War Watch
Seven nurses share their thoughts on the prospect of armed conflict in Iraq

By Phil McPeck
March 17, 2003

Iraq. Saddam Hussein. Possible war. Chemical weapons. Biological weapons. Troop deployments. Terrorism threats. Smallpox vaccinations. If these aren't on the tips of nurses' tongues, they're certainly in the back of their minds.

It's a lot to grasp, but an adage says that many hands make light work. And what hands are better-or more sure-than those of nurses? From civilian hospitals to the military and academic institutions, here are seven RNs, each with a perspective on Iraq, the possibility of a U.S.-led war and other issues.

The nurses range from a civilian emergency room staffer in South Carolina to a Navy director of nursing services in San Diego. A psychiatric nurse addresses anxiety. There is a Muslim doctoral candidate and a retired RN who participated in a New York Times opinion poll. Two nurses have been to Iraq, one as an adviser to the World Health Organization and United Nations Children's Fund, the other as a teacher at the University of Baghdad School of Medicine; both are experts on the effects of U.N. economic sanctions imposed after the 1991 Gulf War to undermine Iraqi President Saddam Hussein.

'It's not a necessary thing-yet'

Diane Robbins, RN, is a 44-year-old emergency room nurse working third shift at Chester (S.C.) County Hospital, about an hour from the Army's Fort Jackson in Columbia, S.C.

Preparation for a war against Iraq, as well as the possibility of a terrorist attack involving chemical or biological agents on U.S. soil, is all you hear on television and in the news, Robbins said, but any threat is going to have to be a little more real, a little more concrete, before she does one thing the federal Department of Homeland Security is asking.

As an emergency room caregiver, Robbins is among the first tier of Americans who are eligible and encouraged to receive a smallpox vaccination.

"I'm not going to," she said. "I had the vaccination as a child. At 6 or 7 years old, I was told what to do. You get into the line and you take your shot. You didn't have any concept of what was going on."

She does now, though, and after considerable Internet research, Robbins said the risk of complications from the vaccine do not outweigh her risk of exposure today. "In the beginning, I was thinking, 'Yeah, I'm going to be ready to go help other people and all of that.' And then, the more I saw the side effects, the more I realized it's not really a necessary thing-yet," Robbins said.

She did extensive research at the CDC Web site [www.cdc.gov] and elsewhere in reaching her decision. Although the centers say that life-threatening complications from the vaccine are rare-1.1 deaths per 1 million vaccinations in first-time recipients-Robbins said there are lesser, undesirable side effects.

Some people experience soreness at the injection site, lymph nodes may temporarily swell and low fever is possible for a few days. The CDC says one in three people may become ill enough to miss work. One in 5,000 may develop a toxic or allergic rash or the more serious eczema vaccinatum, a rash on the recipient that-through contact-may be passed to others.

"I decided the risks of getting sick or making my family sick are greater than the need for me to take it right now," Robbins said. "I may never have to have it. If I do, then it'll be a must and I can get it when I have to."

'This is why we wear the uniform'

Capt. Jennifer Town, MSN, RN, is director of nursing services at the Naval Medical Center San Diego.

Thirty-two of Town's nurses were vaccinated against smallpox before deployment to the Persian Gulf. The RNs-ward nurses, emergency and critical care specialists and nurse anesthetists-are assigned to a Marine surgical company and as support for the fleet hospital at Bremerton, Wash., she said.

In San Diego, homeport to Pacific Fleet aircraft carriers and a host of other Navy and Marine installations, the possibility of war certainly is on people's minds, said Town, 47.

"I think people are very heightened in their awareness. I'm not sure I would call it tension. It's more attention, because this is why we train and this is why we wear the uniform. We do the day-to-day operations in our hospitals and in our clinics to prepare ourselves and our staff to be able to take care of our sailors and Marines in times of war and other operations," she said.

"In the position I'm in, the recruiters bring potential military nurses to our command for tours and an opportunity to interview and ask questions about what it means to have a military career," Town said.

It was on one such tour of an East Coast base 23 years ago that she decided Navy medicine would be a good way to kick off her nursing career. "Part of it was the excitement of having the ability to serve my country, and part of it was my emancipation from small-town Iowa," she said. "But why we wear the uniform is attached to current events."

'Almost every patient is anxious'

Trudy Eggers, RN, is a 56-year-old assisted living case manager in Oklahoma City, and has extensive experience as a psychiatric nurse.

