IraqU'S' Physician Partnership Program Health Resources and Services Administrations Role

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Iraq-U.S. Physician Partnership Program Health
Resources and Services Administrations Role

• RADM Kerry Paige Nesseler
• CAPT Nita Sood
• Office of International Health AffairsJune 1,
  2009

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(No Transcript)
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Map of Iraq
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Background

• Iraqs health care system once regarded as one of
  the best in the region
• Over the last 25 years, the health care
  infrastructure has deteriorated due to neglect
  and war
• Violence and emigration have decreased the number
  of physicians
• Physicians that remain are not up to date on the
  latest evidence-based medicine and technologies
  necessary to provide high-quality care

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Physicians in Iraq

• Iraqi Physicians Registered
• Before 2003 - 34,000
• Iraqi Physicians Who Have Left
• Iraq Since 2003 - 18,000 (est.)
• Annual Graduates from Iraqi
• Medical Schools - 1,800
• Percentage of Work Outside of Iraq- -higher than
  20, many still leave the country to get
  specialized training 
• Average Salary of an Iraqi physician- 12,000 per
  year, higher for specialists

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HHS Initiative

• In May 2008, Department of Health and Human
  Services Secretary meeting with Iraqi Minister of
  Health (MOH)
• MOH requested a physician training program in
  order to understand the U.S. primary healthcare
  model

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Goals of the HHS Initiative

• Promote Health Diplomacy and provide hope and
  inspiration to the Iraqi people
• Educate the Iraqi physicians on the U.S. primary
  health care system and strengthen their ability
  to provide quality care
• Learn from the Iraqi people and
• Enhance the cultural competencies of the U.S.
  physicians.

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Iraqi Physician Training Goals and Objectives

• To build upon current Iraqi health care promotion
  activities in Iraq- Centers for Disease Control
  and Prevention (CDC) partnership with
  non-governmental organization, International
  Medical Corps (IMC) to develop the Centers of
  Excellence
• The Iraqi Government had already invested 8
  million dollars on physician training
• The Basra Childrens Hospital was under
  construction with health emphasis on pediatric
  oncology
• 134 renovated Primary care facilities in Iraq
  needed healthcare provider staffing.

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Iraq-U.S. Physician Partnership Program

• HHS Coordination through Office of Global Health
  Affairs (Jaime Burke and CDR Dan Singer) and U.S.
  Embassy in Iraq (Dr. Terry Cline, Health
  Attaché)
• Iraqi physicians were selected by the MOH
• Out of 41 physicians, 27 were able to
  participate
• 6 physicians were slated for HRSA 3 were able to
  participate
• Observership training- no patient contact
• 4-week timeframe.

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Iraq-U.S. Physician Partnership Program (contd)

• Host Training Sites
• Childrens Hospital, Washington, DC
• Health Resources and Services Administration
  (HRSA)
• Henry Ford Hospital, Detroit, Michigan
• Indian Health Service, Arizona
• Johns Hopkins Hospital, Baltimore, Maryland.

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Iraq-U.S. Physician Partnership Program (contd)

• HRSA Sites
• Community Health Centers (CHC) Two sites
  selected rural and urban sites affiliated with
  teaching universities
• The CHC sites
• Sunset Park Medical Center, Brooklyn,
• New York
• Greene County Health Care Inc., Snow Hill, North
  Carolina

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Physician Training Schedule

• All physicians attended 2-day HHS orientation
• Physicians assigned to HRSA received additional
  2-day HRSA orientation on Prevention, Primary
  Health Care and Chronic Disease Management
• Remaining time ( 3 weeks) spent at CHC sites

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HRSA Physician Training Schedule

• HRSA Orientation, Day 1
• Prevention and Primary Care Expert Panel
• Oral Health
• Maternal Child Health and Children with Special
  Health Care Needs
• Cancer Prevention and Anti-Smoking Campaign
• Chronic Disease Management Expert Panel
• Diabetes Control
• Hypertension and Cardiovascular Disease Control
• HIV/AIDS Care and Treatment
• Quality and Evidence Based Care
• Site Visit to Urban CHC
• Unity Health Care, Washington D.C.

