A tale of two health systems

By Chra Abdulla:

Many people complain about the healthcare system in Kurdistan and how it needs to become like the west, but have you ever sat down and actually compared the two? I am going to try my best to give you a glimpse of what Kurdish and Australian hospitals are like through a fictional character.

Omar Faris, aged 42 years, lives in Sydney, Australia with his wife and two teenage girls. He owns a local business in the heart of Sydney’s busiest western suburbs. One day, coming home from work, Mr Faris gets into a car accident and someone on the pathway immediately dials 000.

The people around him make sure he is fine and, since they can see no threat with the car, they leave him in there to minimise his injuries. The ambulance arrives within 10 minutes of the phone call. The two paramedics assess the situation and administer life-saving drugs or resuscitation if necessary. Also, any broken bones would be handled with care and placed in a splint. Now that Mr Faris is stabilised he is taken to a nearby hospital.

When he arrives at the hospital he is taken to the emergency ward. On the way to the hospital the paramedics would inform the hospital of the patients name/age, his injures, condition and estimated time of arrival. This allows the hospital to take proper action before he arrives. Meantime, the hospital allocates a senior doctor and briefs him in about the case and a team of doctors and nurses on awaiting Mr Faris’ arrival. The Radiology department would have been notified and they will send a mobile x-ray downstairs to the room.

The paramedics then arrive at the closest hospital and hand over the patient to the waiting team outside. They will take over and assess the situation to begin diagnosis and treatment. Not only are emergency doctors present but a team of different doctors, including anaesthetists, surgeons and orthopaedics, are available to check for any airway problems, internal bleeding, fractured bones and to ease the pain of the patient.

Mr Faris’ wife was also informed and she is on her way. When she arrives the nurses ask Mrs Faris to calm down and take a seat and someone will inform her about everything very soon. Mrs Faris is informed of all the injuries her husband sustained and given further reassurance that they are doing everything to bring him back to health and she is provided with refreshments while she is waiting.

Once Mr Fairs is stabilised he is given an x-ray by his bed and other tests to be sure that everything is fine. If there is any need for operations, Mr Faris will have all the emergency operations within hours of his arrival. After his operation, if physiotherapy is required, he will also be provided with this. Also, since all these tests are covered by health insurance provided by the government, the patient has no medical bills and is discharged to go home. He is advised to go to his family physician for regular check-ups.

Now imagine the same scenario … but in Erbil, Kurdistan.

Mr Faris was involved in an accident and people around him are either in shock, drive by, stare or run to the car to get him out. Since first aid and ambulance are not available, they pick him up and drive him to the hospital. Someone sees his phone and dials a family member who in turn goes and picks up ‘everyone’ and arrives at the hospital. Mr Faris is then carried out of the car by a few men and rushed to the only public hospital available in Kurdistan. The family members arrive and place him on a hard steel bed that a nurse allocates to them. The patient has a blanket placed on him from his house since none are provided by the hospital. The patient is in a lot of pain and this is not helped with several female family members crying and male members running around trying to find a doctor.

When a doctor is ‘finally’ found, he asks for an update by the patient’s family members. The doctor that has been allocated to this patient is usually a recently-graduated doctor with no advanced life-support training and no supervision since he is not a qualified emergency doctor. So it is this doctors job to identify ‘all’ the problems.

The patient’s family is then notified by the doctor that they need to take him for an x-ray so that the doctor can further assess his situation. On a good day, this will generally take about two hours, so the family members have no choice but to take the patient to another building for the x-ray. Two hours and a lot of pushing and shoving later, the x-ray is finally taken and they can bring the patient back to the doctor. However, the same doctor is usually never found and so the family is forced to find another doctor and explain the situation once again.

As the new doctor examined the x-ray and found a few broken bones, and a CT scan is necessary to make sure his brain has not sustained any injury too. This further upsets the family members as they should have been informed about this sooner since the patient is in pain and tired. So they again take him to another building and wait for a further few hours until the CT scan is taken, and then go back to the emergency ward. The previous young-faced doctor looks at the CT scan quickly and, having no speciality training in Radiology, informs them that there was no serious injury. The family members are confused but relieved about this news. However, they find out that the ‘public’ hospital doesn’t operate at this time. This is where anger builds up and they rush him to a private hospital.

