Friday, July 15, 2005

Horror Story

I get bored from the fruitless discussion about politics in general and the hopeless situation in Iraq in particular.
Waldschrat is (up to my knowledge) the only one who take positive steps to help.
I copied his last post here. I hope it will encourages the other for similar positive action

"Lets talk about horror stories. One of the worst I can think of is a cancer hospital with a total lack of chemotherapy drugs. Here is a list of chemotherapy drugs and a description of the shortages at the hospital in Mosul:

===============================================================
Mosul Oncology & Nuclear Medicine Hospital
Mosul, Iraq

Anticancer Drugs Urgently Needed (Not Available)
July 2005
Priority Generic Name Formulation
1. Vincristine inj. 0.5 mg. vials.
2. 5- Fluorouracil inj. 10 mg and 50mg vial
3. Adriamycin inj 15 mg amp.
4. Carmustine vials 100 mg vials
5. Procarbazine Hydrochloride 10 mg. and 50 mg. vials
6. Actinomycin-D inj. 20 mg. vials
7. Bleomycin inj. 100 mg. amp.
8. Cisplatin inj. 250 mg/ amp.
9. Etoposide inj. 1gm and 2 gm. Vials
10. Oxaliplatin inj. 50mg and 100mg vials
11. Gemcitabine inj. 50 mg caps
12. Docitaxel (Taxotere) inj. 1 mg and 2 mg. vials


N.B.
1. This hospital gives medical care for cancer patients living in Mosul (2.55 million population) and nearby northern provinces (Erbil, Duhok & Kirkuk - approximately 2.85 million population )
2. In 2004 the hospital treated 2115 new cancer patients ( Mosul : 1175 patients, nearby provinces : 940 patients )
===============================================================

I'm told by the hospital contact that Truth Teller put me in touch with that requisitions are submitted but supplies never arrive. I'm beating the bushes bigtime over the phone and the internet trying to figure out how to resolve these shortages but neither Truth Teller's contact nor I fully understand the best way to do this yet. The shortages seem totally believable considering the pathetic state of the Kimadia website (link) which is full of broken links and has apparently been penetrated by a hacker who replaced the organizations news releases with a list of online games.

My trial shipment of ostomy supplies to the hospital was stuck in Dubai for a few days waiting for a flight but seems to have begun to move again according to FedEx tracking.

If anybody out there knows how to lay hands on even limited quantities of those drugs, post here or email truth teller!

That's all for now. Go back to your nice discussion, folks."

Waldschrat


All what can I say is THANK YOU WALDSCHRAT we will never forget you.

69 comments:

A Free Writer said...

Dear Truth Teller , Waldschart :

We must be thakful for your efforts to support our community and needy people for urgent assistance.I spent this morning searching for every possible ways for shipping Drugs to Iraq
safely and Thanks God I had found a company named (Iraq Shipping)
In facts I knew nothing about them but you can invistigate by writing to then directly :
http://www.iraqshipping.com/services.html
I wish you good luck in helping poor and sick Iraqis, God bless you for your efforts

waldschrat said...

My contact has the same name as physician quoted in international news stories where he was described as being the head of a Mosul hospital. He answers at a Mosul phone number where a nice lady is somewhat confused by callers unexpectedly speaking English but recognizes his name. In conversations he is well spoken, pesponsive and concerned. He provides me with contact information for highly placed people in the American Caner SOciety and elsewhere with whom he has had previous contact. I have every reason to believe what he says. I have no evidence that suggestss that shortages of critical medical supplies in Iraq are not hideously real.

Kimadia is clearly a key part of the Iraqi supply chain for medical supplies. Their website is tragically defective. Their reputation is poor in almost every reference I have found to the organization. While there may be honest people at Kimadia doing the best they can, that "best" is not getting the job done from every report I have obtained from various sources. Shortages of medical supplies in Iraq seem to be due to causes on the supply-chain end, not the hospital end.

The advice I have recieved from folks who have previously shipped medical supplies to third-world countries is "ship to the hospital". I consider that the best route. Hospitals everywhere routinely maintain secure supply rooms and drug accounting systems of necessity. Mosul is no exception so far as I can tell.

To be fair to Kimadia, there are a thousand problems to be overcome in getting chemotherapy drugs to Iraq. Shipments to Iraq have never been routine, nobody has experience, many US companies and organizations think only of doing business in the US, and nobody trusts anybody. I am trying hard to find solutions but I can guarantee absolutely nothing at this point. I wish I could find an American oncologist to advise me - I have requests out but no advice so far. I will keep trying.

waldschrat said...

For some perspective on the problem I am passing along an email message I received from a US physician:

Dear Pete,
These medications are exclusively used by the oncologists and are totally
outside my sphere of experience as a rheumatologist. A place to start
talking would be with the pharmacists at a large medical center that has an
oncology unit. These medications are usually managed, compounded and
prepared separatelly from the more generally used medications. Usually it
is a specialized staff that deals with them. These are the people who may
have some idea about how to deal with the manufacturers and distributors.
Remember that these are generally highly lethal cell poisons that are
tightly controlled. You will need someone in the oncology community to act
as an intermediary because it is an absolute certainty that they cannot be
released to you as an intermediary with the Iraqi oncologists.

David


I knew this going in. The side effects warnings on this stuff read something like "If you receive an injection of this stuff your arm may fall off." Doctors use this stuff only because the consequences of NOT it using are worse. Reviewing Reviewing my experience of the last few days it seems the best reception I have recieved in my search has been from pharmacists. Receptionists at medical offices in the US seem to be trained to shield doctors from being bothered by patients. Pharmacists seem more helpful. I need to somehow establish a rlationship of trust between a pharmacy and the hospital in Mosul and stuff needs to be shipped directly from the pharmacy to the hospital in Mosul, I think.

I continue to pursue all avenues of search.

waldschrat said...

I continue to learn as I go, in this search.

One possibility is that drug manufacturers might be solicited for donations or samples so I am trying to identify manufacturers.

A problem (relatively minor) is that nomenclature varies and common names of drugs used in the US do not correspond perfectly to the names on the "shopping list".

Another problem which needs to be considered is the need for refrigeration during shipment and storage. Although my contact expressed optimism regarding this, Carmustine (also known as BiCNU) on-line label information says "BiCNU has a low melting point (30.5° to 32. 0° C or 86. 9° to 89.6° F). Exposure of the drug to this temperature or above will cause the drug to liquefy and appear as an oil film on the vials. This is a sign of decomposition and vials should be discarded." It sounds like it could be rendered valueless by exposure to Iraqi summer heat!

Some excellent information on US drugs can be found at the following URL's which I discovered only last night:
http://www.fda.gov/search/databases.html Link: Databases at FDA
( see, particularly, at that FDA website
http://www.accessdata.fda.gov/scripts/cder/drugsatfda/ Link: "Drugs@FDA "Catalog of FDA Approved Drug Products' )

and

http://www.nlm.nih.gov/index.htmlLink: US NIH "National Library of Medicine"

My search continues.

Lynnette In Minnesota said...

Waldschrat,

You are a good man with a generous heart.

I fear the corruption in Iraq or simple theft in the pipeline may be a big part of the problems in receiving any drugs through normal channels. I left a message on Ali's blog asking him if they have problems like this in Baghdad that he is aware of.

