From destruction to rehabilitation

Last year a physiotherapist from Kent steered a course through several Iraqi 'hotspots' to work with the ethnic Kurdish population. As Frontline reports he found causes for hope amid the turmoil

Saddam Hussein called it 'the head of the snake'. This was the city of Sulaimany in northeastern Iraq, where Eduard Hoogeland stayed after leaving the UK for a three-month study break. Thousands of its Kurdish inhabitants were forced to flee to the mountains at the end of the first Gulf war in 1991 when the dictator sought revenge for an uprising by the ethnic population. But after Saddam's capture two years ago, they celebrated for four days. 'Perhaps one positive side of years of oppression is that the Kurds are skilled at building up life after it has been repeatedly destroyed,' says Eduard. He adds: 'Despite the ravages of war the Kurdish cities now have fairly good living standards and they are building the town up quickly.' Eduard took time out last summer from his job with Medway Teaching primary care trust in Kent to go to Iraq with his wife and two young children. He says they felt safe travelling in an area four hours' north of Baghdad with the help of interpreters but without the need for personal bodyguards. 'In the Kurdish controlled region we never saw or heard a bomb explosion. The media portrays this country to be in great turmoil, but they do not show the safe areas.' However he found people wary of speaking out and offering opinions - the result of being punished or tortured for voicing dissent or showing initiative under Saddam. 'This shows in the assessments and treatments that the physiotherapists do,' Eduard explains. 'They follow exactly what they have been shown and do not deviate an inch to learn something else.' He continues: 'The former regime certainly had strong ways to discourage people from thinking for themselves. Critical analysis is not done. Also, patients answer questions according to what they think you want to hear.' During his visit, Eduard taught for two days in Halabja, notoriously where several thousand civilians died in 1988 from bombs dropped by 'Chemical Ali'. He recalls: 'I could clearly see the destructive effects - after 17 years. We spoke personally to the people who lived through this gruesome regime and it is amazing how they all cope with it.' Eduard says the level of physiotherapy provision in Iraq is 'very low'. 'There is no standardised training level and no protection of title. There is a need for resources, books, equipment, financial help and for knowledge and skills, especially from professionals visiting the area.' However, he found a 'small but active' number of foreigners from different organisations working together in Iraq to raise the standard of physiotherapy education and service delivery. 'All the media focuses on the troubles,' Eduard says, 'but as the national elections showed, the Iraqis do want to develop and move forward. Foreigners are welcomed with open arms.' Eduard worked in Iraq with ACORN (A Community Oriented Rehabilitation Network), which focuses on rehabilitation in areas such as education and health and job creation. His colleague there was Kathie Sayeed, an Australian physiotherapist living in Sulaimany who married a Kurd and has two children. Eduard told Frontline: 'Currently one of the main focuses is on assisting the government in determining the design for a purpose-built rehabilitation hospital.' During his stay, Eduard led teaching sessions in hospitals and wrote a report assessing the status of physiotherapy in Iraq and suggesting how progress might be made in future. The report, now printed and burned onto CD-Roms, has been made available to different government branches and some international organisations and embassies. Eduard presented the report to several hospitals and a university, assisted by Kathie and another physiotherapist, Zach Sommermeyer, who was helping to set up an Iraqi physiotherapy association. 'Zach stayed in a town four hours' drive away. Getting to each other took a driver with car and a guard as we had to pass several checkpoints and as we came close to several hotspots.' Eduard and Zach led teaching sessions that focused mainly on electrotherapy, a treatment now available in several hospitals and clinics. 'An interesting point is that the teaching hospital did not have any electrotherapy but two TENS machines while the Children's Rehabilitation Centre has got the latest electrotherapy machines standing. However, the therapists do not have the knowledge or the skills to use them. We also tried to teach clinical reasoning and assessments skills.' Eduard used an interpreter where necessary called Ezzett, a locally trained physiotherapist who works in the Children's Rehabilitation Centre and is responsible for training all the physiotherapy students. Ezzett is now trying to study in England to get a degree, helped by ACORN. 'Besides his work, Ezzett helped me when I was treating patients and teaching in other facilities.' Eduard, who says he managed to set up a meeting with the deputy minister of health, says he was well received: 'Everywhere I went the physiotherapists were extremely eager to develop and to learn. I definitely would love to go back there.'

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