Iraq Blog VI

Nothing Spared to Save Our Soldiers

Baghdad is still a tough place. Though there were apparently a couple of IED episodes in Baghdad while I was there, I was not aware of when they happened. However, a visit to the Combat Support Hospital (CSH) inside the Green Zone had a powerful impact on my understanding of the reality of war.

I met the doctors and nurses on duty that day. They walked me through their sobering business as if I was a patient arriving by helicopter, as most of their patients do.

I noticed a flag had been hung on the ceiling of the doorway through which wounded soldiers would be wheeled. I was told, “We want the American flag to be the first thing they see here. We want them to know they have come to a place where no effort will be spared to give them what they need. We want them to know once they get here, there is a 98-percent chance they will survive.”

In general, the staff observed that, thankfully, trauma treatment for combat-related injuries had slowed dramatically. We walked into the trauma center. During my visit, it lay quiet, but, on some days, as many as 40 soldiers will lay on those tables, victims of explosions, bullets or other combat injuries. The chief nurse who briefed me said, “Sometimes all three of these tables will be full, the floor will be covered with blood, and there will be a line of gurneys waiting, but the most remarkable thing to observe is the calm professional way in which this team provides care. Nothing is spared.”

After a wounded soldier has been stabilized, and the extent of injuries determined, most must go to the operating area. We walked the pathway along which so many had been rolled. I found myself imagining what would go through their minds as they deal with the pain and uncertainty of their circumstances.

Secretary Leavitt and Chief of Staff, Rich McKeown on a tour of the CSH.

We entered the operating area. At the moment we were there, only two of the several operating theaters were in use.

I looked through the window of the dual swinging doors, and could see the body of what was obviously an Iraqi man, lying naked on the operating table, with a team of four working over him. He had lost a hand, had a serious wound to his head, and the team had his chest open working to remove a piece of metal.

The chief nurse explained to me he was Iraqi, and appeared to have been setting an explosive device of some type when it had blown up prematurely. He had received the blow he had intended for one of our soldiers.

What interested me is that the United States provides him the same care we would one of our soldiers. Something tells me that isn’t true of the insurgents and the terrorists.

In the second operating theater was another Iraqi, wounded in combat. It was another scene where the nature of his injuries made the seriousness of war graphically apparent. I won’t go into detail, except to say they were extreme. The surgeon, a youngish looking guy who was on his second tour, conceded to me that the first time around it was somewhat shocking, but this time, he knew what to expect. The emergency surgeries are, he said, “a professional challenge like none other I have ever faced.”

It is not unusual to have a wounded American soldier arrive at the CSH, get stabilized and be on an airplane to Germany on the same day.

On my way out the door, I saw a little Iraqi boy who was being treated for a poisonous snake bite. His father was at his side. A significant part of our military medical resources in Iraq go to provide treatment to local citizens. One thing I know is that their view of America and Americans will never be the same.

As Prime Minister Maliki told me, “Health care is one of the best messengers of peace between nations.”

Iraq Blog V

Meeting Prime Minister Maliki

On my second day in Iraq I had a 30-minute meeting with His Excellency Nouri Kamel al-Maliki, Prime Minister of the Republic of Iraq. I had not met him before.

His office is inside the protected Green Zone, in a rather remarkable building I understood to be the home of one of Saddam’s sons at one time. I’m not sure of that, but, by any account, it was ornate and tastefully done. I was joined in the meeting by the Ambassador from the United States, Ryan Crocker, with whom I had met the previous day, and the senior members of my delegation. Minister of Health Salih also attended, sitting on Prime Minister Maliki’s left.

Prime Minister Maliki went into exile in 1980, after Saddam Hussein’s regime sentenced him to death for his leadership role in an opposing party. He spent his time away in Iran and Syria. He was elected as Prime Minister in May of 2006.

Visits with a Head of State or Prime Minister have a rhythm about them. There is a formal greeting, and a few pictures. Generally, one sits on the right of the host. The media is invited in for a picture; when the media is cleared out, a more formal part of the conversation can begin.

Typically, the Head of State speaks first, and offers a greeting, maybe laying out some things he or she is interested in talking about. Then the visitor responds with similar expressions.

I told the Prime Minister why I was there by relating the experience I had in talking with the American health community about receiving Iraqi physicians for short-term exposure to current medical practice. I referenced the unqualified generosity and willingness uniformly expressed by everyone I spoke with.

