A “reawakening” for Iraqi physicians
U.S. orthopaedists play key role at historic Iraqi Medical Specialty Forum
By Carolyn Rogers
Hundreds of Iraqi physicians traveled to Baghdad Feb. 14-17, 2004, to attend the Iraqi Medical Specialty Forum (IMSF)—the first international medical conference held in Iraq in more than two decades. The opportunity to update their knowledge and chart their own futures drew physicians from as far north as Kurdistan to as far south as Basra.
|“Iraqi physicians are savvy, sincere and very determined to rebuild their medical community,” says Michael Brennan, MD, a retired military ophthalmologist who helped organize the Forum.||
Rick Wilkerson, MD, (third from right) shakes hands with Shakir al-Ainachi, MD, Iraq's Assistant Minister of Health, during a meeting with Iraqi orthopaedic surgeons at Amal Hospital in Baghdad.
“Like Rip Van Winkle, it’s a reawakening of a population of physicians that’s been in the dark for 20 years in terms of technology and interchange.”
U.S. physicians befriend Iraqi docs
In Amman, Jordan, Dr. Wilkerson boards an Air Force C1-30 bound for Baghdad.
|A total of 30 U.S. and U.K. physician delegates—representing every specialty in which Iraqi physicians are trained—also traveled to Baghdad to serve as facilitators at the Forum. Each of the physician delegates—several of whom were Iraqi-born—were asked to prepare a lecture on a specific aspect of medical society function, as well as a clinical update on their specialty.|
The Forum’s primary goal was to restructure Iraq’s current, loosely organized medical specialty societies into independent, democratic, meaningful societies that can work with the country’s health agencies to improve Iraq’s health care system.
Once home to the most advanced medical care in the Mideast, Iraq’s health care system has been devastated by 25 years of war, economic embargo and the tyrannical regime of Saddam Hussein.
“In 2001, Iraq’s national budget provided just 67 cents per Iraqi citizen per year for health care—close to the lowest on Earth,” says Rick Wilkerson, DO, an orthopaedic surgeon who played a key role at the Forum. “Under the previous system, Iraqi physicians had no input or influence over any policies developed by their country. They had no power to improve the health care situation for their patients.”
Iraqi medical leadership in disarray
Inspiration for the IMSF project came in April 2003, when U.S. forces reached Baghdad and realized that the country’s medical leadership was in disarray. “Although there were some disorganized medical specialty societies in Iraq, there was no strong, inclusive national society. Very few physicians were willing—or even able—to stand up and account for their profession,” Dr. Brennan says.
The commander of the medical brigade in Iraq, Col. Donald A. Gagliano, MD, believed that American physicians could help rebuild Iraqi medical societies—a vital step in reestablishing the voice of physicians in the delivery of health care in Iraq.
Col. Gagliano asked orthopaedic surgeon Timothy A. Gibbons, MD, to take on the project of reorganizing Iraq’s 20,000-physician medical community into professional, non-governmental medical societies. Dr. Gibbons—a member of the Iowa National Guard on active duty in Iraq—eagerly accepted the task. (See related article in February 2004 Bulletin.)
“Without Tim’s hard work in the summer and fall, the Forum would not have happened,” says Dr. Brennan, who signed on to the project last fall, at the request of his former West Point classmate, Army Surgeon General James Peake, MD. In October 2003, Dr. Brennan left his private practice in Burlington, N.C., and spent the next two months visiting Iraqi hospitals with Dr. Gibbons, meeting with Iraqi doctors—specialty by specialty—to encourage their participation in the Forum.
|“We went to hospitals in Kurdistan, Mosul, Babylon, Al Hillah, and virtually every major hospital in Baghdad, many of them several times,” he says.||
(Above) U.S. physician-delegates are briefed on security measures at Saddam Hussein's former palace in Baghdad, now headquarters to the Coalition Provisional Authority.
He returned to Iraq to oversee the IMSF in February, and continues to volunteer his time on the project. For this role, “It’s better that I don’t belong to the Army or to the CPA [Coalition Provisional Authority],” he says. “I’m independent of the government, and that’s what you need to be.”
Dr. Wilkerson became involved in the project at the invitation of his friend Dr. Gibbons, a fellow Iowan.
“That was a great call on Tim’s part,” says Dr. Brennan.
“Rick was really a natural at forming personal relationships with the Iraqi doctors. He’s just stellar in making that genuine, sincere personal connection.”
Forum successful despite bomb scare
Although a bomb threat necessitated a last-minute change in venue—from Baghdad’s Medical City complex to the convention center within the more secure “Green Zone”—the Forum managed to attract hundreds of Iraqi physicians.
Multiple security checkpoints prevented and/or discouraged a number of doctors from attending, but enough determined Iraqi physicians were present to make the event a successful one.
The Forum was comprised of academic symposia, multidisciplinary panel sessions and various keynote speeches and organizational sessions. The academic portion was devoted primarily to updating Iraqi specialists on a variety of medical and technical advances. Multi-disciplinary activities included sessions on medical ethics, the role of medical specialty societies, emergency medical systems, medical school curriculum, and board certification and recertification.
Iraq’s new Ministers of Health and Higher Education spoke at the Forum, as did Ambassador Paul Bremer—current administrator of the CPA—and Raja Habib Khuzai, MD, one of three female members of the Iraqi governing council. The Forum was supported by a grant from the U.S. Agency for International Development (USAID), and was endorsed by the Iraqi Governing Council, the CPA, and the Combined Joint Task Force 7 Medical Command, but it was not a government event.
Shakir al Ainachi, MD, an orthopaedic surgeon, served as chair of the IMSF. He also serves as Iraq’s assistant minister of health and chairs the new provisional Iraqi Society of Physicians.
