Healthcare in Iraq Pre and Immediately Post Operation

Healthcare in Iraq Pre and Immediately Post Operation Iraqi Freedom Michael J. Keller, MBA, FACHE

Geography Medical indicators Health care professionals Ministry of Health Private sector

Geography

Land Mass Comparison -

Babyl Province Population Est. 1. 2 million Principle City Al Hillah (Babylon) Hospitals 400 Bed General Hospital 250 Maternity/Children’s Hospital Healthcare staff 470 Physicians (420/50) 1100 Staff

Medical Indicators Iraq United States Population 23. 6 million 284 million Hospital Beds 14/10, 000 37/10, 000 Physicians 4/10, 000 27/10, 000 Infant Mortality Rate 92 deaths/1 k live births 7 deaths/1 k live births Life Expectancy at Birth 59 years 77 years

Al Hilla Maternal/Child Hospital

Medical Supply Missions

Absence of Equipment

Sole Incubator

Sanitation Standards

Al Hillah Hospital Today

Physician Training All conducted in English (British) 4 year medical school, standard residency training programs Iraqi developed and administered final exams since 1981 Little or no professional contact outside Iraq during Saddam’s regeime No new textbooks or journals >10 years

Nursing Estimated 250 formally trained professional nurses (RN’s) No nursing schools operating No resources Care provided by Aides & Orderlies No appropriate work uniforms Lack of basic care training

Allied Health Personnel Medical Laboratory Technician – trained in Baghdad MOH PT, OT, Speech, Respiratory, Medical Records – not to be found Bio-Med - None Management/Administration

Ministry of Health Baghdad centric Assigned staff upon completion of training Handed down operating budget Salaries controlled and ‘regionalized’ Directed treatment protocols

Mo. H Elections

Office of Public Health Cholera Malaria Year Diagnosed Carriers Deaths 2000 6 4 0 2001 0 3 0 2002 3 2 0 2003 0 0 0 2000 16 7 2001 19 6 2002 14 4 2003 17 8

Medical Supply System Kamidi Central purchasing and distribution system Provincial warehouse & cold chain storage Former régime requirement for ‘testing’ of all pharmaceuticals and reagents Ban on U. S. produced Rx’s & reagents Oversaw Iraq Rx manufacturing Endemic corruption and graft Administration ‘clung’ to Kamidia until finally realizing that it was beyond rehabilitation.

Private Sector Operated throughout the time of the former régime in all provinces Obstetric & Ophthalmology Forced to black market for supplies Global fee - negotiated between physician & patient

Closing comments Dedicated and ethical providers Desperately wanting to return to US/European standards of care Appropriate spending investment and removing corruption are key Exportation of knowledge and learning materials is the way ahead Mo. H was among first ministry to be returned to Iraqi sovereignty

Questions & Comments A Portion of the Presidential Palace, Tikrit, Iraq