Basra Diary

Dr Eva-Maria Hobiger, of the Aladdin’s Magic Lantern organisation, which 4Basra supports, attended an international medical conference in May at the University of Basra – making a visit has been impossible due to the violence in the city over the past several years.

Below are some extracts from her diary:

WE pass the cities of Safwan and Al-Zubayr. There are countless police checkpoints along the way, often within sight of each other.

Added to these are numerous military posts, which lie between the police checkpoints.

Street vendors have erected scanty booths along the median of the highway from which they peddle watermelons and other fruit.

Across the street I see somebody driving the wrong way – a man with a horse-drawn cart loaded with gas cans under a covering made of reeds driving headlong into traffic.

At some of the checkpoints we also drove the wrong way; as we approached a checkpoint, our police escort would suddenly change lanes and speed past the long string of stopped cars in the opposing traffic lanes.

In the distance one can see smoke billowing from the oil fields; we are driving through the part of Iraq under which the country’s greatest riches, the super giant oil fields of Rumaila, the largest petroleum deposits in the country.

Herds of sheep graze on both sides of the road, searching for isolated blades of grass offered up by the desert in spring.

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GREY SKIES, PURPLE HOSPITAL

SOON after, we approach the entrance to the city of Basra and this view of the city is a familiar one to me, resembling the images that had made such an impression on me so many years ago.

To my utter dismay, I don’t notice any substantial changes or improvements.

There are a substantial number of housing projects under construction, which I later learn are really just a collection of many individual projects that were begun and then hastily abandoned when the money ran out.

Today, just as it has been for years, garbage lines the city streets to the left and right: plastic bags, tin cans, bits of metal, paper, rotting fruit.

The air is dusty, the sun hidden in a sky made grEy by clouds of dust. I discover some new shops along the street and there are many new cars.

But today, just as before, I still see children selling gasoline from plastic canisters and bottles.

These are little boys only 8, 10 or, at the most, 12 years old, who should be at school at this time of the day.

In order to make a living for themselves and perhaps their whole family, these children sell gas they obtain by siphoning gasoline through a hose with their mouths, a practice both dangerous and risky to their health.

When we get to the Mother’s and Children’s Hospital, it impossible not to notice that it was very recently painted.

The peeling light green paint from the 1970s has been replaced with a fresh coat of light lavender, a somewhat unusual color in this part of the world.

Does this one change signal other improvements to the hospital?

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EPIDEMICS IN BASRA

ANOTHER mother calls me to her child’s bedside. Her child is not doing well and cannot stop vomiting.

Together with the young doctor I review the child’s chart while she informs me that already, in early May, thousands of children in Basra have fallen ill to diarrhea.

Under normal circumstances one would not expect to see so many patients suffering from diarrhea until June or July.

But the temperatures have already risen and the water quality, as it was before, is horrible.

Those who depend on tap or untreated river water are at highest risk, especially children who have yet to develop sufficient immunity to these disease-causing germs.

And, if contracted by a child with leukemia or any cancer who is on chemotherapy, the infection can be especially severe.

I try to reassure the mother, telling her that her child is getting IV fluids and the necessary medications and it will be a few days yet before the child recovers.

There are so many cases of infectious disease in Basra. Currently there is an epidemic of measles; when it was still a bit cooler, rampant whooping cough.

I see a number of children with chicken pox during this trip. In recent years, immunization programs have not been adequately implemented.

The poor security conditions are to blame, as well as the fact that many children were unable to attend school; many immunization programs take place in the schools.

Apart from this, it has been impossible to provide continuous cold storage of the vaccines because of frequent power outages and interrupted electrical service and therefore the vaccines, when given, often no longer work.

The presence of so much disease really shouldn’t come as a surprise, all one really needs to do is look around and see the large packs of stray dogs searching through garbage strewn about everywhere.

Leishmaniasis, the quintessential disease of poverty, infects countless Iraqi infants.

