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19 May

Envied Health Care System Destroyed by War

Iraq’s once-envied health care system lost to war, corruption

McClatchy Washington Bureau, May 18, 2009

Full Article

BAGHDAD — Dr. Zinah Jawad leaned over her patient and peered into his glazed eyes. It doesn’t look good, she said, shaking her head.

The man had arrived at Baghdad Teaching Hospital’s emergency department a few hours earlier with a high fever and dizziness. Now he lies shaking, sweat soaking his dirty clothes.

The Teaching Hospital’s emergency room is cleaner than most in Baghdad. In fact, it’s widely considered the best in the Iraqi capital. Still, flies buzz overhead, and on busy days there aren’t enough beds or oxygen tanks. Across the room, a crude sign made with binder paper and tape marks the department’s two-bed cardiac unit, which lacks a reliable defibrillator.

Jawad, a second-year medical resident, turns to the sick man’s wife, who’s perched anxiously on a ripped chair at his bedside. “We suspect meningitis,” she says.

If Jawad is correct, the man probably will die long before she can confirm her diagnosis. Her chances of getting antibiotics to treat him are even slimmer.

The hospital can’t perform the lab test she needs. Its stock of drugs and basic supplies is so unreliable that doctors routinely dispatch patients’ relatives to fetch medicines, IV fluids and syringes from private merchants or the black market.

Jawad can’t explain the shortages. Her department is always careful in placing its orders with the national health ministry, which supplies all of Iraq’s public hospitals. Often, though, the medicines never show up.

“No one can tell us why,” Jawad said. “It is as if they just disappear somewhere.”

Stories of missing drugs, of desperately ill-equipped doctors and of patients left to suffer the consequences are everywhere in Iraq’s public health care system. Some hospitals are filthy and infested with bugs. Others are practically falling down. More and more, the blame is being placed on Iraq’s U.S.-backed government, which by many accounts is infested with corruption and incompetence……………………………………….

Corruption and ineptitude aren’t limited to health care, of course; they’re endemic in most Iraqi public institutions. When it comes to public health, however, the repercussions are devastating, and they bring into sharp focus the failures that are threatening Iraq’s American-financed effort to rebuild itself as a democracy at peace with itself and with its neighbors.

“It costs lives every day,” said a fourth-year resident at Baghdad Teaching Hospital who asked not to be named for fear of retaliation by his superiors. “The security situation is better now. The government has money. So you tell me why I can’t get basic medicines at the best ER in Baghdad.”

“A lot more would survive if we had more medicines,” Alwan said. “I try not to think about how many.”

Ali Mohammad Abed, a student teacher from Baghdad’s Bayaa neighborhood, said he thinks his 2-month-old nephew died because the public children’s hospital where he was taken last month didn’t have the tools to diagnose him.

“We noticed a strange color around his lips,” Abed said. “They couldn’t do the tests they needed to figure out what was wrong. He died the next day.”……………………………………………………………

Before the 1990s, Iraq had perhaps the best health care system in the Middle East. Nearly two decades of international sanctions and war have changed that.

For nearly two years in 2006 and 2007, when Iraq’s sectarian violence was at its worst, the national health ministry was controlled almost completely by Shiite Muslim militias. In many neighborhoods, Sunnis avoided hospitals for fear of being killed in them……………………………………………………

Even at Baghdad Teaching Hospital, the emergency department’s shelves often run dry of antibiotics, painkillers and life-saving drugs for heart attack victims.

“Much of the time we don’t have IV fluid, so the family will go out to buy it and bring it to us,” second-year resident Jawad said. “The pharmacies know they are desperate, so they charge them three or four times the normal price.”

The department also lacks most basic diagnostic machines. Its lone defibrillator breaks regularly. Patient samples often must be sent out for testing because the lab can’t handle them.

“We must be careful to only use the dependable labs,” Jawad said. “There are many that give incorrect results, or they leave the samples to expire.”……………………………………………………..

At Yarmouk Hospital, a 600-bed facility where entire wings are blocked off for fear they’ll fall down, nurses complain of constant shortages. One said the hospital regularly uses water as a substitute for ultrasound gel.

“One day we will have a lot, and the next day it will all be gone,” she said.

Huda Fadhil, sitting at her ailing mother’s bedside, said doctors at Yarmouk had sent her out several times to fetch supplies the hospital lacked.

“I just got back from buying this,” she said, holding up a plastic syringe. ” With all the fortunes this country has, the hospitals don’t have syringes? It’s crazy.”

The shortages are so endemic that some hospitals refuse to treat noncritical patients if they come without friends or relatives to act as runners on their behalf…………………………………………….

Patients said bribery is so widespread that the sick now accept it as part of the process of getting treatment from hospital and clinic workers. Those who’re able sometimes use payoffs or personal connections at the health ministry to avoid long waits for surgeries or hard-to-get tests such as MRIs.

“My case is a simple one, so I haven’t paid any bribes,” said Widad Jalal, who was admitted to Yarmouk for a lung infection. “But many times you do. This is not hidden. It’s common.”

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