Do you read Michael Yon's blog? He had a post a few days back about a doctor organizing a medical text book drive for Iraq. I think it was on July 11. Anyway, there is an e-mail address for him at the end of the post. Maybe he might have some ideas for you. I will put the link at the bottom of this as I seem to have problems with them on this blog.

Michael Yon

Lynnette In Minnesota said...

Waldschrat,

I almost forgot. You mentioned something awhile back about organizations that had sent supplies before. Are they still active? If so can we not send them contributions?

jemyr said...

I can't believe I just signed up with blogger to post here.

Alright, waldschract, truthteller, can you give me more info?

Is the Mosul hospital capable of paying for these drugs in the long term? The list of drugs that are needed, is that a monthly supply, yearly supply? How does procurement in Iraqi hospitals operate? Are drugs supposed to be provided free from the government, or do hospitals pay privately for their drugs?

For instance, the hospitals my family works for are all private. They purchase their drugs directly from the manafucturers, who ships the drugs directly to the hospitals.

I can't tell, waldschraft, if you are saying that the Mosul procurement guy tries to purchase these drugs through kimadia, and Kimadia botches it. Or, if the hospital has no money to purchase drugs, and so submits paperworks to governmental authorities, who don't have enough money to purchase drugs, and therefore never send them any drugs (presumedly because they are lower priority), or perhaps because the government procurement system is incompetent.

If I understood the root of the problem, then I would know that we are addressing the long term AND short term issues. I have friends who have personally flown medications to Haiti and areas of South Africa, and can contact them for advice, but that kind of solution is effective when there is just a short term disruption in supply.

So, is the problem one of procurement (administration problems), AND finances (hospital does not have money to purchase drugs) ? Where does the hospitals annual budget come from? Where does the money come from for salaries and drugs and equipment?

Lynnette In Minnesota said...

jemyr,

It is my understanding that the drugs are normally supplied by the government. Under Saddam it was not really a free market type of system. Except for the black market, of course.


Yes, I think it is both short term and long term issues. There is obviously something wrong in the normal government supply chain. Whether it is a combination of no finances, theft, safe delivery issues I don't know. Probably a little of each.

They mentioned something about there having been help from other organizations, but I don't think they mentioned specific names.

I tried to find current information about Red Cross/Red Crescent activities before, but was unable to find any beyond 2003.

For more detail you will have to wait for Waldschrat as he has actually contacted people in Mosul.

pebblepie said...

Thanks for bringing it to our attention. I can't help but wonder how easy/difficult for items to get in and out of Iraq :^(

Pebble

Chriswab said...

Nice page!!! Greatings from Germany!!!

Truth teller said...

jemyr

"Is the Mosul hospital capable of paying for these drugs in the long term?"

Unfortunatly NO. The hospital can't buy any thing. All the medicine and medical appliances were supplied through the MOH.

"The list of drugs that are needed, is that a monthly supply, yearly supply? How does procurement in Iraqi hospitals operate? Are drugs supposed to be provided free from the government, or do hospitals pay privately for their drugs?"

The drugs and all medical appliances were provided freely from the government, the responsibility of the hospital is to make a list of the needs for the next year. (this is only applied to the governmental hospital, the private hospital has to buy their needs from the private sector.)

"and therefore never send them any drugs (presumedly because they are lower priority), or perhaps because the government procurement system is incompetent."

Although this question is directed to waldschrat, but I will answer it, the both reasons are correct.

"is the problem one of procurement (administration problems), AND finances (hospital does not have money to purchase drugs) ? Where does the hospitals annual budget come from? Where does the money come from for salaries and drugs and equipment?"

It is a procurement problem, the hospital annual budget come from the government (the Ministry of Finance), which also pay the salaries and for drugs and equipments.

Truth teller said...

moron99

"Does TT no longer need the bags and rings?"

No WE still need the sags and rings. The drugs is a different issue.

"do you still need these non-drug supplies? "

Yse I do.

"Or would recieving US deliveries place your clinic in danger?"

Probably yes. Delivering these supplies to the hospital is more save and secure.

waldschrat said...

Lynette, Moron99 -
One reason I have been concentrating on the problem of chemotherapy drugs recently is that I did have some luck identifying the charity that contributed previously and found that they were quite interested in shipping some supplies. Beyond this, the problem of Ostomy supplies is a simple one - all that is really required is money and the will to act, there is no need for a prescription, materials will not deteriorate in transit or storage, people are willing to ship them anywhere, and shipping by multiple channels is apparently available at varying costs.

Chemotherapy drugs are a much harder problem. They can not and should not be administered except by very knowledgeable doctors because they are very dangerous. No sensible pharmacist would give them to a customer who was not a doctor or hospital employee. They can not be obtained without a doctor's prescription, and this normally means a LOCAL doctor in the same city as the pharmacy. Most pharmacies do not even carry them because their use is so specialized. At least some of them normally require refrigerated storage.

Today I talked to a pharmacist at the local Walmart pharmacy. He immediately recognized them as chemotherapy drugs and explained why I couldn't possibly get them at Walmart and why they didn't carry them in stock and that I didn't have a prescription and that they didn't mail drugs and that any hopes I had of getting them from Walmart were totally misguided and etc etc blah blah blah. After many minutes of persuasion I talked him into giving me some price information regardless of all these problems and despite the absolute certainty that I could never purchase the drugs from Walmart. It took him many more minutes of substantial effort to identify several of the drugs, some of which he had to guess at, and give me price quotes on 6 out of 10:
2ea Vincristine 1mg/Ml Inj $13.32
1ea Bleomycin 30U Inj $331.72
10ea Fluorouracil 50 mg/ml Inj $5.32
5ea Adriamyc PFS 10mg Inj $37.54
50ea Cisplatin 50mg Inj $83.72
5ea Etoposide 20mg/ml $45.32
These results were generated by the computer and may contain misspellings and confused units of measurement attributable to some computer programer somewhere, but they should represent approximate, competitive low-end prices for individual packages or doses of these drugs on the American market. I asked the pharmacist for "unit prices" and the data above is what was on the computer printout he handed me. The printout had columns for "quantity", "prescribed drug" and "price"; only numbers appeared in the first column but I have added "ea" because I can't do columns here. Drugs ordered in large quantity might be cheaper, but beating Walmart's price has proved impossible for many businesses in the USA.

So far this poor pharmacist at Walmart has provided me with more useful information than I was able to obtain from about a dozen very highly placed people at the American Cancer Society, U.S.A.I.D., the U.O.P. School of Pharmacy, Eli Lily, McKesson Corporation, and the US Embassy in Baghdad, plus two cancer hospital pharmacies and an oncology clinic in Sacramento.

I am losing count of the people who have ignored my email or sent me away to someplace that proved a blind alley. Idiots around the world send me spam email every day offering drugs to make my genitalia longer and stronger or help me miraculously lose weight. Pathetically I am now forced to read these messages carefully before discarding them because I do not want to miss any legitimate offer of help for Mosul from the people I have asked for advice.

It is beginning to look like the problem of getting chemotherapy drugs to Mosul is not so much one of price but more one of regulations and bureaucracy. I have the greatest respect for the quality of American drugs. I am placing highest priority on finding a method to ship from the USA, but at MINIMUM I need to find a pharmacy that can ship chemotherapy drugs internationally and I need to find an American oncologist or other authority acceptable to that pharmacy to authorize that shipment.

