Although being a doctor in the NHS is “great and really rewarding”, Michael Malley says he always struggles to escape the feeling there are greater healthcare needs elsewhere in the world where he could be more useful.
Having worked for the Royal College of Paediatrics and Child Health in Burma, international NGO Médecins Sans Frontières (MSF) offered Dr Malley a placement in Zummar, northern Iraq, about two hours west of Mosul on the road to Syria.
“At first I was perhaps a little daunted,” the 32-year-old paediatrician tells i after two months in post. “Iraq is the buzzword for our generation for conflict and instability [but] I felt strongly that the recent instability and violence was exactly the reason why I should go to Iraq rather than being a reason not to. There is no point going to a place with no medical problems to practice medicine.”
Several MSF briefings prior to his arrival left Dr Malley in no doubt as to how seriously the NGO takes security of its staff – especially the assessment that “injury by accidental shooting” in Zummar was a “high likelihood”.
After arriving at the MSF hospital Dr Malley took charge of a small paediatric and neonatal ward, supervising six local doctors in running the emergency department, which sees around 1,000 patients a month.
“Each day is different. Some days may be less busy than life in the NHS, but the workload is less predictable and has more extremes of intensity. For example, last week we had a mass-casualty situation after a car crash which left myself and one local doctor dealing with 14 trauma victims.
“The local staff are certainly used to mass casualties and it was really inspiring how the whole team pulled together to prioritise, stabilise and refer the patients. After three hours of very intense work, all the patients had been referred out and we went back to a conveyor belt of non-urgent cases for a few hours."
"Each day is punctuated by a variety of severe infectious cases, a number of minor and major trauma including the occasional gunshot wound and a background of general primary healthcare complaints.”
The healthcare infrastructure in Iraq is still seriously compromised says Dr Malley who, like all ex-pat MSF staff at the Zummar project, could not leave the compound outside daylight hours. Huge numbers of local and returning residents have extremely limited access to healthcare and are living in the ruins of their previously proud and prosperous cities, towns and villages.
Although the MSF hospital has three well-equipped ambulances available to transfer sick children, adults and maternity cases to Mosul, Dr Malley says one of the difficulties with having a good level of basic resources is deciding when to refer patients.
“Deciding whether basic emergency care is better in an MSF facility we know or whether it’s better to transfer on an insecure road for two hours to Department of Health hospitals with often with higher level resources, like intensive care, but high levels of overcrowding and a variable level of quality assurance is a challenge.”
Control of Zummar has changed hands several times in recent years – now by the Iraqi military, but previously by the Kurdish peshmerga forces and ISIS at the height of their expansion, meaning local colleagues have shared extraordinary stories of what it was like operating under the latter’s occupation.
“One doctor I work with has a particularly inspiring story of overcoming adversity. Training as a doctor in Mosul, his studies were interrupted by the ISIS occupation. Initially resisting their draconian system, he received a number of threats against his life,” says Dr Malley, who is now based in Mosul.
“He and his neighbour prevented a bomb from being exploded outside a school – an act for which he fortunately went undetected, but for which ISIS fighters burned his neighbor alive as the local community were forced to look on.
“He was asked to join ISIS as a doctor but refused, meaning he had to bribe his way out of the city. Meeting his contact on the morning of his escape, he was denied access to the car which was due to take him towards Baghdad."
"Angry, he returned home to the news that his escape car had been destroyed in a drone strike less than an hour outside the city with no survivors. He was arrested and imprisoned twice by ISIS before eventually escaping to Raqqa in Syria and from there to Turkey in order to fly back to Iraq to continue his medical studies.”
The man now organises illegal street tidying operations to try to help clear the debris in Mosul and works for MSF alongside Dr Malley as “an unassuming, humble and dedicated junior doctor eager to serve the local population”.
Dr Malley says: “Our journeys could not be more different to this place, and I was left humbled by a story he recounted without grandeur or overt exaggeration. There are countless other stories of heroism, dedication, suffering and trauma which have made up the everyday lives of the people here for too many years now.
“Every life in these parts has been touched by the violence, uncertainty and destruction of the last five years. There is a constant undercurrent of instability and a slow rate of rebuilding from the destruction of the last decade. There is a tension between the Iraqi and Kurdish authorities regarding where the true line of separation is between their jurisdictions.”
Dr Malley will be in post until at least mid-January, when the MSF team hope to hand over to local staff prior to pulling out. A two year training programme in paediatric emergency medicine at Bristol Children’s Hospital awaits later this year, but until then he is set on another challenge.
“I’m hoping to undertake further work with MSF throughout my career, starting with going to Sudan in February to hear more humbling local stories and try to support the local teams offering care to children in that region.”
by Paul Gallagher
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