Nursing Infrastructure in Iraq: Rebuilding a War-Torn Country

AAACN Viewpoint, Nov/Dec 2004 by Swan, Beth Ann

Iraq is a culturally rich region where the first ancient civilizations were born 4,500 years ago. Everyday, as we hear of the injuries and mounting death toll to civilians, we have to wonder how the people of Iraq survive as towns crumble around them. What is the psychological impact of watching their national treasures and cultural heritage threatened? The Iraqi people need shelter, clothing, clean drinking water, food, and security. Many are in need of a variety of basic health care services. With a newly developing health care infrastructure, what is the best approach to address the health care issues confronting Iraqi citizens?

The University of Pennsylvania School of Nursing's idea of supplying "nourishment" to the Iraqi nurses began with Dean Afaf Meleis and Dr. Norma Lang in August 2003. Their dream was to assist the Iraqi nurses to flourish and grow, and help them meet the health care needs of their people. An e-mail sent from Dr. Meleis and Dr. Lang stated, "Wouldn't it be fantastic to have Iraqi nurse leaders come to the U.S. for an exchange experience with a School of Nursing? Never been done before; [it] would be a first. "We began the task of planning and implementing this "unprecedented humanitarian educational exchange," which was, in operational terms, a logistical nightmare. We had more questions than answers, including:

* What were the requirements for them to leave Iraq and travel to the United States?

* Would they speak English, and how would they be received in the community?

* Will they be afraid; how will we keep them safe?

* Can we ask about Saddam Hussein, and how do they feel about the war and their new government?

Some of the proposed activities for our Iraqi nurse visitors included: 1) meeting with Penn Nursing faculty, staff, and students, as well as other individuals who expressed an interest in meeting with them; 2) observing how nursing is practiced in the U.S., 3) learning more about the nursing education process; and 4) learning more about the history, arts, and culture of Philadelphia. Our hope was to be able to collaborate with our nursing colleagues in Iraq and begin to develop collegial bonds between Iraqi and U.S. nurses. No politics. We shared a passion for taking care of people in need of nursing care.

Through e-mail and telephone calls, I came to know Colonel Gerber, who until December 2003, was with the Coalition Provisional Authority (CPA), Ministry of Health, Baghdad. During this time, he identified the visitors for this International exchange - Ms. Intisar Abdul-Hussein Abbas and Mr. Amean A. Yasir Al-Yassiri. Ms. Abdul-Hussein is employed by the Inspector Directorate, Ministry of Health, Baghdad. She is working with the World Health Organization (WHO) and the Iraq government to re-establish the nursing profession in post-war Iraq. Mr. Yasir Al-Yassiri is the Director of Nursing at the Medical City Hospital in Baghdad; he is also a Lecturer at the University of Baghdad-Iraq College of Nursing. Mr. Ammean is working to rebuild the nursing infrastructure in the Iraqi health system in order to ensure that hospital nursing departments are properly staffed and supplied.

Intisar and Amean were both approximately 40 years-old, younger than I expected, and both spoke English. They would travel 12 hours by jeep on the lone road between Baghdad to Amman, Jordan. Once in Amman, they would take a 10-hour flight to the U.S. It was the first time they were ever on an airplane. Iraqi citizens are not being granted VISAs to enter the U.S., so they were required to leave Iraq via a Department of Homeland Security rule, "Protocol Governing Significant Public Benefit Parole." Since this protocol is law-enforcement oriented, our visitors' whereabouts and activities would need to be closely monitored and reported. Intisar and Amean stayed in guest accommodations on campus along with their military escorts. Their goal was to engage in a rich International academic enrichment experience so that they could learn more about the state-of-the-art nursing education and nursing practice. Thus, aiding them in their mission to rebuild Iraq's damaged health care infrastructure and to begin to build nursing capacity in Iraq.

Prior to coming to Penn Nursing, they spent one week in Washington D.C. This part of the visit was sponsored by Colonel Fred Gerber, and the AMEDD (U.S. Army Medical Department). I met Intisar, Amean, and their U.S. military escorts, Colonel Linda McHale and Lt. Colonel Ed Mattern for breakfast on Monday July 25, 2004. I was struck by the Iraqis' beautiful brown eyes, broad smiles, and warm, welcoming handshakes. Our visitors looked very similar to anyone you see on the street, and they ate the same breakfast foods except for the meats. I learned of their love for their families, their country, and of their courage. They took extraordinary personal risks in traveling through Fajullah in order to reach Amman. I was humbled to hear how these nurse leaders journeyed through many dangerous areas so they could come to the United States.