Last November, I sent 300 packets of Pentostam to Basra, enough medicine to effectively treat about 1,000 children.

One doctor told me that over the entire past year, the Iraqi Ministry of Health had only provided five packets of Pentostam for his hospital – this in a region where thousands of people, mostly children, contract the disease annually.

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BEYOND SALVATION

I WANT to see another ward and Jenan takes me.

As we go, I notice that many of the ceiling tiles have been removed from the hallways, as well as in some of the rooms.

I ask Jenan about them and am appalled at her explanation.

She explains that they were removed when it was discovered that thousands of rats were nesting in the space above them, between the water pipes and electrical wiring.

There were cats up there as well. Vermin of all sorts contaminate the floors of the hospital; bugs and insects are not uncommon.

The walls in other neighbouring wards are moist and covered in mold and mildew.

The condition of the hospital is indeed much worse than before.

The rooms, in which seriously ill children lie, are unlit; there is no air conditioning.

A glance into these rooms reveals only the bleakest of pictures: the beds and all the contents of the rooms were more than unsightly.

One wonders: Is it even possible to get well here?

Only the children’s cancer ward, which we renovated so many years ago, remains the exception to the decay of the rest of the hospital.

The basic structures of the hospital have decayed to the point that general disinfection is pointless and impossible.

I know how horrible the conditions are in the operating and delivery rooms.

The only reasonable option left for this place is to tear it all down and build a new hospital; it is way beyond salvation.

To think this was once one of the critical care trauma hospitals in Southern Iraq.

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THE NEW HOSPITAL

OUR group insisted that at the very least we be allowed to visit the construction site of the new hospital, a project initiated in 2003 by the wife of the ex-president of the United States, G. W. Bush, and mired in controversy from the very beginning.

This was to be a modern, 100 bed facility, fully appointed with all the tools of modern medicine with a construction budget of $50 Million dollars.

How on Earth is such a hospital supposed to function in a place where even the most basic services, like electricity and clean drinking water, are lacking; when most medical specialist have left the country, where practically no nursing staff remains, and there aren’t even any medicines or cleaning supplies?

By 2006, all $50 Million dollars were gone and the hospital project was nowhere near completed.

Today, still, it is far from finished. In the meantime, however, the project has devoured more than $200 Million dollars.

The reality is that this hospital, if and whenever it finally does open, will never be able to replace the Mother’s and Children’s Hospital. It has far too few beds.

We visit the construction site and are lead around some parts of the hospital. Some areas are inaccessible to us because there is no electricity.

Indeed, it is a hospital of monumental proportions—especially in relation to its bed capacity—and I feel sorry for the personnel who will need to traverse the wide distances between isolated work areas.

In a quiet moment I ask myself: How do they expect to address and overcome some of the biggest of Iraq’s facility problems, namely lack of maintenance and upkeep?

When this hospital finally opens, how will it look after a few years?

I ask these questions of the future hospital director who is leading the tour of the building.

He is one of the doctors who has been to Vienna for advanced training.

He confirms the problems will stem from the fact that there will be very little money for general maintenance.

I can barely comprehend this, we know exactly what kinds of patient burden Iraqi hospitals cope with daily.

(For example: One “delivery room” with only two beds performs 80 deliveries a day.)

Some of the patients are nomadic and have never lived in a house and have no idea how to use many household appliances.

Given the importance of janitorial and maintenance work demanded by these conditions, there would need to be a correspondingly large budget to address them.

For this there will be nothing?

Presently in Iraq there are about 1.2 beds per 1,000 residents. In Germany and Austria the number is between 6 and 7 per 1,000.

Our little Austria, with a population of 8.3 million has more hospital beds than Iraq and its population of 28-30 million.

Just to achieve the average benchmark of 3.3 beds per1,000 people, Iraq would need to create almost an additional 100,000 beds—and, of course, the hospitals they would occupy.

