Local physician: Iraq lacks public health

By Dr. Michael Rath
The Free Press

Mankato physician Michael Rath is back in Iraq on his second tour of duty, training and assisting medical personnel near Baghdad. He is supplying The Free Press with e-mail photos and short accounts of daily life for military members there.

Col. Rath is an 18-year member of the Minnesota Army National Guard and its top medical official. He was first activated and sent to Iraq in February 2005. His tour ended early when it was discovered he had heart disease. He underwent angioplasty and stenting, recovered at Walter Reed in Washington, D.C., and returned to Mankato and his practice at the Mankato Clinic Wickersham campus. He had no permanent damage.

He was deployed again late last year.

In the past three weeks, it is evident that more American soldiers are moving into the country. The Baghdad area and Al Anbar Province continue to gain most media attention with civilian and military casualties. Insurgent activity is deadly and unpredictable in many cases. The 1st Brigade saw its 17th fatality last week.

Many local children are seen at a clinic supervised by American soldier medics and providers. The majority of these children have been burned by cooking fires or hot water spills. Most severely burned adults and children are transferred to larger civilian or American military hospitals for initial burn care, but eventually transferred to local hospitals with limited resources. Many doctors have left Iraq with their families to escape sectarian violence.

Much first-aid is ultimately left to the parents. Many cases are seen several days after the burn incident, wrapped in bedding, and “cleaned� with gasoline or layered with folk remedies. All debris must be removed, wounds cleaned and dressed. Morphine may be given to control pain. The Australians have introduced a “honey dressing� for burns that is inexpensive and easy to apply and remove. Some victims return daily for several weeks, while others leave and may not be seen again.

An Iraqi medical NGO (nongovernmental operation) has recently appeared bringing hope that more will be done for the local population. Health care is private in Iraq, and there is no insurance or medical assistance. Patients rely on relatives or a local sheik for assistance if money is unavailable.

Coalition forces are also training Iraqi Security Forces EMT (emergency medical technician) and advanced first-aid in the hope that villagers will receive education and services while soldiers are on duty.

The unanticipated troop extension has placed everyone in limbo.

In the meantime, soldiers go on with their mission and try to keep their families supported in any way possible. It is a difficult task 7,000 miles from home. Support groups throughout Minnesota do what they can, helped by agencies and organizations including the Department of Military Affairs. Nearly 3,000 Minnesota soldiers serving overseas or returned from active duty are still on orders and their families, employers, businesses and communities are all affected. It is truly a stressful time.

A few weeks ago, sports fans watched the Super bowl. Here, with gusty winds and blowing dust, the game was watched at 2:30 a.m. for those who could stay awake. There were no Super bowl commercials to watch on Armed Forces Network by policy, which took something off the time outs. With two daughters in the Chicago area, I was rooting for the Bears. Maybe next year.

Public health lacks many resources in this region, including education, providers and services. In rebuilding sectors of developing nations, both military and nongovernmental organizations provide limited direct services and focus on disease prevention and other sustainable projects that will improve overall health. This is a daunting task in Iraq, with security issues and limited NGOs who are willing to work in the region.

I am feeling fine, have lost some weight by running about three miles nearly every day, and keep in contact with Carol every day.
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