By the end of this year, I will have served 24 of the last 36 months in Iraq. I am the chief medical officer of a BCT (Brigade Combat Team) of the 101st Airborne Division. In military circles, my title is BCT Surgeon. By training, I am a Family Medicine Physician. My unit operates in North Baghdad. My part in the fight involves engaging with Iraqi medical authorities and caregivers and targeting coalition force assistance in order to improve the medical capability of the Iraqis in our sector. We as a military have been doing this for 5 years. I would like to think that we are better off now, but sadly I’d be lying if I said so.
I have visited many clinics and hospitals in Baghdad, many repeatedly. For the most part I see severe shortages of basic medications and broken equipment. I have had mothers present their children to me as I walked through a hospital desperate for American assistance because their doctors are not equipped to help. Some doctors admit that the supply problem has caused them to buy drugs on the black market because their own state run supply system is broken. Clinics also wrestle with the problem of essential services. Some have toilets that back up because the central sewer lines are inadequate. Most clinics in Baghdad operate on 2-3 hours of electricity per day. For those that do not have proper freezers which are able to maintain proper temperatures, this means that they cannot keep immunizations.
The MOH (Ministry of Health) reports that they have a 5 year plan, however when one actually studies it, it clearly is not reasonable. Listed are dozens of hospitals which the MOH states it will build in the next 5 years from the ground-up. Many of these are very specialized centers such as cancer centers and those specializing in blood disorders. What is missing is a plan to fix primary care clinics, to provide citizens with clean drinking water, a real public health focus, a plan to fix the medical supply system, a plan to attract doctors and nurses back to the country. Given the MOH's track record, it will be doubtful if even 10% of their projected facilties are complete in 5 years.
The root causes are vast and multifactorial. Public health issues started with the diversion of moneys away from preventive medicine initiatives and essential services and into Iraq's military machine. After the US invasion, there was a resultant fleecing of a great amount of talent. Shortly after the successful overthrow of the Hussein regime, those in positions of authority were systematically fired and members of the Shia religious sect were placed in power to counter the previously majority Sunnis. Because this population had not held power and was excluded from government jobs, most were very inexperienced. In addition to this, the great majority of the professional talent have fled the nation due to very real security concerns and poor living conditions. This has created a talent vacuum which has resulted in very little improvement. Those in power in the MOH are ill equipped to manage their posts.
What is the US solution? At my level, we are improving clinics and providing much needed equipment and structural refurbishments to clinics and hospitals. Although this is a step in the right direction, it still reminds me of the clichéd action of rearranging deck chairs on the Titanic. Despite all of our efforts, there is still the supply issue, a doctor shortage, an inability for the MOH to come to grips with the true scope of the problem and no realistic assessment or plan for the future. Until these are addressed at the national level, I fear that we are their only hope- which is difficult to swallow given the fact that our efforts should be aimed at Iraqi self-sufficiency.
A possible solution
The MOH has shown that in 5 years it is no closer to providing the leadership and expertise to formulate and execute a real plan to fix the many problems within the health structure of Iraq. At this point, the US and new Iraqi government continue to pour millions of dollars into a corrupt and unlead health system.
What is needed is a new direction. Corporate America and Europe are fat with the expertise and investment capital to easily develop an in-depth analysis and business plan to fix this broken health care system. Sure it may cost billions, but Iraq has plenty of oil revenue. All it takes is a little swallowing of thier pride to bring in outside help. I’m sure for the right price and guarantees, Humana Healthcare, or Health South, or any large health system will be happy to form an executive analysis team of people with seven figure salaries, spend a few months on the ground analyzing the problem, and provide a plan to completely restructure the healthcare delivery in this nation. All that stands in the way then is the Iraqi government’s willingness to write the check.
Actually it’s a little more complicated than that. For one thing, the US congress needs to provide companies willing to stake a claim in this market with some safety mechanisms. For most, investing here is probably a less secure bet than opening up a shop on the dark side of the moon, but Congress can certainly make the initial pill much less bitter. Consider terrorist and violent action insurance, for one thing. Another would be tax breaks for those who are willing to be the first in their respective service areas to set up shop in Iraq. Another suggestion is for the US to insist on its financial institutions such as Bank of America or Chase Manhattan to be allowed to bring Iraq’s commerce capability into the modern era with the advent of electronic funds transfer and other improvements to legitimize it as a true trading partner. Iraq can presently only spend a fraction of its capital because it lacks the talent to properly manage and execute national level fiscal policy and procedures. Once we set the conditions for trade, this nation, with its vast oil exports will begin to look less like a war zone and more like Dubai or Kuwait.
