In 2004, Iraqi-born Maha Alattar, MD, former assistant professor of neurology at the University of North Carolina at Chapel Hill School of Medicine, returned to her native country for the first time after an absence of 21 years. She went as part of a large delegation of US medical doctors from multiple specialties to visit their Iraqi counterparts, a mission sponsored by the US Agency for International Development.
“My family left in 1983, when I was 14 years old, because of harassment from the Baathist/Saddamist regime,” explained Dr. Alattar, currently a neurologist and sleep specialist at Mary Washington Hospital in Fredericksburg, VA. “Other family members of mine were murdered. So, we left for our safety.”
Dr. Alattar last spoke to Neurology Today in 2004 on the state of neurology in Iraq, describing the threadbare supplies, paucity of medication, outdated treatments and technology, and dearth of nurses and neurologists. She traveled to Iraq again in February for a five-day symposium for neurologists and neurosurgeons, which focused on neurology training. In a phone interview with Neurology Today, she shared her observations about the state of neurology in Iraq — the gains and losses — five years later.
WHY DID YOU RETURN TO IRAQ?
We went as part of the International Medical Corps (IMC). The IMC is a comprehensive program with national reach from centers in Irbil, Baghdad, and Basra that aims to provide continuing medical education and professional development through training by experts from all over the world. Cornelia Drees, MD, John F. Kerrigan, MD, and Kevin Chapman, MD, from Barrow Neurological Institute, were part of my team. Our focus was to update, train, and help with organizational issues.
WHAT WERE YOU ABLE TO DO IN THE FIVE DAYS YOU WERE THERE?
We presented daily up-to-date PowerPoint presentations to our fellow neurologists and neurosurgeons on topics such as epilepsy surgery, the relationship between sleep disorders and neurological disease, and updates on the treatment of stroke and epilepsy in both children and adults. We also had roundtable discussions of cases that were presented to us by the Iraqi doctors. And we helped them re-establish their subspecialty society, the Iraqi Neuroscience Society. That was one of our highlights for this symposium. Best of all, we connected with them as colleagues and as friends and established the appropriate links for future projects. My Iraqi neurology colleagues are very interested in catching up to the world. They are a smart group of doctors who are very dedicated to helping their patients.
HAS THE STATE OF MEDICINE OR NEUROLOGY IMPROVED SINCE YOUR TRIP IN 2004?
Some things have improved; others have not. Few cities besides the major cities (such as Baghdad or Irbil) have been able to access updated technology such as MRIs or four–vessel angiograms. Access to technology remains problematic because of the paucity of trained technicians and issues related to priorities (for example, the allocation and distribution of health care money). It impressed me that they had many questions about deep brain stimulation and device-related epilepsy care, but basic monitoring and lesion-resection services are undeveloped. Access to medical journals has been poor. Online access has improved but needs more improvement. Medications are available, however. The Iraqi doctors are quite knowledgeable in all the medications that we have available to us in the United States, and for the most part have access to them.
Nursing care remains outdated. The concept of teamwork has not caught up yet. However, during our visit, they were very open to teamwork and “centers of excellence” (in stroke and epilepsy, for example). They realized that optimal treatment of a stroke or an epilepsy patient rests on a combination of factors that include not only the well-trained neurologist but also good nursing, physical therapy, technicians, pharmacists, neuroradiologists, and psychologists.
HAS THE CONCEPT OF SUBSPECIALTIES IN IRAQ CAUGHT ON SINCE YOU VISITED IN 2004, WHEN THERE WERE JUST GENERAL NEUROLOGISTS?
The concept of subspecialties has caught on but needs more fine-tuning. Many neurologists in Iraq are generalists who took a specific interest in a neurological specialty but have no formal training (a fellowship program, for example). They were quite interested in this issue. I hope to be able to support the future neurology residents to take a year and receive fellowship training in subspecialties like stroke, epilepsy, and headache treatment.
WE READ THAT MANY PHYSICIANS, INCLUDING NEUROLOGISTS, HAVE LEFT IRAQ; A FEW HAVE BEEN KILLED. ABOUT HOW MANY NEUROLOGISTS ARE LEFT IN IRAQ?
Forty percent of Iraqi physicians left the country, and most, it seems, will not return. The 60 remaining neurologists — those we met in February — are going to stick it out. Many of the academic neurologists who were training the neurology residents have left. Neurology training in Iraqi has become anemic. However, the residents have managed quite impressively.
ARE CERTAIN NEUROLOGICAL DISORDERS MORE COMMON IN THE IRAQI POPULATION?
There are no studies that show the disease prevalence of a specific neurological disorder. However, from our interaction and discussions, it appears that the major neurological problems are similar to those we see in the US. We actually did a survey of the attending neurologists and neurosurgeons and the most common problems they encounter are stroke, epilepsy, and pain (back pain, headaches). The neurosurgeons do quite a lot of general neurology specifically in the management of pain and epilepsy.
HAS VIOLENCE AFFECTED NEUROLOGY TRAINING AND MEDICAL CARE?
Violence has overall decreased. Many of my friends and relatives are there now, visiting and even looking for job opportunities. Life is becoming near normal, slowly. Of course, every time violence increases, doctors and other health care providers leave, which has been a chronic problem casting a blow to the Iraqi health system. Unfortunately, few doctors have returned to Iraq in the recent past due to improvements in the security situation.
WHAT WOULD YOU HOPE TO ACCOMPLISH AS A MEMBER OF THE AAN ETHICS, LAW AND HUMANITIES COMMITTEE?
I hope the board will look into lending a hand to countries and more specifically the doctors that require the knowledge to better themselves and in turn help their patients. Education is my priority and I hope to encourage others to give some of your brainpower to countries like Iraq. Knowledge goes a long way to better the lives of people all over the world.
WHAT WOULD YOU LIKE MORE US NEUROLOGISTS TO KNOW ABOUT IRAQ NEUROLOGISTS, AND HOW COULD THEY HELP?
I certainly can use help to assist the Iraqi neurologists. Any neurologist who wants to help can let me know and we can establish a more comprehensive team. My work has just begun. I plan to go there at least on an annual basis. But there is a lot of work that can be done here in the US to promote training, establish connections between universities or departments, send PowerPoint presentations online, or help in future projects such as establishing centers of excellence (stroke, epilepsy).
Iraq will need to have their interested physicians spend time being specialty trained through fellowships or other training venues in countries with reputable institutions to build quality sub-specialty neuroscience programs back in Iraq. Such training is important to build the usual academic triad of clinical care, research and future training purposes. I don't think they will be able to do this well, or quickly, based purely upon existing internal resources. But those neurologists are very dedicated.
International Medical Corp's Continuing Medical Education program for Iraqi physician is ongoing. For more information, visit www.imcworldwide.org.