Donating Knowledge: How Books and Journals Can Help Mend Iraq's Fractured Healthcare System

Laura A. Stokowski, RN, MS


February 18, 2010

In This Article

Talking With David Gifford, MD

Medscape recently spoke with Dr. Gifford about the continuing need for current health professions books and journals in Iraq.

Medscape: First, tell us a little about the history of this amazing project. Who first discovered the Iraqi physicians' needs for current medical literature?

Dr. Gifford: In 2003, I received a message from my son, then-Major Mark Gifford, who was located in Tikrit, in northern Iraq, with the 4th Infantry Division. Mark conveyed to me that his boss, Lieutenant Colonel Dr. Kirk Eggleston, 4th Infantry Division Surgeon, had visited the Medical College of Tikrit and discovered the utter absence of modern medical texts and journals (Figure 2). I contacted Medscape, and we began publishing regular reports about the program, and asking for donations from readers. The response has far exceeded our expectations.

Figure 2. The formerly empty shelves of the Medical Library at Tikrit are now filled with donated books and journals.

Medscape: How do the books actually get to the people who need them?

Dr. Gifford: In the beginning, then-Captain Alex Garza, MD, MPH who was Public Health Team Chief of the 418th Civil Affairs Battalion, 4th Infantry Division, in Tikrit, Iraq, was the point of contact for receiving and distributing books to the medical college there as well as to the regional hospitals and smaller hospitals and clinics. The military point of contact has changed over many times in subsequent years, and presently it's Lieutenant Colonel Dr. Vince Barnhart, the command surgeon for the 1st Armored Division in central and mid-Iraq.

The books are all delivered by US servicemen and women who volunteer their time to take the books where they are needed. Since 2003, a sequence of more than 60 Army and Navy medical personnel, physicians, physicians' assistants, nurses, as well as Civil Affairs personnel, have volunteered to establish relationships with the Iraqi medical communities and to receive and distribute donated texts and journals. In the first several years of the effort, these individuals were under considerable personal risk when they travelled throughout Iraq to deliver the books. At the outset, those Iraqi doctors who cooperated with our donor medical personnel were also at risk of retaliation from terrorists. Although the danger associated with travel in Iraq has diminished, it is never zero.

Medscape: How many books and journals have been donated to date?

Dr. Gifford: We don't have firm numbers, only the roughest of estimates. I'd say that approximately 2 million books, and 2 to 3 times as many journals, have been donated. Donations have varied from single volumes to pallets holding as many as 3000 volumes and collections of over 2000 textbooks donated by students and faculty of medical schools.

Medscape: Are English-language books and journals really useful to Iraqi physicians and nurses?

The usefulness of English-language literature stems from the history of Iraqi medical education. Iraq became a British protectorate following World War I, and a holdover from British colonial rule is that Iraqi medical education is based on the 6-year British curriculum and is carried out in English. So virtually all of Iraq's physicians (but not its nurses) can speak English and can read and comprehend English medical literature without difficulty.

Medscape: What does a donated book mean to an Iraqi physician?

Dr. Gifford: You have to understand, these doctors had not held a current textbook in their hands for many years (Figure 3). When the first donated books arrived, they couldn't believe they were holding a book that was only a few years old. It was unheard of. Medical books aren't published in Iraq, so everything they have comes from the outside. Even at the medical college in Tikrit -- there were nothing but empty shelves before the book donation drive began. They are very grateful for these books. The proof of this has been photos of the smiling faces of Iraqi physicians and of new libraries with shelves of books and journals where before none existed.

Figure 3. Iraqi physicians receive current medical books.

Medscape: What is the status of nursing in Iraq now, and is nursing literature of use?

Dr. Gifford: Nursing, as it is practiced in the United States, doesn't exist in Iraq. There is no such thing as a nurse practitioner. Women generally don't work outside the home; there isn't a large professional class of women in Iraq. Women have been prohibited by Muslim culture from personal contact with men not related by blood or marriage. In many areas, if a person takes ill and must be hospitalized, a family member comes to the hospital to take care of them, feed them, and so forth.

Right now, nursing textbooks, especially those that describe basic principles and techniques of nursing, will be most helpful. Nursing journals don't tend to be as useful, particularly those that deal with administrative or quality of care issues. This might change if nursing gains a foothold in the Iraqi healthcare system.

Medscape: What do you foresee as the future of the project? Will there be a need for many years to come? Will our ability to help diminish as we draw down?

Dr. Gifford: There will certainly be a need because our military has been progressively isolated to specific areas of the nation as more provinces are returned to Iraqi military oversight. How long? As the military draws down in Iraq, our ability to assist will diminish accordingly. So it is important to get as many books as possible to them now.

Medscape: Is a similar book donation program for Afghanistan a possibility?

Dr. Gifford: Probably not. There is no equivalent historical basis for their medical personnel to read and comprehend our English-language texts and journals, and they are building from an enormously lower foundation for medical care.

Growing Professional Relationships

As the violence wanes in Iraq, the donation of books and journals to the country's medical practitioners has produced an unanticipated benefit. Reaching out to Iraqi physicians to determine their pressing needs for medical literature, and delivering the donated books and journals have opened the door to further interactions about clinical issues. As a result, US military medical officers have had the opportunity to participate in teaching symposia with the Iraqi physicians. Since September 2009, US medical officers have attended 3 Iraqi Security Forces Grand Rounds medical conferences and shared the podium with Iraqi physicians to present talks about the latest advances in medicine for many of Iraq's urgent health problems (Figures 4-6).

Figure 4. Lieutenant Colonel Qaisar Alshami, a rheumatologist specializing in medical rehabilitation, speaks to medical personnel from US Division-Center about ankylosing spondylitis. The Iraqi-led conference was held at Al-Muthana Military Hospital January 18, 2010. (US Army photo by Specialist. Daniel Schneider, 366th MPAD, USD-C)

Figure 5. Colonel Alex Stojadinovic, chief surgeon assigned to Medical Task Force 28, explains to Iraqi surgeons how to treat an internal abdominal injury during a medical conference held at Al-Muthana Military Hospital (US Army photo by Specialist. Daniel Schneider, 366th MPAD, USD-C)

Figure 6. Lieutenant Colonel Vincent Barnhart, surgeon of U.S. Division -- Center, meets with Colonel Amir, the commander of Al-Muthana Military Hospital, to donate medical journals and texts to the hospital after a conference held January 18, 2010. The donation has effectively doubled the size of Al-Muthana Military Hospital's medical library. (US Army photo by Specialist Daniel Schneider, 366th MPAD, USD-C)


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