Hope for the Future of Iraqi Critical Care
Imagine not leaving the intensive care unit (ICU) for years. Packing all your belonging and living in the hospital, unable to see family or friends because the commute home is far too dangerous. This has been the case for many critical care professionals in Baghdad, Iraq. Each day, they sacrifice their own comforts in an effort to provide the Right Care, Right Now™ and establish long-term plans for the future of critical care in the country.
In the August 2007 issue of Critical Connections, physicians and military personnel working in Afghanistan recounted how years of war had stunted, if not reversed, the progress of the country’s healthcare community. The people of Iraq struggle through similar healthcare challenges as war continues within the country’s borders. Society of Critical Care Medicine (SCCM) members Col. Lisa Zacher, MD, and Maj. Kevin Chung, MD, both have served as the chief of critical care services at the Army’s Ibn Sina Hospital, the main Combat Support Hospital in Baghdad. At Ibn Sina Hospital, they have not only treated U.S. and Iraqi combat casualties as well as a variety of non-combat related conditions, but also have reached out to Iraqi physicians and nurses. The education and collaborative relationship they have fostered are a vital part of rebuilding Iraq.
Among those aiding this improvement effort is SCCM member, Waleed Ibraheem Ali, MD, ICU manager at the Surgical Specialized Hospital in Medical City Teaching Hospital. Dr. Ali recently joined SCCM after finding its resources so helpful. He is organizing educational sessions, mentoring many young critical care practitioners and rebuilding the ICUs to reflect modern standards.
Every other Friday three to four Iraqi physicians, led by Ali, travel seven miles from Baghdad’s Medical City Hospital to the Combat Support Hospital to participate in educational activities. It is not an easy trip. The group must cross from Iraq’s Red Zone into the Green Zone to reach the Combat Support Hospital. The physicians risk their lives as they travel through security checkpoints; they are likely targets for violence because of their association with Americans.
“They come here on their day of rest at some risk to their lives. It truly shows their commitment to continuing medical education,” said Zacher. The dedicated physicians accompany staff on patient rounds, review radiographic studies, and attend an afternoon continuing education lecture. Hospital staff usually eat lunch with the visitors and discuss the day's lessons. They act as mentors, friends and supportive colleagues, knowing that these physicians are the future of critical care in Iraq. However, these Iraqi doctors are teaching their American colleagues just as much in the way of dedication and
resilience.
“They are very heroic,” said Zacher. “They are really trying to improve their healthcare system. They are underpaid with little to no ancillary support staff and still constantly battle with lack of supplies, equipment and even electricity. Many have lived in the hospital for the last five years and have only seen their families a few times since the beginning of the conflict. They are true professionals – completely immersed and dedicated to the practice of medicine without any of the benefits we all enjoy in the United States.”
I AM SCCM
These educational sessions are part of broader plan for improved care being implemented by Iraq’s Ministry of Health (MOH). Progress within critical care has been facing hurdles since the first Gulf War in 1991; the destruction and embargos took a great toll on the country’s ICUs. Operation Iraqi Freedom also has put new stresses on the system. The area’s instability, increased demand for critical care services and an exodus of healthcare professionals from the region have produced what amounts to a critical care crisis, according to Ali, who has emerged as a leader in critical care in Iraq.
One of Ali’s key projects is redesigning the Medical City Hospital ICU to reflect modern standards. For the past five years, the ICU has been growing at a random and unplanned pace. It grew from six beds to 16, and equipment was added as resources become available without much attention to layout and needs.
“They are starting from scratch as far as what an appropriate level of care is. They don’t really have a standard or a basis of comparison,” explained Chung. So, when Ali asked Chung for advice on ICU design, he pointed him to SCCM’s LearnICU.org, where Ali found the American College of Critical Care Medicine Guidelines for Intensive Care Unit Design as well as many other resources to aide future developments.
“A lot of his questions center around ‘how do we do things in the United States?’ so to have access to all those guidelines is perfect,” Chung said. “He found exactly what he needed, and he was very happy.”
Small Steps Toward Far-Reaching Goals
The MOH, with Ali’s continued dedication, plans to improve work standards in the ICU by upgrading and improving the scientific knowledge of the medical and nursing staff. Ali will ensure Medical City staff are able to use new methods of mechanical ventilation and to implement proper monitoring and charting techniques as well as the latest protocols. He wants to see disabled instruments repaired and to increase the number of nurses. Long-term plans also include establishing an SCCM Chapter.
Last year, Ali helped organize The First National Conference on Continuing Professional Development in Iraq, the first medical conference held in the country in more than 20 years. The program included established local and international speakers and participants were impressed by the level of organization and quality of information, but the struggles of the region still showed through. “The electricity went off at least three different times, and the speakers just kept right on presenting using flashlights and laptops,” said Zacher.
