It looked like a typical doctors’ seminar. The room had a high ceiling and was graciously appointed. During a mid-morning break, the doctors balanced their cups of coffee and discussed catheter infections, surgery during pregnancy, even organ transplants.
In many other ways, though, the gathering was anything but typical. The conversation was tense and purposeful. No one told clever stories or traded jokes. Laughter was rare. Three of the six women had their hair covered by scarves. Most of all, this continuing medical education course in anesthesiology was inside the Al-Rasheed Hotel in Baghdad and many of the participants were emerging from two decades of dictatorship and five years of near anarchy.
“This is fantastic; we haven’t had a conference like this in years,” said Dr. Sharaf Aziz, a 66-year-old Baghdad resident and London-trained anesthesiologist who arranged the two-day seminar under the auspices of the International Medical Corps. Their efforts were complemented—one might say inspired—by a physician 10,000 miles away: Dr. Tom Cromwell, the mayor of Belvedere and an anesthesiologist at California Pacific Medical Center in San Francisco.
“Our visit’s objective,” Cromwell, also 66, explained during an airport stopover in Amman, Jordan, en route to Iraq, “is to help with the restructuring of Iraqi medical specialties following the fall of Saddam.” Cromwell, who’d made a similar journey to the Middle East in 2004, said Saddam Hussein nearly destroyed Iraqi medicine during his 25-year rule. “Medical care went from being the best in the Middle East to among the world’s worst,” Cromwell said. “We’re here to start reversing that trend.”
Comparable visits, funded by a $3 million grant from the U.S. State Department, have been—and will be—made by U.S. physicians specializing in emergency medicine, orthopedics, psychiatry and psychology, internal medicine, plastic surgery as well as anesthesiology. Also, the outreach effort by the Americans is not war-related. It’s intended to serve the civilian population as hostilities hopefully wind down. Cromwell’s Bay Area group included Drs. Barry Rose, 53, of Sausalito and Gersh Levinson, 65, and Derrick Haerle, 37, both of San Francisco—and this reporter.
From Amman to Erbil
We flew Royal Jordanian Airlines in the middle of the night from Amman, Jordan, to Erbil (also spelled Arbil and Irbil), one of the oldest continuously inhabited cities in the world and the regional capital of Kurdistan, the autonomous (and mostly peaceful) region in northern Iraq. It’s the site of immense construction activity, including an international airport being built with U.S. financial assistance and massive apartment structures with United Arab Emirates backing.
As we checked into the surprisingly upscale Erbil International Hotel, Cromwell wondered about attendance at the two-day seminar, which would be conducted in English, a language nearly all Iraqi physicians speak. “Honestly,” he said, “I’ve no idea how many doctors will show up. It could be four; it could be 40.” Attendance was questionable because the seminar started the day after the end of Ramadan, the monthlong Muslim religious observance.
By 9 a.m. the next day, October 6, 70 Iraqi anesthesiologists were seated in the Ministry of Health lecture hall. After introducing his team, Dr. Cromwell explained the thinking behind their presentations. “From a medical standpoint, we recognize the challenges you’ve been facing—not just in the last five years,” he said, “but for over two decades under your previous administration.” As a result, Cromwell said, “we’ve aimed our talks midway between the latest advances in anesthesiology and the more basic approaches.”
Then he launched into a 30-minute presentation of the anesthesiological aspects of an organ transplant surgery, be it bone marrow, kidney, liver, cornea or even heart replacement. In the process, he mentioned “organ donating,” “cadaver harvesting” and the often-lengthy legal matter of how, in the United States, one is “declared legally dead.” The latter topics attracted numerous questions. One was from Allah Yousif, Ph.D., of Sulaymaniya, a city two hours to the east.
