Teaching Emergency Medicine in Erbil, Iraq

ACEP News
April 2008

By Dr. Ross I. Donaldson

Before leaving, when I told friends I was heading off on a trip to Iraq, most of them looked at me with a strange expression. "But, you're not in the military," they inevitably said.

Throughout the normal American work week, we hear scattered news about of our soldiers and their weaponry being exported abroad--it seems like that is all we send to that far-off country. Despite vocal dialog from people such as the International Medical Corps' (IMC) Iraq country director, Agron Ferati, not as much else is heard about our humanitarian efforts.

I knew little myself about the "humanitarian surge" in Iraq, until I was invited by the IMC (and the Medical Alliance for Iraq) to be one of four Americans formally teaching emergency medicine in Iraq for the first time in that nation's history.

Immersed in war and dictatorship for the last few decades, Iraq has missed out on the development of emergency medicine as a specialty, along with its associated benefits of reduced mortality from medical and traumatic emergencies. With a poorly developed prehospital ambulance system, many Iraqis continue to die from survivable injuries. If anywhere in the world deserves a good emergency system, it should be Iraq. My three fellow ACEP members and I were supposed to facilitate getting that ball rolling.

As an emergency physician, the chance to be one of the first to help start my medical specialty in a needy country was more than enough to excite me. But my feelings of being on a historic trip to teach Iraq's budding emergency medicine community doubled when I met my three impressive colleagues on the flight over: Dr. Robert Norris, the director of emergency medicine at Stanford University and a well-known toxicology and airway expert; Dr. Luke Larkin, the associate chief of emergency medicine at Yale University whose resume was barely downloadable to my computer because of its massive size; and Dr. Craig Manifold, a chief of emergency services in Texas and a flight surgeon with extensive experience in mobile field surgical teams.

Our team of emergency physicians finally reached Iraqi soil, landing in Erbil (northern/Kurdish Iraq). There, we were met by staff from the IMC and Hawler Medical University, who ushered us into our new home with welcoming smiles and open hands. Despite being wonderful hosts, our new friends soon put us to work.

From all over the country, close to a hundred Iraqi physicians attended our teaching program. Because the specialty of emergency medicine is just starting in Iraq, their prior training was diverse, ranging from internal medicine to anesthesia and general surgery.

Our participants, several of them in their latter decades, were perhaps the most excited students I have ever had (even thanking us afterward for giving them a test - certainly a first for me). They ate up our presentations and the copious free materials donated by ACEP, much like starving men who had, at long last, stumbled upon a rich banquet of learning.

Our faculty taught the group with lectures, moving to practical instruction using small groups and mannequins. The two main focuses were airway management, the source of many preventable deaths, and trauma, which is an obvious issue in the war-torn country. We also spent time touring the local hospitals and teaching by the bedside. The Iraqi doctors proved to be bright and quick to ask insightful questions--we ended up learning as much as teaching.

Overall, the week-long course proved to be an amazing meeting of medical minds, despite the assembly attendees' seemingly disparate backgrounds. Both the Iraqi and Kurdish ministers of health personally attended, adding additional weight to the proceedings. The program allowed for the sharing of ideas and brought together those Iraqi doctors at the forefront of making emergency care a reality for the average Iraqi citizen.

Together at the end, the participants founded the Iraqi Emergency Medicine Working Group, to continue forward the important effort to bring modern emergency medicine to the country.

Our visit was, of course, only a small beginning toward that end, and much work still needs to be done. Iraqi prehospital personnel need to be trained to international standards, so that children and their parents do not die from preventable injuries en route to the hospital. A model program to train the first emergency medicine specialist physicians in Iraq also needs to be initiated and carefully nurtured to fruition.

In addition to the medical gains, there were also many side benefits from the trip, including the good will that was shared so freely among those of a mutual profession. Iraq is clearly a traumatized land, but there is much to be said for the healing powers of simple human interaction over a meal of bread and hummus, while the guns and artillery are safely far afield. As we continue to ramp up the provision of humanitarian aid to Iraq, we can expect this to be one of its main beneficial outcomes.

Hopefully, some day after countless such meals have more normalized the relationships between our two peoples, I can tell my friends I am leaving for Iraq, and they will only nod their heads in understanding. "Of course," they might simply say. "Along with your medicines, take our best wishes with you."

Dr. Donaldson is a medical professor at UCLA, specializing in emergency medicine and global health. His memoir, "The Lassa Ward: Life, Death, and My Time in Sierra Leone," is being published this year by St. Martin's Press (www.TheLassaWard.com).

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