Amid trauma, getting medical relief to Iraq civilians

Courtesy of Robert Norris

A survey done by Iraqi and Kurdish ministers of health showed 151,000 violence-related Iraqi deaths from 2003 to 2006. The country’s health care was once the premier system in the Middle East but has declined.

Courtesy of Robert Norris

Robert Norris, at right, was one of four emergency medicine experts who toured northern Iraq recently to help plan a medical training program.

When he looked at one small accident victim—a boy shot in the head by his brother—Robert Norris, MD, saw the need for emergency medical care for the people of Iraq. And it is urgent.

"The scene was just chaotic," said Norris, who saw the boy, surrounded by distraught family members, among hundreds of others waiting for care in the casualty units in the Sulaymaniya Emergency Hospital in northern Iraq. Unconscious, wrapped haphazardly in a colorful blanket, he'd been rushed to the hospital by his family. "Not much was being done for him. The outcome probably wasn't going to be good."

In a country daily beset by conflict and trauma, Iraq has a severe lack of emergency medical care. With limited ambulance service, no 911 system and no paramedics, many Iraqis die preventable deaths while waiting for care or en route to hospitals.

"There's a lot to be done," said Norris, associate professor of emergency medicine at the School of Medicine. He was one of four U.S. emergency medicine experts flown to northern Iraq recently as part of a fact-finding mission and early training team. Their goal is to help set up a formal emergency medicine training program for Iraqi health professionals for the first time in that nation's history. "The past regime was not conducive to medical training," Norris said.

Patients, like the boy with a bullet lodged in his brain, usually arrive at hospitals by taxi or car. They are then transferred to stretchers and taken to casualty wards where they await another transfer to an appropriate ward before getting treated.

"There's a lot of moving around before getting care," Norris said. "They need a system to be able to do triage, to get patients to the most appropriate care as quickly as possible."

During the two-week trip in February to northern Iraq, Norris taught a medical course in airway management to a group of about 50 Iraqi physicians and toured eight hospitals. The program, held in the city of Erbil, was a joint effort put together by the Medical Alliance for Iraq, a volunteer group of western doctors that joined forces with the International Medical Corps, a nonprofit group that's been working to improve medical care in Iraq since 2003. Funding came from the U.S. government's State Department and the Iraqi government.

"Twenty-five years ago, Iraq had the premiere health-care system in the Middle East," said Mike Brennan, MD, a South Carolina ophthalmologist who recruited the 50 or so volunteer doctors who make up the Medical Alliance for Iraq including Norris. "During Saddam's regime, it was cut off from the outside world and fell way behind on technology. You couldn't get in or out of the country for education. Then, in the last five years with the war, it's been hit from all sides."

In an effort to bring educational aid to Iraqi physicians, Brennan said the Medical Alliance for Iraq approached the Iraqi ministers of health to see what training was needed most. Their list started with high-risk obstetrics, pediatric infectious disease, psychiatry and emergency medicine.

"The infrastructure of emergency medicine in Iraq is in shambles," Brennan said. "They don't have graduate or residency training in Iraq. They need everything from ambulances to triage to getting nurses involved."

Emergency medicine is a relatively new concept to the Middle East. The Arab Society of Trauma and Emergency Medicine was started in 2002, but few countries have well-trained emergency medicine specialists, according to a report on the project published by the working group that organized at the meeting. Deaths from trauma, cardiovascular emergencies and other treatable conditions such as asthma are much higher in the Middle East.

The four U.S. doctors toured northern Iraq hospitals joined by both the Iraqi minister of health, Saleh Hasnawi, MD, and the Kurdish minister of health, Zryan Othman, MD. Hasnawi had recently reported the results of the "Iraq Family Health Survey" which estimates there were 151,000 violence-related Iraqi deaths from 2003 to 2006.

"It seems to most of us, that if anywhere in the world deserves a good emergency system, it should be Iraq," wrote Ross Donaldson, MD, UCLA professor and one of the other three doctors on the mission.

Norris and the three others plan to return to Iraq in December, visiting Baghdad as the next step in helping to set up an official emergency medicine training program.

"I was impressed by how warm and open the Iraqi physicians were," Norris said. "They were incredibly appreciative that we wanted to help rebuild their health-care system, which I guess at one time was phenomenal. With Saddam, it crumbled to nothing. They're just hungry for access to knowledge, and any help they can get to better care for their patients."