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

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

5. Geography

6. Land Mass Comparison -

9. 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

10. 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

11. Al Hilla Maternal/Child Hospital

12. Medical Supply Missions

13. Absence of Equipment

14. Sole Incubator

15. Sanitation Standards

16. Al Hillah Hospital Today

17. 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

18. 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

19. 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

20. 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

21. MoH Elections

22. Office of Public Health YearDiagnosedCarriersDeaths Cholera2000640 2001030 2002320 2003000 Malaria2000167 2001196 2002144 2003178 Dr. Hazim Al Nassiry, May 17, 2003

23. 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.

24. 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

25. 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

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