There are other possible avenues. Just across the California/Mexico border in Tijuana, Mexico there are dozens of pharmacies that sell drugs which could not be purchased in the USA without a prescription. They exist because they are profitable, and they are profitable because some people want or NEED to circumvent the medical bureaucracy that makes obtaining drugs in the USA inconvenient. Sometimes what they sell is of good quality, sometimes it it is not. It might be possible to find what Mosul needs there, but there would necessarily be legitimate doubts about the quality of what was available.

Some avenues of search are not available to me. This includes web sites in Arabic and other non-English languages. There are cancer hospitals in Jordan and Turkey that have chemotherapy drugs, I think. If we could find out how they get them and where, that might help.

One thing bothers me. The Health Ministry and Kimadia are the usual source of drugs and supplies in Iraq as I understand it. I assume that the hospital in Mosul has done everything possible to get what they need through the official, approved supply channels. However, because of the war there are various reasons (all unknown to me) why procedures for ordering drugs may have changed and messages or shipments may have been lost or misdirected. It is unlikely but just barely possible that somewhere in Iraq the drugs Mosul needs exist and could be delivered if the need were understood and the proper forms filled out. If I were a hospital clerk and knew that some drugs had been unavailable for years, I might stop sending requests I knew would never be filled. It might be worth investigating. Miracles happen sometimes. The hospital should definitely double-check periodically to see if what they need has become available. I assume they know that and do that, but sometimes obvious things are forgotten or overlooked.

The search continues. I need a pharmacy that can ship chemotherapy drugs internationally. I think I need an American oncologist to advise me and authorize such shipments.

waldschrat said...

Dan -

I am married to a breast cancer survivor. Cancer patients are the most courageous people I know. They stare death in the face, grit their teeth, and willingly(!) undergo any necessary treatment, whether it be injection of near-lethal drugs, disfiguring and debilitating surgery, or radiation burns, to fight death to a standstill and make it retreat. Everybody dies eventually. Cancer patients and their doctors wage truly heroic battles before they go. Vitamins and a healthful lifestyle are good, nobody denies that, but when prevention fails and death comes knocking and you decide to do battle, you use the most powerful weapons available.

Truth teller said...

strykeraunt

"I stopped working on this issue at that point because a post from Truthteller right after that point indicated to me that he really did not want help from "the stryker family."

Truth Teller did not want help from any body to him self.
What is going on here is a help to cancer patients, nothing personal.
If you want to help, you are welcome.

Lynnette In Minnesota said...

Waldschrat,

Have you contacted or thought about contacting Chief Wiggles? He already has a delivery and distribution line set up for his Toys for Joy program. He may have some ideas as well or be able to help in some way.

Here is his link:
Chief Wiggles

Truth teller said...

moron99

I am ready to meet Michael yon if he can visit the Oncology and Nuclear Medicine Hospital, I am available there every Wednesday after 10:00 PM

Truth teller said...
This comment has been removed by a blog administrator.
jemyr said...

Truthteller,

This is very enlightening.

I'm working through the WHO, USAID, IRRFI right now, and waiting back to hear from friend in Africa. Unfortunately, my family includes neurosurgeons, obstetericians, and internal medicine people, so they're no help. They're trying to track down an oncologist friend for me.

But, in the meantime, I think understanding these long term issues is extremely helpful. So the hospital's budget is approved by the Ministry of Finance, and the hospital procures things through the Ministry of Health?

Do the doctor's salaries get paid on time? Does anything come through in a proper manner? If so, what things seem to be procured efficiently, and what things are not procured efficiently?

Specifically, drugs were disbursed through this entity "Kimadia"? Is that correct? Before the war, was this who disbursed the drugs? Were they any good then?

This stuff is the nuts and bolts of Iraq. I think it gives me a far greater understanding of the difficulties and problems you face than anything else I've learned so far.

Thanks for educating me!

Jonathan said...

I'm looking into it but I think the best people to work with are the US Army Civil Affairs guys in Mosul. I'll get the contact info for the CMOC (Civil Military Operations Center) in Mosul. Usually several people are assigned to work with the ministry of health in an area. If someone can come up with the supplies, they or someone they know can most likely fly them directly to the airfield in Mosul from either Kuwait or one of the large bases in Iraq. Either fly the supplies in on a military transport or ship it via DHL or FEDEX, both of which fly their cargo planes into various locations in Iraq. I someone can come up with the supplies getting it to Mosul is not going to be a huge problem.

Contact me directly for further coordination.

Jonathan Trouern-Trend
jtrend@earthlink.net

jemyr said...

Here is a private medical procurement company in Iraq:

http://www.alassad.biz/contactus.html

I'll email him and see what he says.

It may be possible to have the Mosul hospital place an order directly with these guys (if they are not corrupt), and then we pay for the items.

If this works, it could be the beginning of a long term solution, we'd just have to figure out how to have the MOH reimburse this private organization instead of Kamidia. But the issue could be that the MOH doesn't have enough money to procure the supplies. I wish I knew if the problem is that there isn't enough money available for health, or if the money is being siphoned off. I wonder how we could figure that out?

waldschrat said...

The US branch of the Canadian charity which shipped some ostomy supplies to Musul in the mid 1990's sent me a list of questions related to the hospital's needs and other matters related to delivery of the supplies and I forwarded it to the agreed hospital contact. These folks really want to make sure the supplies get to the patients. They have had experiences in other countries where supplies were instead intercepted and sold on the black market. I'm going to omit mentioning their name here to make sure they are not confused by getting messages from multiple correspondents. The text of their message was as follows:

========================================================================
We will be glad to consider your request.

FOW-USA is a totally volunteer organization. None of our workers are paid. We use our home computers for all email correspondence. All products are donated to us by ostomates and pharmacies in the USA. We try our best to select and send ostomy products that will be useful to you.

If there are any problems with shipping or with customs, we need to hear from you immediately.

We need stories (and if possible pictures) telling how this shipment helps you and the people you are helping.

Please send us the following information

1. What ostomy services does your organization provide?

2. How do you decide who will receive supplies from this donation?

3. Is there cost to the people who get supplies?

4. Is there a doctor or nurse who will choose the correct type and size?

5. How many people does your organization serve?

6. Is there a contact person who reads & writes in English who can correspond by email with FOW-USA?

7. What is the email address, phone number, FAX number for this person?

8. Do you know if import documents / stamps / seals needed? If so, what?

9. Please type the name and address as you want it on the shipping label.

10. Please give us the name, telephone number and email of the person responsible for receiving the shipment in your country. This name and telephone number will be on the shipping information as the person to contact when the shipment arrives.

11. What ostomy equipment do you need?

Size range of stomas?
Size range of wafers/flanges?
Can you use urostomy equipment?
Can you use irrigation equipment?

We always have excess wafers/flanges (ConvaTec and Hollister.) Can you use wafers/flanges with no matching pouches?

12. Can you use ostomy care information in English (pamphlets, videos.)

This is a lot of questions. We need this information to send the right supplies to you.

Sincerely,

etc etc etc
Shipping Coordinator

========================================================================

I'm going to email truth teller the same info I sent the agreed contact, because he has better internet access and to keep him in the loop.

If Michael Yon were to do a story on the hospital it might help verify the hospital's legitimacy and need and assist this charity in understanding that they could truly benefit patients in Iraq by sending supplies to the hospital.

waldschrat said...

