Exclusive Interview (part 1) by Harem Karem:
The renowned Professor Anwar Sheikha has done more than anyone to improve the quality of cancer care in the Kurdistan Region.
HK: Could you give us a brief account about your professional background as a haematologist and oncologist?
AS: Let me start by thanking the Kurdistan Tribune for arranging this interview. I graduated from the college of medicine in Baghdad in 1977. I then moved to the United Kingdom and worked at the Royal London Hospital in Whitechapel for five years and I received my membership at the Royal College of Medicine. I was very much interested in collecting degrees, hence I moved around the world and got more degrees in Australia and I did my fellowship with the Nobel prize winner Professor E.D. Thomas, who pioneered and refined the art of bone marrow transplantation. I have worked in Saudi Arabia, Italy, and in many centre in the United States. My permanent residence is in the United States, where my children currently live.
I returned to Kurdistan ten years ago to help my people create the manpower for a proper cancer care and haematology service. I’m very pleased to have managed to prepare about a hundred professionals with masters and PhDs who are currently practising to the best of their abilities. This is conducted very much in cooperation with the Mississippi Medical Centre, where I was clinical professor of haematology. I also managed to bring most of the staff to Kurdistan to help train my students. Right now we have Hiwa Hospital in Slemani, we have Nanakali Hospital in Hawler and, in each of the cities of Kerkuk and Mosul, we have six cancer care physicians (oncologists) – all were my students. I can comfortably say, we have managed to move the capital of cancer and haematology to Kurdistan and Slemani in particular. I’m working hard to make things better. Right now we have the best cancer care centre in Slemani, but unfortunately the building is too small, the centre is crowded, but that doesn’t stop us from continuing.
HK: What motivated you to return to Kurdistan back in 2004 to work as a volunteer?
AS: It’s a good question, I mean you reach a point in your life where money is no longer an issue, and your loyalty to your country is becoming your priority. I can gladly say, after working in almost every English-speaking country around the world, and after a long time in Saudi Arabia, I have achieved all my goals: whether they are degrees – which are very important to physicians, I have achieved eight royal college degrees – then I become interested in research, which resulted in fifty-plus peer-reviewed articles in the world journals. So, yes, I reached a point where I felt I owed something to my country.
You know, back in the day, we used to have the best medicine in the Middle East but, after three decades and several wars, we were left with no medicine by any standard, so I thought that this land was fertile for me to contribute to the prosperity of my people. I’m very proud to say that I have done all of that mostly at my own expense. I have never charged a patient for the last ten years; doing everything absolutely free-of-charge. And I’m very proud to see so many of my graduates are young and energetic – doing a fantastic job.
HK: you were contributing to local universities, even when you were abroad – how was this?
AS: That’s right, in the past thirty years I have never stopped doing my bit for the people. When I was working abroad, during my summer holidays, I used to return to Kurdistan to cover the haematology curriculum at Duhok, Hawler and Slemani universities. Even when I was away, I used to contribute by sending journals, making the subscriptions for them, buying the resources etc… so, yes, I have never stopped contributing to the medical colleges here. After reaching my ultimate goal, the pinnacle of my career, I realised that the situation here at home was very bad and needed people like me to help improve it, and so I made a decision after my family’s wellbeing in America was guaranteed. It was certainly a good decision, yes, you have a family, but the bigger family is your city and bigger than that is your country.
In medicine, you have ten specialties, and mine is one of them. If ten Kurdish people like me return and educate a hundred locals, then we will have a thousand professionals and that way we have the manpower to deal with the Kurdistan health issues.
HK: What is the latest cancer figure in Kurdistan and is there an upward trend?
AS: If you go to Hiwa Hospital in Slemani, the crowd is so much that it gives you the impression that cancer is up by 100 times, but this is not the real issue. If we compare our figure with the Americans, we have about 10 per cent the US level of cancer in Kurdistan.