Secretary Leavitt (left); interpreter (middle); Prime Minister of the Republic of Iraq, Nouri Kamel al-Maliki (right)

I expressed the view that our Governments were developing working relationships, but it was important, in my view, that we begin concentrating on connecting the American and Iraqi people. I referenced the historic quality and regional leadership of the Iraqi health-care community, and acknowledged the damage it had sustained during the previous 30 years of neglect. I told him we wanted to support the goal of returning Iraq to its previous stature as a center of excellence for medicine in the Middle East.

The Prime Minister said he was not surprised to hear of the positive way people had responded to my request. “This matches what we have come to know about the American people and their desire to help others,” he said.

He went on to say, “We need to build bridges based on love and appreciation. Health care is one of the best messengers of peace between nations.”

We had a fairly lengthy conversation about the dual agreements currently being negotiated between our nations. A blog is not a place to be talking about the specifics of that kind of conversation. It was candid and productive.

I will say that he had some fascinating observations about the challenges of governing people who have freedom thrust upon themselves for the first time. I saw some of that play out, first-hand, later in the day, as I traveled outside the Green Zone to a major teaching hospital in the Medical City complex in Baghdad. (I wrote about that in my previous blog.)

Iraq Blog IV

Iraqi Health Outside The Green Zone

I wanted to see health-care facilities, patient care, and to talk with doctors and health-care workers outside the Green Zone. It was suggested I visit Medical City in central Baghdad.

Medical City is the largest medical complex in Iraq, and includes six hospitals and the Baghdad University College of Medicine. It has almost 3,000 beds, and is the leading provider of tertiary services for the entire country.

During the 1990s, the complex’s infrastructure aged, and the hospitals have suffered rapid degradation. As Prime Minister al-Maliki told me, “Medical City has exceeded its expiration date.”

The tap water in many of the hospitals is not safe to drink, equipment is not sterilized and doctors cannot find water or disinfectant to wash their hands. The availability of medicines and medical supplies is a major problem.

Getting there was rather instructive on the challenges that remain. While I acknowledge my profile as a target likely warranted some special precautions, there are obvious risks anytime an American ventures outside the Green Zone, and serious security operations have to accompany any such move. The people executing the moves are well-trained and operationally proficient.

For security reasons, I won’t go into details, but, suffice it to say, the move involved a coordination of multiple operating units on the ground, and in the air. We wore heavy protective gear on our persons, and moved fast, minimizing any opportunity for a negative incident. I feel appreciative toward those who planned and executed my travel around Iraq so safely and efficiently.

Once at Medical City, it became clear health care in Iraq is different from that in many countries. Iraqi health-care facilities rely less on nurses and technicians. It is not uncommon for families to take up residence in the hospital to care for family members. In fact, I was shown facilities set aside to house some of them. I was told in some facilities they will even cook in the hallways, but I didn’t see that during my visit.

While I did tour a pediatric unit, where I mostly saw premature babies, most of whom had been born in other regions of Iraq, I was not able to tour many of the patient areas because of security concerns.

Much of my time was spent talking with students, faculty and staff. I began to experience what the Prime Minister had referenced in our conversation about what happens when freedom is given to people who have been oppressed for a time. There is a profound impatience for improvement.

Secretary Leavitt talking with Doctors

Students would talk about the inadequacy of their training. Using the Internet, they know what is available in the rest of the world, but they see little of it.

In a meeting I held with students who were bused in from Baghdad University, I ended up playing referee for a fascinating exchange between a student and the Dean of the university’s medical school.

The student, in his final year of his six-year course, had made the point he and his peers were not being exposed to new imaging technology. The Dean stood up to say the medical school did have some new imaging equipment, and that the students’ training included exposure to it.

The student responded, “With all due respect, sir, we don’t have access to it. I just finished my radiology section, and we only got to see the CAT scanner through the glass of a locked door. Nobody knows how to use it.”

That exchange was symbolic of what I heard over and over again.

At the conclusion of my meetings with a fairly large sample of Iraqi medical people, I came away resolved that in the short time I have left at HHS, I would find a way to facilitate more direct contact between practitioners in Iraq and American doctors. Even if it is just e-mail, calls over cell phones and an occasional video conference, both sides of the equation will benefit, and our relationship with the people of Iraq will grow.

We have a strong and complex relationship with the Government of Iraq. Our relations now need more contact between our people.