Truth Teller, the Hospital contact attempted to answer the list of questions but the file format of his response is all messed up and almost totlly impossible to read (some kind of deffective rtf code pasted into an email, I think). The charity volunteers sent the questions in rtf format when they should have sent plain text or almost anythinng but rtf. I can't reach him on the phone and will be busy tomorrow. Please try to help straighten things out. ANother day or so will not matter, but communications need to be clear and what got sent seems badly garbled, largely due to file format problems I think.

Lynnette In Minnesota said...

Jemyr,

If you can get USAID involved that would be an excellent solution for all of the needs. Obviously, the best solution would be for the Iraqi government to get it's act together. But, with things the way they are, that might take awhile.

Waldschrat,

As the Canadian group found out, it doesn't always work to just send stuff. You need someone trustworthy on the end to get it to the people in need. Which is why I think Strykeraunt would prefer to work through the US military. Even then it doesn't always work out. I keep seeing all those police uniforms that ended up in the markets. But at least they are people WE trust. You may trust TT and the other gentleman you have been e-mailing implicitly, but I do not. TT has given me no reason to. His and his families friendship with people like the Jarrars does not help. But if you can get Michael Yon or someone in our military to check them out than that would help a great deal. Their credentials might also help with some of those people you have been e-mailing and not getting a response from.

I don't mean to sound harsh, but I would never just send money to anyone without some kind of assurance that it could not be used in some way to harm any of our troops or innocent civilians in Iraq.

Lynnette In Minnesota said...
This comment has been removed by a blog administrator.
Lynnette In Minnesota said...

I was going to comment on Hurria's comment regarding sending money to the U.S. government, but I liked Dan's response better. So that deletion was me.

waldschrat said...

I have been contacting drug wholesalers and identified two US companies which definitely ship chemtherapy drugs internationally and 4 possibles. I sent email messages to all 6 asking for information about the availabiity and price of chemotherapy drugs for Mosul. I will put the Mosul contact in touch with any company that responds with encouraging information and let him know which companies I have contacted.

Knowing that Israel trades with Turkey and Mosul is close to the Turkish border I also asked for advice from one Israeli company. I would ask for information and assistance from the devil himself if I thought it might help Mosul.
I am concentrating on companies in the US because what they ship should be of known, good quality and I am better able to contact them and assist in payment.

At least one company representative mentioned over the phone that they had decided not to do try to do business with Kimadia after investigating them - I do not know the exact reasons.

Ultimately, all concerned must recognize that charitable donations will not be able to fill all Mosul's needs in the years to come. Iraq and it's hospitals are going to have to solve the problem somehow. I suspect that Kimadia is either going to have to be replaced or somehow assisted in learning to provide the doctors and hospitals of Iraq with what they need.

It is unlikely that any US pharmaceutical supplier will ship to anyone unless they are certain that the recipient is legitimately entitled to recieve and use the materials shipped. They will probably want information about the licenses and credentials of the recipient. Photographic evidence of such documents may be requested.

Photographs of the hospital would also be valuable for helping the charity which is interested in shipping ostomy supplies understand the hospital and it's patients.

Najma has posted photos taken with a digital camera in her blog occaisionally. Any photos which may compromise the security of the hospital or it's doctors and patients should not be published in any blog, of course.

The file formt problem mentioned previously in connection with Mosul's response to a charity's questionaire has been resolved beautifully by the hospital contact.

Truth teller said...

Hi every body

Sorry for the delay in response. I am very busy right now. I will try to comment this night if I got time.

Lynnette In Minnesota said...

Moron99,

My only concern was that these things could be sold on the black market and the money used for other purposes. All I was looking for was for someone that I know I can trust, like the US military civil affairs people or an established NGO to basically OK it.

jemyr said...

Still waiting to hear back from the phone calls I've made. I'm certain I'm on some FBI watch list now. Here's what I learned:

Back in 2003 there was a Col named Scott Svabek who was associated with the White Plains procurement group. I called them and chatted with a guy for a while. He said Scott finished his tour and is back home with his family. Scott was in charge of coordinating the CPA and Kamidia, and said he was going to privatize the services Kamidia offered, because Iraqis had consistent problems with Kamidia that had to deal with corruption and incompetence. He was starting this privatiziation process supposedly in 2003, and so there is supposed to be a few private Iraqi drug procurement countries now operating so the government doesn't rely on one government owned procurement company.

Anyway, I tried to discuss this with the White Plains group and they had no idea what I was talking about. When the CPA dissolved,, all the responsibility for this went back over to the Ministry of Health.

Now, Doctors without borders was really concerned about the procurement process and they took up a large portion of disbursement in Iraq until some of their members were killed, and they decided it was too dangerous to work there anymore. That was last year.

I called them up, and they're supposed to tell me who is actively working on drug distrubition now.

I find all this fascinating. This kind of stuff is the reason a country will succeed or fail. How can you get anything done if there is no organization in place to get anything done? No wonder so many people are so frustrated.

The White Plains office has a fantastic organizational structure set up to make certain that the American traige units in Iraq are running efficiently, and that the drugs they ask for are purchased and distributed.

I asked them who distributed drugs to the Iraq government hospitals themselves, and they had no idea. I asked them if private groups could procure drugs from them and then use their structure to disseminate drugs to government run hospitals in Iraq, and you can imagine my response to that.

The old structure, of course, was Kamidia, but Kamidia went through a major upheavel, and many employees operated through under-the-table corrupt deals which are no longer viable under occupation.

Obviously, an organized distribution system is a priority, but who is working on it? Who is in charge? Is it the MOH? Should the U.S. be responsible for setting up an efficient and organized drug procurement program? Even if it shouldn't be responsible, is it possible to have a good quality of life in a country where doctors have no stable system to procure medicines for emergency procedures?

While it may be easy to demonize the MOH as a bunch of incompetents, how difficult would it be to set up an organized request and drug distribution system when you start out 1) with a war 2) shut down for 6 months 3) responsibilities transferred to the UN and a U.S. general 4) responsibilities overtaken by a Col Scott Svabek who decides to transform the system from scratch 5) responsibilities given back to you, but with no clear understanding of how the new funding system is going to work (because the budget has to be approved by a new government, and no one is certain what international money is coming in and when, and then who does it go to and in what priority) 6) Many of you are fired for abusing your position from before the war.

Now, on the flip-side, how easy would it be for the U.S. to set up an organized system when: 1) the MOH resents them butting in on their business and wants them to stop confusing the issue and leave them alone 2) the army doesn't have any organizational structure or personnel in place who have set up a drug procurement system from scratch. And they never thought they would need to do so. 3) The bureacracy to create a new organization that would effectively do this is so convoluted, it's uncertain whether or not the army could be more timely with a solution than the MOH anyway.

So that gives us all a taste of why, at the end of the day, pre-planning for the boring mundane aspects of things is much more vital than preparing for the spectaculur things. The mundane things take far more organization and leadership than the rest.

Anyway, still working on it, although I think waldschrat will have this all done before I can. Amazing work, by the way.

jemyr said...

Alright, the new U.S. guy appears to be James Haveman
http://www.marinecorpstimes.com/story.php?f=1-213079-2174059.php

And he says:
The toughest challenge for health care in Iraq, Haveman said, is creating a delivery system for services.

