Remarks As Delivered at the Combined Information Center Media Roundtable

SECRETARY LEAVITT:  My visit to Iraq was caused primarily by a conversation I had with the Health Minister, Minister Salih.  I would like to describe that conversation to you, because I think it is significant, in terms of why I am here, and how I can endeavor to be helpful to the Iraqi people.

Minister Salih and the ambassador from Iraq to the United States came to the Department of Health and Human Services for the purpose of making a specific request.  We have been working together on a number of subjects, but Minister Salih indicated to me that a significant need that they have – the people have here, in Iraq – is to begin to see the regional leadership that the health sector has had or had for many years restored, and that a significant part of that need was to have training of Iraqi physicians with doctors in the United States.

He indicated to me that many of the physicians in Iraq who had stayed, or those who had left and were returning, had not had an opportunity to improve or to enhance or to update their skills during a period of 5 to 10 years.  He requested that we develop a program where Iraqi physicians could come for a short time and then return to Iraq with relationships and skills that had been enhanced through their observation.

I met, while I was here, with a group of physicians and practitioners in the mental health area who have recently returned from the United States.  And, I also met with a group of more than 30 that will be leaving next month to go to various locations throughout the United States. We see this as a pilot program that we see as being expanded to a much larger number than the 30 that will be going in the first group.

I have had an opportunity, as well, to meet with Prime Minister Maliki, to talk about a wide range of subjects related to our relationship.  I also have had a chance to visit various places, including Medical City, this afternoon.  I had a chance to meet with a significant number of medical students, as well as practitioners.  It's been very helpful for me to understand the nature of the challenges that they face.

With that brief introduction, I would be very pleased to entertain any of your questions.  Should I just go ahead and call?  Yes, sir?

QUESTION:  (via translator) (Inaudible) News Agency.  So, while you have met the Minister of Health, were you informed about the number of – the danger of the spread of cholera in Iraq?  What is your opinion about the measures adopted by the Minister of Health to stop this disease?

SECRETARY LEAVITT:  I understand that in years past cholera has been a routine visitor in Iraq and that in years past there had been many more cases than at least have presented themselves this year.  I have been told that there were reports in the media of high numbers that appear to have not been accurate. 

The number I was given was 504 cases thus far this year, with, regrettably, 8 deaths.  And, while that is a significant number, and presents itself as a serious public health problem, it is not nearly at the proportion that has been seen in years past.  So, it looks to me like the aggressive prevention activities that have been undertaken by the ministry are now paying off.  Yes, in the back?

QUESTION:  Secretary, Jonathan Blakely, from National Public Radio.  To piggy-back on the cholera issue, what is the U.S.'s role in helping to fight it here?  And, is it as simple as fluoride in the water, adding fluoride to the water supply, or is it more complicated than that?

SECRETARY LEAVITT:  Others would have the capacity to respond technically on this issue better than I. 

But, I will say that this is quite typical right now of our relationship with the Iraqi government.  We are doing all we can to advise.  Our Centers for Disease Control, for example, is available to advise them.  We are also quite heavily involved with a field epidemiology training program through our CDC, where we can provide public health skills throughout the country.

Obviously, at the root of this problem is the need for better quality water systems.  That involves infrastructure, as well as public health.  Yes, sir?

QUESTION:  (via translator) Amil Jabar (ph), Iraya (ph) Newspaper.  Sir, my question is about aid and construction – about the infrastructure offered by your side.

As you know, the U.S. Army has projects to develop the infrastructure.  For example, the brigade of the Army Corps of Engineers is now trying to establish hospitals and other facilities in order to elevate the health sector in Iraq.

Do you have future plans by the U.S. Ministry of Health in order to support Iraq?  Do you have joint programs with the Minister of Iraq?  Thank you.

SECRETARY LEAVITT:  I am told that the number thus far is about 130 hospitals that have been – or clinics that have been – constructed, completed, and turned over to the Iraqi government.  That's part of the infrastructure that's been developed. Our focus now has been to try to develop the people who work in those structures.  The Minister told me that there had not been hospitals built since, as I recall, the mid-1980s in this country, and that the supply of beds, as compared to the need, is still very low.  Despite the building program, there is still a need.

So, while that is not part of the portfolio that HHS carries to actually build the hospitals, we are working directly with them in the ways that I've described, to assure that they have adequate people who can actually operate the hospitals.  Yes, sir?

QUESTION:  (via translator) Iraq Voices Radio.  An Iraqi official – and a U.S. official also – have talked about health sectors and developments.  Would you please inform us about the (inaudible) Iraqi citizens are going to benefit about health cooperation?

SECRETARY LEAVITT:  Iraq was, for many decades – and perhaps one could say centuries – a leader in this region, in the area of health care.  Over the past 20 years, the health care system has been deprived of resources, and under-represented, in terms of the need for investment. 