Creating the Iraqi Orthopaedic Association
“To the Iraqi physicians, the idea of creating democratic medical societies and having input into their national health care development was a new concept—one they greeted with enthusiasm and determination,” says Dr. Wilkerson.
On the Forum’s second day, he led a breakout session on the formation of a professional orthopaedic association. “We talked about organizational issues such as reconstitution of their society, remodeling their bylaws, rejuvenating their membership and sort of restating some principles of leadership,” he says. “The orthopaedists in attendance were very enthusiastic about the concept, and they offered to take me around to public and private hospitals in Baghdad to see patients and to discuss the society with more orthopaedists.”
|Muthaffar Kurukchi, MD, an orthopaedic surgeon in private practice, even invited Dr. Wilkerson to his home to finalize plans over dinner. At Dr. Kurukchi’s hospital, Dr. Wilkerson met with 18 orthopaedic leaders within Baghdad. When the discussion first turned to the formation of an orthopaedic professional society, the doctors’ body language showed their resistance to the idea, he recalls.||
As the parents look on, Dr. Wilkerson examines a baby with congenital dislocation of the hip who was being treated with triple diapers because Pavlik harnesses are not available in Iraq. Upon returning to the U.S., Dr. Wilkerson sent the parents a harness, which the child is now using.
“I tried to demonstrate that societies are not necessarily run by cronyism and nepotism, but can be democratic, with leadership changing regularly based upon the vote of the society,”
he says. “I explained how they can actually play a role in working with the government health agencies to shape health care policy in their country.”
He also offered them samples of AAOS bylaws and continuing education materials, including Orthopedic Knowledge Online, Orthopedic Knowledge Update and the AAOS Monograph series.
“Within five minutes, the doctors’ attitude changed to ‘When can we start?’” he says. “They’d never looked at the advantages of a democratic society before.”
After some discussion, the Iraqi orthopaedists decided not to wait until national elections had been held, but to form the orthopaedic society immediately. They agreed to meet again in one month, and each person present agreed to bring two additional orthopaedic surgeons to the meeting.
Since that time, the group has gathered twice and is in the process of establishing their new society.
The Forum also assisted Iraqi physicians in developing credible specialty board certification procedures. “They’re desperate for that because they want to demonstrate skills internationally,” says Dr. Brennan.
Dr. Wilkerson co-chaired a multidisciplinary panel on specialty board certification, along with otolaryngologist Richard Holt, MD.
“Currently, Iraqi physicians can become board certified via one of five paths, none of which are very well controlled,” Dr. Wilkerson explains. “No recertification process exists.”
The panel recommended that each of the Iraqi medical specialty societies adopt certification requirements, with one board-certifying body per specialty. They also encouraged the Iraqis to organize recertification boards.
“This discussion was met with great interest and further emphasized the need for developing medical specialty societies so that board certification/recertification can occur,” he says.
Other panels addressed the need for a national medical licensure board. “Iraq does not have a physician registry that ensures the public safety by guaranteeing that a doctor is who he says he is,” says Dr. Brennan.
Maintaining the relationship
Dr. Wilkerson’s time in Iraq was “extremely rewarding,” he says. “The Iraqi physicians I met are intelligent, hard-working professionals who endured hardships most of us can hardly imagine. The medical lectures and the sessions we provided were very helpful, but the most valuable aspect of our trip was the one-on-one time together.”
Iraqi physicians are “grateful and eager to maintain the relationship across the ocean—person to person and specialty to specialty,” Dr. Brennan says.
Every U.S. and U.K. specialty representative delegate was asked to make a connection with their counterpart Iraqi specialists, and to keep that connection after returning to his country. They were also asked to talk to their specialty societies and try to establish a formal relationship between that organization and the corresponding Iraqi society.
After Dr. Wilkerson’s return to the United States, he began working with the Academy to try to secure sponsorships to the 2005 Annual Meeting for Iraqi orthopaedic surgeons, and is also talking with the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America. He’s also arranged for several more U.S. orthopaedists to visit Iraq.
“A number of ventures were sparked by the trip,” Dr. Brennan says. “There are telemedicine projects, a major oncology project, a ‘twinning’ package—in which a San Francisco hospital will twin with a hospital in Babylon—and others.”
Dr. Brennan talks with his new friends in Baghdad a couple of times a week.
“In fact, Dr. Shakir and I are going to the World Medical Association meeting in France in May, where he’ll be recognized as the chair of the provisional Iraqi Society of Physicians. They’ve invited him to come and tell the story of the reconstitution of the Iraqi physician community.”
AAOS plays leading role
“The AAOS has clearly played a leading role in this project,” Dr. Brennan says. “That has something to do with Tim Gibbons, but also the leadership of Dr. [William] Tipton [former AAOS EVP and Executive Director for Medical Affairs] and Lynne Dowling [director of the international department] also made a big difference.
When I approached other societies about the project, I didn’t receive anywhere near the same reception. My own specialty was maybe a close second. Some societies were even reluctant to sponsor a doctor, fearing he might get hurt. AAOS really put the first foot forward.”
External fixators needed
During his participation in the Iraqi Medical Specialty Forum, Dr. Wilkerson became aware of the need for external fixator devices for trauma cases. Due to the 1991 United Nations embargo on Iraq, there is a very serious shortage of multiple medical supplies. One way AAOS members can help their Iraqi peers is to donate external fixator devices that they have used for their patients under the Orthopedic Outreach-Iraq program. Receipts for donations will be made available upon request. Orthopaedic surgeons are encouraged to collect external fixators and send them to Dr. Wilkerson for their eventual packaging and shipment to Iraq for distribution to trauma centers there. Any questions regarding this effort can be directed to Dr. Wilkerson at: