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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
After the end of the war?
- AK Al-Sheikhli, Mrs.Luma Al-Azzawi,B.Sc (23 May 2003)
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No mass graves in the UK-really?
- Mark Houghton, Based from home (7 June 2003)
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Aiding and Abetting the Politicians?
- Janice Tate (29 June 2003)
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Aiding and Abetting the Politicians?
- Janice Tate (30 June 2003)
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AK Al-Sheikhli, Loc.Consultant Psychiatrist Nuneaton CV11 5HWX,UK, Mrs.Luma Al-Azzawi,B.Sc
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Dear Editor, It was interesting to read the Editorial choice,After the cameras are gone,(BMJ 2003),I would like to mention the following: 1.The situation in Iraq,was very bad before the last Gulf war,due to the sanction which was imposed on Iraq following the occupation of Kuwait,1990,I woundered wheather the International community,and The United Nation was with us as a Nation(Iraqi),or against us(1). 2.The situation was getting worse during and after the invasion of Iraq,2003,Why?,The United States and Britain have a legal resposibility towards the Iraqi people,their security,health,food..etc. Thank You
Dr.AK.Al-Sheikhli Competing interests:
None declared |
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Mark Houghton, Non Principal Family Doctor 45 Crimicar Drive, Sheffield,S10 4EF, Based from home
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Sir, At first sight most of us would agree with the throw away comment, "Britain doesn't have anything so dreadful" as the mass graves of former Yugoslavia (Editor's choice 24 May 2003). Yet the BMJ/BMA rather undermines its correct concern for my asylum seekers and Somali patients (p 1108). Indeed my Somalis would find the BMJ position a little odd: because, while it champions the refugees, it simultaneously ignores 180,000 small people we doctors send up our hospital chimneys each year. These “therapeutic abortions” are also bodies with bones-isn't that a mass grave? It seems to me the BMJ/BMA will lead us better in their ethical concerns once there is consistency on these big issues. Competing interests: None declared |
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Janice Tate, GP East End Bromley by Bow Health Centre E3 3BT
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Below is an extract from an article that I wrote in March of this year prior to the conflict in Iraq. It describes some of the challenges I encountered when working with The Department for International Development in post-conflict Kosovo (1999). The article challenged the assumption that aid is a universal panacea and identified some of the difficulties involved. I finished with the sentence "When I arrived in Kosovo eight short weeks after the 'liberation' a rose petal welcome still hung in the air. When I left six months later many Albanians were dejected, depressed and resentful. They had seen one form of oppression replaced by another." I strongly believe that many of the events that are occurring in Iraq could and should have been predicted. I was based at Pristina University Hospital, the jewel in the crown of the regional health system. This was largely fortuitous – the hospital had been secured by a British unit. The hospital was vast and in a poor state of repair and it was quickly apparent that the available funds were not going to provide for its entire reconstruction. An early decision was made to establish an Emergency Department. This was intended to handle gunshot wounds (guns were widely available and tempers ran high); casualties from road traffic accidents (traffic lights worked only intermittently, cars lacked plates, and documentation regarding driving qualifications had largely been destroyed); and trauma injuries caused by Serbian landmines and NATO unexploded ordnance. State of the art equipment was flown in and walls were rapidly knocked through to provide resuscitation rooms and emergency operating theatres. Meanwhile, elsewhere in the hospital, toilets were left to overflow. Capital expenditure was generous – much of the equipment would have been the envy of District General Hospital in the United Kingdom – however little thought was given to recurrent costs and few attempts made to obtain equipment locally thereby improving the chance of sustainability. A significant problem was that Emergency Medicine was not recognised as a speciality in Kosovo. There was no postgraduate curriculum and little hope of obtaining one. The University was bankrupt and at a standstill, and anyway it takes years to train a specialist. Additionally Albanian doctors had been excluded from public healthcare and university education. Training had been earnestly pursued in front living rooms but there was little hands on experience and skills were rusty. Serbians who had run the >hospital prior to the conflict remained eligible for employment but heads were being nailed to walls and most had fled. Some Albanian doctors