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HRSA Physician Training Schedule (contd)

• HRSA Orientation, Day 2
• Site Visit to Rural CHC- Eastern Panhandle of
  West Virginia
• Shenandoah Valley Medical System, Martinsburg, WV
• War Memorial Hospital (critical access hospital),
  Berkeley Springs, WV
• Then to Observership Training Sites
• Two Iraqi physicians (pediatrician and general
  practitioner) at Brooklyn, New York
• One physician (orthopedics) at Snow Hill,
• North Carolina

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HHS Debriefing

• One day debriefing in Washington DC
• Overall the physicians were very satisfied with
  their experience and would like to see this
  happen again in the future
• Breakout Group Sessions discussed 3 topics
• Alternate Models for the Physician Partnership
  Program
• Application of Lessons Learned in Iraq
• Maintaining Links and Sustaining Partnerships

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HHS Debriefing (contd)

• The breakout group discussed several issues
  related to the effectiveness of the current Iraqi
  model
• There are two specific needs that must be
  addressed
• improving provision of care (training, access
  to new technology), and
• improving the overall health care system
• Improve the health care infrastructure
• Improve the ability of health care providers to
  function as a team interdisciplinary model
• Enhance the relationship between the health care
  system and the community
• Improve the skills of individual practitioners
  (practitioners must be motivated to change and
  seek out opportunities)
• Enhanced involvement of planners and policymakers.

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Alternate Models for the Physician Partnership
Program

• Bring teams of U.S. physicians to Iraq
• Implement the model described above in a site
  outside of Iraq
• Train Iraqi physicians in the United States
  extend to 6-8 weeks

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Application of Lessons Learned in Iraq

• Develop a clear strategy for delivery of health
  care (e.g., financing)
• Establish short-, middle-, and long-term
  strategies for managing challenges
• Address the technology gap - Incorporate the use
  of information technology
• Improve the level of nursing care
• Adopt electronic medical records
• Establish an independent regulatory authority for
  the health care system, medical societies,
  licensing, and continuing medical education.

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Application of Lessons Learned in Iraq (contd)

• Facilitate the adoption of evidence-based
  practices
• Develop a system for the referral of patients
• Focus on primary health care to reduce the burden
  on hospitals
• Rehabilitate sub-specialty centers
• Control medicine management and use
• Improve patient management systems
• Improve communication (within service settings).

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Maintaining Links and Sustaining Partnerships

• Participants exchanged e-mail addresses with
  their U.S. colleagues and will remain in contact
  via e-mail
• Webcams and telemedicine provide opportunities
  for communication
• HHS to explore ways to conduct long-term follow
  up with participants
• HHS learn how participants disseminate what they
  have learned in the United States to their Iraqi
  colleagues.

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Follow-up

• Several follow-up items are being coordinated by
  HHS, including issues of connectivity between the
  host-sites and their respective participants
• Information from this pilot will be used to
  evaluate this particular model and to formulate
  next steps to continue collaborative
  relationships between the two countries.

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Acknowledgements
The individuals below contributed to the success
of the Iraq-U.S. Physician Partnership Program
for HRSA

• Dr. Therese Hughes
• CAPT Donna Hutten
• Jim Macrae
• Dr. Daniel Mareck
• Tim Montgomery
• Tom Morris
• Shawir Nawruz
• Dr. Tanya Pagán Raggio-Ashley
• RADM Deborah Parham Hopson
• Sara Rue
• Richard Sayre
• Leslie Shah
• CDR Dan Singer
• Dr. Peter van Dyck
• RADM Donald Weaver
• Maureen Williams
• Sunset Park Medical Center, Brooklyn, NY
• Greene County Health Care, Snow Hill, NC

• Anthony Achampong
• Dr. Jay Anderson
• Tara Balsley
• Dr. Marcia Brand
• Jaime Burke
• John Cafazza
• Gina Capra
• Tina Cheatham
• CAPT Gail Cherry-Peppers
• Dr. Terry Cline
• Tom Coughlin
• Loretta Ellison
• Diana Espinoza
• Dr. Kaytura Felix
• LT Ulgen Fideli
• Tanya Gadzik
• Kate Guzzone
• Sandy Harris
• Joanne Howard

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Iraq- U.S. Physician Partnership Program

• Contact Information
• RADM Kerry Paige Nesseler
• CAPT Nita Sood301-443-2741
• KNesseler_at_hrsa.gov
• NSood_at_hrsa.gov