Not an easy road ahead

Armed soldiers and basic services are just part of the job in a post-war city, writes Gold Coast nurse Andrew Cameron.

Usually I am employed in rural and remote Queensland, at out-posts such as Dajarra, Richmond, Quilpie and most recently as a reliever at Woorabinda. In January of this year, I jumped at the offer by the International Committee of the Red Cross, of a demanding 12-month posting to Iraq.

I had not long before been in Yemen and Afghanistan. The new mission was to lead a team of medical and nursing staff, teaching emergency and trauma management to Iraqi emergency room employees. Challenging indeed.

So here I am in Iraq. The country is in a post-war situation, where damage from the wars of the last decade is still widespread and very evident. Electricity generation, water supply and other basic services are still not provided in many areas. Police and military are still seen on street corners. A rotation of guards sleeps in a house in our small garden.

The place where I am stationed is Najaf – a city of 900,000 people on the banks of the Euphrates River, just a few kilometres downstream from the ancient city of Babylon.

After Mecca and Medina, Najaf is the most holy city to Shia Moslems.

It is a very conservative place where strict codes of behaviour and dress are maintained. The men are expected to wear long trousers, long-sleeved shirts and jackets, the women to cover themselves from head to toe, with only the face showing – even at work in the hospital wards.

The hospital I work in is called Najaf Medical City. There are close to 800 employees. Maybe due to my age and gender, after only a short time, I had built up a good rapport and became well accepted in the hospital; free to drop in to the hospital director’s office at any time.

The program we run consists of a series of three-week long training modules in emergency nursing. My surgeon colleague runs a concurrent program for emergency physicians. The participants come from surrounding provinces (or governorates as they are known here). The students normally work in emergency departments, intensive care units and operating theatres.

Subjects in the curriculum are similar to those taught in an ATLS course and are expanded upon to include weapon injuries and other aspects of care of war-wounded.

Handling of mass-casualty situations is prioritised. All of our talks and practical training sessions are translated on the spot into Arabic because most of the students have only a rudimentary grasp of English.

Some of the most rewarding facets of this kind of work include living in a culture so incredibly diverse from our own. The customs, the food and the patterns of daily living makes one think we are from different planets. On a personal level, I find it very enriching to live here and see how others live.

Some of the tough things we face daily relate to living in a high-security environment. I have to carry my passport and other documentation wherever I go. Armed police guard the entrance to the hospital as well as many of the internal departments such as x-ray, laboratory and pharmacy.

A soldier sits at the triage desk of the ER, with his loaded Kalashnikov on open display. Generally, security is fragile. Another downside is the lack of freedom simply to go for a walk in the street, jog in the park, or visit neighbours, for example. Of course, consumption of alcohol is strictly forbidden.

To my way of thinking, seeing tangible results of our training efforts and other rewarding aspects of our work, far out-weigh the disadvantages. Iraq has a rich and complicated history, which has produced a unique kind of people.

The way ahead for them will not be easy. Conflict has, and continues to shape their nursing and medical education, making a life and a career that are in themselves difficult - of the kind that most of us have never had to confront and survive.

I am very honoured by the opportunity to work in this country with remarkably talented health professionals, who have endured tensions and hardships completely unknown to the average nurse at home.

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