Iraq-U.S. Physician Partnership Program Iraq-U.S. Physician Partnership Program Health Resources and Services Health Resources and Services

Administration’s RoleAdministration’s Role

RADM Kerry Paige NesselerRADM Kerry Paige Nesseler

CAPT Nita SoodCAPT Nita Sood

Office of International Health AffairsOffice of International Health AffairsJune 1, 2009June 1, 2009

Map of IraqMap of Iraq

BackgroundBackground

• Iraq’s health care system once regarded as one of Iraq’s health care system once regarded as one of the best in the regionthe best in the region

• Over the last 25 years, the health care Over the last 25 years, the health care infrastructure has deteriorated due to neglect and infrastructure has deteriorated due to neglect and war war

• Violence and emigration have decreased the Violence and emigration have decreased the number of physiciansnumber of physicians

• Physicians that remain are not up to date on the Physicians that remain are not up to date on the latest evidence-based medicine and technologies latest evidence-based medicine and technologies necessary to provide high-quality carenecessary to provide high-quality care

Physicians in Iraq• Iraqi Physicians Registered Iraqi Physicians Registered Before 2003 - Before 2003 - 34,00034,000• Iraqi Physicians Who Have Left Iraqi Physicians Who Have Left Iraq Since 2003 - Iraq Since 2003 - 18,000 (est.)18,000 (est.)• Annual Graduates from Iraqi Annual Graduates from Iraqi Medical Schools - Medical Schools - 1,8001,800• Percentage of Work Outside of Iraq- Percentage of Work Outside of Iraq- -higher -higher

than 20%, many still leave the country to than 20%, many still leave the country to get specialized training get specialized training 

• Average Salary of an Iraqi physician- Average Salary of an Iraqi physician- $12,000 $12,000 per year, higher for specialistsper year, higher for specialists

HHS InitiativeHHS Initiative

• In May 2008, Department of Health In May 2008, Department of Health and Human Services Secretary and Human Services Secretary meeting with Iraqi Minister of Health meeting with Iraqi Minister of Health (MOH)(MOH)

• MOH requested a physician training MOH requested a physician training program in order to understand the program in order to understand the U.S. primary healthcare modelU.S. primary healthcare model

Goals of the HHS InitiativeGoals of the HHS Initiative

• Promote Health Diplomacy and Promote Health Diplomacy and provide hope and inspiration to the provide hope and inspiration to the Iraqi people;Iraqi people;

• Educate the Iraqi physicians on the Educate the Iraqi physicians on the U.S. primary health care system and U.S. primary health care system and strengthen their ability to provide strengthen their ability to provide quality care;quality care;

• Learn from the Iraqi people; andLearn from the Iraqi people; and• Enhance the cultural competencies of Enhance the cultural competencies of

the U.S. physicians.the U.S. physicians.

Iraqi Physician Training: Iraqi Physician Training: Goals and ObjectivesGoals and Objectives

• To build upon current Iraqi health care promotion To build upon current Iraqi health care promotion activities in Iraq- Centers for Disease Control and activities in Iraq- Centers for Disease Control and Prevention (CDC) partnership with non-Prevention (CDC) partnership with non-governmental organization, International Medical governmental organization, International Medical Corps (IMC) to develop the Centers of Excellence;Corps (IMC) to develop the Centers of Excellence;

• The Iraqi Government had already invested $8 The Iraqi Government had already invested $8 million dollars on physician training;million dollars on physician training;

• The Basra Children’s Hospital was under The Basra Children’s Hospital was under construction with health emphasis on pediatric construction with health emphasis on pediatric oncology; oncology;

• 134 renovated Primary care facilities in Iraq 134 renovated Primary care facilities in Iraq needed healthcare provider staffing. needed healthcare provider staffing.

Iraq-U.S. Physician Iraq-U.S. Physician Partnership ProgramPartnership Program

• HHS Coordination through Office of Global HHS Coordination through Office of Global Health Affairs (Jaime Burke and CDR Dan Health Affairs (Jaime Burke and CDR Dan Singer) and U.S. Embassy in Iraq (Dr. Terry Singer) and U.S. Embassy in Iraq (Dr. Terry Cline, Health Attaché);Cline, Health Attaché);

• Iraqi physicians were selected by the MOHIraqi physicians were selected by the MOH• Out of 41 physicians, 27 were able to Out of 41 physicians, 27 were able to

participate;participate;• 6 physicians were slated for HRSA; 3 were 6 physicians were slated for HRSA; 3 were

able to participate;able to participate;• Observership training- no patient contact;Observership training- no patient contact;• 4-week timeframe.4-week timeframe.