For the province of Slemani, with around two million inhabitants, plus thirty to forty per cent of its patients coming from south Iraq, we need ten centres like Hiwa Hospital. I begged the authority here to give me one of the floors of the new 400-bed Shar Hospital. Unfortunately I wasn’t successful. Although we are currently renovating Hiwa Hospital, it will not solve the problem. If we look at Saudi Arabia, there you have all these newly-built, fully-equipped hospitals, but there are no Saudi doctors who can care for the patients. Here in Kurdistan, it’s the opposite now: I managed to create the manpower, but we do not have the space.
HK: And that leads me to the next question: What is the current state of cancer care in Kurdistan, and what are the main ways to improve it?
AS: I can proudly tell you that we have the best cancer care in Iraq, the results of most of the cases we are managing are comparable to the West. Definitely in line with Jordan and Turkey, we are better than Iran. I can say that ninety five per cent of the time, we are providing an American standard of care. But, for those with bone marrow transplants, we need space. We now have the centres, the manpower, the professionals, we are providing the service in our own language, the patient is in the same city, s/he doesn’t have to go abroad spending tens of thousands of dollars, it’s very convenient here.
And for that, I have to thank the ministry of health. Each patient that is admitted to Hiwa Hospital: from the day s/he is admitted, until the day s/he is cured (two-thirds of patients) or s/he dies (one-third of patients), we spend around $280,000 on every single patient. It’s a very expensive specialty and we need more support.
HK: What about the impact of oil-extraction and other pollution such as H2S?
AS: Let us not politicise the issue, I don’t think I’m the right person to answer that question. I think the environmental factors are contributing very little to the majority of cancer cases. As it’s said, cancer is a gift from god; if we can at all call it a ‘gift’. We have so many patients with different types of cancer and we cannot say they have all had environmental factors contributing to their cancer.The most important thing is to treat them.
HK: Are you implying we do not have scientific evidence to prove it?
AS: Well there is scientific evidence connecting these things to cancer, but it’s not a major issue, so I don’t want the media to cause a moral panic by telling the public it’s a major issue.
HK: You mentioned the cost of treatments, how do poor people afford it?
AS: Well, I’m proud to say that it doesn’t cost them a penny, except in very rare cases when we are short of certain medication. All our services are now free of charge at Hiwa Hospital whereas, previously, patients were travelling abroad to get treatments with all the costs entailed and inconvenience they experienced. And often, after spending months receiving treatment, the patient was dying – and bringing back the body was also an issue for the family.
HK: Can you provide adequate service – given the pressure your hospital is currently under?
AS: Well, we have to do our work. We have a charity box at the ministry of health and our colleague, Doctor Dosty, who has recently become the manager of Hiwa Hospital, has good connections with Western countries where the rich people are contributing. We have laid the foundation for incomes through many sources, aimed at improvements. But, again, this is a very expensive process and we require regular support.
HK: What is the overall state of medical care in Kurdistan?
AS: As I told you, when I was a student in Baghdad, we used to have the best medical health care in the Middle East. After three decades of Saddam’s rule and three vicious wars, by the time I returned, we did not have medicine; there was no medicine whatsoever. There were no blood tests, no radiology, nothing… but right now, because the economy is booming, money is coming, I have a feeling that we are progressing very well. I wish to say this to my fellow countrymen and women in the medical profession who read my remarks and are currently based in the West: It’s time to come back and contribute to the service here. I know that you have built your lives there. Your families are there. But remember: you grew up in this part of the world, we need you badly now, we need your experiences, it will be a golden opportunity for each specialty, whether it is psychiatry, neurology, or any other field. It will be great to have you contribute to the services here.
HK: What model of healthcare should Kurdistan follow? Why?
AS: I’m obviously a British graduate; I spent five years in one of the top hospitals in London. But I never recommend the United Kingdom; it’s very tough on the graduates, especially for people from the Middle East. British degrees are very difficult. Honestly, if I were back at a young age, I would never go to the UK. But the US is my ultimate model. There is no racial stigma to the service, once you land in that country, you feel that you are part of that country. The opportunities are very good, you will never fail in the examinations, they provide you with a comfortable financial and moral life and they will give a very good degree and your future is guaranteed. If I have to choose a healthcare system for Kurdistan, then it will definitely be the US model.