BY TONI LAPP
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 Iraqi health care professionals listen as Lt. Col. Mark Harris, M.D., discusses emergency obstetrical procedures during an ALSO course that has engendered an overwhelmingly positive response from participants. |
In post-war Iraq, an AAFP CME program is helping to rebuild the shattered medical system -- and response from Iraqi medical providers so far has been overwhelmingly positive.
The Advanced Life Support in Obstetrics, or ALSO, provider course teaches techniques for handling obstetric emergencies.
One need only look at statistics to recognize the need for such a program in Iraq. According to the CIA World Factbook, 55 Iraqi infants die for every 1,000 live births. By comparison, the infant mortality rate in the United States is 6.75 per 1,000.
That's why one FP in the U.S. military led the push to teach the ALSO in Iraq.
Lt. Col. Mark Harris, M.D., a family physician in the Army's 1st Armored Division, and other physicians presented the course to Iraqi medical professionals for the first time in late October. The seed of the idea was planted when Harris saw the course advertised in an AAFP catalog.
Presenting ALSO has been a gratifying experience, said Harris, who -- along with most other members of his division -- had been in Iraq about six months by late October. "This course was definitely a highlight for me, and was the best event in the deployment for many of our other physicians," he said in an e-mail interview recently.
Harris has encountered cultural barriers to teaching ALSO in Baghdad. "Language is the biggest," he said. Arabic is a difficult language for English-speakers to learn, he said, but most Iraqis receive their medical training in English. So the presenters teach the course in English, and the more fluent Iraqis help the less fluent.
Then there's the delicate issue of societal norms.
"Most providers of women's health care in Muslim countries are women because of cultural and religious concerns, so we weighted our faculty towards women, even though there are many more male physicians in the Army. Many Muslim women will not even touch -- even shake hands with -- a man," he said.
Thirty-two Iraqis, five U.S. Army instructors and two student facilitators attended the first course in Baghdad. The 1st Armored Division plans to offer the two-day course at least twice more, said Harris.
"The response was overwhelming," said Harris. "They invited us to their hospitals, their universities and even their homes. Many gave me their home phone numbers -- those who have phones -- and asked me to call them personally for further classes. We are planning to accept as many invitations as possible, but people are dying every day out here, so security is a major issue."
Harris said ALSO was his favored maternity care training program. "I learned these skills for the first time from ALSO," he said. "It is concentrated, systematic and comprehensive.
"It is a good way to learn and teach."
The notion that ALSO can spread American good will overseas is not new. ALSO has been presented in Canada, England, Scotland, Wales, Australia, New Zealand, Hong Kong, People's Republic of China, Denmark, Haiti, Nepal, Kenya, Pakistan, Greece, Brazil, Ecuador, Paraguay, Qatar, Ireland, Italy, Turkey, Gaza Strip/West Bank and Zambia. Plans are in the works for a course in the United Arab Emirates in February.
In addition, the latest Physicians With Heart airlift arrived in October in the former Soviet republic Kyrgyzstan, where airlift delegation members presented the ALSO courses and provided education about family medicine to Kyrgyz physicians. The delegation built on the success of the 2002 Physicians With Heart participants, who presented the courses in Uzbekistan. The Academy; AAFP Foundation; and Heart to Heart International of Olathe, Kan., are partners in Physicians With Heart, a humanitarian effort that brings needy countries donated pharmaceuticals and other medical supplies.
ALSO Manager Diana Winslow, R.N., is not surprised by the program's reach overseas.
"As the ALSO program is implemented internationally, it is clear that this type of education is adopted with great success," she said. "It is primarily the structured, evidence-based, multidisciplinary approach that seems to appeal to all, especially the interactive training."
For more information about ALSO, go to http://www.aafp.org/also.xml.
To reach writer Toni Lapp, e-mail tlapp@aafp.org.
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Copyright © 2003 by
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