Iraq-U.S. Physician Iraq-U.S. Physician Partnership Program (cont’d)Partnership Program (cont’d)

• Host Training Sites:Host Training Sites:– Children’s Hospital, Washington, DC;Children’s Hospital, Washington, DC;– Health Resources and Services Health Resources and Services

Administration (HRSA);Administration (HRSA);– Henry Ford Hospital, Detroit, Michigan;Henry Ford Hospital, Detroit, Michigan;– Indian Health Service, Arizona;Indian Health Service, Arizona;– Johns Hopkins Hospital, Baltimore, Johns Hopkins Hospital, Baltimore,

Maryland.Maryland.

Iraq-U.S. Physician Iraq-U.S. Physician Partnership Program (cont’d)Partnership Program (cont’d)

• HRSA Sites:HRSA Sites:– Community Health Centers (CHC): Two Community Health Centers (CHC): Two

sites selected; rural and urban sites sites selected; rural and urban sites affiliated with teaching universitiesaffiliated with teaching universities

– The CHC sites: The CHC sites: • Sunset Park Medical Center, Brooklyn,Sunset Park Medical Center, Brooklyn,

New YorkNew York• Greene County Health Care Inc., Snow Hill, Greene County Health Care Inc., Snow Hill,

North CarolinaNorth Carolina

Physician Training Physician Training ScheduleSchedule

• All physicians attended 2-day HHS All physicians attended 2-day HHS orientation orientation

• Physicians assigned to HRSA Physicians assigned to HRSA received additional 2-day HRSA received additional 2-day HRSA orientation on Prevention, Primary orientation on Prevention, Primary Health Care and Chronic Disease Health Care and Chronic Disease ManagementManagement

• Remaining time (~ 3 weeks) spent at Remaining time (~ 3 weeks) spent at CHC sitesCHC sites

HRSA: Physician Training HRSA: Physician Training ScheduleSchedule

• HRSA Orientation, Day 1HRSA Orientation, Day 1– Prevention and Primary Care Expert Panel:Prevention and Primary Care Expert Panel:

• Oral HealthOral Health• Maternal & Child Health and Children with Special Maternal & Child Health and Children with Special

Health Care NeedsHealth Care Needs• Cancer Prevention and Anti-Smoking CampaignCancer Prevention and Anti-Smoking Campaign

– Chronic Disease Management Expert PanelChronic Disease Management Expert Panel:: • Diabetes ControlDiabetes Control• Hypertension and Cardiovascular Disease ControlHypertension and Cardiovascular Disease Control• HIV/AIDS Care and TreatmentHIV/AIDS Care and Treatment• Quality and Evidence Based CareQuality and Evidence Based Care

– Site Visit to Urban CHC:Site Visit to Urban CHC:• Unity Health Care, Washington D.CUnity Health Care, Washington D.C.

HRSA: Physician Training HRSA: Physician Training Schedule (cont’d)Schedule (cont’d)

• HRSA Orientation, Day 2HRSA Orientation, Day 2– Site Visit to Rural CHC- Eastern Panhandle of Site Visit to Rural CHC- Eastern Panhandle of

West Virginia:West Virginia:• Shenandoah Valley Medical System, Martinsburg, WVShenandoah Valley Medical System, Martinsburg, WV• War Memorial Hospital (critical access hospital), Berkeley War Memorial Hospital (critical access hospital), Berkeley

Springs, WVSprings, WV

• Then to Observership Training SitesThen to Observership Training Sites– Two Iraqi physicians (pediatrician and general Two Iraqi physicians (pediatrician and general

practitioner) at Brooklyn, New Yorkpractitioner) at Brooklyn, New York– One physician (orthopedics) at Snow Hill, One physician (orthopedics) at Snow Hill,

North CarolinaNorth Carolina

HHS DebriefingHHS Debriefing

• One day debriefing in Washington DC

– Overall the physicians were very satisfied with their experience and would like to see this happen again in the future

– Breakout Group Sessions discussed 3 topics:– Alternate Models for the Physician Partnership Program– Application of Lessons Learned in Iraq– Maintaining Links and Sustaining Partnerships

HHS Debriefing (cont’d)HHS Debriefing (cont’d)• The breakout group discussed several issues The breakout group discussed several issues

related to the effectiveness of the current Iraqi related to the effectiveness of the current Iraqi modelmodel– There are two specific needs that must be There are two specific needs that must be

addressed: addressed: • improving provision of care (training, access to new improving provision of care (training, access to new

technology), andtechnology), and• improving the overall health care systemimproving the overall health care system

– Improve the health care infrastructure;Improve the health care infrastructure;– Improve the ability of health care providers to Improve the ability of health care providers to

function as a team; interdisciplinary modelfunction as a team; interdisciplinary model– Enhance the relationship between the health care Enhance the relationship between the health care

system and the community;system and the community;– Improve the skills of individual practitioners Improve the skills of individual practitioners

(practitioners must be motivated to change and (practitioners must be motivated to change and seek out opportunities);seek out opportunities);

– Enhanced involvement of planners and Enhanced involvement of planners and policymakers.policymakers.