“In the Muslim world rapid burial is critical while legal issues aren’t foremost,” he said, “so how in the U.S. are organs kept vital for extended time periods?” Cromwell’s answer included references to donor pledges, cryogenics and failures caused by our legal complexities. During the break, Yousif told us that in 1999 he was jailed for 65 days for making a negative comment about Saddam. “But my father, thank goodness, came up with enough money that I received lenient treatment,” Yousif said. “But I knew by their screams others weren’t so fortunate.”
When the presentations resumed, Sausalito’s Dr. Barry Rose’s topic was “Regional Anesthesia and Pain Management in Adults,” followed by Dr. Levinson with “General Anesthesia for Cesarean Section,” then young Dr. Derrick Haerle presented “Blood Transfusions in the Operating Room and ICU.” After insightful questioning, the seminar adjourned at 5:30 p.m. Dr. Aziz, who was traveling with us, declared, “This day has been very successful.” Belvedere’s Mayor Tom Crowell added, “I agree. It went really well.”
The next day followed a similar pattern – a series of 30- and 60-minute presentations followed by lively question-and-answer sessions, with interruptions for snacks and lunch. “Frankly, for me, during the breaks and meals are when some of the best information exchanges occurred,” said Levinson. Later, the group visited Erbil’s Rizgary Hospital, where Rose donned scrubs and demonstrated local anesthetic techniques he uses for surgeries involving the hand, arm or upper shoulder. The Iraqi doctors attentively followed every step of the procedure being performed on a local patient and then inundated Rose with questions.
With work finished, we were given a tour of Erbil, a city whose population is four times that of Marin County, about 1,000,000. We traveled freely about the city, which, thanks to its homogeneous Kurdish Sunni population, has been spared the destruction of the war. The local economy appeared to be booming, with tall cranes jutting into the sky and dense traffic clogging the streets. Our stops included the 600-year-old citadel on a plateau overlooking the city, shopping at a bustling souk, snacking on kebabs, naan bread and tea in a crowded, walk-up cafe, and touring the massive two-year-old Al-Hajj Jalil Khayat Mosque, which can accommodate 1,500 supplicants. The day ended on a warm evening with a traditional Kurdish fish barbecue. War was the furthest thing from our minds—but tomorrow it was on to Baghdad.
Baghdad and the International Zone
Our anxiety level rose as we headed to the airport and the 90-minute flight into Baghdad. Adding to our tension, at the terminal we learned the Iraqi Airways Boeing 737 was delayed for four hours. Once airborne, I wrote in my journal, “Nothing below but parched, barren, level land, miles of it.” Then, as we got closer: “It’s Baghdad’s vastness that’s impressive—it goes as far as the eye can see.” We were relieved when our landing didn’t involve the expected “corkscrew” descent in order to evade hostile ground fire—hopefully, this meant security had improved.
Once again, an International Medical Corps delegation greeted us. After four security checks, we loaded ourselves (and baggage) into a 1998 Mercedes with lead doors and bulletproof windows for the six-mile notorious drive once known as “the World’s Toughest Commute” into the International Zone (previously known as the Green Zone). The drive, thankfully, was uneventful. Eighteen-foot blast walls lined much of the way—many of them featuring painted-on bucolic scenes and joyful settings.
The International Zone is a four-square-mile haven on the banks of the Tigris River surrounded by blast walls. This is where Saddam’s Republican Palace and most of his architectural monuments are located. Today, it is a dusty, litter-strewn enclave of diplomats and visitors. To enter the IZ, we passed through four more checkpoints, including one featuring bomb-sniffing dogs and a full body pat-down from Peruvian soldiers. Our destination was the famed 14-story Al-Rasheed Hotel. This is where former CNN reporter Peter Arnett did his bomb-by-bomb telecast of the opening salvos of the Gulf War in 1991; where Saddam installed a mosaic likeness of President George H. W. Bush in the entry hall for guests to trample upon (since removed); and where in October 2003 rocket fire killed one American and injured 17. In contrast to that violent past, our stay at the Al-Rasheed could not have been nicer (well, maybe if the majestic, marble-floored lounge actually served alcoholic beverages).
