent war in Iraq has taken its toll on the health system. Ioana Vlad investigates the current situation for medical students For most of us life as medical students means attending lectures held by professors who we know in buildings that have stood for years. Life may also include joining doctors on ward rounds and going out and having fun--all important parts of our student life.
The situation is slightly different for medical students in Iraq. Alexander Garza, the public health team chief for the 418th civil affairs battalion of the US army and responsible for the medical redevelopment for the Salah al Din province of Iraq, says the medical schools he sees are "a little more austere." His job includes working with the hospitals, clinics, health departments, nursing schools, medical schools, veterinarians, and pharmacists: "I basically help with the administration of health throughout the province, try to get money for them to rebuild their facilities, and troubleshoot some problems for them," he says. Welcome to postwar Iraq.
Unesco prize winning system
Iraq was once considered to have one of the strongest education systems in the Middle East, winning the Unesco prize in 1982 for eradicating illiteracy. Medical school lasts for six years and is based on the European system, in which medical students enter college after secondary school and usually have to be in the upper 6% of their class.
But, according to Iraqi interim minister of health, Khudair Abbas, the situation started to deteriorate during the Iran-Iraq war. In 1991, as a result of the economic sanctions that put a financial strain on the country, Saddam Hussein began to sacrifice education and the other needs of the population and to invest in military programmes. No foreign medical textbooks or journals were allowed into the country. Library books became old and out of date and investment declined in other educational materials. Medical teaching supplies were scarce. "The library is small for a medical school and the contents are very outdated, with most publications more than 25 years old," says Alexander.
Ba'ath party bias
According to Alexander, academic promotion was made according to membership to the Ba'ath party. Even the examination system for students was politically biased--children of members of the Ba'ath party would get five extra points in examinations. Already fragile, the education system was destroyed by the second war last year. Lectures stopped in March before the war started, and most students stayed home until the end of May. For some, it was a shock to return to find only ruins where their university once stood. Others returned to find the building vandalised or accommodating US troops.
Fifth year medical student Jabar Kirbit from Ramadi describes the situation, "Most students in Baghdad remained at home except for few who had the courage to get out and see what had happened to their college; some were shocked to find that their colleges or universities are wrecked by looting or that some are bases to the US army, and they were not allowed to get near them."
Final examinations were delayed by one to three weeks, but, in October, the new university year started as planned. The students found themselves doing procedures that they would not normally do. Jabar helped the short staffed local hospital by suturing, treating fractures, and helping in operations. Some students worked as interpreters for American and British troops.
According to Jabar, immediately after the war some students gave up university for fear of being kidnapped: "Some of the students, especially females from Baghdad, had to give up the studying in the first few months due to the repeated cases of women being kidnapped there."
Working at gunpoint
Security problems occur inside hospitals as well. It is not unusual for medics to be attacked or threatened by patients or their families, who want better treatment and medicines that are not available. "The approach to patients is not that much different although the patient attitude toward doctors has changed. In some instances when the patient was critically ill, you find members of his family threatening the doctor with guns due to lack of security officials in the hospital," says Jabar.
CHRIS ISON/PA
Troops attending to a small childLinks
Medical students can also be arrested and questioned by US troops, which allegedly happened to Jabar and his friends while they were getting ready for a party: "The attack by Americans took place at sunset when we were inside the college preparing a sort of graduation party. At that time an American patrol was passing by and some shooting was heard that they interpreted as coming from us in the college. So they fired back on us and arrested the guards of the college because they were armed, and we were also arrested. Although we tried to explain we were ordered to shut up and we were held at a military base for three weeks. We did not know our accusation nor did we meet any of our family members, who were told two days after our arrest that we were arrested."
According to Jabar, students are more apathetic about studying because of daily threats. Some doctors from Baghdad have left for calmer areas, like Jordan or other countries. This has caused a shortage of doctors, a delay in lectures, and has left the medical education system in pieces.
A call for aid
Firas Al Ani, a cardiothoracic and vascular surgery specialist, thinks that the education system is worse than before. His hospital was destroyed during the combat, and he is thinking of leaving the country to continue his training: "Doctors in the wards were affected to the extent that many of them were not able to rejoin their work even after many weeks, as it happened to me. One of the causes is that our hospitals were totally demolished and I found myself unable to continue my training as a postgraduate student in the optimal recommended way."
The situation is not the same, however, throughout the country. The northern region of Iraqi Kurdistan has been stable since 1993. Dean of Dohuk College of Medicine, Farhad Sulayvani, says lectures at his university were stopped from 15 March until 20 April 2003. Dohuk College boasts excellent security facilities. Examinations were delayed by one week and no student discontinued their studies because of the war. Stable areas, such as Kurdistan, will be the starting points for a new examination system. Iraqi interim minister of health, Khudair Abbas, has appealed to foreign medical bodies to help Iraqi universities and hospitals with this by supplying books and study grants.
Despite the widespread desire to flee Iraq and start a new life abroad, some doctors want to stay and help rebuild the country. They told me they are amused by questions about their capacity to continue in the face of assaults claiming that they will stay. Doctors and medical students are ready to do jobs that they are not trained to and to work extra hours.
Rising from the ashes
"The exterior may have been stripped away but the nucleus remains," writes Gary
Selnow, the founder and director of WiRED International, a non-governmental organisation that provides computer technology to bring healthcare information into troubled regions. Gary describes his experience at Al Kadhymia Teaching Hospital in Iraq, "The doctor themselves and their students had spent hours late at night after their last rounds, washing the floors, tossing the trash, and preparing the space. Why, I asked, did they do this? Because, they said, they desperately wanted the medical e-library we were bringing them, and they didn't want to lose the chance to get it." The situation of medical students in Iraq is definitely not one that we dream about. But they fight everyday not only for their life but also for their education. Some decide to leave, and some prefer to stay and look for a brighter future. Gary is adamant, "These colleges and universities will rise from the ashes."
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Ioana Vlad junior doctor, Iasi, Romania
Email: ioanavlad@hotmail.com
March 2004
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