An Iraqi medical resident, Mohammed Hassan, is worried about fulfilling his Hippocratic oath.
A recent graduate in cardiothoracic surgery from Karbala Medical College in Iraq, the 27-year-old is worried he might hurt, rather than help, his patients.
Most of the professors “were not able to explain the subjects well,” said Hassan. “The lack of academics led the college to bring working doctors and even professors from other faculties. They give us long chapters to study on our own. The exams were from the Internet.”
Hassan’s complaints that Iraqi medical professors are not the best teachers are common.
Years ago, graduates of Iraqi medical schools were considered among the best doctors in the Middle East. Today, a year after the rise of the Islamic State and more than a decade after the United States invasion, the country’s 21 medical schools lack professors, cadavers for anatomy lessons, laboratory equipment and other basics.
“The most important obstacle is the number of teaching staff,” said a surgery professor at the University of Baghdad Medical College, Tharwat Sulaiman Al-Hayo. “We have a severe shortage of teaching staff,” he said. “The other problem is the financial support, which was almost nothing in the past year. The situation is quite similar this year.”
As a result, said students, many Iraqi medical courses concentrate on theory rather than clinical medicine or research. Students also complain about professors’ style and qualifications.
“The problem in the labs was the lack of professional teaching staff,” said Ahmed Mafraj, a physician who graduated from Al-Mustansiriyah Medical College in 2013. “Most of the instruments are never used, and the lab courses were just like any other lectures.”
The pedagogical style of Iraqi medical education reflects its theoretical bias.
In exams, professors expect students to regurgitate the steps in diagnosing and treating ailments or injuries rather than quizzing them on how they might apply those steps in case studies—a common approach in the United States and elsewhere. Rote knowledge, after all, doesn’t help in real-life situations, said academics.
“The examination method is not useful. It is all about diagnosis management,” said Sarah Al-Obaydi, a former Iraqi medical student who is now a postdoctoral visiting scholar at the University of Utah. “The American system with multiple-choice questions is much better and can assess knowledge in a thorough way.”
Iraqi medical students are also unable to get practical experience because they rarely get access to cadavers. Professors cite the high cost of bodies as a reason why students don’t get hands-on training.
“We have only plastic bodies,” said TukaJawad Al-Jubory, a fourth-year student at Thi-Qar Medical College. “Bodies are expensive. Even the skeletons are plastic models.”
Religious objections have also stymied efforts to bring cadavers into medical schools.
“There was several efforts to bring new bodies, but all of them failed due to religious opinions that forbid dissection of corpses,” said Mafraj, adding that the University of Baghdad has preserved corpses dating from the 1970s, which are used for demonstrating features of human anatomy, without dissection.
Political upheaval has exacerbated the problem, especially after Islamic State militants took over large swaths of Iraq last summer.
“Before I graduated, the college brought a big life-size electronic screen where you can do an electronic dissection,” said Aws Al-Jammal, a recent graduate from Nineveh Medical College, in Mosul. “That happened just before the Islamic State overran Mosul.”
The closure of the medical school in Mosul—Iraq’s second-largest city—after the Islamic State took over the region last year made matters worse, especially for physicians interested in specializing in a field beyond general medicine. The Islamic State shut down the country’s second largest medical school, which catered to specialized medicine.
Other cities also have difficulty hanging on to specialists. “The head of the gingival diseases department brought professors from India,” said Saif Al-Deen Hashim, a dentist in Basra who had been interested in more training at the University of Basra College of Medicine. “But they left after six months. We need more seats for specialization.”
Hashim couldn’t necessarily afford the training if he found a course he liked. “The Iraqi Dental Association provides part-time specialization to get a technical diploma in cosmetic dentistry on weekends only,” he said. “It costs $10,000.”
Students who are passionate and smart enough to get a medical degree then must enter dispiriting residencies in the shambolic Iraqi hospital system.
“The new graduates have a scientific mentality, ready to be trained, and full of ideal dreams until they face the shocking situation of the health care system,” said Hiba Abdulrahman Rashak, 29, who studied at Al-Kindy Medical College in Baghdad before she left the profession in disgust in 2013. She recently got a Fulbright scholarship to study for a master’s degree in epidemiology in the United States. She said Iraqi hospital wards are often packed with family members in addition to patients, doctors, nurses and other staff.
“The practical sessions consists of 12 students each,” said Al-Jubory. “However, sometimes the wards are small and cannot contain all of us.”
As a result, residents often jostle with working staff and relatives as they try to absorb the attending physician’s lessons. “In Iraq, there are no well-equipped and organized teaching hospitals,” said Mafraj. “It is too difficult to teach 20 student in a room that contains 10 patients and 20 relatives with no air conditioning.”
Crowded conditions lead to poor sanitation, infections and other complications that can result in a patient’s death from conditions that a few decades ago entailed just a short hospital stay. As a result, in addition to other tensions that might arise from political or religious differences, assaults on doctors by angry or grieving family members are now common.
Ultimately, said Rashak, the patients suffer.
“The catastrophe is that doctors are brought in after graduation, with their theoretical knowledge, to be left alone in the emergency room after giving them few instructions,” said Rashak. “Everyone throws the work on someone else, from the specialists downwards.”