Interview with Minister for Health in Sulaymaniyah

Remedying a brain drain of medical staff is one of the greatest challenges facing the Minister of Health in the northern Iraqi governorate of Sulaymaniyah. In an interview with IRIN, Mohammed Khoshnaw said the authorities were trying to encourage specialist doctors back to the region, not only to practise but to help teach and train other medical staff to meet the needs of the local population. QUESTION: As Minister of Health for Sulaymaniyah, what have your priorities been in the 18 months since the fall of Saddam Hussein's regime? ANSWER: One of the most important problems has been increasing the number of specialist doctors in the region. Instead of the thousand-plus we should have, we have fewer than 200. Q: What are the reasons for this shortage? A: It has largely to do with the years of sanctions - 1991 to 2003 - when, like everything else in the Kurdish-controlled areas, the medical system was cut off from the rest of Iraq. The number of doctors graduating from Sulaymaniyah medical school as general practitioners remained the same - around 200 a year. But we did not have the facilities here to offer much specialist training, and the Baathist regime did not allow doctors to go to Baghdad to continue their studies. As a result, in 12 years, we had fewer than 30 newly graduated specialists. And of course a number of senior professionals left the country at that time. Q: In 2002, 36 doctors completed higher studies. This year another 170 are due to finish. What's behind this rise in numbers? A: We are bolstering facilities at the medical school here, but that will take time to complete. In the meantime we are benefiting from an influx of specialists - around 50 so far - fleeing insecurity in the south and centre of Iraq. These are doctors who planned to move to Jordan or Syria but who we managed to persuade to come here instead. As well as paying their rents and for hospital work, we also provide them with a salary for assisting in the post-graduate teaching programme we have set up within the Health Ministry building. Thanks to them, we are now able to offer post-graduate options in 20 branches of medicine. Q: Most Iraqi specialists make their money from private practice. Is the same true of your new colleagues? A: Actually, we do everything we can to dissuade them from opening private clinics, for the simple reason that we want them to be at the forefront of another new initiative - the consultant clinic. The aim, as I see it, is to bridge the huge gap between public and private practices in this country. Q: Could you give more details? A: In public clinics, open from 8 am to 2 pm, patients pay 250 Iraqi dinars (US $0.20) per consultation and prescription. That's nothing, and there is evidence that some of the drugs prescribed end up being sold on the black market at a much higher price. On the other hand, the private afternoon clinics are often beyond the means of poor patients. The consultant clinic - open evening and night - comes between the two, with consultations and prescriptions costing 1,500 Iraqi dinars ($1). As well as getting the consultation fees, the doctor also receives a ministry salary. Apart from being cheaper, these consultant clinics also have the advantage of grouping specialists in different disciplines together. There are now five in Sulaymaniyah city, either open or on the verge of opening. Q: That's all very well. But it is in rural areas that the medical infrastructure is most wanting, isn't it? A: Indeed, although insufficient medical coverage in rural areas is one of the main reasons for overcrowding in the city's facilities. The basic problem until now has been that, after 2 pm, when the public facilities close, anybody in need of a doctor was obliged to go to Sulaymaniyah Emergency Hospital if they didn't have the money to pay for a specialist. We have tackled that problem, both in the city and outside, by opening 24 hour clinics. These have more staff and better facilities - electrocardiograms and delivery rooms, for instance - than local clinics. There are now 10 in Sulaymaniyah and 15 outside. Q: Does that number cater for the population here? A: For Sulaymaniyah city, yes. For the outside, we're aiming for a total of 30. But it is sometimes difficult to find staff. Q: What other changes would you like to see in Iraq's medical system? A: We are fortunate in having a very good minister of health in Baghdad, Ala'adin Alwan. But he alone is unable to combat the highly centralised nature of Iraq's medical distribution system. Medicine coming into Iraq must be checked, but the only laboratory is in Baghdad. That is not satisfactory. And it is ludicrous that the same rule applies to medical equipment, which has no need of quality control. Why should we send newly bought machines down there before being able to use them? Generally, though, I am very optimistic. If there is peace, I think our system should be on a par with our neighbours' within five years.