Local doctors teach in Iraq

Practicing medicine in a war zone isnÂ’t easy. Even if health care workers are in a relatively secure area, like the northern Kurdish area of Iraq, some of the basics of modern medicine are overlooked due to a lack of staffing and funding.

Three Texas doctors recently traveled to the city of Irbil to present a three-day seminar on infectious disease control for Iraqi doctors. Dr. Barbara Atkinson is the head of the infectious disease section at UNTÂ’s Health Science Center department of medicine, and Dr. John Podgore is the head of the infectious disease section at the Health Science CenterÂ’s department of pediatrics. They traveled with Dr. James Brien, who is head of infectious disease service in the pediatrics department at Texas A&MÂ’s medical school.

Podgore, who had traveled to Baghdad in early 2004, said the physicians there were all eager to learn more about medicine. In the United States and other wealthy countries, physicians and other health care workers take continuing medical education classes, learning about new techniques or trends, he said.

But Brien said many of the Iraqi physicians told him that medical funding dried up when Saddam Hussein was in power. Subsequently, hospitals fell behind, and physicians and patients had to deal with the consequences.

“They were fairly bitter about the way medical funding had gotten cut up there,” Brien said.

Irbil is home to a new center for continuing medical education, though, and this seminar on infectious disease was the third one available to doctors from all over Iraq. It was funded by grants and assistance from the International Medical Corps and the U.S. Agency for International Development.

Podgore said that diseases ran

rampant in hospitals because of overcrowding and a lack of sterilization and cleaning supplies. Children may be lined up in beds butted right against each other, he said. Some studies estimated that half the people who entered a hospital caught an infection while there, he said.

“They get a double whammy,” Podgore said of patients. “One, their immunity isn’t there because it’s been knocked out by something else, and two, they’re exposed to dangerous pathogens.”

Because there arenÂ’t sinks with running water in every room, itÂ’s hard for health care workers to wash their hands between patients, Podgore said. Cloth towels are the norm if thereÂ’s anything available for hand-drying, and cloth just retains bacteria, so even if hands are washed, the germs are reapplied. Germs are also spread from patient to patient.

Tuberculosis, a rarity in this country, is significantly more common in Iraq. Only basic vaccinations are available to prevent diseases, and laboratories used to test for diseases are as underfunded as the hospitals themselves, Podgore said.

Brien was deployed to Iraq during the first Gulf War, when he was a pediatrician in the Army, and he said his first patient while there, 17 years ago, was a girl with a bad infection. Her elbow had been hit by stray shrapnel a few days before, and when she arrived at his medical station, it was badly infected. Ultimately, her arm had to be amputated, he said, because the infection had caused so much damage.

“Infection control is a problem over there, probably for the same reason that medical care in general is a bit of a problem – so many resources are being diverted for different things,” Brien said.

‘Hungry for information’

On his recent trip, Brien saw flies on hospital equipment and makeshift supplies, such as the hard plastic bottles used to hold IV fluids. Decades ago, hard plastic or glass bottles were used to hold IV fluids. Today, the safest way to deliver fluids is through a pump or a collapsible soft plastic bag, Brien said, because these defend against outside air or contaminents getting inside the closed system and they allow fluids to be administered at a controlled rate. The tops of the hard bottles have to be pierced so that the fluid drains downward into a patient, Brien said, and this hole makes the set-up vulnerable to contaminents.

“That’s medical technology from the ’60s and ’70s,” Brien said.

On another occasion, Brien saw a child with heart failure brought to the hospital only to be told there would be a wait of several days to get a heart test because the cardiologist traveled through the area and only visited about once a week with the testing equipment.

“If you did that here, there’d be an outcry like you wouldn’t believe,” Brien said.

By encouraging Iraqi doctors to take some simple measures, like washing their hands between patients, using paper towels and wearing face masks over both the mouth and nose, the visiting physicians hoped to help control some of the infections that plague hospitals.

“They were just hungry for someone to give them new information,” Podgore said.

He added that the people who attended the seminar will go back to their respective hospitals and teach fellow employees what they learned.

“It was sort of a training-of-trainers program,” he said.

Podgore said he is also encouraging Iraqi health care workers to seek more extensive infectious disease training through the Centers for Disease Control and other organizations. He also said he will travel back to Iraq to do follow-ups with the seminar attendees or give another seminar. Brien said he would go back if he could find the time; helping with education and other support is a way of fixing the problem, he said.

“They have to work with what they have,” Brien said. “The doctors are very bright ... but they can’t create what they don’t have.”

Contact Bassett at ebassett@bizpress.net