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By Laween Atroshi:
Kurds have a famous saying of having no friends but the mountains due to their being let down throughout history and so being unable to trust anyone. However, from my experience on a visit to the Kurdistan autonomous region of Iraq, this is starting to happen with the healthcare system.
Due to the commercial-driven economy it seems that the bespoke field of medicine is adopting a business-driven rather than a patient-centered culture. We know from British studies that there are two approaches to undertake with patients. One is the doctor-driven approach, explained by Bryne & Long, with the consultation being doctor-driven and with little input from the patient; the other is the Pendleton approach of a patient–centred relationship to maximise and utilise the patient’s input in the consultation. Research has suggested that the patient-centred approach is more successful in treating patients over the long-term and on an ethical basis.
As a UK biomedical informatician, it was interesting to look at the system in the Kurdistan Region by considering patient attitudes and then the doctors’ perspective. Due to the competition available and with the lack of a strong regulatory mechanism, it is evident that there has been a breakdown of trust in the medical sector of Kurdistan. I find this alarming because trust can prevent unnecessary fatal mistakes and create a positive long-term trajectory for patients. Furthermore, the system lacks clinical governance frameworks which should be embedded with strong ethical and moral values.
However, I can also say from my observations that a big health reform is occurring in the region and the Ministry is trying hard to tackle these issues. Nevertheless, I feel it is important that the damage is minimised and trust is brought back into the medical sector in Kurdistan. Doctors hold the highest level of responsibility: they deal with the vulnerable – our children, fathers, mothers, daughters – and their conduct should be under review by a strong regulatory board. It is clear that the psychological contract between patients and doctors has been violated and, to minimise further damage, strong messages need to be sent out to penetrate the core of the problem.
The argument can be made that there are private alternatives but, without strict regulation, there is no guarantee that this will be better.
Furthermore, I strongly feel there should be more preventive campaigns, concentrating on the key chronic illnesses within the region such as diabetes, cardiovascular disease, etc. Additionally, taboo though it is in the region, there should be a campaign promoting sexual health. It is very important that patients and the public are educated on these matters and key guidelines put in place to prevent medieval remedies which have no evidence-base and could be more harmful.
Laween Atroshi is a UK Health Informatician and Ambassador For Peace (UPF): Tweet me @laweenatroshi and let me know your opinions, I could be wrong but this is how I feel from my experience. My views do not reflect those of any other individual or institution. www.laweenatroshi.com