“The infrastructure of the 240 hospitals is extremely poor,” he said. “To revitalize that, to get things online, to get basic services has been a challenge.”

Iraq’s health system was one of that country’s most corrupt agencies, he said.

It also was significantly under funded. Saddam Hussein spent the equivalent of $23 million in the United States on 23 million people, Haveman said. The country has been isolated from medical schools for 15 years, and up to 70 percent of hospital equipment doesn’t work, he said.

madtom said...

This all sounds like the mythical Free Cuban health care system which is touted world wide as the 9th wonder of the world. Of course non of it's world wide supporters would have a hang nail treated in Cuba but they are certain that what's there now is what's best for Cubans.

Lynnette In Minnesota said...

Jemyr,

Thank you for that update. Your info is fascinating. It doesn't help to try and set all these things up when you are being attacked constantly.

Truth teller said...
This comment has been removed by a blog administrator.
Truth teller said...

jemyr

Sorry to be late in response.
"So the hospital's budget is approved by the Ministry of Finance, and the hospital procures things through the Ministry of Health?"
-That is right.

"Do the doctor's salaries get paid on time?"
-Yes the salary paid at time, but one thing is astonishing, during the last 2 years, every month we received diffirtent salary from the previous month!!.

"Does anything come through in a proper manner?"
-There is no fixed manner any more, every day a new thing is emerging.

"If so, what things seem to be procured efficiently, and what things are not procured efficiently?"
-To be honest, only painting and decorating the building are done efficiently. All other thing including Drugs supply, tools, and medical appliences are all in very bad status.

"Specifically, drugs were disbursed through this entity "Kimadia"? Is that correct? Before the war, was this who disbursed the drugs? Were they any good then?"
-Kimadia, is the organization responsible for importing and distributing the drugs. It was not good from the start, but now it is much warse.
________________________

"I wish I knew if the problem is that there isn't enough money available for health, or if the money is being siphoned off. I wonder how we could figure that out?"
-I think it is a mixture of both. It is not possible to figure it out now!. May be in the future.

Unknown said...

I just contacted a physician who specializes in Oncology who used to work at the hospital at Mosul, he is now at Wayne State University. His name is Anwar N. Mohamed, M.D. I have asked for any help he can give in assistance or information.

He has the information to contact you via email, TT, hope this will help. If I find out any other sources or information will advise.

Truth teller said...

moron99

"From what I can gather, a box full of bags delivered to the hospital is going to end up on your desk no
matter what route it takes. Is this a fair assumption?"

-You are right, but every thing have to registered and to supplied to the patients who need it according to a well organized and registered file system.

"What we need to do is get a "donations" button on your blog (and maybe some other blogs) and try to set up an ongoing trickle of bags to you."
-That's may work perfectly, but I don't want to be involved in any financial or money collecting system if possible.

"what I'm trying to say is that patients shouldn't suffer because the doctors have political differences."
-You are right again moron, but the warmongers have different opinions than yours.

Truth teller said...

strykerdad

"only nonperichable items are allowed"
-The bags(pouches) and the rings(flanges) are plastic materials, {Nonperishable}. Isn't it?

"And if those who are on the recieving end don't find him trustworthy or a propagandist."(Michael Yon)
-Even if he is a propogandist, the truth is evident, no body, even a propogandist can't conceal it.

"and from what I've read about TT's attitude, he might proudly provide a sniper with aid. He does seem to oppose efforts of the current Iraqi government, and US troops and then blames them for the lack of supplies."
-A very good excuse not to provide a help.

Truth teller said...

strykeraunt

"TT, I understand if may be a safety issue in regards to meeting Michael Yon. However, if there isn't and the opportunity arises I hope you would still be willing to meet with him."
-If he manage to visit the Oncology and Nuclear Medicine Hospital, It is not a problem to meet him there.
It will be an apportunity for him to write a report about the cancer patients suffering in the city.

Truth teller said...

lynnette

"You may trust TT and the other gentleman you have been e-mailing implicitly, but I do not."

"My only concern was that these things could be sold on the black market and the money used for other purposes."
-These are good excuse not to help.
Thank you any .way

Truth teller said...

hurria

thank you for your concern. I looked at his website and ready to meet him, if he will.

Truth teller said...

dan

" So, what do YOU have to say, "Truth Teller?""
- I think, I said enough. But in short:
"To those who don't want to help, just say it, no need to find excuses for that."

Truth teller said...

jemyr

We appreciate your efforts. Thank you a lot.
You and waldschrat are a good examples of the goodness that still in the hearts of man kind

Bruno said...

Waldschrat –

You have expended considerable time and effort in your endeavour to help Truth Teller; for that you must be commended. Thank you. I’ll try to bear in mind that you put your money where your mouth is when commenting to you in future.


Moron99 –

[m99] “I guess what I'm trying to say is that patients shouldn't suffer because the doctors have political differences.”

That’s the first decent thing I’ve heard you say. I thought I’d point it out and focus on that rather than all the *other* points that I’d like to, um, belabour.


Strykerdad –

[strykerdad] “After writing to a frontline troop on this subject, I got word of our troops wounding, hopefully killing, a couple of snipers in Mosul this week---I would hate for one of them to be treated using anything I helped provide, and from what I've read about TT's attitude, he might proudly provide a sniper with aid.”

Mm. I’m sure that you speak the truth. We all witnessed how US troops care for wounded, captured enemies in Fallujah. This also fits in with US trends of bombing hospitals and shooting ambulances because they are providing aid to the enemy. Gotta maximise those body counts, eh?


Dan –

[dan] “Hurriah [sic] , this is NOT the POLICY of the American government. While you may argue from now until the end of time whether the MNF was correct to liberate Iraq, you KNOW that the US DOES NOT target civilians [sic].”

I refer you to:


The “Salvador option” For Iraq
By Bill Van Auken - 14 January 2005 - World Socialist Web
“The article cited the little-reported assessment given by General Muhammad Abdallah al-Shahwani, director of the Iraqi puppet regime’s intelligence service, that the resistance is 200,000-strong and enjoys broad sympathy, particularly in Sunni areas.
A US military official, who agreed with this assessment, told Newsweek: “The Sunni population is paying no price for the support it is giving to the terrorists. From their point of view, it is cost-free. We have to change that equation.”
As the occupation authorities see it, those who choose to collaborate with them are paying a very heavy and visible price in the form of assassination of political leaders, bombings of police stations and wholesale killing of militiamen. The purpose of the plan is to exact a similar price from those who oppose the occupation.” //end extract
Does this seem far fetched? Yet it is true that Negroponte, a man with bloody hands, has been assigned to Iraq, and that Steele, the coordinator of the US terror in El Salvador has been despatched to get the death squads up and running. The Special Police Commandos are a result of these efforts. Yes, the same people who let nine bricklayers suffocate to death in a metal van a week ago.
In other words, the aim is to crush the populace itself, and make them fear the government to such an extent that they will hand over their own brothers and sisters. All dissent must be eliminated. Look at the arrest of blogger Khalid Jarrar for example – arrested without charge because he said something against either the Iraqi ‘government’ or the US. He is currently still in jail, without charge, incommunicado.