With the glaring shortage of medical personnel in Iraq, how is that supposed to happen?

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A SONG FOR LIFE

IN the morning we are loaded into cars and the convoy leaves the hotel headed toward the place where the conference is being held.

One more trip with flashing lights and howling sirens.

The canals, pictured in postcards from the 1950s flowing with clear water and possessing a deep blue hue, are dirty brown and their banks are heaped on both sides with towers of garbage.

Curious, we peer out from the car windows and take photos.

This is our only opportunity to see and experience something of the world outside.

The conference is being held on the premises of the Southern Oil Company and the first talk is given by a professor from Hiroshima, Japan.

During the coffee breaks there are many opportunities to converse with other doctors.

Sometime after lunch the Minister of Health arrives, the conference is taking place under his sponsorship and at least he participates from time to time.

A man comes to talk to me; his 14 year-old daughter has leukemia.

Today she stands before me wearing a colorful dress and is healthy.

The father thanks me for his daughter’s life; for he knows that the medications that restored his daughter’s health came from me.

These are the moments when a person knows for whom they work, for whom they fight, and for whom they endure so many difficulties; moments that are simply priceless.

The conference’s official opening ceremonies are held that evening.

They begin with the Iraqi national anthem and a speech by the Minister of Health. Afterwards I give my presentation on our work in Basra of the past years.

Then comes the high point of the evening: a song, sung by more than twenty children who have had cancer and are now healthy.

Dr. Jenan had called up fifty families, but many of them live too far away from Basra and their parents were unable to bring them to the rehearsals.

The children sing a song that carried the title: A Glimmer of Hope.

I’d like to share the lyrics of the song here:

From this place forward we give our thanks

Our hope has returned

And the wish we dearly wished, came true

With your love and with your medicine, we were healed

With patience and faith, we conquered cancer

You opened a window of hope, and we took a step into the future

We will keep singing, for a new world, for happy days

Free from despair

Our belief in life we shall never lose

We are filled with hope, we are filled with happiness

And today we come to share with all who’ll listen this, our happiness.

The lyrics were sung in Arabic, of course, but they were also projected onto a screen in English so everybody could understand.

I can’t look around the hall because I am fighting back tears, and afterwards many people tell me they were not able to hold back their tears.

I believe the raw emotion brought the entire hall nearly to tears. It was a truly unbelievable moment, emotional and deeply felt.

These children, standing before us so healthy, would have been dead—without our help, without our donations, without our work, without our involvement.

And I know this was only twenty out of thousands who are still around today, although we can’t see them all.

The children’s performance was Jenan’s idea, intended as thanks for our help over these past years.

They sang of hope and happiness—and did so from the midst of chaos and terrible circumstance that is still very much the rule in Iraq.

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DEPRESSSION AND HOPE

WHEN we get stuck in traffic the next morning, our convoy manages to avoid the mess by turning down a side street—and we are all appalled at how the streets look just a few yards from the main thoroughfare.

We see huge potholes, up to three feet deep, punctuating the street; crumbling walls surrounding homes; giant ponds of sewage heaped with garbage; old car tires, and huge cracks in the pavement under the feet of playing children.

On the thoroughfares police and military fortifications stick out: made either of corrugated steel roofs mounted on four posts, or some sandbags, or even just a pile of old bricks.

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IN a quiet corner of the lobby I strike up a conversation with one of the doctors. I will never forget him.

He expressed deep frustration and depression when he told me that all of his siblings had left the country.

He had stayed, because he wanted to change things here.

But countless times every day he confronted huge insurmountable barriers: every day of ever week of every month of every year, and now for so many years running.

He feared he might lose his strength. Then what? Just give up? Just leave, like all the others?

There are hardly any specialists left in the whole country, who is supposed to treat the sick, how are things supposed to continue in Iraq if all the people leave?

Those who have fled to other countries are very often the most educated, the academics, and the specialists.