Today's events and the anxiety of uncertainty are constants around Oklahoma City, home of Tinker Air Force Base and nearby Fort Sill, Eggers said. "There's a lot of military personnel around here and a lot of lives are connected with the military in some way. Stress, that's just part of our lives."

Eggers said that each crisis survived makes some people stronger and more capable of problem-solving and handling anxiety. But for others, anxiety is cumulative. National Guard call-ups and terrorism warnings are like straws on the camel's back and each event is possibly the one that will break it. "Almost every psychiatric patient you have is anxious," Eggers said.

"I think by the nature of my work, my deal is calm reassurance. I'm not the kind of person who runs out and buys the plastic and duct tape to duct tape all my windows," she said, referring to preparedness advice issued-and later softened-by the Department of Homeland Security in its concern about chemical or biological attacks at home. "The chances of that saving your life are probably nil to none. I hate to say that, but it's true," Eggers said.

"A lot of people sometimes overreact, and I don't know that that's necessarily wrong," she said. "Right at this point, we're not in war. I think that you have to try to encourage people to be realistic. You can't live your whole life worrying that the Mideastern guy down the street is going to blow up your house.

"The situation is very volatile. Hopefully, we'll have a voice of reason and look at all the pros and cons: When we go to war, it doesn't just affect us. It's almost a global thing. Hopefully, there will be a lot of thought put into any kind of action."

'Why are we the ones going in?'

Nancy Alonso, RN, of Central Falls, R.I., worked as a float nurse in a hospital and with her physician husband before retiring. When The New York Times conducted a public opinion poll in February regarding Iraq and U.S. policy, Alonso, 66, was one of the voices.

"I don't have kids that are going to war," Alonso said, but she has children all over the world. For 26 years, she hosted exchange students, including an Arab from Tunisia who was living with her when President Anwar Sadat of Egypt was assassinated in 1981. She said exchange students opened her eyes to world politics and today's possibility of war is often a topic when she and friends gather.

In readings-Helen Caldecott's The New Nuclear Danger: George W. Bush's Military-Industrial Complex and Joseph Campbell's Myths to Live By, among others-Alonso said the question that keeps coming back to her regarding Iraq is "Why are we the ones who are going in?"

"I think if I had kids or grandchildren who were going to go, I would probably feel more threatened," she said. "My gut feeling is we're just going too fast. We need to be more universal. We need to be a globe. We need to be joined with rest of the world. I don't think we should be doing this alone."

To go to war without wider international support, Alonso said, demonstrates an American arrogance that Alonso said she's seen in travel abroad. "I'm proud to be an American and when I travel I'm very proud to say I'm American. But I've also traveled and been very ashamed when I see how Americans behave abroad. I lived abroad for about three months in Mexico and was just ashamed to listen to some of these Americans who were just so arrogant and would look down at people as if they were nothing."

'Generations will suffer'

Kay Shishani, MSN, RN, is a doctoral student from Jordan who is advancing her women's health career at the University of Pittsburgh. She is 36, the mother of four children, and Muslim.

"You know they sometimes try to portray this as religion against religion," Shishani said. "I think it's not something that has to do with religion in any means. The Muslim leaders themselves say we should not be looking at this as religion against religion because all religions, no matter what, they are all about peace, about tolerance and teaching people about living with each other.

"Make our differences a strength point, not something where we say, 'Oh you are this, you are that. We are different, so I don't respect you, I don't even recognize you.' No, no, that's not right.

"You know, sometimes I ask myself, 'Who is Saddam Hussein?' " Shishani said. "We know this is the leader of Iraq, but we don't know much [about] who is this person. I don't care what happens to him."

What she cares about is that war will rekindle and prolong the medical fallout begun in the 1991 war. "Generations and generations will go through the suffering. It needs hundreds of years to get over it. We are seeing kids-I'm talking about thousands of kids-born with leukemia, with congenital abnormalities" as a result of Desert Storm, she said.

For that reason, "I hope that they try to get a peaceful solution."

Shishani said she follows the Middle East situation closely in the United States and world media.

"The good thing in the Middle East is that people understand what is going on here and that people are supporting a peaceful resolution," she said. Americans who support continued diplomacy understand that, like herself, "there are people in Jordan and Iraq, people who have families, who like to live their lives peacefully, who want to have a future plan and not just be serious in life, but to also have fun.

"It's not just Iraq that will be involved in this if something happens, God forbid," Shishani said. "The whole area will be affected in terms of people who will be killed and in terms of the economy. I like to think this way: I have a family, four kids. We are going back home this summer, and you know this is their future and other kids' future."