Alternate Models for the Alternate Models for the Physician Partnership ProgramPhysician Partnership Program

• Bring teams of U.S. physicians to Bring teams of U.S. physicians to IraqIraq

• Implement the model described Implement the model described above in a site outside of Iraqabove in a site outside of Iraq

• Train Iraqi physicians in the Train Iraqi physicians in the United States; extend to 6-8 United States; extend to 6-8 weeksweeks

Application of Lessons Learned in Application of Lessons Learned in IraqIraq

• Develop a clear strategy for delivery of Develop a clear strategy for delivery of health care (e.g., financing);health care (e.g., financing);

• Establish short-, middle-, and long-term Establish short-, middle-, and long-term strategies for managing challenges;strategies for managing challenges;

• Address the technology gap - Incorporate Address the technology gap - Incorporate the use of information technology;the use of information technology;

• Improve the level of nursing care;Improve the level of nursing care;• Adopt electronic medical records;Adopt electronic medical records;• Establish an independent regulatory Establish an independent regulatory

authority for the health care system, authority for the health care system, medical societies, licensing, and medical societies, licensing, and continuing medical education.continuing medical education.

Application of Lessons Learned in Application of Lessons Learned in

IraqIraq (cont’d)(cont’d)• Facilitate the adoption of evidence-based Facilitate the adoption of evidence-based

practices;practices;• Develop a system for the referral of Develop a system for the referral of

patients;patients;• Focus on primary health care to reduce Focus on primary health care to reduce

the burden on hospitals;the burden on hospitals;• Rehabilitate sub-specialty centers;Rehabilitate sub-specialty centers;• Control medicine management and use;Control medicine management and use;• Improve patient management systems;Improve patient management systems;• Improve communication (within service Improve communication (within service

settings).settings).

Maintaining Links and Maintaining Links and Sustaining PartnershipsSustaining Partnerships

• Participants exchanged e-mail addresses Participants exchanged e-mail addresses with their U.S. colleagues and will remain with their U.S. colleagues and will remain in contact via e-mail; in contact via e-mail;

• Webcams and telemedicine provide Webcams and telemedicine provide opportunities for communication;opportunities for communication;

• HHS to explore ways to conduct long-term HHS to explore ways to conduct long-term follow up with participants;follow up with participants;

• HHS learn how participants disseminate HHS learn how participants disseminate what they have learned in the United what they have learned in the United States to their Iraqi colleagues. States to their Iraqi colleagues.

Follow-upFollow-up

• Several follow-up items are being Several follow-up items are being coordinated by HHS, including issues of coordinated by HHS, including issues of connectivity between the host-sites and connectivity between the host-sites and their respective participants;their respective participants;

• Information from this pilot will be used to Information from this pilot will be used to evaluate this particular model and to evaluate this particular model and to formulate next steps to continue formulate next steps to continue collaborative relationships between the collaborative relationships between the two countries.two countries.

Acknowledgements

• Anthony Achampong• Dr. Jay Anderson• Tara Balsley• Dr. Marcia Brand• Jaime Burke• John Cafazza• Gina Capra • Tina Cheatham • CAPT Gail Cherry-Peppers• Dr. Terry Cline• Tom Coughlin • Loretta Ellison• Diana Espinoza• Dr. Kaytura Felix• LT Ulgen Fideli• Tanya Gadzik • Kate Guzzone• Sandy Harris• Joanne Howard

• Dr. Therese Hughes • CAPT Donna Hutten• Jim Macrae• Dr. Daniel Mareck • Tim Montgomery• Tom Morris• Shawir Nawruz • Dr. Tanya Pagán Raggio-Ashley• RADM Deborah Parham Hopson • Sara Rue• Richard Sayre • Leslie Shah• CDR Dan Singer• Dr. Peter van Dyck• RADM Donald Weaver• Maureen Williams• Sunset Park Medical Center, Brooklyn, NY• Greene County Health Care, Snow Hill, NC

The individuals below contributed to the success of the Iraq-U.S. Physician Iraq-U.S. Physician Partnership Program for HRSAPartnership Program for HRSA

Iraq- U.S. Iraq- U.S. Physician Partnership ProgramPhysician Partnership Program

Contact InformationContact InformationRADM Kerry Paige NesselerRADM Kerry Paige Nesseler

CAPT Nita SoodCAPT Nita Sood301-443-2741301-443-2741

KNesseler@hrsa.govNSood@hrsa.gov