They are a blessing for the countries where they now live, but they are missed in Iraq. His heart has hardened in the course of the past years, he fears.

Well, I don’t believe this man has a hardened heart, but surely he has protected it with a strong shield. It’s unavoidable; you have to protect yourself if you want to survive.

We sit there silently for a few minutes, what can I possibly say or do that would give this man courage? Are there any words that help under these conditions?

He anticipates my question and says, “The fact that you accepted our invitation to come gives us courage. We need to keep working, no matter how hard it is.

“When times were really bad in the past years you never forgot about us, never forgot about our children. That gave us courage, strength and motivation—and also hope,” he added.

Perhaps we accomplish more with our work than it first appears, more than we are told…

The conference comes to an end, finally, that afternoon.

This event certainly required long and arduous preparations and involved a huge effort of the organizers.

Considering the prevailing conditions makes it all the more a remarkable achievement, especially because we, the foreign guests, represented so much uncertainty.

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POLLUTION

CHILDREN and old ladies beg on the street corners; some children sell fruit or bottled drinks.

They stand there, all day long, in the middle of the traffic turmoil, breathing exhaust fumes.

Many children have lost their lives in accidents doing this work, which is hardly surprising given the way people drive around here.

We drive through a part of the city unknown to me until now.

It’s surreal; cows wander the streets searching out blades of grass between piles of trash – very different from our cows grazing in soft green meadows at home.

On a street with forlorn and disintegrating houses on both sides, we stop in front of a gated entrance—you never leave your car on the street here.

Inside, the entire family has gathered, many relatives have come to see the woman doctor from “Nimsa”—the Arabic name for Austria.

It is quite an experience, and always surprising, to witness Iraqi hospitality. I always imagine that at least ten other visitors are expected when I see the plates full of food set before me.

The woman of the house is constantly worried that I am not enjoying the food, because even when I am done, almost everything remains.

No wonder, given the massive quantities she prepared.

I go out into the “garden”—a couple of chickens kept in tight quarters in a pen in a yard full of junk.

One of the canals flows behind the yard and I want to take a look at it—and then I have to catch my breath at what I see beyond the bank: a thick dark brown sludge emitting a horrible stink—the ideal breeding ground for insects, parasites and vermin.

It comes as no surprise that there is so much sickness in Basra; it is not possible to be healthy in this environment.

On the opposite bank a couple of feral dogs look for food.

Pollution in Iraq has progressed to the point that, in my opinion, I am afraid it might be too late to reverse.

On the way to the border, I once again notice the pollution around me: the desert was once kept clean by birds, but the vultures can’t eat the waste of these times— bottles, plastic and metal—and this is what covers the desert as far as the eye can see.

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SCORCHED EARTH

IRAQ is a failed nation, a country wasted.

Its historical and cultural roots have been shattered, the environment devastated, its most basic capacity to support life destroyed, society is ruined—and its people psychologically devastated.

Where to begin? How to begin?

How can reconstruction truly get under way here, without the constant fear that every new project, once started, will ultimately, dismally fail because all prerequisites for success is absent.

Never before have I been more aware of the extent of the devastation of this country as I was during this visit.

One of the doctors described it simply, but appropriately: “There is no light at the end of the tunnel.”

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MY feelings regarding this recent trip are so ambivalent.

On the one hand the trip was very sobering for me; I expected more, more positive development—in this realm I was disappointed.

Security has improved—although it is far from optimal.

But other than that, everything is pretty much the same as it was four years earlier—or even worse.

You can paint the outside of the hospital, but that alone does not change the fact that it is rotting from within and pests devour it from the ground up.

You can build a modern hospital, yet lack the means to bring it into service.

There are still no medicines for the sick children, or any other sick people.

If an individual doesn’t have money—which a majority of the population does not—to buy medicines on the black market, then what they get is a death sentence.

And what of the father, the mother, forced to watch their child die because they couldn’t scrape together the money to buy medicine?

What about them?