Attendance at the two-day Baghdad seminar was lighter than in Erbil—about 30 doctors—testament to the bureaucratic challenge Iraqi doctors face in gaining entrance to the IZ. However, its importance was underscored by the attendance of Iraqi Minister of Health Dr. Salih Al-Hasnawi, who delivered an inspirational appeal in English for improving Iraq’s health care capability.
In the midst of the minister’s remarks, Baghdad suffered one of its frequent power outages—and the room went dark. Instantly, Dr. Aziz produced a flashlight and shined it on Al-Hasnawi, who, not missing a beat, continued to implore his colleagues to strive for greater heights.
When power returned, the medical presentations began again. During one, Dr. Tara Rashid, who identified herself as “an ophthalmologist working out of eastern Baghdad’s Al-Kindi Teaching Hospital,” asked Dr. Cromwell a technical question about the merits of local versus general anesthetic during eye surgery. I sat next to Rashid during the presentations and had gotten to know her a bit. She was a single mom, outgoing, and had taken to calling me “Sweetie.” After Cromwell answered her question, I asked her in a whisper, “How many women become eye surgeons in Iraq?”
“Oh, sweetie,” she replied, “almost all eye surgeons in Iraq are women.” Rashid explained that tradition holds that only women have the gentle and steady touch that eye surgery requires. She shared that she had performed countless surgeries on war victims, but was hesitant to elaborate. “Wars have become part of our lives,” she said. “My mother is a Shiite, my father a Sunni, and it’s never made a bit of difference, but now I fear for my daughter’s life; she’s only 13 years old.”
By midafternoon, the seminar was ended, a late lunch consumed and handshakes, hugs and e-mail addresses were exchanged. There was considerable praise for the outstanding organizational job done by the International Medical Corps. Now it was time for a tour of the International Zone. Although the few U.S. soldiers we talked with appeared upbeat, to many of us the compound proved less than inspiring. Towering blast walls topped with concertina wire lined almost every road. Dust and trash were everywhere; nary a twig of vegetation anywhere. “Now I know why it’s no longer called the Green Zone,” remarked one doctor. As we passed the bombed-out hulk of the former Baathist Party headquarters, Dr. Cromwell, who’d been there in 2004, commented, “This whole place looks worse, much more constricted, than it did four years ago. I wonder why that is?”
The next morning, a Saturday, the five of us began our nearly 20 hours of flights back to the Bay Area. En route to the Baghdad airport, once again passing through countless security checks, Sausalito’s Rose reflected on the week we’d spent with the 100 Iraqi physicians in Erbil and Baghdad. “Whether they were young or older, many of the doctors’ questions were 25 years behind the times,” he said, “because that’s effectively where their medical training left off, where it was stopped.”
“You have to remember,” he added, “they’ve been targets—first for Saddam, then for the insurgents.” Next came an observation that reflected on us all: “And yet they’re so far ahead of us in making the most of what they have—I can’t imagine having the perseverance to do what they’re doing.”
After a silence, Rose concluded, “If we can give even one of them the chance for a better day, then our mission was accomplished.”
CAPTIONS: (photos below lead in order) During a break, Belvedere’s Mayor Tom Cromwell (center, right) discusses medical procedures with Iraqi anesthesiologists. Working with the International Medical Corps, Baghdad’s Dr. Sharaf Aziz organized the exchange of information between American and Iraqi doctors. • Following their two-day seminar, the four Bay Area doctors toured Erbil’s recently completed Al-Hajj Jalil Khayat Mosque and a colorful museum-bazaar in the city’s 600-year-old citadel. • Soldier from Hamilton, Ohio, at the rear of an armored personnel carrier. When asked if he was anxious to be back in Ohio, he answered, “Not really. I really like my job here.” The only, albeit considerably defaced, remaining image of Saddam inside the Inter-national Zone. • (below) Jim Wood in Baghdad's International Zone.