Of course, these broader, more indirect efforts are supported by direct collective punishment of civilians by the US, as well as the direct targeting of the said civilians. To whit:


Ambulance torn apart in Fallujah as US launches 'precision' strikes
From Patrick Cockburn in Baghdad - 14 September 2004

“A plume of grey smoke billowed above Fallujah yesterday as the US military claimed they were making precision air strikes against insurgents in the city and local doctors said that civilians were being killed and wounded. The US army said its warplanes had bombed houses because it had intelligence about the presence of fighters loyal to Abu Musab al-Zarqawi, whom the US sees as the guiding hand behind many attacks on its forces. Dr Adel Khamis of the Fallujah General Hospital said at least 16 people were killed, including women and children, and 12 others were wounded. Video film showed a Red Crescent ambulance torn apart by an explosion. A hospital official said the driver, a paramedic and five patients had been killed by the blast.” //end excerpt


Oh dear, ‘collateral damage’. Gosh, who could have imagined that dropping 2000 lb bombs on civilian areas might produce civilian casualties? I mean, hey, Al Qaeda didn’t target civilians on 9-11, they were actually trying to kill some cops in the Towers. The rest of the people happened to get in the way. So sorry for the collateral damage.

And also:


Empire Notes 2004 – Rahul Mahajan

“After initial instances in which people were prevented from leaving, U.S. forces began allowing everyone to leave – except for what they called “military age males,” men usually between 15 and 60. Keeping noncombatants from leaving a place under bombardment is a violation of the laws of war. Of course, if you assume that every military age male is an enemy, there can be no better sign that you are in the wrong country, and that, in fact, your war is on the people, not on their oppressors,, not a war of liberation.
[…]
In addition to the artillery and the warplanes dropping 500, 1000, and 2000-pound bombs, and the murderous AC-130 Spectre gunships that can demolish a whole city block in less than a minute, the Marines had snipers criss-crossing the whole town. For weeks, Fallujah was a series of sometimes mutually inaccessible pockets, divided by the no-man’s-lands of sniper fire paths. Snipers fired indiscriminately, usually at whatever moved. Of 20 people I saw come into the clinic I observed in a few hours, only five were “military-age males.” I saw old women, old men, a child of 10 shot through the head; terminal, the doctors told me, although in Baghdad they might have been able to save him.

One thing that snipers were very discriminating about – every single ambulance I saw had bullet holes in it. Two I inspected bore clear evidence of specific, deliberate sniping. Friends of mine who went out to gather in wounded people were shot at. When we first reported this fact, we came in for near-universal execration. Many just refused to believe it. Some asked me how I knew that it wasn’t the mujaheddin. Interesting question. Had, say, Brownsville, Texas, been encircled by the Vietnamese and bombarded (which, of course, Mr. Bush courageously protected us from during the Vietnam war era) and Brownsville ambulances been shot up, the question of whether the residents were shooting at their own ambulances, I somehow guess, would not have come up. Later, our reports were confirmed by the Iraqi Ministry of Health and even by the U.S. military.” //end excerpt


And this demonstrates that these trends have not stopped :


Iraqi government worried about civilian killings by US fire
AFP 3 July 2005

BAGHDAD (AFP) - The Iraqi government said it was worried about the rise in incidents of civilian deaths by US fire and that Prime Minister Ibrahim Jaafari will raise the issue with US officials. "The prime minister will take up this matter at the highest level," spokesman Leith Kubba told reporters, citing the case of Yasser al-Salihy, an employee of US media group Knight Ridder. Salihy, 30, was killed June 24 near his home in Baghdad's western Ameriyah district by purported US sniper fire, one of his colleagues said, adding that the US military has promised to investigate the incident. He was a physician by training who had been working as a translator and fixer with Knight Ridder for about a year.

Hundreds of Iraqis have been killed by US fire especially on highways given the US military rule of keeping Iraqi motorists at least 100 meters (330 feet) at bay from their convoys due to the threat of car bomb attacks.” //end excerpt


Sure it’s not POLICY to kill Iraqi civilians, except if they happen to be driving on Iraqi roads, or if they look ‘suspicious’ or if they are out late, or take a wrong turn or if their car has shifty headlights .... of course, if the Russian Army was poncing about on US roads wiping out families who happen to get ‘too close’ or take a wrong turn, I suspect your attitude to this would be quite different.

Lynnette In Minnesota said...
This comment has been removed by a blog administrator.
Lynnette In Minnesota said...

I don't know if I could add anything to Srykerdads comment. He has been very thorough.

"These are good excuse not to help"

I will add this. If my intention were not to help, I would simply remain silent. Like you. When the conversation turns to the actions of the so called insurgents in Iraq.

jemyr said...

Can we stay on the topic of the issue with well functioning hospitals in Iraq?

In terms of what expertise Truthteller has, this is his area of expertise. We can debate about insurgents and the motivations of people who murder civilians, and whether or not the army functions correctly, but truthteller is not in a position to enlighten us on any of those issues. He is an a position to enlighten us about a key aspect of "nation building", namely, the suffering of patients and the origins of that suffering. Corruption in health care. Incompetence in health care organization. The roots of those issues, and who is responsible for the problem, and what solutions need to be worked on to rectify the problem.

For instance, I think it is important that the people who have said that they are concerned about helping, have aired their concerns. This lack of trust is a great example of the reasons why we aren't seeing improvement in Iraq. How do you provide help, when you don't trust the people you are helping?

Can we learn from the past? In other cases were we have not been able to trust someone enough to help them, has that inability to take a leap of faith been the main reason, or a smaller reason, for not creating positive change?

This is all important stuff.

I'm not saying I know the answers, because I don't. But we are stepping, first hand, through the issues that present themselves when a nation riddled with corruption is transformed through the tool of war. We are in the reconstruction phase now. The issues and problems we face are rooted in the sins of the people who have come before us. What has caused the most damage? Corruption from the previous group? Lack of trust by the populace toward their armed "benefactors"? Lack of trust by the armed benefactors to the untrusting populace? Lack of organization by the lower ranking citizens whose history is riddled with active programs to prevent them from correctly organizing, and no guidance or leadership to provide them with any sort of way to organize now? Lack of organization from the indviduals who were in power before but used that power for corruption, and can't be trusted not to use that power for corruption again? The new Iraqis placed in power who have never organized something on this scale and are just testing out what authority they do and do not have (and are continually being replaced with new people and new systems as the politics flux day by day)?

The armed benefactors who trade out jobs and positions, and also don't have clear authority on what they are and are not allowed to do, and have not ever been responsible for creating a system like this in their lives, and so continually recreate new "solutions", while at the same time being threatend with murder (as James Haveman has almost been killed a few times)?

What is the central organization structure here? Who is coming up with it? Who is in charge? These are the first things we have to know, in my opinion. Otherwise, how is any of this going to change?

Iraqis and Americans have to take responsibility for THIS issue. How can truthteller be expected to think that things are going to get better, if I (an American) am not even certain if there is someone in place to make sure his hospital is capable of functioning. Why is his salary changing every week? (Truthteller, do you know why that is?) Why is the building getting painted, but the drugs aren't getting procured? Who is making decisions? What are we moving towards?

This is complicated, big stuff. And there's plenty to talk about. So let's talk about this, and leave other topics for later.

Mad Canuck said...

Strykerdad,

I'm a bit confused about something. You've expressed a lot of concern about ostomy supplies being used to "aid the enemy", and yet what would your daughter do with a wounded insurgent who showed up on a stretcher? I'm guessing she'd probably do the same as any medical professional: she'd treat him to the best of her medical ability. You mentioned in your last post she does this "almost daily" at Mosul Army Hospital.

