Best of PSN: Letters from Iraq
Editor's note: The following article was originally published in April 2005 received a Gold Award in Feature Writing from the Society of National Association Publications.
The working and living conditions for plastic surgeons in Iraq could hardly be worse: operating as hospitals shake from explosions, electrical service that cuts in and out, and an acute nursing shortage that has forced them into multiple roles in the O.R. They have been targets of harassment, kidnapping and execution, yet they remain undeterred in their efforts to provide medical care for their countrymen.
In late 2003, four plastic surgeons were among a group of six Iraqi physicians who visited the United States to meet with President George W. Bush and undergo relatively brief but intensive training sessions. PSN contacted each of the plastic surgeons, all of whom received significant logistical assistance from Randy Sherman, MD, Los Angeles, and Bernard "Bud" Alpert, MD, San Francisco, among others, for their trip to America.
PSN presents their stories as "letters from the front," rather than through a news article format, believing it to be a much more effective means of conveying the true sense of what it means to be a plastic surgeon today in Iraq.
Azzam Farroha, MD
Dr. Farroha was part of the six-surgeon contingent from Iraq that traveled to the United States in late 2003. He practices at Al-Wasity Hospital and runs a private clinic in Baghdad.
I am sorry to tell you that the conditions to work in Iraq are not very well, because of the poor security and because the Iraqi Ministry of Health administration is not very organized and powerful...and because some of the doctors, nurses, administration staff and patients are not using their freedom well. They were used to being treated by force under Saddam Hussein, and now the freedom is something new to them.
Also we have the problem of terrorists. They are some of the fundamental Muslims and the remnants of Saddam's followers. They do not want Iraq to be free and developed, so they try to make explosions, killings and kidnappings, so that most of the foreign companies will not stay or come to Iraq to rebuild Iraq, to make the people angry and unsatisfied.
In spite of these conditions, I try my best to work.
In the last month, some terrorists tried to kidnap me, and they threatened my family. The Iraqi Ministry of Health could not protect me, so they gave a two-month vacation, which saved my life. The reasons I have been targeted for kidnapping are:
- I had the honor of traveling to the United States, where I met President Bush.
- I am Christian, and now some of the Muslim fundamentalist terrorists try to hurt Christians, especially prominent ones. This, too, was due to Saddam Hussein, because in 1994 he started his Islamic Campaign to make Muslims in Iraq and all around the world hate the United States, the United Kingdom, and in fact all Christians and Jews around the world. But he did not close the churches at that time because he was afraid of the Pope and the press. He did, however, interfere with our religious ceremonies.
- I have a private clinic for plastic surgery (in Al-Mansur, the highest class district in Baghdad), and it has been successful. In Iraq today, terrorists try to kidnap and threaten well-known physicians to get money and force them to leave Iraq.
We need help, and I think the best thing that U.S. doctors can do is be in touch with Iraqi doctors through the Internet. Also, we would benefit from training courses for them in a nearby country such as Jordan or Kuwait, so it will be safe for them to come. Also, I believe training the Iraqi nurses is very important, because we have poor nursing services.
Maybe the security conditions will improve now that the Iraqi elections have been held, and my dream of making an American-Iraqi Teaching Hospital in Baghdad will come true. I suggested this when I was in the United States, but I think it will be possible in the future.
My trip to the United States was very important to me for several reasons:
- This was the first time that I traveled abroad since 1980, because during Saddam's period I could not travel because I am a physician. My entire education was in Iraq (including an MD, PhD and a Higher Diploma for Laser in Medicine degree), so it was a great opportunity for me to get training abroad, and it was my good luck to be in the United States, the best place for medicine.
- I trained in general plastic surgery, focusing on breast reconstruction and laser surgical techniques (both are new to Iraq). This training took place at the University of Southern California in Los Angeles, Beckman Laser Institute at the University of California-Irvine, Johns Hopkins University in Baltimore, Georgetown University Hospital in Washington, D.C., and the California Pacific Medical Center in San Francisco.
- I got the chance to visit my family and celebrate the Christmas and New Year holidays with them. I had not seen my brother (Sam Farroha, MD) in 21 years and my sister (May Habboosh, MD) in 15 years.