So, the first scenario shows you the AVAILABILITY of: ambulances, trained personnel, the wellbeing of the patient, care in minimising further injury, an organised health system from the time of injury until even after the discharge of the patient, the importance of family physicians within society and even the family members’ knowledge of what is going on.

The second scenario, with all due respect to all health professionals in Kurdistan, shows the LACK of: ambulances and hospital staff, regard for the family members’ state of mind, minimising further injury, availability of different types of doctors and of family physicians for check-ups.

Out of the two scenarios, which would you prefer? Isn’t it disappointing and shameful to say that we all prefer the first scenario and but we are in fact living with the second scenario in Kurdistan? Where are our ambulances, first aid training for these young doctors, 24/7 care by our public hospitals and General Practitioners? I doubt there is even awareness of the problems and, even if there is, the government and health officials are turning a blind eye to this situation.

There is a dire need for an organised health system and this can only happen with a team of dedicated health professionals of different fields to come together and turn scenario two into scenario one. As a future doctor, I am willing to help and provide my ideas for change – but is there anyone willing to listen to my ideas??

Chra Abdulla is a Medical Student from Hawler Medical college. Born in Iran, grew up in Australia, she has recently moved back to Kurdistan to continue her studies from Dubai. She is very passionate about changing the health-care system and the way people approach health in Kurdistan.

Copyright © 2013 Kurdistantribune.com

18 Responses to A tale of two health systems
  1. Heval
    August 16, 2013 | 04:30

    Thank you Chra for this informative piece on the deficiencies in the health care system present in South Kurdistan.
    Let’s hope those governing the KRG can implement policies to address the needs of our people instead of building palaces, malls etc with public money.

    • Chra
      August 16, 2013 | 21:20

      Thanks so much for your kinds words and yes I hope the govt does read this too and takes my opinions into considerations, I would love to them if they ever wanted suggestions. It is kind of time for our health system to change and I hope it does in the ‘near’ future

      • Iman Adil
        October 4, 2013 | 13:07

        Dear Chra, one day in hot summer day one of my relatives who was suffering from diabetes while he was walking in suq suddenly fell down regarding the high level of diabetes, many people gathered around him and try to aid him they by giving him a cold bottle of pepsi, causing his death immediately. this result is one of all lack of knowledge of first aid, ambulance insurance, health, that every one has document health recording all his past life health..

  2. Kawa
    August 16, 2013 | 10:15

    Dear Chra, you have made a very simple but significant comparison. I suggest you join the facebook groups of doctors who campaign for promoting healthcare in Kurdistan, if you have not done already. You can share your observations and opinions with hundreds of other Kurdish doctors on Kurd Doctors group or Kurdish Young Doctors

    • Chra
      August 16, 2013 | 21:19

      Thanks so much for your reply and kind words, I appreciate it. I hope the Kurdish health system does change one day inshallah. Can I ask what is the exact names of the Kurdish Facebook pages, thanks

    • Ari Ali
      August 17, 2013 | 06:26

      Chra , you are wrong to distance yourself from politics ! Barzanies are running the area like Saddam and Tikrities . Maybe you can write an article about that next time .

      Also you seem to be too young to realise the pitfalls in british based healthcare system : look at this and thanks god for what you get in Erbil :

      An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire.

      • Chra
        August 17, 2013 | 13:35

        Well I am not a politician but a health professional so my priority is with patient care not legislation but I am hoping that the govt will listen to me and other returnees who want to help change the healthcare system. I talk about ‘patient care’ and how things are organised in ‘Australian’ hospitals as I have experience about them and not British healthcare but they do a better job then kurdistan does, I hope you realise that. Because at the moment the only hospital that do an excellent job in kurdistan are the private hospitals and not the public, and this is what I wanna change ‘public’ healthcare

  3. Ari Ali
    August 16, 2013 | 22:09

    Chra in general one compares like with like : Australia vs Britain or Germany . Pumpkin is one thing and water melon is another .

    But I agree with that ” the government and health officials are turning a blind eye to this situation” . That if there was a proper accountable government . What you have in Erbil is a family run business . They are more interested to recruit people to be Peshmerga or a grade in barzan cemetery than training paramedics or nurses and allied health professionals .

    Now why you do not tell us how are things run in Iran or in Dubai and compare them with Erbil ? It would make more sense .

