Inside the government-run Al-Alwiyah Pediatric Hospital in central Baghdad, nurse manager Kamel Mahdi darts through the corridors, units, and patient rooms in an effort to keep pace with the mounting challenges he faces.
The hospitals ill-equipped ED is crammed with infants and young children who are primarily suffering from dehydration and malnutrition. The ED has no monitoring devices to check blood pressure, pulse, respiratory rates, and heart rhythm.
Upstairs in Alwiyahs newborn ICU, a pair of infants share one of the few available incubators. An elderly nurse in a white headscarf works without the protection of a gown or plastic gloves. And hordes of concerned family members crowd around the young patients.Nurse manager Kamel Mahdi (center) in the neonatal ICU of Alwiyah Hospital in Iraq.
These are just a few examples of the obstacles impeding Mahdi and his colleagues.
Working as a nurse in Baghdad today is becoming increasingly complicated. Baghdads hospitals are admitting more patients because of an increase in water-borne diseases and war-related injuries. The escalating number of patients is compounded by the shortages in basic medications, equipment, and supplies.
Were not only facing an increase in the number of patients, but we are seeing more seriously ill and seriously injured patients, says Mahdi, who has worked as a nurse in Iraq for the past seven years. We lack lifesaving medicine like potassium and IV solutions as well as basic equipment and supplies needed to care for our patients properly.An Iraqi nurse inserts an IV in a 5-month-old girl at Alwiyah Hospital in Iraq.
Meanwhile, nurses in the Iraqi capital are often prevented from reaching their jobs because of curfews, road closures, and fighting. Despite the ever-growing demands and risks involved with their jobs, Iraqs nurses are still among the lowest-paid professionals in the country.
An uphill battle
While nurses at Alwiyah care for at least 10 patients each during their shift, patient loads and acuity change rapidly because of the steady stream of new patients with water-borne illnesses and victims of sporadic attacks across Baghdad.
Leaking sewage and the lack of potable water has contributed to a startling increase in water-borne diseases in the capital, according to Iraqi officials. The problem is so severe that, in July 2007, the health ministry in Iraq warned the number of water-borne illnesses throughout the country could reach epidemic levels, particularly among children and the elderly this summer, if water and sewage networks are not repaired (www.irinnews.org/Report.aspx?ReportId=73052). No significant changes or improvements to this situation have been reported in recent months. Plus, UNICEF expressed concerns in a December news release that the critical state of Iraqs water network is a major contributing factor in a cholera outbreak in Baghdad.
Many of the admissions we get are emergency cases of gastroenteritis, mostly from drinking contaminated water, says Mahdi. But we dont have enough antibiotics to treat the infections. Were also short of IV cannulas to administer these treatments.
Iraqi nurses also must contend with spates of admissions injured in the car bombings, roadside explosions, mortar attacks, and firefights across the city, although the number has decreased in recent months.
Tanya Zuhair, 27, an ED nurse at Alwiyah, says a surge of attack victims only adds to the pressures of working as a nurse in Baghdad.
Patients family members also can add to the pressures.
Its very confusing and stressful, Zuhair says. The family members all crowd into the room as were trying to work, and theyre so anxious that they stand over us watching every move we make as we treat the children.
In need of the bare essentials
The looting in Baghdad following the fall of the former regime stripped many of the citys hospitals of essential equipment. Today, poor security makes it difficult for hospital officials to locate qualified technicians to repair faulty machinery.
After a year or so, our incubators and monitoring devices break down, and it is impossible to find anyone who knows how to fix them, says Tahreef Fadhil Raham, MD, a pediatric specialist and medical director of Alwiyah Hospital.
A string of five broken down incubators sat idle along a landing on the hospitals second floor as evidence.
In the meantime, nurses working in the ED and ICU at Alwiyah treat patients without the advantage of sphygmomanometers and portable oxygen saturation monitors. Patients are brought directly here without the benefit of triage. And the ED has no air conditioning to combat the scorching heat, which commonly rises above 100 degrees during the summer.
The hospitals nurses even suffer from a scarcity of the most basic tools and supplies, such as stethoscopes, thermometers, and plastic gloves.
Ali Kareem Khdayer, director of the Iraqi Nursing Association (INA) says the conditions inside the countrys hospitals are in steady decline.
Many hospitals in Iraq are in desperate need of repair, and most of the equipment is outdated, Khdayer says.
Adding to woes of Alwiyahs patients and nurses, the number of beds at the hospital recently was reduced from 211 to 87 due to reconstruction.
The toils of war
Government-imposed curfews, spontaneous road closures, fake checkpoints, and relentless fighting are additional impediments facing nurses in Baghdad.
Sister Buschra Gaegi, 57, the director of the Al-Hayat Maternity Hospital, a private facility located in central Baghdad, says these obstacles frequently prevent nurses and auxiliary staff from reaching the hospital. As a result, Sister Gaegi is often forced to tackle additional tasks, ranging from clinical care to maintenance duties.
Sometimes I assist the doctors in cesarean sections and provide postnatal care after a delivery, Sister Gaegi says through an interpreter. One time I even had to wash maternity gowns.
Further complicating Sister Gaegis job, Al-Hayat maintains limited stocks of drugs vital for labor and delivery, such as methylorgonovine maleate (Methergine) and oxytocin (Pitocin), because of the hospitals small storage refrigerator. The government stores its medications in two vast warehouses located in volatile areas of the capital difficult to access.
The health ministry has the largest cooling system in the city, but its located in the north and west [of Baghdad], says Sister Gaegi. These routes are not safe, so we cannot travel there very often.
Despite their rising workloads and risks, Iraqi nurses still are poorly paid. Though salaries for the countrys nurses have slightly increased since the toppling of Saddam Husseins regime in April 2003 nurses were paid about $108 per month during Husseins reign the starting salary for new Iraqi nurses today is only 150,000 Iraqi dinars roughly $120 monthly.
Mahdi, who has worked at Alwiyah for seven years and is a nurse manager, is situated in the middle of the salary scale for Iraqi healthcare workers, earning 370,000 dinars monthly, or nearly $300.
By comparison, senior physicians garner about 850,000 dinars, or about $680, according to Alwiyahs director, Raham. He adds that the health ministry recently announced an increase in the salary scale for its employees, and he expects wages for nurses to rise in the near future.
A report released in July by Iraqs parliament says 80% of physicians have abandoned their posts at government-run hospitals, shifting more responsibility to nurses.
And like many Iraqi health professionals, the countrys nurses are often victims of violence. A UN Assistance Mission for Iraq Human Rights Report says that 164 Iraqi nurses were killed between April 2003 and May 2006 and another 77 were wounded during that same period.
Still, many of Iraqs nurses feel compelled to keep working.
This is a humanitarian job, says Mahdi. I decided to become a nurse because I wanted to help people. Now, my services are needed more than ever.
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