A Week in Iraq
Iraqis share their thoughts with a California visitor
“Considering the amount of oil our country has, American policy regarding Iraq will never change no matter who is elected their president—so I don’t think they will be leaving that quickly despite what Barack Obama says.” Rizgar Ali, taxi driver in Erbil, the capital of Kurdistan
“In 1984, when I was in high school and Saddam was in power, we wore skirts and never wore scarves. Now, women wear scarves and I do not like it. It’s all because fundamentalists have come into power. I believe in the Koran and when I meet my God, maybe then I’ll wear a scarf, but not now. Life with Saddam was secure; now it’s ungovernable. The educated people have all left.” Uruba Al-Rawi, program manager, mother of two teenagers, formerly of baghdad, now living in erbil
“Saddam made life miserable for my family. Both my parents were professors and each only earned $12 a month while rent was $48 a month. So how could we live? I was in Baghdad during the ‘shock and awe’ attacks. We knew the U.S. knew what they were doing so we opened our windows and watched. They hit all their targets, bull’s eye. Now the U. S. must stay for at least five years or there’ll be civil war.” Jacob Kahlid, barber at the Erbil International Hotel
“We are Iraq’s real people, not like the ones Americans see on television. We want to live in harmony and peace. The American army are occupiers and must leave as soon as possible. There may be problems in the short run, but in the long run it will be okay. The Middle East has been through so many wars. All we want now is peace.” Imam Basheer Khalil Haddad at the Al-Hajj Jalil Mosque in Erbil
“What America must do now is perform a ‘surge of humanitarianism.’ Demilitarization in the way services are delivered is urgently needed. Just today we sent relief teams into Mosul with food, water and blankets for 265 Christian families that have been left homeless. More of that is needed.” Agron Ferati, director of the International Medical Corps in Iraq. with a yearly budget of $40 million and over 300 employees, Imc (and ferati) have been in Iraq continuously since 2003.
“My life in Iraq is getting better. If it weren’t, I would not have come to this hotel and this seminar. Iraq is our country, our only country; we can’t belong to any other country. However, our life, unlike yours, is uninteresting. We need a tough guy; we need more checkpoints.” Dr. Ajed Al-Hassani, an anesthesiologist living in Najaf, a Shiite city 100 miles from Baghdad
“I’m a Shiite who works with Sunnis and lives with Christians and there’s no difference—we don’t know one from another. Saddam had guns stored everywhere and those fighting now are the lowlifes; many of them are hooked on drugs and Scotch whiskey. Americans only protect the politicians and the U.S. must stay here for at least five years more.” Wahid Al-Karada, a nongovernment agency worker campaigning to get the age limit for individuals serving in the Iraqi parliament reduced from 30 to 25
“I think there are fewer than 10,000 insurgents in Iraq—probably more like 7,000.” Dr. Sharaf Aziz, Baghdad anesthesiologist who helped organize the doctors exchange
“How, for God’s sake, do you impose democracy on a country that’s been living under dictators for 50 years? It’s impossible to just switch it on. By spending billions in U.S. taxpayer dollars you’ve funded 160 new political parties—and soon they’ll just disappear, enjoying life somewhere in the world, with American money.” Mouayed Al-Asaad, a pharmacist, who’s lived in Australia for years but returned to baghdad to help the U.S. transition
In summary, almost everyone among the dozens I talked to in Iraq had a different story, a different slant. If there was a consistency, it was this: at present, Iraq is not ready for democracy. An oil field engineer, born and raised in Baghdad and waiting with his wife and three-year-old daughter at the airport for flights taking them to a new life in Seattle, put it this way: “Right now, looking at the entire country and being very honest, we’re too uncivilized.” —J.W.
Belvedere to Baghdad Attend a talk and photo narrative by Belvedere Mayor Thomas Cromwell and Marin Magazine executive editor Jim Wood focusing on their trip to Iraq. 7:30 p.m., December 11. Belvedere-Tiburon Library, 415.789.2665, bel-tib-lib.org