Iraqi pharmacists contend with violence, murder and uncertainty…
Two years after the start of the war in Iraq, Ayad Ali,
an Iraqi pharmacist, shared with me his experiences and reflections on
the impact of the war
on pharmacists and pharmaceutical services in Iraq.1
Following
recent reports in UK medical journals of a rapidly deteriorating health
situation2 and an exodus of medical
staff from the Iraq,3 I contacted Dr Ali
again to find out about the pharmacy
situation.
Currently, Dr Ali is a student in the US. Two years ago, he won a Fulbright
scholarship to study for a master of science degree in pharmacoepidemiology
at the University of Florida College of Pharmacy. Having completed his
master’s degree, he has been accepted to do a PhD in the same department,
again in pharmacoepidemiology, a subject that had become his specialty
while he worked in Iraq.
However, Dr Ali cannot start his PhD until he
changes his visa status. That entails him going back to Iraq through
the US embassy in Baghdad. At the time he wrote to me, in September,
he said it was impossible to go back. He is now trying to convince the
US authorities to let him change his visa status without returning to
Iraq. However, he tells me: “Everything is used as propaganda and
is related to the war status in Iraq.”
Dr Ali is clearly enjoying his studies in the US. “The environment
at the department of pharmacy health care administration at the college
of pharmacy is very welcoming. All the staff help me a great deal, both
academically and socially.” He is working with Abraham
Hartzema,
conducting an observational study on the safety of the long acting beta-adrenergic
agonist inhalers in asthmatic patients.
“Our study will have an
impact on prescribers, therapeutic guidelines committees, and the drug
regulatory authorities,” he says. During the three years since
Dr Ali and I have corresponded, the pharmacy situation in Iraq has not
improved. There has been escalating violence, murder of pharmacists and
huge uncertainties for students about to begin their pharmacy careers.
Dr Ali says: “A renowned professor of pharmaceutical chemistry,
Ahlam Alghureri, was killed on her way home from the college of pharmacy
at the University of Baghdad. A roadside bomb exploded and destroyed
her vehicle.”
Iraq is haemorrhaging academics
Many Iraqi professors are leaving the country, and all the colleges
of pharmacy in Iraq now face a tremendous shortage of academics. This
includes the newer pharmacy colleges, such as those at Mosul and Tikrit,
which had a shortage of professors years before the current
situation.
The schools of pharmacy were well equipped with laboratory instruments
and in some cases, remain so. However, one of Dr Ali’s colleagues
from the University of Baghdad told him that the pharmaceutics laboratory
had been plundered.
Many recent pharmacy graduates are in limbo. “My students at the
college of pharmacy in Tikrit have graduated and are in a state of uncertainty
about the future
of their careers. Two of the best in my class, who are dedicated to academia,
have asked me whether I am coming back to work with them on revising
the curriculum so that pharmaceutical care can be the focus of the teaching
and learning processes.
“My ex-dean from Mosul told me some time ago that I should return home
to help at the college. However, the current insecurity and corruption
precludes thinking about any vision I have for a career in academia in
Iraq. My ex-dean has fled to Syria, and advises me not to think of going
back at the moment.”
Community pharmacies in Iraq are open and functioning, but only for a
short time each day because of the frequent curfew hours. “My pharmacist
colleague … in Baghdad was threatened by a group of militias. Two
days later, he closed his pharmacy and fled to Jordan.”
The profession still lacks standards, says Dr Ali and is not governed
by any reliable guidelines in clinical practice. “The uncontrolled
availability of medicines from street vendors is increasing and, according
to pharmacists back home, the situation was much better during the first
six to 12 months of the war.”
Continuing education has ceased, he adds. “Two of my students could
not tolerate the situation any more and left their school of pharmacy — they
were in their last year. One went to Syria with his family and the other
is in Turkey.”
Militias target civilians
One medical student at the University of Nahrain (formerly the University
of Saddam) in Baghdad, was killed because of his last name, Dr Ali
says. “This is common practice because the militias target civilians
according to ethnolinguistic affiliations. This student was killed
because his last name was commonly used by the Sunni sect. The Shia
militias of Sadr killed him even though he was only 19 years old. The
irony is that he was Shia not Sunni.”
Dr Ali continues: “Do you see how sad the situation is in Iraq?
