Monday, March 22, 2010

How do you say "FUBAR" in Arabic?

During each shift, we enjoy the luxury of having 2 Arabic interpreters to help us communicate with our Iraqi patients.  Some of these interpreters are American citizens, perhaps Iraqi Christians who emigrated under during the Iran-Iraq war in the 1980s, or Shia escaping discrimination and harassment at the hands of the Ba'athists. A number of our interpreters are Iraqi citizens, and the remainder are active duty military members who speak Arabic as a native tongue or studied it for this precise purpose at the Defense Language Institute (DLI) in Monterey, California.  Near all of these individuals share one thing - in addition to their mastery of Arabic - however, insofar as they previously did something else for a living.

For one of the interpreters, this offered an opportunity to escape the hijab (veil worn by women in Islamic nations) after her university education was interrupted at the end of Sadaam's reign.  Another is a contractor from Dearborn, Michigan, home of the largest Iraqi-American community, here to make 3x the money he can make doing anything else.  He is a young man with education and skill, raised within a wealthy, family who was working as a merchant in the shop owned by his expatriated family.  In the ICU, we also have the luxury of speaking to our patients through translators who also happen to be physicians.  One of these physicians joined the US Army upon naturalization, and is now a corporal serving under the American doctors here as a translator.  He is active duty with a family back in the United States, and filled with joy to be working outside of his field, below his level of education, for a $25,000 salary buttressed only slightly with his deployment hazard pays. 

Without any tone of bitterness, he affably describes the long road ahead of him to return to medicine as a physician in the United States.  Though he completed his medical training and was practicing in Iraq prior to the war, he will be required to gain admittance to a full American residency training program, and this, only after passing the 3 part USMLE test which American doctors normally take after their 1st and 3rd years of medical school, and complete after their internship in order to practice medicine in the United States.  Given his commitment to military service as a translator, this will take him 5 years at minimum, and possibly more.  Nonetheless, he is happy for the opportunity. 

Though he and other Iraqi physicians who now work to relay my messages to any Arabic speaking patients, live on Post, they often travel to clinics outside the gate, and previously had gone with special operations units on goodwill missions, or, in some cases, in terrorist search missions.  Now they are mostly at the hospital, working in the ICU, but they say living outside the wire within the local population would be suicide.  The resistance sees these individuals as traitors, and American sympathizers, and several of them have been brutalized, beheaded and defiled in unspeakable ways. 

The history of violence under Sadaam and then in the anarchy that ensued after the invasion, has left Iraq similar to a large Lebannon or Palestine - deplete of professionals, victim of a massive brain-drain.  Those with opportunity, whether actively pursued and harassed, or just seeing the writing on the wall, have fled this chaos to protect themselves in their family.  They left for nearby, stable regimes (Jordan, Egypt), Europe or the United States.  The result is a populace replete with uneducated leaders, grand fodder for religious fanaticism, and a vacuum of educators to give the swelling mass of youth skills with which to busy their lives.  In medicine, I see this first hand, when, after caring for the traumatic injuries of Iraqi soldiers, we have no outlet of suitable rehabilitative care.  These patients, often now without a leg or use of half of their bodies, are left to the mercy and devices of their families.  There is no Center for the Intrepid  ( in Iraq.  If patients are deemed too ill or injured, their families may just dump them into the Tigris days after release from our care. 

How do you go about fixing this problem?  The prevailing answer is:  the youth.  New leadership is stressing education and making some strides.  But just like with the stories you hear back home of a rag-tag Iraqi police force, the medical corps has its challenges.  In a country of 30 million people, the need for medical professionals is dire.  It is hoped that ensuing political stability can ensure safety for those from around the world still willing to come here and help.  Regardless, it will be a long road.

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