- I also had the honor of meeting President Bush on Dec. 15, 2003. And I received another meaningful honor: I became an ASPS Corresponding Member.
After my return to Iraq in March 2004, I used what I learned to help patients in Iraq and also teach my resident physicians. I try to remain in contact with my teachers in the United States; sometimes I send photos of operations that I did in Iraq and get their opinions.
And I continue to request from the Iraqi Ministry of Health new devices (for instance, laser devices to treat congenital anomalies) and other medical materials to be sent to government hospitals to serve poor patients, but the ministry has its priorities and does not provide most of these things. I hope I can get what I want for the Iraqi people.
Best regards,
Azzam Farroha, MD
Ali Aarif Bayrakdar, MD
Ali Aarif Bayrakdar, MD, works in the microsurgery unit at Baghdad's Al-Wasity Hospital. He belonged to the group of Iraqi surgeons that visited the United States in late 2003 and was the only one to return for the Breast Surgery Symposium in Atlanta in January.
As Iraqi surgeons, we were kept out of touch with the outer world for the past 23 years, after Saddam Hussein wrapped his fist around this country. For some reason, he hated doctors and most of the time did what he could to make our working environment as bad as he could. Yes, he ordered a few new hospitals built, but that was just to put his name on them so that people and the media could say how great he was!
After the fall of his regime, I was able to get a passport and travel abroad. This was impossible before, because I am a doctor and needed special clearance for the passport - which I never got, because I was not one of his Baath Party members. But thanks to Dr. Alpert, Dr. Sherman and the International Medical Corps, I was one of the six Iraqi doctors to visit the United States for three months, taking tours of the hospitals and watching surgeries that some of us have only read about in the textbooks, and learning tons of ideas from great names we already knew from the books and magazines. (Although these are relatively old books and magazines, they were keeping us going somehow.)
During that visit, we attended a meeting in Palm Springs (my first-ever meeting); it was a feeling between shock and amazement for me considering the facilities and sum of knowledge offered in that meeting; I was able to see many great names in my field of work (those people were like the gods of plastic surgery). When I got back to my country, I was loaded with ideas and thought to elevate the standards of our working environment, at least in our hospital. I and my colleague, Usam Najjar, MD, started to make some changes. I was able to establish the first microsurgery training lab in the country to teach and train other surgeons (the lab was made possible through the help and support of Dr. Sherman and Micrins, a company that makes microsurgical instruments, which donated a complete set of instruments to us). The facility is now open and serving the doctors in that field.
On the other hand, life began to get more and more difficult since I returned from my first visit to the United States, because of the ongoing process of devastating everything good in this country. Bad people are trying their best to keep us without electricity and fuel, and as we all know, to be modernized we need a lot of energy resources. In conjunction with that, the outlaws started to kill, kidnap and terrorize doctors. (Kidnappers told one doctor, after he was taken a second time, that he should leave the country to avoid being kidnapped anymore!)
So although I personally hate guns, I have started to carry one to defend myself (as if I could ...).
In Iraq, we work in government hospitals, which pay our salaries at the end of each month (which is around $300 for me). After that, we are allowed to work in our private clinics, but due to the bad security, these hours of private work are now very short, because we have to be home by sunset.
The whole security issue is getting worse every day. I used to say that we are living our daily lives as playing the Russian roulette. I was a victim of many nearby bombings, but the worst was in December, when a car bomb went off only three cars away from mine while I was in a traffic jam. Miraculously, I escaped alive.
Then I was lucky again to be invited to the Southeastern Society of Plastic Surgeons' Breast Surgery Symposium in Atlanta. But this time I couldn't speak about my trip to any but my closest friends and colleagues (because of the bad security issue; I might be killed for having something to do with any American), but the things I got from that visit are also so rich that my motivation was brought even higher to try to make a real change in Iraq's health care system.
Unfortunately when I got back to my country this February, I found my hospital damaged by a car bomb, and the main building that we were just finished building and about to move into was the most damaged. So we are still working in the old building (in very miserable conditions) and still doing complicated operations like microsurgery (which is my field of subspecialty and interest) and still getting many wounded people because of the ongoing sabotage and insurgency acts. With all this, we keep praying to God to help us out through these dark days of our history.