Obviously, the last five years and the violence that has enveloped the country have added to the problem.  But this is not a dilemma that has just occurred over the last five years, nor is it something that will immediately be resolved.  However, I sense a real commitment on the part of the Iraqi government to rebuild to that status.

Now, I mentioned earlier the desire of the United States to help build the human capital in the health care sector.  I think I also mentioned the conversation that I had with the Minister in making that request.  What I hadn't mentioned – and I would like to now – is an experience that I had in the weeks following my conversation with the Minister.

I had scheduled previously a tour of the United States to meet with medical associations and hospital associations throughout the United States.  And, as I traveled, I would mention my conversation with the Minister and their request to various medical associations, asking if there would be interest on the part of their members, medical practitioners in the United States, to reach out and help Iraqi physicians.

I will tell you that the response was overwhelming.  It was not just the numbers of people that responded, but the enthusiasm and desire they have to connect with the Iraqi medical community.  There is a deep reservoir of interest on the part of the United States and the medical community to reach out, to help Iraq resume its previous leadership role in the health care sector.  I think we will see many more initiatives with many connections being made among and between – within the medical family.

This is a very important part of Iraq regaining its stature as a regional leader in health care.  There are many physicians who have left the country, many who are coming back.  I was told yesterday that nearly 1,000 have returned during the last year.  That's a very positive development. 

Once those who have left begin to come back, once those who have been displaced within Iraq begin to return to their practice, and we begin to connect them with resources within the United States, I think we will begin to see the degree of sophistication increase, and the quality of care improve.  Yes?

QUESTION:  (via translator) (Inaudible) Newspaper.  Some children, especially in Anbar Province and Baghdad and some other provinces, they have these deformation symptoms, due to the war actions.  Have you targeted this, and how do you intend to treat it?  Thank you.

SECRETARY LEAVITT:  Thank you.  I think anyone who sees a child who has been injured, or in some other way negatively affected, responds to that with both their heart and their desire to help. 

That is not something that I have specifically focused on during this visit, but is something that I know there is openness on the part of our country to continue to help.  Yes?

QUESTION:  (via translator) Al-Rashid (ph) Radio.  You have talked about rehabilitating programs for the physicians.  Are you going to receive Iraqi students in medical schools to study there also?

SECRETARY LEAVITT:  I mentioned earlier that I have just returned from a – speaking with about 150 medical students from Baghdad University, as well as Medical City.  And we talked about the desire they have to do medical residencies in the United States.  I think that's something in the future that can and should happen.

There are some barriers to that that are, in some cases, in the Iraqi side, and there are some complications in the U.S. that need to be worked through.  But we clearly need to move that -- move toward that.

In the meantime, we discussed ways in which we could begin to connect students with students in the United States, with practitioners in their particular discipline, and that that would have substantial value as we moved toward the more formalized relationship of residencies and more extended periods of training.

QUESTION:  (via translator) (Inaudible.)  Sir, my question is about education, medical education.  You have mentioned there is some cooperation.  Are you going to put the programs, teaching programs, in Baghdad, like to change them?  They are old, the ones that are in Baghdad.  Are you going to develop them, sir?

SECRETARY LEAVITT:  Again, referencing my conversation with the medical students, I would say their appetite is very strong to have exposure to the most sophisticated techniques and equipment and procedures.  And, I think their appetite and impatience is a very positive thing, because it will begin to drive the system.

What we now need to do is connect them with people in the United States and other places in the world, so that they have opportunities to interact.  That will happen.  It will happen gradually.  As those relationships develop, the connection between our medical community in the United States and our medical community here in Iraq, to me, is a very important symbol of something else that needs to happen.

Right now, our governments are working hard to consummate agreements that will define what our government-to-government relationship will be in the years to come.  The next logical step is to assure that we have not just government-to-government relationships, but people-to-people relationships.  It will be the power of medical students in Iraq having access to resources in the United States, getting to know them.  When that occurs, then we will begin to see people in the United States seeking opportunities to come to Iraq to interact.

The same thing will happen in education, it will happen in the arts, it will happen in many other aspects of society.  So, both the normalization of relationships, or of the security situation, and the enhancement of human interactions will begin to develop this.  And I think that, in the health care sector, it will be particularly prominent.  Yes?

QUESTION:  (via translator) (Inaudible) Newspaper.  Sir, my question is about the water that has existed now in the rivers.  It is dirty water, and hospital waste is thrown there.  These are making lots of diseases.

Also, the cholera disease.  Do you think we are going to end this disease?

SECRETARY LEAVITT:  Prior to my becoming the Secretary of Health, or as you would know them, the Minister of Health in the United States, I was the head of the Environmental Protection Agency in our country.  That is the equivalent of the environmental minister.

