In a newly refurbished wing of the Ministry of Health building in mid-August, a U.S. advisor, Lt. Col. Charles Fisher, is giving a PowerPoint presentation at the first postwar conference of the Kimadia, the large public agency responsible for distributing medical supplies and medicine to hospitals. Facing him are 200 or so Iraqi pharmacists, Health Ministry officials and Kimadia chiefs as well as a cluster of U.S. Army officers looking for answers. In late May, Fisher took over as the coalition's overseer for the Kimadia, which, he explains, operated as a top-down "controlled system of allocation" under Saddam Hussein, and was, by all counts, totally and utterly corrupt. Fisher is trying to make clear that he wants to create a new system, one that is "customer-driven" -- where the customers, i.e. the hospitals, are "empowered" to request the drugs and supplies they need themselves.

The military leader is speaking the language of American corporate reform, and his translator has trouble finding the right words in Arabic. After a minute of awkward silence, she steps away from the podium, befuddled. A man replaces her and Fisher continues.

He scrolls through three pages worth of instructions on the large projector screen behind him, introducing his employees to customer service, American-style. He spends a while detailing how to deal with complaints. When a Kimadia official hears a complaint from a hospital or clinic that they lack a certain drug, Fisher says, he should ask the "customers" if they've been to the local Kimadia to request the medication. Then the official should ask the "customers" if they have a letter signed from the regional Kimadia director stating there's a shortage.

"That's the first step in owning where the problem is if there's no drugs," says Fisher. The letter from the local Kimadia, Fisher says, continuing down the long, Byzantine chain of command, will then be sent to the national Kimadia, and that will trigger a response from the import department to address the shortage of the drug in question, which will then be sent back to the local Kimadia, and so on.

But Fisher insists there is no shortage of drugs. He says even though most of the Kimadia warehouses were bombed, ransacked and burned during and after the war, he has enough supplies and medicine for the Iraqi people. After the presentation, we catch Fisher as he is leaving the podium and tell him of the things we have seen at Alwiya, which seem to contradict his claim. He says that in his experience, if hospitals don't have sufficient drugs or supplies, the problem is that they haven't asked for them.

"My grain of salt to your story is: There is not a shortage," Fisher tells us. He blames the paucity of medical supplies on a "lack of empowerment" on the part of hospital workers and administrators, who he says simply don't ask for what they need. "I'll give them whatever they want. My job is to get that warehouse empty." But nine out of 10 directors never ask, he says, and that's why he wrote out the long list of instructions. Most of them never went to the Kimadia for drugs because they didn't receive orders from the Ministry of Health to do so.

"As best as I can tell, it was such a strong command-and-control system [under Saddam Hussein] that unless I'm empowered or I have a written piece of paper, I can't do anything," Fisher tells us.

This could be part of the problem at Alwiya. When we try to ask the hospital director why he thinks there's a medicine shortage, he blanches and says we need to get permission from the Ministry of Health even to speak to him. We say we have been to the Ministry of Health and no one mentioned our needing permission. "I'm sorry, you do not have an appointment scheduled with me and I have another meeting," he says, rushing past us and out the door. "You're going to make me late."

But Dr. Yassen, one of the doctors at Alwiya, says the director has made requests for medicine and equipment but has received none. He says his director has given up. "He simply closes his door and sits in his room, completely isolated from the hospital," he says.

We ask Fisher if he's been to Alwiya. He says no, but he'll go anywhere to get the job done. He says he is "the No. 1 answer guy in Iraq," having personally overseen the delivery of 6,500 tons of medical supplies to local Kimadias and hospitals in 80 days. He is changing the Kimadia leadership from the national level on down, and while he may not be able to get to every single place, he is "in power to say who stays and who goes," Fisher says. "If there is some bad actor playing a game on the supply side," Fisher says he hasn't seen it yet. "But if I found there was a withholding [of supplies] I tell you on the spot that person would be fired and I might even bring criminal charges. Period. Full stop."

Col. John Black, a bald, stocky soldier in the audience at Fisher's presentation, stands up during the question and answer session to say he has heard persistent complaints about drugs not arriving at the hospitals from the government warehouses. "I think it needs to be clearly articulated who is responsible for delivering the drugs and medical materials to the clinics and hospitals," he insists.

"These are excellent, focused and pointed questions," responds Fisher. "I agree with you there needs to be sound responsibility so it's clear who will be responsible for transporting ... each of you in conjunction with people in your region need to develop a solution for every clinic for every hospital where both parties are in agreement."

Then it is break time. The conference goers spill out into the lobby, where a huge spread of catered food awaits them. When they run out of plates, some men lean over the large serving trays of rice and chicken and scoop heaps of food into their mouths with their hands. That's where we met John Padgett, the doctor and reserve Army officer who has been visiting hospitals in Baghdad with his special ops team and doing a needs assessment. He agrees children are dying because supplies are not reaching hospitals. The irony, he says, is that the warehouses -- one after the other, Home Depot-sized warehouses -- are full, overflowing with medicine and supplies trucked in by the international community, and yet the hospitals don't have what they need. Sometimes the problem is bureaucracy and sometimes it's that the drugs are disappearing, being sold on the black market. Children with cancer are dying needlessly, he says, because cancer medicine can draw the biggest profit.

"You go looking for cancer medicine on the shelf you know has come in, where the hell is it? It's not in the hospitals, it's not in the warehouses, it's in the street," he says. Padgett's own son had leukemia but now is in remission. The corruption makes him furious. And he says it's more than just the end-user sitting in his office not feeling empowered. The whole system, from the warehouses on down, is a mess, Padgett says.

Walking out of the conference auditorium, we are still confused about how the Kimadia works, even after Fisher's presentation. With its national and local branches and warehouses, the distribution system seems like a self-tangling octopus. We can only imagine how the Iraqis feel.

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