January 4, 2007

Childbirth: Yet Another Risk in Iraq

How bad is it in Iraq? The Washington Post today provides yet another gauge for the appalling conditions: the decline in maternal health.

According to the front-page story by Nancy Trejos, more women are forgoing prenatal visits and are pre-scheduling Caesarean operations, so as to avoid going into labor after dark, when violence increases and fewer doctors are available.

Medical supplies are in short supply. Birth defects are on the rise. And the country is dealing with a major shortage of doctors.

“Spontaneous road closures, curfews and gun battles make even getting to the hospital a challenge for expectant mothers,” writes Trejos. “Once they arrive, the women have no guarantee that they will receive adequate health care from a qualified physician.”

Trejos notes that more women are turning to midwives for delivery assistance, though the story seems to take a dim view of the practice.

Here’s a look at hospital working conditions:

One of al-Jarrah’s most experienced obstetricians carries a pistol to work.

She has received three death threats. Her ultrasound machine has been stolen. She agreed to speak to a reporter only if her name were not used because, she said, she feared for her life.

“I came here to serve my people,” said the Iraqi-born and London-educated doctor, who wears a purple hijab, or head covering, and green scrubs when delivering babies.

According to a December 2006 report by the Washington-based Brookings Institution, 34,000 physicians were registered in Iraq before the 2003 U.S.-led invasion. Since then, about 12,000 have fled and 2,000 have been killed, it said.

At al-Jarrah, two doctors have been kidnapped and killed. Two were kidnapped and released. Three have left Baghdad. Thirteen remain on staff. [...]

The Iraqi health-care system was once considered one of the best in the Middle East, with the most up-to-date equipment and well-educated doctors. Iraqis could get basic health care free, and each town had at least one hospital. That changed when the U.N. Security Council imposed an embargo after Iraq invaded Kuwait, leading to the 1991 Persian Gulf War.

Medical instruments and drugs used to be shipped from Germany, France, Japan and Switzerland. Now, hospitals buy cheaper supplies from Egypt, Jordan and India, the doctors said.

At al-Jarrah, staff members do not have fetal monitors, so they use a trumpetlike device held over the womb, the doctors said. The delivery room has a chair with rusted metal footrests and an examining table with a hole in the leather cushion.

The hospital has three ultrasound machines, but no one to operate them at night because administrators cannot find a qualified person to stay at the hospital during the curfew.

And when the hospital runs out of blood, which it often does, staff members have to go to Baghdad’s central blood bank, located in a neighborhood with frequent shootings, too dangerous for even an ambulance to reach. What do they do when they need blood at night? “We hope for sunrise,” said Sadik, the anesthesiologist.

As the story opens, 20-year-old Noor Ibrahim is at al-Jarrah Hospital, where she has just delivered a baby boy via emergency Caesarean, after nurses at the first hospital she went to tried unsuccessfully to deliver the infant using forceps (there was no obstetrician and no anesthesiologist on duty when Ibrahim arrived). The nurses eventually sent her to another hospital, but the ambulance driver refused to take Ibrahim and her husband.

They drive themselves, but it is too late to save their child. It is unclear whether it’s too late for Ibrahim as well.


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