Raed Jarrar published a few interesting pictures a while back. Interestingly, Raed didn't realize what was going on and called it a "war crime", but if you look at the pictures, you can clearly recognize what's happening: army medics are removing the clothing and bandaging the wounds of two insurgents who they'd just wounded in a firefight.

If the US Army provides treatment to wounded insurgents, how could you expect Truth Teller to act differently? Not that it's likely that a wounded insurgent would show up at a cancer clinic for treatment, but in the remote chance that one did, I would hope that Truth Teller would honor the Hippocratic Oath and provide medical care to the guy, just like I'd hope he'd do the same for a US Soldier.

If we were talking about shipping supplies of bullets or clothing or boots, the whole "aiding the enemy" concept would be much more relevant, but I don't see what the big concern is with plastic bags and chemotherapy drugs.

Unknown said...

I don't visit often and it's because to read the comments you have to wade thru all of the various stryker stuff.

However, TT there are alot of us out there that do care and are trying to do what we can to help.

When I come here and I read some of the things written I am reminded of an old saying "If you are not part of the solution you are part of the problem".

I also add my thanks to Waldschrat because he has not only acted but inspired some of us to try to act as well.

Unknown said...

Also, thank you to free writer for your information, I am waiting for information back from the shipping company you listed.

So far? They appear very helpful.

Unknown said...

Of course, it is somehow my fault for not wanting to scroll thru the various rants that have nothing to do with the topic at hand.

I'm sure all of you strykers have other places to gather so asking you to not bog down a thread that is important to some of us should not be a large request. From a professional courtesy level when you are trying to provide this site as a verification of real need posts like yours do add nothing to this. While you may feel your thoughts are so important, there are others with more important immediate needs which bogging down this thread serves no purpose.

As I stated, but will clarify, if you do not desire to help? Please step aside so those of us who are trying to do something do not have to deal with trying to explain to humanitarian sources, please excuse the yahoos, there is a real need for assistance.

Unknown said...

Let me also add strykerdad that I have had and still have contact with soldiers in Iraq so I'd say your assumptions are wrong.

All you do here is bash, there is much work to be done and if your really do support what your children are attempting in Iraq? You do not come across that way.

You only want to help healthy children? Well then jump in because children in Iraq are starving. There has been no baby formula available to those who relied on UN aid in Baghdad since January.

Conditions in Iraq are worse now than they were under Saddam so please, use your stryker powers and do something, or continue to slam TT for trying to help. You may fool some here, but not anyone who actually has a clue as to what real life conditions are for the average Iraqi.

jemyr said...

*sigh* Might I suggest we put off-topic arguments on hold until truthteller puts up his next post? Is that too much to ask?

Tracked down James Haveman's email address and sent a message. His tour was up in 2004. I'm hoping he can tell me who's in charge now.

jemyr said...

Here's interesting info about organization for the Health Ministry back from 2003.

http://www.cpa-iraq.org/factsheets/05222003_Health.html

jemyr said...

And here's an article on the handover. This is where James Haveman stepped down, and the MOH took over fully.

http://www.tricare.osd.mil/eenews/downloads/moh040104.doc

It's short on details but interesting. It says: The reorganization, as approved by Dr. Abbas, will: reduce centralization and encourage collaboration across divisions and governorates; create new systems for the procurement and distribution of pharmaceuticals, medical supplies and equipment;

I wonder what the new system is?

jemyr said...

A comprehensive study done by a NGO, and published in 2005. A far bleaker view:

http://www.medpeace.org/news/mfp-report-civilian-health-in-iraq.htm

Bruno said...

Dan, Strykerdad –

So basically you’re resorting to the old “its all propaganda” routine. Well, here’s some more for you:


Turk.US Daily News
Friday, July 15 2005

“US snipers killed two Iraqi suspects as they passed by the governorate of the Iraqi town of Ramadi, carrying bags on their way home from the mall, on Friday. US troops took away the bodies two hours after the incident and sealed off the area. Some Iraqis at the scene claimed US troops kicked the bodies. Iraqi Ahmed Sadun said, “Two teenagers were coming from the mall. They were carrying bags. US soldiers suspected them of being suicide bombers and shot the two down in front of the Ramadi governorate. It is unacceptable. We waited for two hours. US soldiers opened fire on us when we approached to carry away the bodies". //end


The problem is, there seems to be SO MUCH of this propaganda, independently corroborated by different sources time and time again. Yup, it’s a world conspiracy by the evil socialists and the Iraqis to spread rumours JUST to make you look bad. Why, I bet those two ‘suspects’ acted suspiciously JUST so that US snipers would shoot them and thereby besmirch the good name of the US armed forces. I mean, the gall of them to carry bags down the street. Obviously criminals.

And I just love the way the war groupies manage to spin any incident into a justified reaction. A bunch of kids killed in Buhriz? No problem, they were actually six teenage ‘insurgents’ that (supposedly) attacked dozens of heavily armed US soldiers with (allegedly) a *single* RPG amongst them.

Sounds likely, huh?

But look! The soldiers are providing ‘medical attention’. Well, that’s all right then.

And a wounded POW murdered in cold blood in a mosque in Fallujah? No problem, given that the Geneva Conventions no longer apply, no crime was actually committed. It’s just US soldiers treating their prisoners with compassion as usual.

Grrr.

Look, whatever.

I’m going to give this blog a break, because I suspect that these rants from both sides are derailing the discussion from Truth Teller’s problems, and Waldschrat’s efforts.

I’ll return later some time.

Truth teller said...

moron99

"If you want to meet Michael Yon, I think you will have to go to him."

This is impossible at the current situation. If he, with the US troop guarding him feel it is unsafe for him. I have no guard to protect me, so it is unsafe for me too.

" Whether you wish to accept it or not, most of the world believes his to be the voice of truth."

I would like very much to listen to this voice, and let him hear my voice. What I read in his blog is only the military point of view, which is not unbiased.

In my point of view, I consider This link and this link as the voice of truth.

Every body believes what seems to be truth to him.

jemyr said...

Might I suggest that the "fruitless discussion" posts be posted in the "Searching" July 4th post, and the medical procurement discussion continue here?

No new information on my end.

Truth teller said...

strykeraunt

"Truthteller, may I make a suggestion? Perhaps you can have a post that limits discussion to the medical supplies, and provide another post for all of the other "fruitless discussions of politics."
-This is a good idea, I agree with you.
let's limit this post just for medical supplies. The political discussions will have enough space in the future.
BTW I will post a story about terrorist action in my family blog

jemyr said...

Aha!

The lovely U.N. WHO does it again. I should have remembered to go here first. I did a report in high school, and I called the U.N. to get background on the forgiveness of debt to Brazil, and they were fantastic. I was 15, and they sent me 5 packets of information and talked to me for hours. Ah... so organized.

So here is the WHO Health Systems Profile report for Iraq:
http://www.emro.who.int/iraq/pdf/HealthSystemsProfile.pdf

The section of interest is Pharmaceuticals which starts on page 45. It's fascinating reading.

49/61 Iraq HSP working doc 11 May 05 edited june 121
8.7.7 Planned reforms

MOH has indicated that it will embark in a series of reforms of the pharmaceutical sector including the restructuring and re-definition of responsibilities and roles of Kimadia. MOH is also planning to review and update current strategy and policy texts regarding the pharmaceutical sector. Work has started with the development of the National Medicines Policy (NMP) which in its final stage. The concept of essential Medicines List is reaffirmed in the texts.

