Since 2003 Canadian doctors have been giving continuing medical education (CME) to rural physicians in Kurdistan, a wartorn and underserviced region. This is a unique partnership between the Canadian rural doctors / ob-gyn specialists, Canadian Friends Service Committee (Quakers), and the Kurdistan government. Delicate negotiations with leaders different tribal areas, deans of medicine and provincial ministers were also required.
In this region 70% of births are at home with untrained attendants. The other 30% are in hospitals or birthing centres -- where the Caesarean section rate is 50% and the episiotomy rate is 100%. Women fear to go to the hospitals because they will “get cut”. There are worse risks. Maternal morbidity and mortality are high. Obstetrical care is left to women doctors with less training, facilities and simple technologies, and less opportunity to travel for education.
Each session trains up to 40 physicians and nurses in up-to-date skills for early recognition of obstetrical emergencies and interventions.Some will be trained to teach alongside the Canadian instructors in a “train the trainers” project.
One team member stated that it "far surpassed [my] expectations with respect to welcome, teaching opportunities, safety and travel opportunities." Another noted: "[I] developed a respect for the skill and knowledge of Kurdish physicians" and found the people "fiercely proud, warm and welcoming ... we will never fully understand the decades of suffering and loss they have endured."
Along with rural expertise, the trainers share a passion for women's health and women's rights. Dr. Jaelene Mannerfeldt, an obstetrician from Okotoks, Alberta, is in charge of 2008-09 courses. She has experience both in the Canadian development of ALARM (Advances in Labour and Risk Management) and in instructing nationally and internationally. Two other instructors last fall were nurse Christine Nadori from Ottawa and Dr. Ahmed Ezzat from Saskatoon. The facilitator is Dr. Dale Dewar from Wynyard, Saskatchewan who with Dr. Narmin Ibrahim of Saskatoon initiated the Kurdistan project.
One of the 2003 trainings took place in Halabja, site of an infamous gas attack by Saddam Hussein's forces in 1988, when a fifth of the 25 000 local inhabitants died immediately and the rest fled. What was not reported by Western media was that more than 250 Kurdish villages were attacked. Local medical staff still see severe medical effects (respiratory, neurologic, oncologic and fertility) 15 years later. Ground water and soil have yet to be tested.
On the road to Halabja
The local hospital director of Halabja and his medical staff of 12, most of whom were general practitioners, took part in a series of interactive workshops over four days. Being close to the Iranian border, the community was not felt to be safe enough for westerners. At the Ministry of Health's suggestion the visitors spent 4 hours a day travelling by road to and from a more secure area.