'There will be thousands who don't get basic support'

Richard Garfield, ADRN, is the Bendixon Professor of Clinical International Medicine at Columbia University in New York. At age 49, he has a degree in epidemiology and teaches community health and research methods to graduate and doctoral students in Columbia's School of Nursing.

"I think we are going to war. That is what is going to happen. There will be a military engagement and a defeat of the army of Iraq. And there will be an occupation force led by the U.S. military for an undefined, but extended period of time. If that's not what happens, then I don't know anything," said Garfield, who returned from the Persian Gulf the last week of February. There, he advised some of the 35 nongovernmental organizations that have set up in Amman, Jordan, to assist Iraqi civilians in the aftermath of a war.

"I've made a specialty of assessing humanitarian conditions in countries with economic crises or wars," Garfield said. He has documented conditions under United Nations economic sanctions in Cuba, Haiti, Liberia, Yugoslavia and, since 1996, Iraq, both independently and for the World Health Organization and United Nations Children's Fund.

As far as what U.S. policy regarding Iraq should be, Garfield said that is not for him to say. He adopts a position along the lines of the International Red Cross, which he said doesn't decide who is right and wrong in a conflict, but instead tries to identify ways to reduce the number of people who are harmed and help victims.

Although plans have yet to be firmed up, Garfield said he soon may go to Kuwait to discuss protective health measures with U.S. military personnel massed there for an invasion of Iraq. "The big-ticket item is the unknown, which the military is spending a good deal of attention preparing for," Garfield said. "The concern for the military is biological, chemical or nuclear exposure. However, it is minor compared to the concerns for those matters among civilian populations in the area, particularly among displaced people."

Garfield said he doesn't anticipate as many refugees as in the 1991 Gulf War, but as long as there is fear-or even rumor-of chemical or biological weapons in play, humanitarian aid agencies can't commit relief personnel. "There will be thousands of people who don't get basic support. Those are the people who are really at risk. They don't have protective mechanisms and they don't have food or medicine of a basic nature," he said.

'It is a public health disaster of major proportions'

Gerri Haynes, RN, is a palliative care consultant from Seattle. At 60, she is a former critical care nurse, nursing administrator, and for 8½ years, a palliative care consultant at Seattle's Children Hospital. She completed the history and ethics course work for a master's degree, but put off a thesis because she was in the process of establishing a hospice, she said.

Haynes is the first to admit that when it comes to Iraq and military action, "I don't know what's going to happen." But she has witnessed in four trips to Iraq what has happened under U.N. economic sanctions imposed after the last war to undermine Saddam.

It is "a public health disaster of major proportions," in a country that until 1990 was widely regarded as the finest medical community in the Middle East outside of Israel, Haynes said. "By 1998, the medical community had suffered so extensively, and the public health had suffered so deeply, that my impression was of a country that had suffered a man-made disaster to their public health and to their society that was unconscionable."

Three times, Haynes has led fact-finding delegations to Iraq under the auspices of Washington Physicians for Social Responsibility. She was president of the organization last year.

She also has taught grief, bereavement and sustaining culture through a time of intense loss at the University of Baghdad School of Medicine.

"All of the medical education in Iraq is done in English. Their textbooks are in English; they chart in English," Haynes said. "And now they have this impoverishment of extended education because much of their secondary education for medicine happened outside the country and then people went back in. But that's no longer possible because of the sanctions."

Although Iraq is a secular nation, "There is a rising tide of Islamic fundamentalism," Haynes said. "But that happens in any country under siege. The sanctions have hurt the Iraqi people."

According to the United Nations, she said, the sanctions are independently responsible for the deaths of more than 500,000 children aged 5 and younger. "Those are excess deaths, more than would have been predicted under the Iraqi system of medical care."

Iraqi scientists attribute a sevenfold increase in the rate of childhood leukemia since 1990 to exposure to low-grade uranium 238 from weapons used in the first Gulf war, Haynes said. "That's something that needs a lot more study across the world because this substance, uranium 238, has been used in the Balkans and Afghanistan and perhaps in other places as well."

Haynes said she believes a new war-and she prefers the term "attack"-is "an economically driven enterprise."

"What I think would be better than an attack on the civilian population of Iraq would be some form of the Marshall Plan, and some economic development plan that would help the Iraqi people regain their economic stability. I also think direct diplomacy would have a much more profound effect on saving both civilian lives in Iraq and our military lives than the plan that seems to be in place."

Contact Phil McPeck at getpjm@aol.com