At this stage, it is premature to indicate which directions the planned reform will take with regard to private sector versus public sector.
---------------

If you compare this to the rest of the report (which goes into great detail on plans), you'll see that it indicates that no one knows what the plan is. They're talking about moving towards a plan, but no plan. That's a bad sign.

jemyr said...

"Before the 2003 war, there was also plans for Kimadia to improve its computerized medical supply management system (Microdrug) which was used at the main central
medical warehouses in Kimadia and in each one of governorate Department of Health (DOH) warehouses. Each warehouse was using the system at the facility level, there was no networking or possibility of data transfer from one warehouse to the other. This was to be done through floppy disks."

Floppy disks?!?!?!?!? Truthteller, tell me it ain't so!

jemyr said...

I think I just emailed the Director of the International Health Department of the Iraqi Ministry of Health. Does anyone know what the heck that title means?

waldschrat said...

Well, I've been encouraged by a few things recently and very worn out by several things, so I figured I'd break my silence and try to report what I've learned for those who may be curious.

Mysearch continues for chemotherapy drugs. I had one positive response from 7 inquiries to pharmaceutical wholesalers - they are definitely the right people to go to, although proving that the hospital in Mosul is a legitimate place to which such drugs may be delivered is a problem that will take some work.

I also learned that ostomycaresupply.com has a wholesale pharmacy license - although they do not normally handle the needed drugs they can if necessary (they would have to figure out the required formalities and be sure to comply with all regulations) and have show some willingness to do so. Cynthia Hacherl there is a very kind person!

I need to do some follow-up on the phone withthe wholesaler who responded - the contact is gone until Monday, so I am doing other things.

When I am not trying to do the impossible to make things better in Iraq (sometimes I feel I am tilting at windmills, solid steel windmills of enormous proportions) I fix houses. Spent much of the last few days trying to plaster up some big holes in a cieling, getting dust and wet plaster in my face, trying to get the place ready to rent out ASAP for folks who want to move in Aug. 2. If working late on that wasn't enough, I started trying to riga wireless network between a new laptop and an old PC, and that chewed up more time.

TT emailed that the trial shipment of ostomy supplies seemed stuck in Baghdad. I told him I was pretty sure it just had to wait fo the next plane, and FedEx confirms that is correct - perhaps it will arrive Sunday.

Some folks have worried about supplies donated to the hospital possibly being misdirected. I think that is much less likely than many othe things. Medical supplies may have substantial value, but hospitals are aware of this and normally maintain careful records and secure storage rooms for stuf that might be an atractive target for theives. I've been assured that this is the case in Mosul, and I believe it. Beyond that, one has to realize that the market for chemotherapy drugs and ostomy supplies is not large - they are NOT party supplies an recreational drugs, there are very very few places they could be sold. It's much more likely that supplies or the money to buy them with would be diverted by a government agency than by a hospital. Delivery of medical supplies to a hospital is a fairly safe chance to take compared to a lot of things.

I discovered tht the Kimadia website looks better viewed from Windows IE than Netscape, although better does not mean good.

I need some sleep, can't focus on what to write.

The search for chemotherapy drugs for Mosul continues.

jemyr said...

I got a response from James Havemen. I'm going to delete out the contact info, but here is what he said:

...thanks for your note...and for getting supplies to iraq..i would work with ****...she has connections for logistics...her number is ****...her e mail is *****.
or have someone visiting the usa take it back with them...kimadia under the former regime...just brought a two year supply of drugs to the 240 hospitals and 1200 clinics...there was no ordering and processing and records of what was sent and used...kimadia was very corrupt and it has improved since the liberation... however given the insurgent activity its very difficult to get drugs around the country and get an orderly formulary in place...there are 3500 private pharmacies in iraq and they do have some distribution of the newer drugs...iraq still tests all medications coming in to the country and has a very suspicious view of drugs from some developed countries...plus in some hospitals the drugs in the front door go out the back...however this to slowed since the war of liberation.
iraqs are smart and understand how to do it right... however it will take some time to change the distribution and ordering system... to assure proper drugs for the people of iraq. your doctor friend should talk to the minister of health about his needs and it can be added to the tender..if the minister so orders.

----------

So that's it. I'll contact this new person and let you know how it goes.

Lynnette In Minnesota said...

Still out here waiting to see the outcome of this. I have nothing concrete to add right now so have not commented.

John,

Buzz off!

jemyr said...

Just wanted to say that I read over the comments in the last 4 posts, and I apologize for re-asking the same questions on this thread. I hate it when I ask questions that have alraedy been answered.

waldschrat said...

The trial shipment of ostomy spupplies has reached Mosul according to the contact at the hospital who I spoke to over the phone.

I am gradually identifying some pharmaceuticals wholesalers who can ship chemotherapy drugs to Iraq. Pain relief drugs (classifiable as narcotics) aremuch much much mor difficult and I am hesitant toeve mention them to these suppliers at this point.

One problem facing delivry of chemotherapy drugs to Mosul is shipping them through Iraq's summer heat. In the US and elsewhere these drugs ar typically shipped in an insulated container with ice, but transit time is only ~ 2 or 3 days. FedEx, famous the world over for incredibly fast delivries, too 3 weeks to deliver a package from the US to Mosul. There is some hope that FedEx can be persuaded to keep perishable stuff refrigerated while is sitting in a warehouse for a flight or whatever it is that caused the delays in shipping that simple box of ostomy supplies, but it is abundently clear that the usual precautions and methods will not be assured of success when perishable drugs are shipped to Mosul.

Another possible problem is that the drugs might be diverted by Kimadia once they reach Mosul because the hospital as a government organization is bound to work within the rules of the government and the rules have always been that Kimadia decides on the acceptability of drugs and arranges their distribution. There seems to be an Iraqi NGO of sorts that may be able to take custody of the drugs and distribute them to cancer patients directly, effectively bypassing the bureaucracy of Kimadia. I am not a foe of bureaucracies, I used to be a bureaucrat myelf, but if Kimadia can not deliver what is needed in Mosul I must be sure it does not interfere with what little I can deliver. Quality control testing is a good thing, commandeering an entire shipment instead of a sample thereof is not. I have heard few good reports regarding Kimadia but have learned from my contact that they have, in fact, managed to deliver substantial quantities of some drugs even in these chaotic times. Even though there apparently are very serious shortages of many drugs and a total lack of some critically needed chemtherapy drugs, the fact that Kimadia has managed to function and deliver anything at all in the current chaos strikes me as a meritorious accomplishment.

At this point I have seriously exhausted myself pursuing this search. I need to take a couple days off and do other things, urgent things that I have put off to pursue this search. US suppliers will be closed over the weekend. There wil be time to take up the search again Monday.

Jonathan said...

I think using Fedex to ship perishible supplies will have to involve using US military transport. Perishible supplies can be shipped in overnight from Europe to Baghdad by Fedex. Military transport Planes fly directly to Mosul Airfield daily. No cold chain will last the 2 to 3 weeks required for Fedex to get supplies to Mosul on its own. An alternative is to go by refrigerated truck from Turkey through the border crossing at Harbur Bridge.

Jonathan