In The Pediatrics Hospital

IN THE PEDIATRICS HOSPITAL….Halabja has been at peace since American and Kurdish forces pushed a fundamentalist terrorist group out of the neighboring villages in 2003. People here tell me that some of the fundamentalists were Kurds, a thought that unsettles me, but they hasten to add that some were also Afghans and other foreigners fleeing the defeat of the Taliban. This recent history of the Shahrizur region, of which Halabja is a part, has been particularly contentious, because the Bush Administration claimed without much evidence that the terrorists received support from Baghdad. While they were no doubt convenient for the Baath Party, it’s more likely that they received support from Iran, the country to which they eventually fled.

These arguments often create more smoke than fire, but the practical result is that many Kurds are still nervous about terrorism in the Shahrizur. The manager for Halabja Hospital, Dr. Ako, is concerned about being responsible for my secuirity. He mutters something about Guantanamo before stating that he wants me to commute back and forth to the town rather than staying overnight. I am not satisfied with this because I want to be on scene at all times to oversee the research. I begin to tell Dr. Ako that there’s no chance he will end up in Guantanamo, but then I think of NSA taps, Abu Ghraib sex pyramids, and torture memos. We live in peculiar times, and I hold my tongue.

The new routine has me driving to Halabja a few times a week to solve problems while a group of deputized Kurdish nurses collect the data. To be honest this suits me well. In Sulaimania there are hot showers and clean drinking water. There is the bazaar with its endless alleys. And most of all there is the dar of the nchoshani minalan, or children’s hospital. The dar is is my new home in Kurdistan, a communal living environment for all of the doctors working on the pediatric wards. I live with three men, all in their early 30s and equivalent in training to American residents. Some older doctors also live in the dar, though they tend to be transplants from more dangerous cities in Iraq. Housing is free; it comes with three meals a day and as many medical discussions as you want.

Rounding with the Kurdish doctors is an exotic experience for me. I am not headed towards a career in pediatrics, but it is obvious even to a neophyte that therapy here is a matter of improvisation, not protocol. One night a child comes in with diarrhea, dehydration, and rapid breathing. We give him IV fluids and base to slow his breathing, but three hours later his heart stops and he dies. We suspect he had a larger systemic infection, but without simple lab tests ? a leukocyte count, serum electrolytes ? the diagnosis is still unclear. Later I find out that some of these tests are available, but there is no lab technician working in the evening because the government has not approved the idea. This is a typical explanation for inertia in Kurdistan, and it never fails to make my jaw drop.

It is easy to look at the practice of medicine ? or any other sector ? in a developing country and point out the shortcomings. In fact this is a favorite pastime of some of the older, well-travelled physicians on the service. I find this has limited usefulness, and I make a point of staying beside the Kurdish residents even when a child dies of something unheard of in the United States. But some things are easier to correct than others, and as with many problems in Kurdistan, I sense that the centralization of authority is a part of the problem. Throughout the society young people are given little opportunity to pursue innovative ideas, and even simple reforms, like night staff, must be funneled through the political parties. Healthcare workers point every problem towards the Ministry of Health, a building occupied by pondorous people who are more slow and politically sensitive than outright corrupt.

A more decentralized system in Kurdistan would empower younger professionals to try new ideas, and it would end the political cover for bureaucrats that oppose them. In short, it would make everyone more accountable. Complex innovations like bone marrow transplant would take time, but simpler things like research, education reform, and diagnostic services would arrive quickly.

The Kurds are ready for this. Each year hundreds of doctors, engineers, and other professionals graduate from the growing universities, and they are more frustrated by the slow progress than any visitor possibly could be. The pediatric hospital in Sulaimania is an excellent place to see the new Kurdistan in all its strengths and flaws. And it’s a good place to realize that the political parties, long the champions of the people, are becoming a barrier to their further development.


Jonathan Dworkin, a medical student in his final year at Mount Sinai School of Medicine in New York, is travelling in Iraqi Kurdistan from January to March of 2006. Other posts in this series:

February 18: In The Pediatrics Hospital
February 5: Halabja
January 25: Kurds and Jews
January 18: At Home in the New Kurdistan
January 14: City of Refugees
January 11: First Impressions

Jonathan Dworkin

Jonathan Dworkin Dworkin is an infectious diseases doctor. He’s the author of the first medical study to investigate the long-term social impact of chemical weapons on the people of Halabja, Iraqi Kurdistan. His more recent work has focused on typhoid fever in the Iraqi Kurdish city of Sulaimania. He has written several articles on Kurdish culture, Kurdish politics, and relations with America.