I have only been away for two years. I really don’t know what to
say or do. Should I go back home or stay — that is my dilemma.
What about my visions for pharmacy in Iraq?
“So many questions. … But it would be difficult to go back and try
to work for the profession at the moment, especially when people are
being murdered on account of their last name. Imagine what I would face
when it became known that I had come from the United States of America.
“If everyone thinks about children and childhood, there would not be wars,” Dr
Ali’s e-mail concluded.
References
1. Mason P. Pharmaceutical
chaos: e-mails from an academic pharmacist in Iraq. Pharmaceutical Journal 2005;274:115–6
2. Editorial. The deteriorating health situation in Iraq. The Lancet
2007;369:1834
3. Zarocostas J. Exodus of medical staff strains Iraq’s health
facilities. BMJ 2007;334:865 |
… but in northern Iraq the future looks brighter
As an Iraqi I find media reports about my country’s dire state
of health depressing and disheartening. So I was pleasantly surprised
when a family visit to Iraq in July gave me much to be optimistic about.
Landing at the newly built international airport at Hawler, capital of
the northern Kurdish regional government (KRG), my first impression was
that I had arrived on a big construction site. The city is home to about
a million, mostly Kurdish-speaking people and wherever I looked buildings
were going up.
When I left Iraq in 2004 there were only about 50 pharmacies. I had spent
three years in the region. While there I established a community pharmacy,
worked at the university and at the KRG health ministry.
When I returned with my wife and child in July 2007, the number of community
pharmacies had doubled to over 100 and spread beyond the city’s
medical areas, to sites where new medical centres are sprouting up. In
areas where there were no pharmacies or doctors at the time of my last
visit, there were now small communities of health workers.
The expansion of pharmacy was made possible by the establishment of two
schools of pharmacy in the Kurdish region, one in Hawler and the other
in the second major city of the Kurdish north, Sulaimaniyah. The Sulaimaniyah
school of pharmacy is only a few years old.
The area is crying out for a larger network of pharmacies to supply its
growing population of about five million in the Kurdish region. The major
barrier to expansion is the shortage of qualified professionals. This
means the government and the pharmaceutical society of Kurdistan have
been unable to eradicate the sale of drugs by unregistered pharmacies,
which have no qualified professionals.
There is now a unified pharmaceutical society covering the whole of the
Kurdistan region, with headquarters in Hawler. I visited it on several
occasions to get a better understanding of the state of medical and pharmaceutical
services.
Mizhda Xidr Mawlood; supply of drugs has improved |
The president of the Kurdistan Pharmaceutical Society is Mizhda
Xidr Mawlood and her deputy is Shammal Mahmood. They told me that the
supply
of drugs has improved since the removal of sanctions.
Nearly all drugs are available. Insulin had previously been difficult
to obtain but is no longer. A close pharmacist friend who owned a wholesale
pharmacy business was awarded a contract by Novartis. It agreed to provide
logistical help and a walk-in refrigerator capable of holding 700 bulk
boxes of insulin of different formulations.
Overall, the pharmacies have
access to a diverse selection of drugs, many of them similar to those
found in a UK community pharmacy. The main sources of drugs are India,
China, Turkey, Iran, Syria and Jordan as well as Europe.
There are problems with counterfeit and poor quality drugs and the KRG
is building a major quality control unit.
The task is challenging and it is envisaged that the unit will start
operations in early 2008. Once functioning it should help to reassure
the population that the drugs they are supplied with are of good quality.
It will also help tackle the illegal sale of drugs by unqualified personnel,
as the supply chain could be controlled better by such an agency.
Another significant advance is the establishment of the nucleus of a
pharmaceutical industry. At the time of my visit a production facility
was being built adjacent to the school of pharmacy. The idea behind this
development came from expatriate Kurds returning home after working in
the pharmaceutical industry in Europe. The factory is due to start production
by early next year.
All these advances have been made possible by the changes brought about
since the removal of Saddam Hussein. Great advances have been made in
Iraqi Kurdistan and the possibilities for Iraq are endless, if only the
fighting would stop.
Outside observers often think that Iraq’s wealth comes solely from
its oil, but its people are its greatest resource. They are hard-working
and highly educated.
More information is available at www.krg.org |
The
Pharmaceutical Journal