Courtesy of Linda McHale

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Iraqi nurses Intisar Abdul-Hussein Abbas, RN (left), and Amean Yasir Al-Yassiri, RN (third from left), recently visited the University of Pennsylvania’s critical care and pediatric units to see how the hospital is structured. Beside them are Col. Linda McHale, RN (second from left), of the Coalition Provisional Authority-Iraqi Ministry of Health, and Lt. Col. Edward Mattern, RN (right), of Walter Reed Army Medical Center in Washington, D.C.

Col. Linda McHale, RN, knows firsthand the challenges facing Iraqi nurses as they struggle to rebuild a health care system that has suffered years of neglect.

“The smallest thing is an incredible endeavor,” said the U.S. Air Force Reserve nurse who spent the spring as part of a Coalition Provisional Authority medical team helping the Iraqi Ministry of Health implement plans for a new health care system. “I had to get four South African bodyguards to drive me in armored vehicles to the airport to pick up donations.”

Yet McHale sees promise in a country where nurses are dedicated to catching up.

“They’re hungry for information,” she said. The questions she heard most often were about how to get additional training in the United States.

Once the jewel of Middle Eastern health care, Iraq’s medical system suffered during 25 years of war and international sanctions. By the time a U.S.-led coalition invaded in March 2003, medical students studied from photocopied texts of old medical journals and the few remaining nurses used old and scarce equipment to help their patients. Many of the country’s best-trained nurses and physicians had fled.

American nurses, however, are organizing grassroots efforts to help their counterparts in Iraq. Their aid ranges from programs to send textbooks and supplies to organized missions like McHale’s.

McHale said that only about 300 of the country’s 18,000 nurses are college-prepared, and most of those work in academia. The Iraqi medical model is based on Britain’s, so these students are fluent in English.

The majority of the nurses have completed the equivalent of sixth grade, at least, and studied in a three-year technical training program. Unlike the United States, men make up 65% of the nursing workforce in Iraq, she said.

“Unfortunately, a number of those members are illiterate in any language,” McHale said.

Scarce supplies, societal customs, and lack of education contribute to nurses who do more custodial care while physicians perform tasks like taking blood pressure. Even within the limited range of acceptable nursing practices, no assessments are in place to determine levels of expertise, as well as no licensing tests, no accreditation guidelines for schools, no body overseeing license revocation or renewal, and no malpractice laws, McHale said.

Nurses from the Iraqi Ministry of Health — the rough equivalent of the U.S. Surgeon General’s office — identified the strengths and weaknesses of the profession today and developed a plan to improve it.

McHale’s job was to try to help finalize that plan and develop it so that the various outside organizations that would like to help the country would not be duplicating previous efforts.

Setting new standards

McHale helped her counterparts set up a nursing council and an Iraqi nursing association to create a board that would determine licensing and regulation. Despite dangerous travel conditions, 120 nurses (all men) attended a nursing association national election for officers, she said.

She also helped the health ministry nurses write a detailed plan to set up competency evaluation centers in different regions. Certifying who is qualified to be an LPN vs. an RN will allow the Iraqis to determine the scope of practice for each level, she said. McHale would like to secure congressional funds to establish competency evaluations for nurses in Iraq, as well as a rating scale equal to the British or U.S. model.

These funds would include a few million dollars’ worth of equipment, which is also needed for competency evaluations.

“They have no training equipment — mannequins, computers, projectors — all those things were looted after the invasion,” she said.

Brenda Maldonado, RN, a surgical nurse who worked in labor and delivery for eight years, traveled to the Kurdish region in northern Iraq as part of a four-week training effort. She saw equipment, but few who knew how to use it or fix it, she said.