Group looks to establish lasting relationships with Iraqi physicians

Medical Alliance for Iraq is working to set up a second CME center and bring in new technology and updated medical information to the doctors.

Issue: May 15, 2007

ByErin L. Boyle

A physician-based, nonprofit group intends to open its second continuing medical education center in Iraq after the success of its first center in a northern Kurdish city. The group, which began several years ago, is now seeking volunteers.

Michael W. Brennan, MD, is a member of Medical Alliance for Iraq, the group setting up a second CME center in Iraq. The group pledged to Iraqi physician colleagues that it would help provide education and training from international doctors on a medical specialty-by-specialty basis. It is working with the Iraqi minister of health and minister of higher education to determine medical priorities and proper accreditation for Iraqi doctors.

In a telephone interview with Ocular Surgery News, Dr. Brennan said he has visited Iraq three times in the past 3 years, for a total of nearly 3 months. He helped set up the first CME center in the northern Iraqi city of Erbil and watched several surgical cases performed by a skillful Iraqi ophthalmologist.

Focus on education

Dr. Brennan said Medical Alliance for Iraq does not treat patients, but rather helps educate Iraqi doctors. It works with the U.S. and Iraqi governments and International Medical Corps to achieve this purpose. Doctors in Iraq are often 10 years behind in their medical knowledge because newer text books have not been readily available and travel to outside medical conferences has been difficult, Dr. Brennan said. Physicians there are also nearly 5 years behind in medical equipment because sanctions have made it challenging to obtain newer devices, Dr. Brennan said.

John A. Hovanesian

“This is an attempt to form lasting relationships, organizational connections and deliver clinically relevant CME,” he said. “We’re not really in the patient care. We do not aspire to do any significant patient care. When asked to consult, when asked to oversee a surgical case, that will happen and probably evolve, but the first line is education.”

Only about 5% to 10% of cataract cases in Iraq are performed using phacoemulsification, Dr. Brennan said, which is lower than India. Retinal specialists are nearly nonexistent.

Dr. Brennan said doctors in Iraq have learned to work around sanctions and other issues. He noticed that many ophthalmologists use a “patchwork” of surgical devices. For instance, one Iraqi ophthalmologist used an IOL from Japan, viscoelastic from Korea, instruments from India and a surgical system from Germany.

“The doctor had a multinational surgical suite. That’s their innovation. They’re savvy and use their limited bargaining capacity to the max, but they’re still behind,” Dr. Brennan said.

In addition to being behind in education and training, medicine has also been a dangerous field of work in Iraq. According to the American Academy of Ophthalmology, the Brookings Institution’s Iraq Index estimated that about 12,000 of the country’s 34,000 physicians have left the country since 2003, and nearly 2,000 have died since then.

Dr. Brennan said education and training through the CME centers could assist in creating a more stable medical profession in the country.

CME in Erbil

The CME center in Erbil was first set up 4 years ago, according to Dr. Brennan. The center has been designed to feature a different medical field each month. Doctors from that field travel from the U.S., U.K. and other countries to disseminate and discuss up-to-date medical information with Iraqi doctors. Pediatric infectious diseases are scheduled for May, whereas psychiatry and burn issues will be featured in June and July, respectively.

Ophthalmology and otolaryngology will be featured in October. Robert Buttner, MD, will lead the ophthalmology team, while Richard Holt, MD, will lead the ENT delegation, Dr. Brennan said.

Dr. Brennan said the security situation in Erbil has been peaceful thus far. He said the area has had few to relatively no incidents in the past 4 years, making it as safe as some urban American areas.

“You can walk the streets, you can engage with the civilian population readily, the medical staff there is first class, and the teaching facilities are excellent,” he said.

He said Iraqi doctors have expressed gratefulness for the shared knowledge the group provides.

“They’re excited about this,” Dr. Brennan said. “They see this as their opportunity to relate to international colleagues. It’s not just U.S. physicians, but it is also U.K. physicians, and I have recently been in contact with a number of other international physicians. Ultimately, this will become a multinational, international faculty that will be in monthly contact.”

Expanding to Basra

After the success of establishing the initial CME center in Erbil, Medical Alliance for Iraq looked to expand to southern Iraq, in the city of Basra, Dr. Brennan said. The College of Medicine at the University of Basrah will host the CME center and provide the facility. It is the leading medical university in southern Iraq and has been an active, accredited medical college for nearly half a century, Dr. Brennan said.

The university’s dean, an orthopedic surgeon, has been working closely with the group to make Basra the host city for a southern CME center, he said.

Dr. Brennan recently attempted to visit the new CME post, but was unable to travel beyond the Kuwaiti border because of restrictions. He was still able to speak with the dean of the university, who was attending a meeting in Kuwait. He was also able to meet with other leading medical officials. It was decided that the Basra CME center will most likely be opened by the end of the year, he said.

Taking part: What volunteers can expect

Day 1: Medical Alliance for Iraq physician volunteers arrive in Iraq, meet their hosts and tour their host city. In Basra, the city tour will be limited because of unstable conditions in different sections. In Erbil, doctors will go to the medical university and several of the hospitals. They will also meet specialty colleagues and medical leaders and speak about their medical organizations.

In addition, Medical Alliance for Iraq doctors will meet with the dean of the medical university and Dr. Niveen Issaq, an ophthalmologist on the executive staff of the medical university and one of the principal coordinators for the program.
Days 2, 3 and 4: Volunteers give a series of clinical lectures in the mornings to Iraqi doctors in their field, and in the afternoons, volunteers take part in panel discussions. They deliver talks from a set curriculum designed with Iraqi doctors in their field, discussing both advanced and basic concepts.

Doctors will most likely also visit a hospital, where they could participate in clinical discussions and cases related to their field.

They also have time to discuss organizational issues, regarding how the Iraqi doctors could form a society for their specialty as a unified membership organization with effective, steady leadership. Michael W. Brennan, MD, a member of the alliance, said leaders often leave the country because they have been threatened or abducted.

In the evenings, physicians often have social engagements and dinner with officials. They will also have time to visit the market and other communities in the Kurdish region, Dr. Brennan said.
Day 5: At the end of the week, doctors can return home or visit sights in other regions.

Recruiting doctors

Medical Alliance for Iraq is currently recruiting doctors from all fields, including ophthalmologists, Dr. Brennan said. For this year, he said the physician teams will be small because of administrative and travel issues.

“It’s more difficult to get into Iraq than it is to get into Guatemala, for example,” he said.

For now, doctors will be spending about 5 or 6 days in the country. He said, hopefully, by next year, doctors will stay for about 10 days.

Dr. Brennan said Medical Alliance for Iraq does not deal in politics, but instead attempts to build strong relationships with fellow medical colleagues that will hopefully last into the future.

“If there’s a keynote to the story, it’s that we really want to form trusting, personal relationships, we want to expand the personal relationships to organizational connections, so that the American Academy of Ophthalmology is related to the Iraqi Ophthalmology Society,” Dr. Brennan said. “We’d like them to ultimately come together and form a viable, healthy Iraqi medical society, which they don’t really have right now. We want to keep these bridges active with educational interchange.”

For more information:

Michael W. Brennan, MD, can be reached at Alamance Eye Center, 1214 Baughn Road, Burlington, NC 27215; 336-228-0254; e-mail: mbrennan1@triad.rr.com. To find out more about becoming involved with Medical Alliance for Iraq, contact Dr. Brennan.

Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.