Healthcare in Iraq Pre and Immediately Post Operation Iraqi Freedom Michael J. Keller, MBA, FACHE

 Geography  Medical indicators  Health care professionals  Ministry of Health  Private sector  Geography  Medical indicators  Health care professionals  Ministry of Health  Private sector

Geography

Land Mass Comparison -

Babyl Province Population Est. 1.2 million Principle City Al Hillah (Babylon) Hospitals 400 Bed General Hospital 250 Maternity/Children’s Hospital Healthcare staff 470 Physicians (420/50) 1100 Staff

Medical Indicators IraqUnited States Population23.6 million284 million Hospital Beds14/10,00037/10,000 Physicians4/10,00027/10,000 Infant Mortality Rate92 deaths/1k live births7 deaths/1k live births Life Expectancy at Birth59 years77 years

Al Hilla Maternal/Child Hospital

Medical Supply Missions

Absence of Equipment

Sole Incubator

Sanitation Standards

Al Hillah Hospital Today

Physician Training  All conducted in English (British)  4 year medical school, standard residency training programs  Iraqi developed and administered final exams since 1981  Little or no professional contact outside Iraq during Saddam’s regeime  No new textbooks or journals >10 years  All conducted in English (British)  4 year medical school, standard residency training programs  Iraqi developed and administered final exams since 1981  Little or no professional contact outside Iraq during Saddam’s regeime  No new textbooks or journals >10 years

Nursing  Estimated 250 formally trained professional nurses (RN’s)  No nursing schools operating  No resources  Care provided by Aides & Orderlies  No appropriate work uniforms  Lack of basic care training  Estimated 250 formally trained professional nurses (RN’s)  No nursing schools operating  No resources  Care provided by Aides & Orderlies  No appropriate work uniforms  Lack of basic care training

Allied Health Personnel  Medical Laboratory Technician – trained in Baghdad MOH  PT, OT, Speech, Respiratory, Medical Records – not to be found  Bio-Med - None  Management/Administration  Medical Laboratory Technician – trained in Baghdad MOH  PT, OT, Speech, Respiratory, Medical Records – not to be found  Bio-Med - None  Management/Administration

Ministry of Health  Baghdad centric  Assigned staff upon completion of training  Handed down operating budget  Salaries controlled and ‘regionalized’  Directed treatment protocols  Baghdad centric  Assigned staff upon completion of training  Handed down operating budget  Salaries controlled and ‘regionalized’  Directed treatment protocols

MoH Elections

Office of Public Health YearDiagnosedCarriersDeaths Cholera Malaria Dr. Hazim Al Nassiry, May 17, 2003

Medical Supply System  Kamidi  Central purchasing and distribution system  Provincial warehouse & cold chain storage  Former régime requirement for ‘testing’ of all pharmaceuticals and reagents  Ban on U.S. produced Rx’s & reagents  Oversaw Iraq Rx manufacturing  Endemic corruption and graft  Administration ‘clung’ to Kamidia until finally realizing that it was beyond rehabilitation.  Kamidi  Central purchasing and distribution system  Provincial warehouse & cold chain storage  Former régime requirement for ‘testing’ of all pharmaceuticals and reagents  Ban on U.S. produced Rx’s & reagents  Oversaw Iraq Rx manufacturing  Endemic corruption and graft  Administration ‘clung’ to Kamidia until finally realizing that it was beyond rehabilitation.

Private Sector  Operated throughout the time of the former régime in all provinces  Obstetric & Ophthalmology  Forced to black market for supplies  Global fee - negotiated between physician & patient  Operated throughout the time of the former régime in all provinces  Obstetric & Ophthalmology  Forced to black market for supplies  Global fee - negotiated between physician & patient

Closing comments -  Dedicated and ethical providers  Desperately wanting to return to US/European standards of care  Appropriate spending investment and removing corruption are key  Exportation of knowledge and learning materials is the way ahead  MoH was among first ministry to be returned to Iraqi sovereignty  Dedicated and ethical providers  Desperately wanting to return to US/European standards of care  Appropriate spending investment and removing corruption are key  Exportation of knowledge and learning materials is the way ahead  MoH was among first ministry to be returned to Iraqi sovereignty

Questions & Comments A Portion of the Presidential Palace, Tikrit, Iraq