I came to understand with clarity how important quality water is to public health.  So many diseases are water-borne diseases, particularly among children and the elderly.  So, significant emphasis does need to be put on the quality of water. 

The cholera incident that we have been talking about that routinely comes once a year is a good example.  This falls into a category of learning not just to be focused on treatment of disease, but the prevention of disease. 

The real progress in a health system comes when it begins to prevent illness, not just treat it after people are ill.  And being able to get in front of it; being able to clean the water and improve air quality are two very important indicators. 

I might suggest to you that in the United States we saw substantial improvement in our overall health when we began to focus on cleaning the water and improving the quality of our air.  The same will happen in Iraq, and that is among the things that I believe our governments need to work on together over the course of the next years.  Yes?  You will be next.

QUESTION:  (via translator) Ibanya (ph) News Agency.  The Iraqi Health Minister assured us the anthrax cases and Kurdistan cases – do you have – do you intend to have a rule on fighting this disease?

SECRETARY LEAVITT:  I did receive a short briefing on the anthrax situation.  I don't have a lot of facts.  Those would be best received from the Ministry of Health here in Iraq.  I was told that there had been 28 cases, that they were a natural form of anthrax.  And beyond that, I think you should go to the Ministry of Health here.

I will indicate to you that our technical assistance is available.  I indicated that we were training through our Centers for Disease Control, some epidemiology workers, which would be in the category of this type of incident.  Yes, sir?

QUESTION:  (via translator) Free Iraq Radio.  Sir, you have mentioned a special program in training the U.S.  Do you have a certain number of capacity, or how many doctors are going to be included?  What are the specializations?  What are the future plans for the health sector concerning the support for the health sector in Iraq?

Do you intend to build or to establish – develop health care centers in Iraq?

SECRETARY LEAVITT:  I mentioned earlier that we have had physicians and practitioners in the area of mental health traveling to the United States for some months now.  When one group has completed their visit, another will go soon. 

I also mentioned that a separate group of practitioners in the broader medical disciplines will be going next month.  This is also a pilot.  We would like to – and it's – I think it's 31 different physicians that will be going.  We see that as a start.  We would like to learn from the first visit, conclude how we can improve it and expand it.  I think the Minister of Health in Iraq has a big vision for this, and we're willing participants.

But, I think we also will find ways that we can improve interaction between the medical community in the United States and in Iraq that will not require direct visitation using various technological means: video conferencing, telemedicine, Internet, e-mail, phone, et cetera.

Again, the key, in my mind, is to improve our government-to-government relationships by beginning to see more and more direct relationships between the Iraqi people and the American people.  The American people feel a real partnership in the restoration of Iraq.  They desire to see Iraq succeed.  And there is a significant appetite and willingness on their part, once the avenues are provided for interaction, not just in health care, but in education, in the arts, in economic development, in science, and many other different ways.

And once people begin to interact with people, the relationship that our governments will have framed up will begin to take even more life.

MODERATOR:  Ladies and gentlemen, I think there is time for one more question.

SECRETARY LEAVITT:  Yes?  I am going to show my independence and take two:  one here, and one over there. 

MODERATOR:  Okay.  He's the boss.

SECRETARY LEAVITT:  All right.

QUESTION:  (via translator) Sir, about the international agencies, there are – some of them are restricted and specialized within the health sector.  They have performed some programs with Iraqi ministries. 

But, on the reality, there is something else.  How would you estimate the achievement or the performance of the international agencies in Iraq?

SECRETARY LEAVITT:  Thank you.  That's a good question.  Unfortunately, I don't know the answer.  I have not had enough personal interaction with them to make a good judgment.  I do know that there is great interest on the part of the international community to see Iraq re-emerge. 

Again, I want to emphasize for decades Iraq was not just a place where high-quality health care was provided.  It was a regional leader, and it needs to return to that status.  For a 20-year period the health care sector was deprived of resources, did not have the level of investment.  Physicians weren't allowed to improve their skills, or have access to people outside Iraq. 

That needs to change.  It is now beginning to change.  It won't happen overnight, but it will happen.  And, I think the entire international community sees that as an asset that will strengthen health care in this entire region of the world, once it returns to the status that it is capable of.

QUESTION:  (via translator) Iraq Voices Radio.  Sir, Iraqi health ministry a year ago said the cancer spreading in southern Iraq is because of U.S. using nuclear weapons during the last year.  How do you comment on this?

SECRETARY LEAVITT:  I think it is safe to say the U.S. did not use nuclear weapons.  I am not an authority on that, but I think I can, with authority, say that.

MODERATOR:  Okay.  We have to call it to a close now.

SECRETARY LEAVITT:  Thank you.

MODERATOR:  Thank you very much.

Last revised: January 12, 2009