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[casi-analysis] U.S. Says Iraq's Health Care System Improving

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Dear Casi List,

Here's poignant counterpoint to Mark Parkinson's posting of the Reuter's
report on the assertion by the U.S. Health Secretary that medicine in
Iraq is improving:
Iraqi Hospitals on Life Support
Babies Dying Because of Shortages of Medicine, Supplies
By Ariana Eunjung Cha
Washington Post Staff Writer
Friday, March 5, 2004; Page A01
BAGHDAD -- The stout woman, covered from head to toe in a black abaya,
shuffled into the crowded hospital. She went straight to the emergency
room and opened her robe to reveal a tiny baby wrapped in fuzzy
blankets. The boy had been born prematurely, and the family was afraid
he was going to die.
Uday Abdul Ridha took a quick look and shook his head. The physician put
his hands on the woman's shoulders in sympathy, but his words were
blunt. "I'm sorry," he said. "We cannot help you. We don't have an
incubator, and even if we did, we are short on oxygen. Please try
another hospital."
Scenes like this one at the Pediatric Teaching Hospital in Baghdad's
Iskan neighborhood have become common in Iraq in recent months, as the
health-care system has been hit by a critical shortage in basic
medications and equipment. Babies die of simple infections because they
can't get the proper antibiotics. Surgeries are delayed because there is
no oxygen. And patients in critical condition are turned away because
there isn't enough equipment.
"We are dealing with a crisis," said Abdulwadood Talibi, director
general of the State Company for Drugs and Medical Supplies, which is in
charge of ordering all goods for the 240 public hospitals and 1,200
health centers in Iraq.
There are shortages in basic items like as cough syrup and also in
critical items such as diabetes medications, anti-cancer drugs,
intravenous lines, tuberculosis test kits and ventilators, say doctors
and nurses at Iskan, the Medical City Center, Yarmouk Hospital and other
The U.S.-led occupation is preparing to hand over administration of the
health-care sector to the Iraqi government, perhaps in a few weeks. The
Health Ministry will be among the first to have operational
independence. Health Minister Khudair Fadhil Abbas said about 90 percent
of the hospitals and clinics have been brought back to the same poor
conditions as before the war but that the others will take more time to
reach even that low level.
Occupation officials say they have made many improvements in the health
sector since the end of the war, and that much of the work is not
obvious because it involves training nurses and doctors and changing
inefficient practices. The U.S. Agency for International Development has
financed vaccines for 4.2 million children and is beginning to
distribute supply kits to 600 clinics. The Iraqi government and the U.S.
military have financed reconstruction of nearly 40 hospitals and
improvements to 130 more are in the works..
Jim Haveman, the Coalition Provisional Authority's senior adviser for
health, said he had heard "community concerns" about medical supplies
and that the occupation authority and the Health Ministry have
dispatched quick-assessment teams to identify and fill shortages. Among
items being sought: incubators.
Iraq's hospitals were once the envy of the Middle East. Wealthy
businessmen used to fly their relatives in for everything from heart
transplants to plastic surgery, and Iraqi specialists traveled the world
lecturing about their research. But medical care deteriorated under the
economic sanctions imposed after the Persian Gulf War in 1991, and
President Saddam Hussein banned the importation of medications produced
by U.S. companies and their affiliates, even though those were often the
best available.
Doctors, nurses and Iraqi officials said some things have improved since
the war -- especially the infrastructure of some hospitals and clinics
that have been rebuilt. But in other respects, conditions are worse.
Damaged records, attacks on convoys carrying supplies, looting at
central warehouses, inoperable factories and bureaucratic confusion have
delayed repairs and the restocking of medicine and equipment. Some
Iraqis also say the U.S.-led occupation authority's overhaul of the
system for ordering and distributing supplies might have been too
ambitious for a country reeling from war.
The Health Ministry developed a new list of standard drugs to replace
medication that is outdated, but wrangling over the list put large
purchases on hold. The ministry also decided that all shipments of
humanitarian aid should go through a central depot and not directly to
hospitals, so the government could ensure that medicine and equipment
were distributed fairly. But that extra layer of bureaucracy delayed
getting the supplies to the hospitals.
Some medical centers, such as the Iskan hospital, have had to bear the
burden of treating patients from other facilities that were damaged and
had to be shut for repairs.
The Iskan hospital was built for 170 patients, but it has been treating
more than 300. Two or sometimes three children have been crammed into
single beds. Sewage leaks onto the floors of the rooms where doctors
perform surgery. And the lines to get prescriptions filled stretch
outside the doors. Flies hover around beds that smell of wet bandages.
And it is not uncommon for blood and other spillage to remain on the
floors for hours because antiseptic cleaning supplies are not available.
Abbas, the health minister, said the Spanish government had pledged
$10.5 million to help rehabilitate and restock the hospital. Contractors
have arrived in recent days to assess what needs to be done.
The situation is so precarious that twice in the past few months the