had been ambivalent about the creation of an Emergency Department from the outset and equipment was carefully watched as concerns arose that it might be disappeared to other departments. Nevertheless despite all these difficulties the ER - trussed in a white banner proclaiming ‘Emergency Department’ in English - was eventually opened by Bernard Kouchner, head of the UN in Kosovo, accompanied by a fanfare of publicity. Improved health care outcomes seemed less important than a public declaration that the British people cared, and this was tangibly provided by the all singing all dancing equipment and whitewashed walls. The need for education and training remained pressing, but perhaps did not present the same photo opportunities or meet exit strategy deadlines. The World Health Organisation (WHO) in Kosovo took the lead on primary health care. Curiously however it took many months before a lead delegate was appointed although I do recall that another delegate was rapidly recruited on a six-month contract to promote breastfeeding. GPs in the region were accorded little respect and the quality of care being provided was precarious. This was due to a combination of factors including dingy facilities, limited drug supplies, exclusion from education, and non-existent regulation. Requesting proof of qualification was difficult in a context where much documentation had been destroyed and the suggestion that local practitioners be appraised and accredited by internationals was sensitive and inflammatory. A decision was finally taken, as an interim measure, to promote a six-month fast track course for primary health care professionals. This would be presented to local GPs as Continuing Professional Development. Meetings at the WHO office were necessarily consensual and clear efforts were made to include all relevant parties. The result was an eclectic mix of representatives from the overabundance NGO and international governmental organisations, as well as Albanian and (occasionally) Serbian health professionals. Although the UN insisted that a multi-ethnic community was being facilitated Serbians were reluctant to engage in UN activities and were vulnerable travelling without military escort. Despite the participatory intent of these meetings they were in practise dominated by internationals. English was the language used and Albanians, having been disenfranchised for many years, were unpractised at negotiating. Additionally they had nothing to negotiate with, and were often in the embarrassing position of having to defer to the young heady representatives of overseas NGOs. Although the WHO had authority to lead it had no power to implement. It was a dog with no teeth. Understaffed and under-funded there was no hope of producing a curriculum let alone training local practitioners without support from other organisations. The hope was that Pristina University would lead thereby bestowing the policy with legitimacy. However there were to be no additional stipends and living on air was becoming increasingly difficult for local health professionals. NGOs were initially tempted to collaborate but as time dragged on they were increasingly concerned to meet the timelines and targets agreed with their respective donors. The result was a plethora of diverse, piecemeal, primary health care courses run by multiple competing agencies. None were accredited and there was no overall regulation. Ironically, those who were producing these courses were often themselves unaccredited – there is no formal career path for health professionals seeking to work in international development. The bucketfuls of compassion and goodwill were not enough. Chaos reigned. Competing interests: None declared |
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Janice Tate, GP East End Bromley-by-Bow Health Centre E3 3 BT
Send response to journal:
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Below is an extract from an article that I wrote in March of this year prior to the conflict in Iraq. It describes some of the challenges I encountered when working with The Department for International Development in post-conflict Kosovo (1999). The article challenged the assumption that aid is a universal panacea and identified some of the difficulties involved. I finished with the sentence "When I arrived in Kosovo eight short weeks after the 'liberation' a rose petal welcome still hung in the air. When I left six months later many Albanians were dejected, depressed and resentful. They had seen one form of oppression replaced by another." I strongly believe that many of the events that are occurring in Iraq could and should have been predicted. I was based at Pristina University Hospital, the jewel in the crown of the regional health system. This was largely fortuitous – the hospital had been secured by a British unit. The hospital was vast and in a poor state of repair and it was quickly apparent that the available funds were not going to provide for its entire reconstruction. An early decision was made to establish an Emergency Department. This was intended to handle gunshot wounds (guns were widely available and tempers ran high); casualties