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Friday, Jul 10, 2009
Babies die daily of treatable diseases while their doctors search for black-market drugs, because the U.S can't fix Iraq's corrupt, crime-plagued health system.
Aug 28, 2003 | Babies are dying in Baghdad hospitals every day because medicine and medical supplies, lying in abundance in government warehouses only miles away, are not getting where they are needed. It is hard to believe, especially because the young resident doctors who are talking about the problem in the small, shabby common room at the Alwiya Children's Hospital are smiling and chuckling.
For a moment their laughter stuns us into silence. A small TV flashes in the corner with a music video that zooms in and out on some big-haired Egyptian singer. A half-broken fan whirls drowsily above. The faint wailings of infants from the wards down the hall echo as if they are coming from a deep well. Finally someone speaks.
"There are so many disasters," says Manaf Yassen, a doctor whose lab coat looks a size or two too large. "We must laugh, because it is better than crying."
During Yassen's shift the day before yesterday at Alwiya, two newborns died because he lacked the right supplies to treat them. One had septicemia; the other died of respiratory failure. Yassen had no luminal to treat the septicemia patient -- its seizures worsened and it died. He had no ventilator machine for the child whose lungs had given out. Nor did he have any surfactant to help get oxygen into the child's arteries. Yassen and the other doctors gathered around say at least one baby dies in the hospital every day, but they can't estimate how many of those die because of the lack of drugs. "Many," is all they can say, shaking their heads, smiles lingering on their lips.
Basic medicines are missing, the doctors tell us. In the case of newborns, whose immune systems are still weak, these medicines can mean life or death: Phenobarbital or luminal for seizures; immune globulin and surfactant for respiratory distress; and calcium supplements for premature infants, which the hospital has not had in stock for the last six months.
Last week was the height of diarrhea season, a common ailment during summer because of the blistering heat and lack of clean water in Iraq. It was the worst possible time to run out of ringer lactate, a fluid to revitalize severely dehydrated babies, but that's what happened at Alwiya. Yassen and the other doctors gave the children a much less effective saline solution as a substitute, but one doctor called it "show business" to fool parents into thinking they were doing something. They've watched at least 100 children die of diarrhea since the war.
Children who have diarrhea are not supposed to die in hospitals, but here they do. "I have seen 20 die with my own eyes," says another doctor, Ihsan Jassim al Douri, his eyes widening. "You ask another doctor, you get a different number." He smiles.
Children in Baghdad hospitals are dying of highly curable ailments such as diarrhea because of Iraq's corrupt, bureaucracy-plagued, crime-ridden healthcare system -- and the failure of U.S. administrators to come up with a workable alternative more than four months after the fall of Saddam. Certainly, babies died under Saddam's rule, though the dictator blamed U.S. sanctions for medical supply shortages, and treated scenes of dead children as photo opportunities to try to shame Americans. In post-Saddam Iraq, though, the delivery system, at least, is far worse. And just as the U.S. is being blamed for failing to plan adequately for postwar chaos on other fronts -- from restoring power to keeping order -- a growing chorus is outraged about the medical crisis in Baghdad.
But doctors, government agencies and relief organizations point fingers in different directions when laying blame for the troubles. Iraqi doctors say not enough medical supplies are reaching their pharmacies. American and Iraqi officials in charge of distributing those supplies insist Baghdad warehouses are full and supplies are available to those who ask, but the Saddam-era health bureaucracy, combined with a history of passivity on the part of health officials, mean hospitals aren't getting what they need. American soldiers trying to guard the medical warehouses say that Iraqis have been pilfering the medicines to sell on the black market -- and that the U.S. military can't or won't crack down and make sure the medicines are secure. "It's layer after layer of bullshit that you have to get through to solve the problem," says Army Reserve officer John Padgett, a doctor who's helping do a needs assessment of the healthcare system. "But the public hospitals should have some recourse other than going to the black markets for their medicines -- which is what they're doing now."
Whatever the reason, the results are disturbingly clear: Children are dying needlessly every day, and not only at Alwiya.
The Central Children's Hospital in Baghdad is also out of luminal, the anti-seizure drug. Dr. Muhammad Hassan, the chief resident doctor, says he received boxes of it from an aid organization but the solution was tainted -- yellow and cloudy instead of white. At least one baby dies here every day. Many die because there is no medicine or equipment. Premature newborns die, he says, because the electricity will go out in the city and cut off power to their incubators. Some children get renal failure and die because there are no dialysis machines. "This is the life," he says.
At the Ibn al Hatib Hospital for infectious diseases in the town of Tuwaytha some 20 kilometers south of Baghdad, there is no anti-rabies medicine. Three months ago, says pediatrician Sa'ad Jamil, a wild dog rushed into a family's house and bit all the children, five sisters. The doctors sent the family to Jordan to buy the drug, but it was too late to save them. One daughter died 10 days ago. "The others are at home," Dr. Jamil says. "One by one, they are waiting for death."
Although hospitals get some supplies from government warehouses, more come from international aid agencies such as the Red Cross and the World Health Organization. But often doctors are forced to swap drugs from other hospitals or pharmacies. Dr. Hassan at Central Hospital says he had to send families out to the black market -- where prices can be 300 times more than those at public pharmacies -- to find drugs. "There is no one in the Ministry of Health to get this job done so it maybe is also our problem. This is the problem of our children, so we can't wait," Hassan says. "If I had an empty ambulance, I would look for the drug."
Even when medical supplies do arrive from government warehouses, they often do not work, says Yassen, the doctor at Alwiya. He leads us downstairs to the pharmacy in the next building and rips open a box containing a blood transfusion set. "This valve is the heart of the set," he says, shaking the small, clear, plastic piece in his hand. "The valve should be closed, but it has many air leaks. It is expired."
Because of the defective valve, air bubbles can easily get into a child's bloodstream during the transfusion, to create fatal embolisms. Yassen says this nearly happened the night before -- a child developed apnea during the transfusion and had to be resuscitated. Now the small girl is recovering under a phototherapy lamp that is barely functioning. It will happen again and again with these sets, he says.
We look the sets over. They have an expiration date of 2005. "No matter," he says, tossing the pieces back into the box. "They are Iranian. Believe me, they are expired. They are useless. We use them even though they are useless," he says, laughing at his own joke.
