San Francisco nonprofit working to educate medical professionals in Iraq via telemedicine

Iraqi doctors have been cut off from the rest of the world for years, with no access to current medical information, professional journals, or international colleagues. In medicine, that isolation can have tragic results as doctors struggle against already overwhelming odds in a war-torn country.
Iraq's medical care system is in crisis.

But a San Francisco nonprofit, WiRED International, is bringing online medical information and education, and medical collaboration with U.S. doctors, to the region. WiRED sets up real-time lectures from U.S. medical schools and doctor-to-doctor patient consultation via videoconferencing in both countries.

"This program serves the practice and practitioners of medicine," said Executive Director Gary Selnow, a San Francisco State University professor.
"Since 2003, we have provided dozens of medical e-libraries at med schools and teaching hospitals throughout the country, and in 2006, we launched the telemedicine program in Baghdad, Basrah, Erbil and Mosul," he said.

A "Save the Children" report states that 122,000 Iraqi children died in 2005 before reaching their fifth birthday. More than half of those deaths were among newborns in the first month of life. Since 1990, Iraq has made the least progress of any country in reducing its child death rate, the report indicates.

Cancers and heart disease in women, and maternity-related health problems are continually increasing, according to the Iraqi Ministry of Health and other sources.

Pediatricians and specialists in women's health are in short supply.

Human Rights Watch, an independent, nongovernmental agency, documented the dangers Iraqi physicians themselves face in a November 2006 report. Since the 2003 invasion, the Iraq Medical Association estimates that at least 2,000 physicians have been killed and 250 kidnapped, according to the report.
And an estimated 12,000 of the 34,000 doctors registered in Iraq before 2003 left the country between 2003 and 2006, the report states. That leaves those remaining to practice in specialties for which they aren't trained.

When those who have stayed connect with their counterparts in other parts of the world, the results speak for themselves.
"The doctors felt that they were rejoining the global medicine community," said Selnow.

WiRED's Iraq telemedicine program, begun in 2006 and then stopped for lack of funds, will restart in early 2008, according to Selnow. It will cover a full spectrum of medical topics, but will focus on women's and children's health.

The nonprofit prefers to equip the foreign medical schools it assists with access to online databases.

"Now the Internet is the gold standard for providing medical information," said Selnow.

But, in Iraq and other locations lacking predictable Internet access, that's problematic. WiRED volunteers in Iraq get around the problem by using hard drives. Even updating them, which needs to be done every six months, isn't easy due to the dangers of travel within the country.
WiRED's work directly benefits the practice of medicine there, according to internist Lezgin Chali, a physician in private practice who previously worked for Kurdistan's Ministry of Health.

He detailed by e-mail the daunting conditions facing Iraqi doctors: unreliable electricity and Internet access, unhygienic conditions, border closures, patient illiteracy, and difficulty in obtaining prescription and over-the-counter medicines.

Besides Iraq, WiRED works in 10 other countries in Central Europe, Africa and Central America.

It has installed more than 90 medical information centers — MICs — that provide electronic libraries that allow doctors instant access to medical journals, textbooks and databases. The majority of those are in Iraq. Since 2003, when WiRED went to Baghdad following the first wave of U.S. troops, it has set up 39 centers in medical schools and teaching hospitals across the country.

In October, the nonprofit established two more MICs in major Bosnian cities — Banja Luka and Mostar, both of which are still recovering from the brutal three-year civil war in that region.

Another WiRED effort is its Community Health Information Centers — CHICs — geared for grassroots populations in Kenya under a grant from the National Institutes of Health. The centers use interactive computer programs to educate people about HIV/AIDS and other diseases.

Selnow said the nonprofit would continue to expand its reach. It received funding in October to expand into India from the Medtronic Foundation, the philanthropic arm of the medical technology corporation.

WiRED's local medical partners that provide medical content include San Francisco State University School of Nursing, the University of California at San Francisco and California Pacific Medical Center.

It also works with Children's National Medical Center in Washington, D.C. and Massachusetts General Hospital in Boston.

To learn more about WiRED, visit www.wiredinternational.org.

—By Sheila Riley

Eren Goknar is a freelance journalist in San Francisco.