from road traffic accidents (traffic lights worked only intermittently, cars lacked plates, and documentation regarding driving qualifications had largely been estroyed); and trauma injuries caused by Serbian landmines and NATO unexploded ordnance. State of the art equipment was flown in and walls were rapidly knocked through to provide resuscitation rooms and emergency operating theatres. Meanwhile, elsewhere in the hospital, toilets were left to overflow. Capital expenditure was generous – much of the equipment would have been the envy of District General Hospital in the United Kingdom – however little thought was given to recurrent costs and few attempts made to obtain equipment locally thereby improving the chance of sustainability. A significant problem was that Emergency Medicine was not recognised as a speciality in Kosovo. There was no postgraduate curriculum and little hope of obtaining one. The University was bankrupt and at a standstill, and anyway it takes years to train a specialist. Additionally Albanian doctors had been excluded from public healthcare and university education. Training had been earnestly pursued in front living rooms but there was little hands on experience and skills were rusty. Serbians who had run the hospital prior to the conflict remained eligible for employment but heads were being nailed to walls and most had fled. Some Albanian doctors had been ambivalent about the creation of an Emergency Department from the outset and equipment was carefully watched as concerns arose that it might be disappeared to other departments. Nevertheless despite all these difficulties the ER - trussed in a white banner proclaiming ‘Emergency Department’ in English - was eventually opened by Bernard Kouchner, head of the UN in Kosovo, accompanied by a fanfare of publicity. Improved health care outcomes seemed less important than a public declaration that the British people cared, and this was tangibly provided by the all singing all dancing equipment and whitewashed walls. The need for education and training remained pressing, but perhaps did not present the same photo opportunities or meet exit strategy deadlines. The World Health Organisation (WHO) in Kosovo took the lead on primary health care. Curiously however it took many months before a lead delegate was appointed although I do recall that another delegate was rapidly recruited on a six-month contract to promote breastfeeding. GPs in the region were accorded little respect and the quality of care being provided was precarious. This was due to a combination of factors including dingy facilities, limited drug supplies, exclusion from education, and non-existent regulation. Requesting proof of qualification was difficult in a context where much documentation had been destroyed and the suggestion that local practitioners be appraised and accredited by internationals was sensitive and inflammatory. A decision was finally taken, as an interim measure, to promote a six-month fast track course for primary health care professionals. This would be presented to local GPs as Continuing Professional Development. Meetings at the WHO office were necessarily consensual and clear efforts were made to include all relevant parties. The result was an eclectic mix of representatives from the overabundance NGO and international governmental organisations, as well as Albanian and (occasionally) Serbian health professionals. Although the UN insisted that a multi-ethnic community was being facilitated Serbians were reluctant to engage in UN activities and were vulnerable travelling without military escort. Despite the participatory intent of these meetings they were in practise dominated by internationals. English was the language used and Albanians, having been disenfranchised for many years, were unpractised at negotiating. Additionally they had nothing to negotiate with, and were often in the embarrassing position of having to defer to the young heady representatives of overseas NGOs. Although the WHO had authority to lead it had no power to implement. It was a dog with no teeth. Understaffed and under-funded there was no hope of producing a curriculum let alone training local practitioners without support from other organisations. The hope was that Pristina University would lead thereby bestowing the policy with legitimacy. However there were to be no additional stipends and living on air was becoming increasingly difficult for local health professionals. NGOs were initially tempted to collaborate but as time dragged on they were increasingly concerned to meet the timelines and targets agreed with their respective donors. The result was a plethora of diverse, piecemeal, primary health care courses run by multiple competing agencies. None were accredited and there was no overall regulation. Ironically, those who were producing these courses were often themselves unaccredited – there is no formal career path for health professionals seeking to work in international development. The bucketfuls of compassion and goodwill were not enough. Chaos reigned. Competing interests: None declared |
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