Sometimes I cannot make it to the hospital because of a bomb blast and all the routes to the hospital are blocked; that makes a usual story in Baghdad these days - or, if one route is open, then you will be stuck in a very heavy traffic, which means you won't make it on time for any appointment.
The people I met in the United States were the most generous I have ever seen in my life, and I can't mention names in this correspondence because it would be a very long list. The trip really did change my life forever, and when the time comes, I will try to be the one to bring changes to Iraq's health system, or at least where plastic surgery is concerned.
I am still getting e-mails from very good friends in the United States and they are telling me that they are ready to send books and surgical instruments to help us out, which I am working with my hospital administration to do.
Best regards to you,
Ali Aarif Bayrakdar, MD
Usam Najjar, MD
Dr. Najjar performs plastic surgery at Al-Wasity Hospital and also has a private practice in a Baghdad clinic. He belonged to he contingent that traveled to the United States in late 2003.
Al-Wasity Hospital, where I practice, is situated in the center of Baghdad, where there is a gynecology hospital just across the street and a police station and courthouse next door. On Jan. 19, a car bomb detonated in front of the facility - it was intended for the police station across the street - and caused massive damage to our hospital and the gynecology hospital. One guard from our hospital died and most of the windows and doors were avulsed and the secondary ceilings fell down, which may not seem to be great damage, but with all the bureaucracy here, it may require a few weeks to repair. So we are out of work for the time being. (Editor's note: The blast killed 18 and wounded 15.)
With the election and all the violence in the streets, the decision to go out of your house can be a dangerous one. I live in an area south of Baghdad called al Dorah, which is considered moderately inhabited with terrorists and Islamic fundamentalists, and being near an election center - it is located 150 meters away from our house - we hear the sound of bullets and blasts every 15 minutes and all night long.
In January, a window of my house was smashed when struck by a shell fragment from a nearby explosion. One week later, six windows broke when American troops discovered and detonated a bomb in an empty piece of land in front of our house. They blew it up while we were at work.
With all the violence here in Iraq, I always say that when you go out to work or for anything, it's like playing the Russian roulette. Many times, you pass a street and after a few minutes, you hear an explosion occurring in that street. And it seems that only the will of God has saved you from harm.
Furthermore, there is the problem of kidnapping of the presumably wealthy people or their children for ransom that may reach $20,000 or more - if the victims don't get slaughtered.
One of my friends (a plastic surgeon) was going to his private clinic when someone stabbed him with a knife. He barely reached the hospital. Emergency surgery stopped internal bleeding in his liver and intestine, and he had just begun his recovery when he received a letter with a bullet saying he will be killed for being a cooperator with the U.S. Army (although he has nothing to do with them). So he took his family and flew to Syria.
Another friend of mine, a plastic surgery program trainee, was leaving his house when a car stopped in front of it. Men exited the car, put a bullet into his head and ran away. Simply for being a doctor.
Two weeks ago, an anesthetist in our hospital and his father were driving to the hospital when a car stopped beside them and fired four bullets at his father, who was driving. He miraculously survived and remains under treatment for his injury.
One of my relatives was kidnapped from the street three months ago; we still don't know anything about him. (His son is a doctor.)
Many of the famous doctors in Iraq have been kidnapped and released after paying some ransom; some of them have been killed in the streets.
An "accident" happened in front of me in the street three weeks ago when I was coming home. A car filled with armed men (presumably Iraqi National Guard troops) fired a gun on a car near them, for no obvious reason (the victims' car was not moving). The car the shots were fired from quickly drove off and stopped at a National Guard watch station. One of the men inside the targeted car was injured or killed.
Every time you go out of your home you may be hit by a bomb or be a kidnapping target (either you or one of your family), and in spite of that we continue living and working. I don't know when my time will arrive; only God is my protector.
We are about to open the new building for Al-Wasity Hospital, which may give us better circumstances for operations (at least we hope so).
I had hoped that I could send a longer response, but, sorry, the electricity lasts for one, maybe one-and-a-half hours out of every six hours. Then there are shortages of gasoline and kerosene for heating. I'd rather not bother you with my problems.
