Even now, after my third trip to Kurdistan, I continue to be impressed at the strides this fledgling democracy has made within a few short years, in particular the Ministry of Health (MOH). Now, don’t get me wrong, there are significant challenges to overcome but you need to look at the successes and areas of opportunity in the proper perspective. The Kurdistan Regional Government’s (KRG) MOH was created just over a decade ago as politicians sat down to draft a constitution from scratch, and this infant government has, in my opinion, hit the ground running.

After the fall of Saddam Hussein, a public/private model was instituted, and while it may not be perfect, everyone has access to free medical attention. Not to mention access to a litany of pharmaceuticals at the drop of a hat.  I always wondered what that miracle migrane injection was…no wonder it works, it’s Demerol…

The system needs to be reviewed again as the KRG is no longer operating in an immediate post-war environment. However, urgent issues have been addressed by the MOH such as child and infant mortality rates that have been reduced thanks to public health information, vaccinations and access to medical facilities. Cholera epidemics are rare and kept localized once they emerge, and public health teams are actually going door to door to dispense vaccinations to children.

In preparation for this past trip where I lead a team of seven Canadian integrated medical professionals, I consulted with doctors who have visited and worked in the KRG.  One doctor said to me: “The doctors of Kurdistan are technically brilliant and can teach us a thing or two in the west.”  A comment echoed by our team in October. 

Not only are the medical schools in Kurdistan producing excellent doctors, but highly skilled Arab doctors have fled the violence of southern Iraq to practice in the peaceful, safe confines of Kurdistan. This has countered the “brain drain” that occurred as medical professionals fled Iraq during the war years.

This is the good news, but there is room for improvement. The emerging middle class in Kurdistan is expecting more from their health care providers. Due to their access to health care they have elevated the art of doctor shopping to an art form.  This is what drains resources and diminishes opportunities for systemic improvement.Not content with a second opinion, it is not uncommon to see third and fourth opinions requested. In my estimation, this undermines the basic tenants of a system designed to ensure access to medical care for every citizen.

Access to healthcare is a worldwide concern. Canada, with our supposed Cadillac of health care programs, is still grappling with providing their citizens timely access to services like MRI’s, CT scans and certain surgeries. Imagine my surprise when I walked into Rizgari Hospital to find a state of the art MRI machine and wait times that put us to shame.

Physiotherapy and addressing the mobility needs of the disabled and elderly is a distinct area of opportunity. For some it is too late to fully correct the damage done during the war, but there is a chance for increased mobility and a better quality of life for those who have suffered so greatly. Canadians are ready willing and able to partner with the Ministry of Health in progressing this discipline in Kurdistan. 

Providing a better quality of life for one disabled individual has a positive effect on their family who have struggled to help them as best they can for so long, as well as their community where they can now participate in again on a meaningful level.

Touring the psychiatric wing of a local teaching hospital was very disturbing. To see the distress in the eyes of these men, most of whom had been wasting away in prison, was very difficult. However, they were clean, well fed and calm which is a 180 percent improvement from the prison life they were trapped in previously.Electric Shock therapy is still a commonly used tool. Unfortunately, due to a lack of a reliable supply of antipsychotic medications, this is one of the only treatment options available.

If I could do one thing medically, following my last trip, it would be to ensure a sustainable supply of antipsychotic medication for every hospital psych wing and mental health clinic. The reality is that the Kurds have suffered immensely. Each family, each person has been touched by tragedy in some way, shape or form. Not everyone will be able to carry that burden without losing a bit of themselves or needing the help of the medical community to support them in their time of need.

In my view, the test of a truly compassionate medical system is how you help those without a voice, those who you could easily allow to fall through the cracks. In Kurdistan, the mentally ill, through no fault of their own, have lived through the unspeakable and are now clinging to the crevice, desperately hoping not to fall through that crack.