British Medical Journal, My Internship in Iraq

[nabeelraad]

هلو شباب

قبل فترة دزيت مقالة لل بي ام جي....والمقالة انشرت الكترونك اليوم وراح تنطبع بلندن هارد كوبي يوم 20 بالشهر......حبيت اشاركهة وياكم......طبعا المحررين غيرو شوية بالنص فاني راح انزل الرابط مال المقالة المنشورة وراح انطيكم نص المقالة الاصلية.....اتمنة تعجبكم......






http://careers.bmj.com/careers/advice/view...le.html?id=3168






My Internship in Iraq





COVERING LETTER:

The article explains the different aspects of a doctor’s career in Iraq.



ABSTRACT:

Each experience has its own character and internship in Iraq is a unique one .It has good stuff and bad stuff in the same time. I tried to be realistic and comprehensive on my description for the presenting events that I discussed in which I went through during my career as an intern in Iraq.



BODY:

Being an intern in Iraq is a hard way of living (even if you were serving in Al Madina Hospital which is considered the best hospital in Iraq for decades). It changed the way I look at things and made me reconsider every little detail in my life. It is not about logic or morals, no not anymore, it is about your own sense regarding your surrounding. Of course I learned too many things, yet, not all my adventures were pleasant to me! .Am going to list them all in this article of mine but let me start with bad things and then go to the bright side afterwards.

At my first day of service a senior colleague told me a sentence “the patient is your first enemy!!!!!” I was shocked to hear such a comment on my first day at a job that is centered about helping patients. Later on I discovered that it is partially true because the Iraqi patient sometimes is a not just an ordinary patient. He might have some extraordinary talents that I might be unable to handle with my limited ordinary life experience! He might be a mass murdered or a death squad member (we have many of them here in every neighborhood) or might be just someone crazy that is going to kill you if you mess with him with no one to stop him at all! That made me fear patients for a while and as time passed I became an expert in diagnosing both people’s diseases and talents. So when a patient with a “talent” comes to me I just try to get rid of him by any mean possible even if I did not treat him and when an ordinary patient comes to me I can manage him easily and take my time to cure him as he is just an ordinary one.

When I was employed there was a 40 young new fellows just like me assigned to this hospital and we all soon discovered that our number is so tiny to fill quarter our hospital so we were devastated by long working hours and I could barely see my family once a week. After 2 weeks I began to complain as everybody else and we started our own strategies to collapse our shifts. We started to handle more patients in the same time so that the total hours per months would shrink to half, yet, we could not maintain the same efficiency or proficiency. We became more aggressive with patients and more ordering .Each one of us with his own set of magical tactics to escape the work load and it really worked for us but not the patients unfortunately. Logically we did the right thing because simply no one can stand such conditions for too long and eventually we will lose our fitness and our patients will lose their doctors. Morally we should have worked harder and harder because this is other people’s lives and we should always do our best to the last moment. Another factor misbalanced the equation, the routine. You should leave the ward and sign your name at 8 am and at 2 pm. You should satisfy your senior’s psychological needs more than you should care for patients. There was no application for legislations that guarantee the patient’s right of adequate healthcare because simply there were no enough doctors or nurses to do so. The chain of command was so unbalanced that made us all prefer to stay on the safe side and save ourselves and come what may!

Empathy? Sympathy? Passion? All are nice resonating words that I used to hear and believe in my study years, yet, it seemed that I will be schizophrenic in a month if I try to apply these concepts. It is just that there is much pain and sorrow that nobody can take. It is beyond imagination, real tragedies are going on here, too much killing and violence, too much brutality and ruthlessness that no one can handle by himself. I learned how to sort things out, to try curing the patient but not feeling sorry for him. On my first week I felt sad for every patient, everyone even myself! I became so depressed and frustrated that I projected my sadness on to my family and friends and that was pure stupidity. Then I realized that I should overcome this by “apathy”, yes simply apathy. In the past few years I considered apathy a disease entity but now am reconsidering it as salvation. I should not care for a post operative pain because I have no analgesic at hand but I should care for infection and hemorrhage as I have some antibiotics (many are missing) and a blood bank (that barely can satisfy a patient’s needs).Most of the time a patient is complaining and says “Hey, you are supposed to be more caring, you do not deserve to be a doctor, you are not human!”. They look at things in a narrows scope, they do not see the burden the doctor is bearing but they see only their pain. I learnt to ignore these comments too!


