One of the key tasks for the multi-national reconstruction effort in Iraq has been the rehabilitation of the country's beleaguered healthcare system. In Basra, UK teams have been helping the Iraqis breathe new life into their local medical services.
British Army doctor Lieutenant Colonel Martin Bell, Royal Army Medical Corps (RAMC), recently returned from a tour in Basra as the Officer Commanding the UK Medical Group under 4th Mechanized Brigade. Working closely with the Provincial Reconstruction Team (PRT) and Civil-Military Cooperation (CIMIC) teams, part of the work of the Medical Group is to provide clinical training and logistic support for the staff of local Iraqi hospitals and clinics.
Lieutenant Colonel Bell says that the improving security situation has seen Iraqi doctors return in their droves from 'exile' overseas while international aid has pumped money, medicines and new equipment into the healthcare system's veins. But getting life-saving supplies quickly to where they are most needed is still a huge challenge for the hospital administrators:
"The Iraqis had the equipment up in Baghdad, and the finance, but what they needed was the assistance to get it into place; that's where we came in," said Lt. Col. Bell. "Because of the security, we had to make sure that we protected the convoys to make sure that they got to the hospitals and the militias weren't stealing all the medicines for their own route."
The improving security situation in Basra has seen an increase in the number of medical supplies reaching their final destinations:
"From what we were seeing, in terms of stock levels in the hospitals and the local clinics – they were improving week on week," said Lt. Col. Bell. "This suggests that the pilfering that perhaps the militia had been involved in, in previous years, has been significantly affected."
The success of the Iraqi Army-led Operation “Charge of the Knights” against Basra's militia groups this spring marked a series of significant changes for the city. As it became apparent to the local Basrawis that the Iraqi Army could now defeat the militias, the Iraqi Security Forces increasingly gained their support. Insurgents' hiding places and weapons caches were reported in unprecedented numbers, making life for any militias still based in the area very difficult indeed.
Lt. Col. Bell said:
"Charge of the Knights, I think, surprised the locals there, but in a good way. They actually see the end in sight, and they see that, if there is security – and not just the military security that the Iraqi Army brought to them – but it was the follow-up, with them helping to clear the streets, to just make the whole place feel like a nicer environment to be in. The message we got from my soldiers on the ground was that there was genuine hope and aspirations for the future."
"The liberation of some of the militia strongholds by the Iraqi Army actually created more access for the people, because the militia had been actually stopping them going to the more open hospitals," he added.
Training Iraq's Doctors in the UK
When war came to Iraq in 2003, many doctors left the country with their families in fear for their safety, leaving the country's hospitals and clinics woefully short of trained physicians at a time when they were most needed. Part of the reconstruction effort has been to try to facilitate the Iraqi doctors' return to Iraq, providing them with the training and the tools they need to help their countrymen back home:
"The militias in early 2003 to 2004 were intimidating a lot of doctors, and a lot left the country," said Lt. Col. Bell. "What we needed to do was to give them a feeling of safety so that they would go back, because they're all competent people – we just needed to make sure they felt safe."
Alongside the military effort to improve the security situation in Basra, at home a cross-government initiative has seen hundreds of Iraqi doctors receive British National Health Service training in hospitals across the UK:
"Some 500 Iraqi doctors have been coming back to the UK over the last three or four years," explained Lt. Col. Bell. "Not just the military, but the Foreign and Commonwealth Office, and the National Health Service have all been involved in helping to build that capability so they can go back [to Iraq] and do an even better job."
Lt. Col. Bell and his staff were involved in training Iraqi clinicians at the UK military hospital in Basra:
"We did some study periods together with my clinicians," he said, "really just to make sure they were getting as much modern, evidence-based input as we could give them and adapt that to the situation on the ground with the equipment that they had."
Nursing Cultural Differences
Unlike the NHS in the UK where hospitals and clinics are staffed in the main by specialist nurses and para-medical professionals, Iraq's healthcare system is traditionally top-heavy. Doctors deal with saving lives and prescribing medication while much of the nursing and aftercare is carried out by patients' families or a relatively small force of mostly untrained nurses. Lt. Col. Bell believes that the Iraqis could benefit from adopting a more Western approach to nursing care:
"Nursing care tends to be done by family and friends," he said. "They have some degree-qualified nurses and lots of non-degree qualified nurses, but they're not a patch on what we would have as a nurse in our system; so one of the areas we were trying to influence was nurse-training.
"Because it's a cultural thing, it's not something that we can resolve in six months – it's a generational thing – but as they see how better healthcare and nursing can deliver good outcomes – and we showed them around our hospital and explained what our nurses were doing, things which they would normally have doctors doing – I think they were genuinely impressed and they could see the opportunities.
"The doctors are actually very good," he added. "They are educated in either England, America or Cairo; they are all educated in English, so we had very good relations with them – we could communicate very easily. Bringing Iraqi doctors to the UK exposes them to how important quality nursing care is to the after care and the ongoing treatment of patients. Whether their culture will allow them to exploit those opportunities is for them really."