Yours,
Usam Najjar, MD
Ebaa Mahmod Sabri, MD
Dr. Sabri did not travel to the United States with the Iraqi contingent in 2003, but he has forged a relationship with Dr. Sherman and is a close associate of Dr. Quraish Al-Kasir, the Society of Iraqi Surgeons president. Through these relationships he has become aware of the potential good that can result from a joint U.S.-Iraqi support initiative.
I graduated in 2002 from the former Saddam College of Medicine - Saddam University, now known as The College of Medicine -Al-Nahrain University, and I am a first year student in the Iraqi Board of Plastic Surgery in training at Al-Yarmuk Teaching Hospital. I ranked at the top of 44 doctors in a competitive exam.
Although I did not make the trip to the United States in 2003, I hope to visit the United States to learn, study and undergo plastic surgery training. I know Dr. Sherman through Dr. Al-Kasir. I've contacted Dr. Sherman many times to ask him about complicated cases that I have faced in my work, and he has been gracious in lending all the knowledge and advice that he can. Dr. Sherman has been very helpful to me, explaining many things related to plastic surgery and informing me of the many things involved in the U.S. medical evolution. Really, I hope to go to America to study and make my postgraduate study in plastic surgery.
But for the time being, we work here in Iraq in very bad conditions. We work to save the lives of many patients who seek medical help for traumatic injuries, but we have limited, unsophisticated equipment. We continuously perform reconstructive procedures on those who have met injury through the disastrous conditions in Iraq. We have limited time to do elective procedures, especially aesthetic procedures.
For the time being, the security in Iraq is bad; during this security situation my personal security has been very difficult, even in the hospital. I almost lost my life when the car bomb exploded near the emergency ward of Al-Yarmuk Teaching Hospital in August 2004. I was fortunate to escape with only minor injuries.
The situation here it is difficult, but not impossible. These are our people, and we must help them.
U.S. plastic surgeons can help our situation by forging a link between medical facilities here and in the United States, so we can somehow gain benefit from your well-equipped hospitals and well-trained doctors. Perhaps this can come about through the Internet, e-mail or fax, and through training courses directed to Iraqi medical staff and so on.
We know we can provide more help to our patients in Iraq, and we hope physicians in the United States can somehow provide some assistance.
Best regards,
Ebaa Mahmod Sabri, MD
Sarmad Abdulnoor, MD
Dr. Abdulnoor, who practices at the Al-Karama Teaching Hospital in Baghdad, belonged to the group that visited in late 2003. His optimism and outlook sum up the the spirit and resiliency of his Iraqi colleagues.
Thank you for offering me this nice chance to share a few words of mine, which show some of my feelings, daily activities and some aspects of my work as a plastic surgeon in one of the hospitals of Baghdad.
These days, most Iraqis taste the flavor of democracy, including me and my wife. I had the chance to exercise my vote first in the Iraqi Society of Reconstructive and Aesthetic Surgeons meeting - we elected the Directing Committee, in which I had the honor to be one of its members, caring for scientific activities - but more importantly, I was able to vote for Iraq's future and become part of establishing the foundation of democracy not only in my country, but in all the Middle East!
It's a great victory for democracy in spite of all the threats and dangers; Iraqi people have tasted the sweetness of democracy, with all the hopes and dreams for a better future, peace and prosperity.
I, myself, have tasted the pleasure of voting for my representatives in the Iraqi National Council and the Province Council; although I know that my vote is relatively insignificant, I see it as a strong demonstration of freedom, self respect and real humanity...
On the day of the national elections, my family and I were anxious to vote but at the same time worried about the security situation, the threats of the terrorists and the criminal madness! But at last we went, first me alone walking to the voting station in a nearby school, and then my wife with my older son. Because he is age 14, he is not eligible for voting, but I wanted him to go and watch this new experience alive, to go feel what democracy - this magic word - means!
This is a historical day for Iraq and all Middle East countries, as this method and the rules of this election, a first step in the journey of democracy, are unique in the region.
I liked to share with you the Iraqi celebration of starting the big project of democracy, which will bury all the terrorist ideas of violence, while teaching all people that any struggle or conflict should be solved by negotiations - no matter how long does it take...
Let us pray to God for peace, freedom and prosperity for all the world. God bless you all, and God bless the world for peace and prosperity.
Thank you,
Sarmad Abdulnoor, MD
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