Patients are very dull. They are always trying to make you fail. In multiple pathways the Iraqi patient is helping the disease to overcome your interventions just like being “an Iraq patient” is a risk factor and it shortens the 5 years survival rate. They neglect symptoms till they present in a late stage that you can do nothing for them just palliative treatment to let them die peacefully. Sometimes they present to you earlier but they do not stick to your instructions or medications. Sometimes they just commit suicide and finish everything before it starts at all. I feel disappointed for such patients and for myself. Because they are ignorant and they are harming themselves with no intention to do so and meantime I can help them no more. For me it feels boring to spend your time and effort on a patient that will fail you most of the time. This renders your effort aimless. Ignorance is a big problem here.


Doctors are a whole new story. Doctors are supposed to be the best of the best, yet, some of them are trouble makers and they make you regret dealing with them in the first place. Due to the dominant atmosphere of disrespect, doctors started to turn into a masked personalities or dual personalities name them what you like. One personality is for patients and another one for everyone else. Of course the aggressive ,harsh and crude personality is for the patients because it is considered as a self defense mechanism but sometimes it becomes so deep that a doctor forget how to treat others gently even if they were his own colleagues! Sometimes they deal with you on sectarian bases unfortunately .This thing sometimes made me feel ashamed of being a doctor in such a setting because I will be judged by non-medical related personnel in a wrong way. One of the funniest things ever is that doctors with low ethics are most likely to be a general surgeon for an instance and I served for 3 months in General Surgery wards and it turned to be so true, on the other hand the most polite doctors are in Medicine wards and it is so true too, as I witnessed.

In the other hand, good things happen all the time. And we all should keep them in mind. The best thing ever that happened to me is that I helped others .You may ask yourself every doctor on this earth is helping others so what’s new in helping others? In Iraq helping others is much more different on 2 levels quality and quantity. The quality of pain and injuries are much more different, so deep and so disabling for the patient. The quantity is so high that numbers and research statistics are sometimes considered totally unbelievable. According to the previous facts I consider myself helping too much people alleviating too much pain and that really makes me feel (even for a while ) self satisfied.

Being left alone to handle major crisis most of the time makes you gain many skills, vast number of patients gives you a nice variety of cases and good enrichment of your clinical experience over time and I really respect this fact. I feel lucky to do things that an intern in USA would never dream of even after 5 years of service in the medical field.

Privileges of being a hospital resident person are so good especially in Iraq. You may ask yourself what’s good about living in a ward. The smell alone can make feel sick! The power is never off, the lights never turn down, the air cooler is always on, and tap water is always there. These things are the basic needs of a man which are not fulfilled outside the hospital and you must work hard to make it possible living without them. I feel doomed when I go back home and no air cooler is there and I want to sleep and I can not due to hot weather.

Finally I am proud of everything I did. I think I did very well till now. I survived. I learnt too many things and lost nothing but time and some hard work. Sometimes it is good to start your life in a hard way so that when time passes thing will be much easier for you as you become more adaptive and more tolerant. One day I will be somewhere else and I will remember this time of struggle as a spark that made me do good things out of bad things. I have a lot of dreams and for sure it will never be true till I get out of here, out of Iraq, someday I hope.

[cytotoxic]

well done doctor Nabil , I liked the effort u done in the article and appreciate it , still i don't know whether i will agree with all of what is there in it after i do my internship!

anyway , ty for sharing with us ....

[ali al-kafaji]

wonderful effort Nabil,
I really enjoyed it....
keep the spirit up....

ali

[Samer Q N]

sad, sad and sad
wish that it doesnt stay like this

[mermaid]

hii
good article
really
thanks

[yasirmhm]

Dear Nabeel,

I am so proud of your wonderful writing, keep on going and hope to see your name more often in the medical journals. It is a very difficult task, but you have the requirments. Best wishes.