No More Cheap Chickens
In her latest dispatch from Baghdad, Jo Wilding talks to the hospital doctors who drive taxi's in their spare time to make ends meet, and hears how some patients are getting off their heads on ketamine.
21st November 2003
"When Saddam was here," Doctor Faris half-joked, "we knew who to blame for everything. We just cursed Saddam for whatever went wrong. Now we don't know who to blame - Bush, Blair, Bremer, the Governing Council, Aznar, the people who are fighting. This is our democracy. Nothing has changed but now we have a choice of people to blame."
In Faris's paediatric intensive care unit there are only two working units. Of those only one has a spirometer to measure the gases given to the patient and the monitors don't connect to the units any more, so the patients have to be monitored from inside the room. That's less of a problem now there are only two beds in use. The other two units have broken and the companies, Drager and Tema, refuse to repair them - they are out of guarantee.
When they are desperate they resort to manual pumps, blue bubbles with valves. "We ask the mother, we say to her, the life of your child depends on this, so she squeezes until morning, but you know, it's not right.
"Every squeeze is different from each other and with the machine's everything is measured, it's controlled ventilation. This is not controlled ventilation and then things go wrong and the patient will die from another cause. "There is no mixing either. The ventilator will do both, mixing and control, but here we have only industrial oxygen, not medical, so it's too pure so some of the patients die from toxicity. We do the best we can to save the patients but we know that what we do might kill them. When a patient is on a ventilator for a long time, I need to wean him off. I need to measure the gases to withdraw them gradually but I can't. That can cause barotrauma. I do something to try and save him and he dies of something else, or from the thing I did to save him. If he vomits he will die because I have no oral suckers. We know it is all wrong but we have no facilities to put it right and no one trying to solve it."
Faris's former colleague, A'ala, who brought me here, explains: "You know we have no senior doctors. We are still training, Faris and me. We are qualified anaesthetists but we are still under training for intensive care. The ministry of health would be responsible for employing a senior doctor. When I need an opinion I have to call to another hospital to talk to the senior to give me a telephone opinion, without seeing the patient. When I tried to call to ask him to visit me he said, 'you don't know how to talk to me, you should learn how to talk to me', ah, and the bureaucracy never ends."
At frequent intervals both men shake their heads and, in unison, sigh, "Nothing has changed." Doctors' wages are not enough to live on. They all have second jobs in private hospitals or drive taxis after work, sell vegetables or depend on relatives. A'ala is concerned that the effort and energy needed to improve things in the hospitals will not be available when people are working in other jobs to sustain themselves.
"They promised more ventilators but I still don't have them, and from where are you going to get the nursing staff, from where are you going to get the senior doctors. Only the Ministry can put the money into this and if they don't this ward will go down and down until they close the ward and let the children die."
The Ministry has not consistently provided even disinfectant. A'ala told me that sometimes the nursing staff bought the cleaning materials themselves. The wards are never fully cleaned for germ cultures. There is only one cleaner. A'ala wielded a phial of ineffectual drugs bearing the stamp of the old Ministry of Health, which have still not been replaced by new imports: "Did we go through this war to carry on using these things from India and Turkey? Nothing has changed.
"I am so fed up, I don't know how I can continue. I am saturated. Nothing changed when the Americans came except the money increased by little and the market increased by much. Really it's not our country.
"People who used only to hate, now take action. People who were in the middle, started to hate. People who were for them, now are in the middle. That's what happened with Britain in the 1920's, they push, push, push, until 2800 English soldiers were killed. That's not counting all the Indian soldiers who died. Their graveyard is nearby."
Faris smiled. "They fixed it before the war, they put up a new fence. I don't know, maybe they decided to make it ready for the foreign soldiers again."
A'ala and two friends, Doctors Yasseen and Laith, have been seeking out foreigners to offer their services as drivers and translators. Faris recalled government subsidised chickens, raised by the Ministry of Agriculture and sold cheaply for several months of the year. Now, they agree, nothing has changed except the disappearance of the cheap chickens.
But their reminiscences and current complaints are far from being a longing for the return of Saddam. Dr Yasseen had a place to study for a Masters degree in anaesthesia in Cardiff (UK) but doctors were not allowed out of the country under Saddam. If they travelled, it was with false documents that said they were merchants or general workers. There was a joke about crossing the land border out of Iraq. Someone collapsed and, instead of asking whether there was a doctor in the place who could help, they would ask is there a merchant or general worker here who can assist.
They laughed as they talked about the tongue loosening effects of ketamine, a horse tranquiliser used as a sedative when it was impossible or undesirable to use full anaesthaesia. "People didn't care what they said, they just said whatever was in their heads because it removes all the inhibitions, so they would shout and curse Saddam."
Yasseen tried to leave by 'the northern route' via Suleimania, but the 'smugglers' turned out to be government agents. He was arrested and taken to the security building in Suleimania. He was blindfolded and seated, then told, "But you're a doctor, we must treat you with respect." A guard told another to give him a pepsi. He was clubbed across the back. A sinalco (lemonade) was a blow to the face, mirinda (fizzy orange) across the knees. You knew where you would be hit next but not the direction the assault would come from or when. Dr A'ala said everyone could see the changes in Yasseen, how he had aged in those eight months.
After two months of this treatment he was sentenced to a year in jail and all his assets were seized, about 12 million dinars# worth ($6,000). After six months his family were allowed to buy him out for a million dinars because the party was more interested in money than in justice - even their own idea of justice. A'ala was arrested once too and clearly appreciates his good fortune at having spent only a week there, during which his family paid $1000 to protect him from beatings.
A'ala's father died a week ago from multiple tumours. His fiancée is a gynaecologist, whose dad is also dying from a brain tumour. He's been operated on but needs another instrument to remove the last of the tumour and it's not available in the entire country; a specialised knife that costs about $10,000. They are looking for any international organization that can provide one before it's too late, but they hardly expect to find one.
On the way to meet Salma Al-Hadad, the head of Paediatric Oncology [child cancer], we stopped to help two people manhandling a wheelchair with only two wheels left, occupied by a limp child with a tube in her nose, over the ridges in the pavement. There were no orderlies, let alone medical staff to supervise.
Salma summarised the unit's needs as "everything". She's just back from London where a group of Iraqi doctors were hosted by London hospitals. She's very keen on twinning links between hospitals in the UK and Iraq, to raise the Iraqi's skills to the current level of advancement, after the last 13 years of isolation.
She thought links between medical schools would be enormously valuable. Ideas we discussed included visiting lecturers and experts coming to Iraq and bringing Iraqi doctors to the UK to learn from the foremost doctors there. Their medical education is based on the British model and they use many British treatment protocols so they feel already strongly linked to the British medical system.
The same applies for nurses: one of the nurses in the oncology unit told me she went to Birmingham (UK) for training organized by the Peace and Reconciliation Fellowship. The lack of trained nurses is particularly desperate. I've been in touch with a few people already about medical school twinnings and am getting on the case with those. If anyone wants to be part of a hospital twinning, please get in touch.
Jo Wilding can be contacted by e-mail: firstname.lastname@example.org