"Iraq: Neglected nurses fight their own war"
November 19, 2006 -- Today the IRIN news service (Integrated Regional Information Networks) posted a good piece on the Reuters Foundation website about the severe hardship Iraqi nurses face. The unsigned article focuses on the struggle of nurse Nissrin Muhammad to care for patients--150 or more at a time--at a public hospital in Baghdad. The widowed mother of five works six days a week, 13 hours a day, enduring physical and verbal abuse in desperate conditions. She can no longer afford meat, but she no longer wants to eat it anyway; it reminds her too much of the relentless carnage she sees as a result of sectarian violence. The piece says many Iraqi nurses have fled the nation. Those with working husbands stay home to avoid the violence. There are good quotes from a Ministry of Health physician, who stresses that physicians cannot function without the nurses, and that "[l]osing their work means losing lives." The piece might have provided more information on Iraqi nursing generally, both before and after the war. But overall it's a powerful look at a profession in crisis.
The piece notes that Iraq suffers a "dearth" of nurses, given that so many have fled or stay home, but "the rest must soldier on in their fight against fear and poverty." Dr. Yehia al-Mawin, a senior strategy official at the Ministry of Health, explains:
They are our main support. Without their work, doctors cannot do their job because nurses are the ones who maintain the lives of patients after the medical diagnosis. Losing their work means losing lives.
These comments make clear how vital nurses are to patient outcomes. Of course, the notion that nurses are physician "support" suggests that physicians are in charge, and that nursing lacks its own scope of practice. Al-Mawin also reports that, since the 2003 U.S.-led invasion, more than 160 Iraqi nurses have been killed and more than 400 wounded. He also notes that thousands of Iraqi nurses have fled overseas or been "forced to leave their work after receiving threats from insurgents and militia fighters."
Most of the article describes the desperate situation of Nissrin Muhammad. Needless to say, she sees death every day. She wonders when she will be next, and what her children would do without her. She describes her work at the hospital:
I graduated in nursing with the aim of helping to save lives but in the past two years, we are losing more [lives] than improving health conditions...I am stressed and sometimes I go into an empty room behind the hospital's cafeteria to cry and alleviate the tension that I am living under. ...[Nurses'] salary was always one of the worst in the country but families used to give us extra money when we delivered their children, or when patients had successful operations or treatments. But today, even this extra benefit has disappeared. ...Often, the [patient's] family does not have money even to buy medicines.
As you might expect, these conditions do not lead to contented patients or families, or good treatment for the nurses. Nissrin "dreams" of being respected and appreciated for her vital work. Instead, she gets "physical and verbal abuse from angry patients, or their friends and relatives, demanding immediate treatment," including "punches in the face or worse":
Sometimes I feel indignation that even with millions of people depending on our work, they still see us as a lowly profession and treat us badly. ... In the most recent incident, a husband of a patient broke a glass over my head because his wife urinated and I was late changing her. I tried to explain that 50 injured patients had just arrived in the hospital and we were just three [nurses] helping the doctors. He told me that I was useless and beat me.
Nissrin spends her few hours away from work caring for her children and searching for food, which requires that she travel and take more risks, since the violence has shut down shops in her neighborhood. She once asked for time off to care for her kids when they were "particularly sick." Her boss refused, noting that (in her words) the children's "lives were not more important than the hundreds that come into the hospital on a daily basis in need of my services." When Nissrin feels disheartened, she "pulls out a photo of her children and reminds herself why she endures what she does."
This piece puts the phrases "short staffing" and "poor working conditions" into perspective. Of course, our understanding is that prior to 2003, Iraqi nursing was not in good shape, and there were few trained nurses. This piece might have explored that, in particular by consulting a nursing leader. It might also have told readers whether there have been any benefits to Iraqi nursing following the 2003 invasion, such as increased foreign assistance or training opportunities. Of course, it's hard to imagine what could compensate for the apparent loss of thousands of Iraqi nurses, or for the conditions in which those like Nissrin Muhammad try to work today.
We thank IRIN for bringing us this important piece and the Reuters Foundation website for reprinting it.