Iraqi physicians want to have a voice in rebuilding their country’s health care system and in making health care policy decisions. American physicians familiar with the advocacy role of medical societies are sharing their expertise with their Iraqi counterparts.
More than 300 Iraqi physicians from several medical specialties including psychiatry met with about 30 American and British physicians at the first International Medical Specialty Forum in February in Baghdad.
Organizer Michael Brennan, M.D., an ophthalmologist from Burlington, N.C., told Psychiatric News that he was asked by the U.S. Army and Coalition Provisional Authority (CPA) to work with Iraqi physicians in transforming their medical societies into democratic ones.
"Their bylaws are archaic, and they don’t hold regular elections because there are no term limits. We are working with them on rewriting their bylaws and constitutions," Brennan said. The exception is the Iraqi Society of Psychiatrists (ISP), which holds elections for its executive council every three years.
He and the Iraqi Society of Physicians, a loose umbrella group, organized the international forum after Brennan talked to numerous Iraqi physician groups last fall.
Medical societies existed under Saddam Hussein’s regime but were controlled by the ruling Ba’ath party’s Ministry of Health, which had spies everywhere, Brennan said.
"We have impressed upon Iraqi physicians that medical societies should be nongovernmental agencies that operate in a transparent manner with open membership," Brennan said.
Numan Ali, M.D., secretary-general of the 90-member ISP, told Psychiatric News that at least eight members of the ISP, including vice-president Tarik-al-Kubaisy, M.D., lost their university positions last year. The CPA implemented a policy last summer of ridding the government of the upper ranks of Ba’ath Party members, which included the ISP members, according to Ali.
"Professionals were expected to join the Ba’ath Party to keep their jobs, be promoted, or be accepted to certain colleges or universities," Ali said. "Dr. Kubaisy found a good job in England, while two other dismissed psychiatrists found positions in neighboring countries."
Before leaving, Al-Kubaisy told the Guardian Newspaper (August 30, 2003) that the U.S. policy would force more Iraqi intellectuals to leave the country to find work, which could ultimately create a serious brain drain.
CPA officials insisted that the purge affected only between 15,000 and 30,000 Iraqis and 5 percent of the total Ba’ath party membership, according to the article.
Lt. Col. E. Cameron Ritchie, M.C., a psychiatrist in the Department of Defense, met Ali for the second time at the medical specialty forum. They first met at APA headquarters in Arlington, Va., in January when Ali visited Deborah Hales, M.D., director of the APA Division of Education, to discuss professional exchanges.
Ritchie, a member of APA’s Committee on Psychiatric Dimensions of Disasters, gave a presentation on forensic psychiatry, medical ethics, and malpractice at the Baghdad forum.
"I reviewed the basics of medical ethics including informed consent. The concept of patient rights was unfamiliar to many Iraqi physicians and the public, who are not used to questioning physicians," Ritchie said.
"There is an enormous need for epidemiological research on most medical and mental disorders. There is no systematic surveillance that I know of," Ritchie added.
Ritchie visited a few general hospitals with psychiatric units while in the Iraqi capital, but not the two psychiatric hospitals in Baghdad because of potential security threats, she said.
Ali said that psychiatrists have a critical need for newer-generation medications including SSRIs and antipsychotics. "We would like an ongoing supply of the same medications so we don’t have to discontinue them after a few months when a nongovernmental organization donates different medications," Ali said.
Another problem is the shortage of psychiatrists in Iraq—there are only 90 for 24 million people, the bulk of whom reside in Baghdad, Ali said. In addition, there are no subspecialists, such as child and adolescent and forensic psychiatrists, and no psychologists, Ali said.
He and other ISP members want to come to the United States and learn about advances in psychiatry. An alternative Ali suggested was that APA could send members to Iraq to collaborate with and educate ISP members. He also would like to collaborate with APA on research projects.
APA is providing funding for two ISP members to attend the annual meeting in New York City in May, according to Ritchie. APA has also provided ISP members free access to APA’s electronic journals and publications, she said.
APA President Marcia Goin, M.D., is devoting a presidential symposium at APA’s annual meeting to the role of mental health in rebuilding health care systems in countries emerging from conflict, such as Iraq and Afghanistan. Goin invited Ritchie, World Psychiatric Association President Ahmed Okasha, M.D., ISP President Abdul Monaf Al-Jadiry, M.D., and James Haverman, senior CPA advisor to the Iraqi Ministry of Health, to speak at the symposium.
Information about the IMSF is posted online at www.imsf2004.org. ▪