Psychosocial paediatric training in Iraq: perspectives of trainers and students

Perceptions, experiences and expectations of Iraqi medical students

BACKGROUND

The environment for medical education in Iraq has been difficult for many years. The 2003 invasion of Iraq accelerated a steady emigration of faculty and graduates. Kidnappings and deaths of doctors became commonplace. To understand current career plans, expectations and perceptions of medical students, three Baghdad medical schools were surveyed.

METHODS

Written questionnaires were completed by 418 medical students variously in their 4th, 5th and 6th (final)years of training. We asked about perceptions of the quality of their medical education, the quality of health services in Iraq generally, and about deaths, injuries and migration of faculty, classmates and family.

RESULTS

The average age of students was 22 years, with 59% women. Most students (90%) were originally from Baghdad. Although there were some positive responses, many students (59%) rated the overall quality of their medical education as fair or poor. Three-fourths of students believed the quality of hospital care in Iraq to be only fair or poor. A majority of students (57%) stated they were thinking frequently or all the time about leaving Iraq after graduation. Reasons given for leaving included the desire for further education, seeking a better lifestyle and fleeing conflict. Leading reasons for staying included the pull of friends and family, familiarity with the health system, and a sense of responsibility to the country. Nearly one in five (18%) students reported the death of a family member attributable to intentional violence, and 15% reported the violent death of a medical school classmate or faculty member since the 2003 invasion. Half the students reported at least one school faculty members had left Iraq because of the war.

CONCLUSION

Medical students hold a mediocre view of the quality of their medical education and of Iraq's health system. Many of their faculty members have left the country. The majority of students may leave Iraq after graduation, afforded the opportunity. This poses a significant problem for staffing an already demoralized and stressed health system. Current circumstances suggest the situation will continue to deteriorate.

The workload of a psychiatric clinic at a general hospital in a post conflict area: a model from Iraq

Purpose

– The purpose of this paper is to demonstrate how a psychiatric clinic in a general hospital can function in conflict-ridden Iraq through the easing of patient access to services.

Design/methodology/approach

– The workload of psychiatrists was analyzed for one year (2010) at the psychiatry consultation clinic located in the campus of the Medical City Hospital in Central Baghdad which is also a training center.

Findings

– A total of 2,997 consultations (both adults and children) occurred in 2010. In total, 96 percent were self or family referrals. Patient services were provided by five consulting psychiatrists for a variety of psychiatric disorders. The main therapeutic intervention was the prescription of psychotropics.

Research limitations/implications

– Despite the turbulent circumstances and limited mental health resources in Iraq, this clinic was established as a model to attract patients for consultation and triage management to reduce appointment defaults and delayed care.

Practical implications

– The data can contribute to the planning and development of mental health services in Iraq, contributing to the current body of literature and serving as a model for other conflict areas.

Originality/value

– To best of the understanding this study is the first in the country.

Psychosocial research with children in Iraq: current health practice and policy in a context of armed conflict

There is a need to show how psychosocial issues affect children in conflict areas like Iraq. Raising knowledge and awareness of children's mental health status in Iraq has been difficult and the knowledge base has been limited by the shortage of resources, international sanctions and the isolation of Iraqi scholars. Many obstacles to research in Iraq exist but an agenda should be developed emphasising the need for high-quality contextualised psychosocial research. Health researchers in the country need to clarify basic population parameters and to provide culturally appropriate, evidence-based interventions for practitioners.