Johns Hopkins Gazette | March 16, 2009
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The newspaper of The Johns Hopkins University March 16, 2009 | Vol. 38 No. 26
Hopkins for a Healthy Iraq

Melinda Morton and Allen Andrews say they're looking for visionaries who will return to their home countries and be leaders in their field.
Photo by Will Kirk / HIPS

Initiative will assist nations in crisis with public health training

By Greg Rienzi
The Gazette

West Point graduate Melinda Morton recalls precisely the genesis moment of the Crisis Health Initiative, a project she helped found last year that is making a positive impact in a country torn apart by war.

The moment came at a March 22, 2007, symposium titled Iraq: Rebuilding a Nation's Health, co-hosted by the U.S. Institute of Peace and the Johns Hopkins Bloomberg School of Public Health's Task Force on Public Health and Conflict. Morton had just been accepted at the Bloomberg School as a Sommer Scholar.

The symposium, intended to raise awareness of the deteriorating medical situation and health care crisis in Iraq, brought together several public health stalwarts, military officials, dignitaries and those from the medical establishment. At one point in the event, the dean of the University of Baghdad's School of Medicine, Sarmad S. Khunda, spoke up via a conference call from Baghdad.

Khunda described in poignant terms the hardships that medical care providers in Iraq were facing. He detailed how insurgents were targeting physicians and how difficult it was for medical students to even come to school. The horrific violence drove many of the nation's doctors out of the country.

"He said that the physicians who remained were in dire straits, and that the problems were mounting," said Morton, a former military police officer with the U.S. Army who had received a medical degree from the University of Pennsylvania and was, at the time, a research assistant with the Office of the Secretary of Defense for health affairs.

Khunda implored the audience for help, specifically asking the Johns Hopkins community for any assistance it could provide to the Iraqi health care system.

Morton heard the call. Allen Andrews, a fellow student at the School of Public Health, soon joined her.

In early 2008, Andrews and four other Bloomberg School students traveled to the Middle East to conduct a monthlong assessment of the health care needs of the hundreds of thousands of Iraqi refugees living in Syria and Jordan. What he found was chilling, he said, and he was determined to do more.

When Andrews returned, he and Morton conceived the Crisis Health Initiative, a coalition of students and faculty who want to contribute to the health and stability of Iraq and other regions affected by conflict and crisis.

Andrews said that he and Morton share a passion for Iraq and its people.

"We have both seen firsthand the overwhelming health care needs in that country," Andrews said.

The initiative's first program is Iraq HOPE, an effort to rebuild the country's medical and public health system through educational initiatives. The program was funded by the school's Center for Refugee and Disaster Response and later received additional financial support from the Dean's Office to help pay tuition for visiting scholars.

Morton, who graduated from the Bloomberg School in 2008 and is now a resident in the School of Medicine's Department of Emergency Medicine, said that the public health problems in Iraq are numerous and massive. To date, major issues exist with clean water, sanitation facilities, food safety and immunizations. Since the war began, Iraq has witnessed major increases in incidents of communicable, preventable and surgical diseases. To compound matters, many hospitals and health centers have been looted.

The maternal mortality rate, a key public health indicator, was one of the worst in the world at the start of the war. Morton said that and other key public health indicators have shown recent signs of improvement, but not enough.

"Because of the sheer scale of the problems, we feel the best way to approach the situation is to train scholars in public health, particularly due to the lack of traditional public health training in Iraq," she said. "We want to help these scholars identify the most important aspects to attack out of this array of problems. It's all about developing public health priorities."

This past summer, the Crisis Health Initiative hosted two Iraqi physicians who enrolled in an intensive program at the Bloomberg School. They took course work in epidemiology, biostatistics, immunology, health policy, management and health emergencies in large populations.

Soon, two more Iraqi scholars will travel to the United States, this time to attend the University of California, Berkeley's School of Public Health and participate in activities at the University of California, San Francisco's School of Medicine.

To identify the initial scholars, the Crisis Health Initiative sent out notices to all of Iraq's 21 medical schools. The International Medical Corps and the Iraqi Ministry of Higher Education screened the applicants and sent Morton and Andrews a list of the dozen most qualified candidates. The two then reviewed all the resumes and essays and picked from this group.

Andrews said that they wanted to find medical school faculty who were connected to the nation's Ministry of Health and willing to return to Iraq after training and be a leader in public health.

"For example, maybe they trained here in research methods and want to go back and establish an institute in this field," he said. "We are looking for visionaries."

The education the first two scholars received has already made an impact. One of the Iraqi doctors is working with the International Medical Corps to establish a public health program, and the other is establishing epidemiology and biostatistics centers at his university.

In the near future, the Crisis Health Initiative wants to help develop a telemedicine program and physician consultant system to assist Iraqi physicians, who are particularly lacking in specialty care skills. Morton and Andrews also want to help Iraqi doctors have access to online "grand rounds" that are regularly held by Johns Hopkins departments.

Since the organization's founding, Morton has made a trip to Iraq to meet with the physicians in the program, conduct surveys and assist in teaching an emergency medicine course to other physicians in Baghdad.

Morton said the initiative will focus on Iraq for the next several years and then branch out to other countries. She and Andrews have already identified Afghanistan as a logical next destination.

"We plan to make this a wider effort," she said. "I think we are already having a positive impact in some small way. We are engaging U.S. universities and helping raise awareness to the need for public health development in countries like Iraq. The need is great."


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