fathers of babies that died stormed the hospital and attacked doctors,
said Saddam Hussein Ali, 31, a security guard there.
Several witnesses recalled an incident in which a distraught father
shouted, "You are bastards all" at Walid Khalid, the doctor on duty at
the time. The doctor who had treated the man's baby had already left the
hospital for the day, so the father grabbed Khalid by the collar and
shook him.
After the war, the children's hospital and others were overrun with
people who said they wanted to help. But the only follow-ups, according
to nurses and doctors, were visits from UNICEF and the U.S. Army. The
occupation authority said it has also visited the hospital to study its
needs. The visitors brought gifts for the children during the holidays.
There were new clothes, candy and milk, but that only made some parents
more bitter, said Hadeel Jameel, a doctor's assistant in the cancer
"When organizations come and play with the children and take photos, the
mothers will cry because they think it means that this is all they can
do and their children will die," she said.
The shortages have angered many in the medical community. "The most
important thing for Americans is their interest: the Ministry of Oil.
That is where all the money is going. They don't give medical supplies
or oxygen any thought," said Bahaa Abdul Munem, who until recently was
chief resident at Iskan children's hospital but transferred to Yarmouk.
Before Nov. 21, the United Nations, which managed Iraq's oil-for-food
program, had responsibility for ordering medicine and equipment. In
conjunction with the Health Ministry, it shipped in 25,000 tons of
supplies. But because many records were destroyed and there wasn't time
for a proper survey, the supplies ordered weren't necessarily the ones
most needed..
Talibi, director general of the State Company for Drugs and Medical
Supplies, said he believes U.N. officials tried their best but that they
did not have enough information. "It's like you are visiting your
neighbors and want to help. You go to their kitchen, but you don't know
where the cups and the tea are," he said.
Abbas acknowledged that the Health Ministry should bear some of the
responsibility. "Our staff should have done something earlier, before
the supplies were depleted," he said.
On the third floor of the children's hospital, Habeeba Kadhim, a nurse
who works in the infectious diseases ward, said at one point there was
only penicillin to treat patients with diarrhea, and it didn't work, so
babies got progressively sicker and died. On the second floor, where
cancer patients are, doctor's assistant Hadeel Jameel said people only
receive part of their leukemia medications because there isn't enough
for everyone to receive full doses.
But the biggest problem is in the neonatal ward.
Iraq has one of the highest infant mortality rates in the world -- one
that climbed from 40 out of 1,000 live births in 1989 to 108 per 1,000
live births today. One of the main goals of the occupation authority and
the Health Ministry is to cut that rate in half by 2005. They have
allocated nearly $1 billion of the Health Ministry's budget for next
year in addition to $793 million the U.S. Congress has appropriated and
more funds from other countries. Abbas said the top priority for those
funds will be maternal and child health.
There are 30 old-fashioned incubators at the children's hospital, and
all require the temperature to be adjusted manually. At any given time
one or more are out of order. There are usually more than 40 children
who need incubators, said Hayat Katia Sabeeh, a nurse in the ward.
There also has been an oxygen shortage. The two plants in Iraq that
produce the gas and liquid have not been keeping pace with demand.
Twice, in November and in December, the children's hospital ran out of
oxygen for about 10 hours. The babies in the neonatal ward went into
cardiac arrest, said Munem, and some died as doctors and nurses
scrambled to bundle them up and transport them to a nearby hospital.
"When we face moments of deficiency, it makes us feel very sad because
the difficulty is simply because we do not have a functioning machine --
not because we don't have the skill," said Ahmed A. Muhammad, assistant
manager of the hospital who is in charge of supplies.
On one weekday morning last month, Ibtisam Ali, 35, brought her
brother's baby to Iskan. Her local hospital, where the baby was born
that day, had turned her away because it did not have medicine to treat
the baby. The boy looked blue and was bleeding from his nose and mouth.
A doctor told her that the child needed an incubator but that none was
available. Ali called a few hospitals and found that Medical City had a
free incubator. She raced over in a taxi, but when she arrived, she was
told the space had been given to another baby.
Ali argued: "Why did I come here? . . . I spent all my money on taxis
and reserved the place, and you say you are going to take [the
incubator] away. I have the priority."
The doctor replied: "This is not a hotel."
A nurse, Faihaa Muhsin, tried to console Ali by telling her that even if
they had an incubator, they didn't have a mechanical ventilator to keep
the child breathing. "He is a hopeless case. It is up to God," Muhsin
Sanaa Mehdi, 18, the mother's sister, was not ready to give up, so
Muhsin handed her a manual ventilator and told her to squeeze and let
go, squeeze and let go, as long as she could. Shortly before dawn, after
standing by the baby and working the respirator for eight hours, Mehdi's
arms gave out.
Her nephew, Abdullah Hassan Ali, age 1 day, died at 4 a.m. The death
certificate listed "respiratory failure" as the cause.
Special correspondent Hoda Ahmed Lazim contributed to this report.
C 2004 The Washington Post Company

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