March 5, 2007

Building Hope in Basrah
By Tracy Meadowcroft
For The Record
Vol. 19 No. 5 P. 20

Despite the toughest conditions, construction of a children’s hospital steadily marches along.

Weighing the pros and cons of establishing electronic medical records (EMRs) can prove daunting at any healthcare facility—from the smallest clinic to the largest multispecialty hospital. Numerous questions are often raised about the process of establishing EMRs, including what the final cost may be, how to make the transition from paper to electronic records as easy as possible for all those affected by the change, and what, if any, disruptions the process will bring to the facility.

There can also be quandaries about whether to outsource coding or transcription, whether to allow these employees to work from home, or how to recruit and retain qualified candidates for these positions.

Now, imagine answering these questions during the establishment of a children’s hospital in Iraq, a country that has seen its share of violence and turmoil in the last several years alone. Along with addressing the basic needs to establish the hospital come concerns about maintaining safety for patients, their families, and the employees themselves.

Healthcare in a Violent State
In the middle of one of the most violent areas of Basrah, a city of, at one time, more than 2 million people that is located approximately 330 miles from the Iraqi capital of Baghdad, construction is underway at the Basrah Children’s Hospital (BCH). While concerns about violent outbreaks remain high because of the current state of affairs in the city, the desire to provide improved and necessary healthcare, especially for children, ranks higher.

BCH will serve as a referral hospital and is intended to be a “world class clinical and training facility for pediatric specialty care—with a focus on oncology—serving the people of Basrah and the southern provinces [of Iraq] and addressing critical pediatric healthcare needs,” says U.S. Navy Lt Allen E. Willey, resident engineer for the Basrah Children’s Hospital Project Office (BCHPO), Southern District, Gulf Region Division.

These “critical pediatric healthcare needs,” according to Willey, include addressing the high incidences of pediatric disease and cancer, and that more than 100 of every 1,000 Iraqi children will likely die before celebrating their fifth birthday. Additional statistics, provided by Willey, offering the need for such a facility include the following:

• Twenty-five percent of Iraq’s 18,000 physicians have fled the country since 2003.

• Cancer rates in Iraq are eight to 10 times higher than in Western countries.

• Cancer rates in southern Iraq, where Basrah is located, are more than four times higher than the national average.

• Leukemia cases in Basrah have increased by 70% since 1989.

According to Willey, Project HOPE, an international nonprofit health, education, and humanitarian assistance organization, originally pointed out the need for a facility such as BCH. The awareness of the need came during an investigation in 2003 concerning the state of healthcare in Iraq.

“The World Health Organization statistics indicate that 53% of Iraqis are adolescents, so we estimate that the hospital will support more than half of the population of Basrah alone,” said Frederick Gerber, country director, Iraq, for Project HOPE, in a press release about the hospital project.

The U.S. Army Corps of Engineers, through the BCHPO, assumed responsibility for managing the construction of BCH in summer 2006 following the departure of a U.S. construction contractor. Approximately 30% of the hospital’s construction was completed at that time.

“The prime contractor [for the project] is MID-Contracting International based in Amman, Jordan, of which six area managers are on site with approximately 24 additional Iraqi overhead staff members assisting in the project management effort to construct the children’s hospital,” explains Willey. “All of the labor effort is subcontracted out to Iraqi contractors. In all, the daily average employment on site is 475 construction workers and a large security personnel force.”

The Facility
Among the amenities planned for the two-story, 94-bed, 160,000-square-foot acute care pediatric specialty facility are an eight-bed pediatric intensive care unit (ICU), a seven-bassinet neonatal ICU, one special procedure room, two operating rooms, and four general nursing wards, according to Willey.

The hospital, which is located on a 13-acre site, will also feature an oncology center with diagnostic and treatment planning, chemotherapy, and radiotherapy; an imaging department with radiography, fluoroscopy, computed tomography, MRI, and ultrasound; an emergency department with a full trauma room; an on-site residence building for 32 nurses and physicians; an outpatient endoscopy suite; a dental suite; and other specialty clinics.

The Iraqi medical system remains strongly rooted in paper-based operations, though members of Project HOPE are making efforts to, over time, modernize the medical system, explains Douglas A. Pitkin, deputy director and chief financial officer for the Iraq (Recovery) Reconstruction Management Office.

Pitkin says there are no immediate plans to outsource coding or transcription operations at the hospital, establish EMRs, or use telemedicine, as the physical construction of the hospital, which is slated to open in early 2009, currently stands at the forefront.

Pitkin says organizers are looking at the hospital as an employment opportunity, especially for those from the Basrah region. He acknowledges that this could prove a challenge since many health professionals have fled the area because of the ongoing violence, but “Project HOPE has made a strong commitment to recruiting for the facility.”

The projected cost of constructing the hospital is approximately $147 million, according to Pitkin. That includes $95 million from the U.S. government to cover most of the construction costs. The Spanish government has offered $22 million through the United Nations Development Program, though approval from the program for the use of these funds is still pending. Pitkin says approval should come in the near future.

Also, Project HOPE plans to donate $30 million through fund-raising efforts as well as in-kind services, such as helping to train those who will be working at BCH. The Iraqi Ministry of Health will also donate certain basic needs, such as bedding, as the project nears completion, according to Pitkin.

A Sense of Security
“Basrah is a very violent place.… With this in mind, one of our biggest concerns is safety. We have a huge challenge at the BCH but not an insurmountable one,” says U.S. Army Lt Col Kenneth W. McDonald, deputy commander and Oil Area engineer with the Southern District, Gulf Region Division, U.S. Army Corps of Engineers. “The location of the BCH is right in the middle of one of the most violent spots in Basrah. The BCH sits between a predominately Shia neighborhood and Sunni neighborhood and, therefore, can be a huge target of opportunity for both groups.

“One of our methods for securing the site is to get the communities to back the construction,” McDonald continues. “As with most cultures, children are the most important aspects of the community. The fact that this project is a children’s hospital rings home with the people of Basrah.”

One effort to draw in members of the community came in the form of an event to celebrate the “rebeginning” of the hospital’s physical construction, which was organized by the project’s Jordanian contractor, according to McDonald. The event, which was attended by community leaders, Muslim and Christian religious leaders, the Ministry of Health’s director general, the governor of Basrah, several members of the Iraqi media, and nearly 100 school children, proved successful, McDonald says.

“Another approach we have taken is to hire a Basrah security firm to provide protection of the project site. The security company has hired its workforce from the local neighborhoods,” adds McDonald. “This might seem counterintuitive, but it actually has made the project site secure from any attacks. Getting in and out of BCH is somewhat ‘testy’ at times for our engineers, but we use a very good security company that provides excellent support. We use several techniques that have proven very effective.”

Improving the Quality of Life
Although there are many challenges to face in the construction of BCH, many of those involved remain positive about what the end result may accomplish.

Willey says the hospital will deliver the necessary specialty medical care to Iraqi children as well as be a model training hospital for Iraqi nurses and doctors, over time helping to improve the quality of life for the Iraqis.

“The hospital will be a pivotal milestone in improving the life expectancy of young children in Basrah and will be a model for future hospitals throughout the country of Iraq,” he adds. “This hospital is the foundation for building a robust health program for Iraq.”

— Tracy Meadowcroft is an editorial assistant at For The Record.