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A FEW days after my trip, an Iraqi newspaper wrote: “Prime Minister Maliki described corruption as “the greatest enemy of the reconstruction of Iraq.

The Parliament has begun an investigation into the dealings of ministers suspected of corruption and their associates.”

I can only hope this investigation succeeds and is broadened beyond the lower levels of the power hierarchy, because the Iraqi people suffer unspeakably from the consequences of this corruption.

What is especially damaging is the fact that nearly all the educated people in Iraq have left. These days it is increasingly rare to meet anyone who speaks English.

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BUT I also experienced much that was positive, especially the wave of gratitude that I encountered—I must have heard the word “shukran—thank you”, hundreds of times during these past few days.

In the beginning it came from the children and their parents, but then from those who somehow maintained their idealism despite everything, who persevered in their hospital jobs in order to do their duty and provide care for the sick.

Once more it dawned on me: the only way I have been able to stick with my projects is because I’ve had such dependable partners: these doctors, sticking it out in Iraq so they can be there for the sick people—the sick children, they who overcome every setback only to begin all over again and again.

We owe it to them that we are able to achieve so much in a country where so many things fail, where so many projects will never be realized because the money…simply…. vanished.

Thanks to our project partners in Iraq, we can be sure that every single donated Euro is put to good use; nothing in all these years has ever gone missing or been misappropriated.

These doctors painstakingly guard each and every dose of medication we send them.

And yet there is still far too little medication in Iraqi hospitals, a lack of instruments and supplies—and for these reasons thousands of patients die.

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EVEN then there are unbelievable examples of selflessness, courage and idealism.

At the urging of Dr. Jenan, for example, an organization—call it a support group—for parents of children who have had cancer, or are currently fighting cancer, was founded.

Now it is self-supporting.

Just one example of their work: In Iraq there are no blood banks or blood donation centers like we have.

There, somebody in the family must donate blood for a sick relative.

But what if the family lives far away and nobody can come, and the parents who remain with the child have already donated multiple times?

This group of parents managed to get a blood donation drive going among the local soldiers, so that children who needed a blood transfusion would get one—something so completely normal in our countries, but highly unusual in Iraq.

And they have bigger plans.

On their website they call upon the government to provide care for all the pediatric cancer victims in the country.

For us, this is nothing special; but in Iraq, where people are still accustomed only to taking orders and never acting proactively, this is magnificent and exemplary—and a tentative sign that could develop into something positive.

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AND THE FUTURE OF OUR ORGANISATION: ALADDIN’S MAGIC LANTERN?

IT’S more than I’m capable of, to build a hospital in Basra—although I’d truly like to.

But I do want to try to continue the work we’ve begun, despite financial crises and despite weariness, which can afflict anybody who does this work—practically—alone.

The trip to Basra provided a huge incentive to keep going.

We have demonstrated over the past few years that it is possible to provide concrete help, even in a country where chaos rules over everything—I have just experienced it.

To see healthy, laughing children before you and to know that their lives can be preserved by one’s own labor is motivation enough to keep working.

Given the present circumstances I’m convinced that the need to provide further support for medications is absolutely urgent and necessary.

By the end of August, at the latest, I will again need to send another shipment of medication on its way to Basra.

I wish in any case to continue to arrange medical treatment of the sickest children in other western nations.

Last year it was twenty children; this year 11 children have already been brought to Europe for treatment.

I have a long list of others who are still awaiting their turn, because the only chance they have of survival is to have an operation in Europe.

And I would love to start a new project: scholastic sponsorships for children to allow them to attend school.

To accomplish this, I would need to hire someone in Basra to act very much in the role of a social worker by making regular visits to these families, identifying children who need sponsorship, monitoring their academic achievement, purchasing school supplies and uniforms, etc.

The path that now lies before Iraq is long.

It is too long for one generation, too much work for one generation.

Those children, those young cancer survivors, sang about hope—and that should give us all hope.

 

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