Robert Norris left the U.S. military secure in the belief that he had satisfied his duty to his country. But two weeks after his discharge, when Iraq invaded Kuwait in August 1990, he felt the first pangs of uneasiness about what might have been.
“I just felt like I had more that I could have offered,” says Norris, director of emergency medicine at the Medical Center and a former major in the Army Medical Corps. That vague sense of disquiet lingered for the better part of two decades, despite a steady record of public service that includes his work as medical director for the Santa Clara County sheriff's emergency response team.
This year, Norris found a compelling cause that shouted for his particular skills: he is scheduled to be in Baghdad in December to help train Iraqi physicians in up-to-date emergency medical care that is desperately lacking in the strife-ridden nation. It will be his second trip on that volunteer mission, following a whirlwind February teaching stint in the northern city of Erbil. The challenge is daunting, but that special sense of contribution no longer eludes him.
Estimates vary on the number of physicians who have left Iraq, but all reports point to a staggering exodus. The worst-case figures suggest that 20,000 of 34,000 doctors have departed and more than 2,000 have been killed. The precise statistics may be uncertain, but there unquestionably has been “mass attrition of doctors and also nurses,” says Gregory Luke Larkin, associate chief of emergency medicine at Yale University and one of three U.S. doctors who accompanied Norris.
Despite the extraordinary scope of that breakdown in human resources—plus a dearth of equipment, medications and laboratories—Norris and his teammates were intent in February on improving pa-tient care through just 3½ days of instruction for more than 50 Iraqi doctors. They conducted workshops with mannequins and portable ultrasound machines; they visited area hospitals to review the treatment of severely injured trauma patients.
Norris, an associate professor at the School of Medicine, says the training focused on the management of acute trauma patients and airway emergencies because those were “the most important topics, really, in terms of their needs.” But almost every exchange, whatever the subject, allowed Norris to reinforce his ultimate goal: “to demonstrate what the future could look like to them.”
The immediate conditions, even in the relatively subdued Kurdish region visited by Norris's team, were dismal. Critically injured patients, says Norris, might arrive at hospitals “dumped out of the taxi onto a gurney.” And in the absence of pre-hospital services that could help assess and stabilize patients, emergency medicine in Iraq can't “even get through the golden hour,” Norris notes, referring to the initial period after an injury when medical attention may be pivotal for survival.
Even in that grim environment, however, Norris's team found the Iraqi physicians remarkably earnest and receptive. Larkin likes to describe how their enthusiasm prevailed all the way through a post-training test. “I've never had any of my regular students come up to me and say, 'Thank you, Doctor, that was a great exam.'”
Norris, 51, was the designated team leader, having pulled together the group from a short list of candidates with strong qualifications. Larkin's résumé includes work in Turkey, Slovenia, Zambia, Kenya, Peru, Guatemala, Brazil and Venezuela.
The other team members were Craig Manifold, chief of emergency services at Southeast Baptist Hospital in San Antonio, and Ross Donaldson, an assistant clinical professor at UCLA. Manifold, a former Air Force physician, is a flight surgeon for the Texas Air National Guard. Donaldson, whose international experiences include the ordeal of a Lassa fever outbreak in Sierra Leone, is the author of an upcoming book designed to help health care workers communicate with patients when there are language barriers.
Norris, a snakebite expert who has taught and done research in Guatemala and India, was recruited to head the group by the Medical Alliance for Iraq, an association of U.S. doctors working closely with International Medical Corps, a nonprofit organization with headquarters in Santa Monica, Calif.
The Medical Alliance evolved from efforts spearheaded by North Carolina ophthalmologist Michael Brennan, a West Point graduate who served in Vietnam and earned a master's degree in aeronautics and astronautics at Stanford in 1973 before establishing his career as a doctor. In 2003, Brennan was sought out by West Point classmate James Peake—then the Army Surgeon General and now the Secretary of Veterans Affairs—to help Iraqis reconstitute a system of sustained medical education and professional support.
As of last summer, the accomplishments include ongoing training visits, each of which concentrates on a different medical specialty. Iraqi physicians generally have been “starved,” says Brennan, of the training that makes for true specialists, and many of the attendees at the Norris-led sessions were general practitioners who frequently must respond to emergency situations.
Avowedly apolitical, the Medical Alliance did pursue and receive $3 million from the U.S. Department of State, a big plus for the organization's plans to add Basra to the Erbil and Baghdad training sites by early 2009. Most rewarding, says Brennan, has been the increasing responsiveness of young Iraqi physicians. “They're not only listening to what's being discussed, they're applying it,” he says.
Norris says his team seemed to operate in full safety in Erbil, leaving his composure most tested, perhaps, by the loss of all his luggage on a stopover in Jordan. “My wife basically dresses me,” he explains. The time-pressured task of shopping by himself was complicated by a limited fashion selection. The result? “I ended up with a lot of brown clothing.”
Brennan notes that being in Iraq, even in the best scenario, is never so risk-free that it can be taken for granted. He also says that, at least so far, there are no tangible markers that adequately convey the value of each trip made by Medical Alliance doctors. But he's quick to summarize one optimistic development for both his organization and the up-and-coming generation of Iraqi physicians.
“What we have and what they have is the hope and promise that Bob Norris is going back there again.”
Read a March 2010 update on this story.