    Thank you for sharing this with us .

    • Chra
      August 17, 2013 | 00:46

      Well thank you for your ‘comments’, let me start of by saying that Dubai healthcare top notch so no matter what I compare Kurdish healthcare with it will still be less compared to them. But the reason I spoke about Australia is because I grew up ther and I am now experiencing the Kurdish healthcare and one day inshallah I would love for our healthcare to be like there’s, so that is my goal, dream and aim inshallah. Finally I am not he to judge the govt curse I am not a politician but what I want is for people not to settle with what we have now but for them to advocate to the gift for a new, revised healthcare system

  4. Noof Rashid
    August 16, 2013 | 23:04

    Firstly, Congratulations on getting it published. This is not just the case with Kurdistan but many other countries too.We need people to be aware of the situations and do their part to change it.
    I hope ALLAH (SWT) gives you the courage and opportunity to do the same and fulfill your dream.

    • Chra
      August 17, 2013 | 00:48

      Thanks so much for your kind words, and yes I agree some countries are facing the same problem as kurdistan but like you said my aim/dream is for people to be aware of the situation and hopefully for govt to make changes inshallah with the help of experienced returnees (Kurds who have experienced healthcare in the west)

  5. Dr.karzan
    August 18, 2013 | 12:31

    good job…well done…really was informative and very delicate diagnosis of our health care

    • chra abdulla
      August 19, 2013 | 17:00

      Thanx so much Doctor, hopefully govt officials read this and change things. Please share

  6. Suleiyman
    August 19, 2013 | 11:44

    Keep writing.

    • chra abdulla
      August 19, 2013 | 17:00

      I will inshallah, thanx

  7. Kurdistani
    August 20, 2013 | 21:53

    Chra Xan

    Well done. Your paper is beautifully written and easy to read. The contrast between the 2 health care systems (although there is no “system” in Kurdistan) is not imaginable.
    Can I add something onto the 2nd scenario, unfortunately Mr Faris will be pushed by agents (health professional) inside emergency hospital to private hospital to have his operation (most likely unnecessary operation) done. He ends up borrowing $4000-7000 from his family or relative to fund his operation. Who cares!

    I would like to make correction about your subsequent comment. I am afraid private hospital in Kurdistan is not better than public hospital. These recently rapidly proliferating profitable enterprises are completely substandard and it’s nothing more than money generating machinery by doing easy and quick operations. There is no care or compassion. No private or public hospital is equipped with expertise or facilities to care for patients with acute and non-acute medical or other emergencies e.g. stroke/SAH..etc.

    Kaka Ari. North Staffordshire hospital is huge university hospital that serves a one million population. It’s estimated that 400 patients died in it between 2004 and 2008 (4 year period) because of “substandard of care” (by British standard). Government commissioned an independent enquiry lead by Robert Francis to investigate this matter. The lessons drown from North Staffordshire shortcomings are disseminated to all hospitals and health professionals in the UK. Everyone learnt from it, as a result protocol and policies changed. This is a proper system, where individuals, institution, government are learning from lessons and deploying strategies to prevent recurrence. If you ask any British Citizen, what are you proud of in your country? Without any hesitation 100% of people say National Health Service (NHS). Someone like you or I is too little to criticise unfairly one of the largest and most effective institution (NHS) in the world.

    Best Wishes

    • Chra
      September 8, 2013 | 21:49

      Thank you so much for your nice comments and I welcome and feedback as positive cause you didn’t critique only increased from my knowledge, so for that I thank you. In regards to private hospitals (recently I have had a bad experience with them) I have to agree, all they care about is money and doctors here in public or private have no compassion or mercy and frankly don’t care one bit about humanity. I know I will get critiqued for this comment but I have enough on a personal and professional level. Things need to change.

      In regards to your last paragraph I agree the west make mistakes but they learn form it and implement new laws and regulations protecting patients, increasing their care and even apologising for their mistakes. This is what I always preach to my friends, don’t ever settle like doctors in kurdistan otherwise your whole career is for nothing and studying was all a waste. We gotta start caring for our fellow human beings and I hope the govt sees this article and asks for my help in chnaging the healthcare system

      • dlvin
        May 20, 2014 | 20:54

        Well done,,chara it’s very useful 🙂

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