I've said my peace, lets hear your comments
I have visited many clinics and hospitals in Baghdad, many repeatedly. For the most part I see severe shortages of basic medications and broken equipment. I have had mothers present their children to me as I walked through a hospital desperate for American assistance because their doctors are not equipped to help. Some doctors admit that the supply problem has caused them to buy drugs on the black market because their own state run supply system is broken. Clinics also wrestle with the problem of essential services. Some have toilets that back up because the central sewer lines are inadequate. Most clinics in Baghdad operate on 2-3 hours of electricity per day. For those that do not have proper freezers which are able to maintain proper temperatures, this means that they cannot keep immunizations.
The MOH (Ministry of Health) reports that they have a 5 year plan, however when one actually studies it, it clearly is not reasonable. Listed are dozens of hospitals which the MOH states it will build in the next 5 years from the ground-up. Many of these are very specialized centers such as cancer centers and those specializing in blood disorders. What is missing is a plan to fix primary care clinics, to provide citizens with clean drinking water, a real public health focus, a plan to fix the medical supply system, a plan to attract doctors and nurses back to the country. Given the MOH's track record, it will be doubtful if even 10% of their projected facilties are complete in 5 years.
The root causes are vast and multifactorial. Public health issues started with the diversion of moneys away from preventive medicine initiatives and essential services and into Iraq's military machine. After the US invasion, there was a resultant fleecing of a great amount of talent. Shortly after the successful overthrow of the Hussein regime, those in positions of authority were systematically fired and members of the Shia religious sect were placed in power to counter the previously majority Sunnis. Because this population had not held power and was excluded from government jobs, most were very inexperienced. In addition to this, the great majority of the professional talent have fled the nation due to very real security concerns and poor living conditions. This has created a talent vacuum which has resulted in very little improvement. Those in power in the MOH are ill equipped to manage their posts.
What is the US solution? At my level, we are improving clinics and providing much needed equipment and structural refurbishments to clinics and hospitals. Although this is a step in the right direction, it still reminds me of the clichéd action of rearranging deck chairs on the Titanic. Despite all of our efforts, there is still the supply issue, a doctor shortage, an inability for the MOH to come to grips with the true scope of the problem and no realistic assessment or plan for the future. Until these are addressed at the national level, I fear that we are their only hope- which is difficult to swallow given the fact that our efforts should be aimed at Iraqi self-sufficiency.
A possible solution
The MOH has shown that in 5 years it is no closer to providing the leadership and expertise to formulate and execute a real plan to fix the many problems within the health structure of Iraq. At this point, the US and new Iraqi government continue to pour millions of dollars into a corrupt and unlead health system.
What is needed is a new direction. Corporate America and Europe are fat with the expertise and investment capital to easily develop an in-depth analysis and business plan to fix this broken health care system. Sure it may cost billions, but Iraq has plenty of oil revenue. All it takes is a little swallowing of thier pride to bring in outside help. I’m sure for the right price and guarantees, Humana Healthcare, or Health South, or any large health system will be happy to form an executive analysis team of people with seven figure salaries, spend a few months on the ground analyzing the problem, and provide a plan to completely restructure the healthcare delivery in this nation. All that stands in the way then is the Iraqi government’s willingness to write the check.
Actually it’s a little more complicated than that. For one thing, the US congress needs to provide companies willing to stake a claim in this market with some safety mechanisms. For most, investing here is probably a less secure bet than opening up a shop on the dark side of the moon, but Congress can certainly make the initial pill much less bitter. Consider terrorist and violent action insurance, for one thing. Another would be tax breaks for those who are willing to be the first in their respective service areas to set up shop in Iraq. Another suggestion is for the US to insist on its financial institutions such as Bank of America or Chase Manhattan to be allowed to bring Iraq’s commerce capability into the modern era with the advent of electronic funds transfer and other improvements to legitimize it as a true trading partner. Iraq can presently only spend a fraction of its capital because it lacks the talent to properly manage and execute national level fiscal policy and procedures. Once we set the conditions for trade, this nation, with its vast oil exports will begin to look less like a war zone and more like Dubai or Kuwait.
I've said my peace, lets hear your comments
