Doctors help send medical textbooks to Iraqi physicians

One doctor was in Iraq, the other in the United States. Although they were thousands of miles apart, they shared a common desire -- to get up-to-date medical information into the hands of Iraq's physicians.

Alex Garza, MD, MPH, an emergency physician in Kansas City, Mo., and a captain in the Army Reserves, spent a year in Iraq rebuilding its public health system. The University of Tikrit College of Medicine was right next to Army offices, and he witnessed firsthand the empty shelves in the school's library.

Retired Col. David Gifford, MD, who works two days a week as a rheumatologist at Darnell Army Community Hospital in Fort Hood, Texas, learned about the conditions in which Iraqi physicians practiced through a physician friend stationed in the Tikrit region who was writing online about his experiences.

That Iraqi physicians had been denied access to Western medical literature for years was quickly apparent to both men.

While in Tikrit, Dr. Garza and his team met with the medical school's dean and teachers. "We took a look at the school, the library," he said. "Most of the textbooks were pretty old, say 15 to 20 years. One or two were current textbooks, but they were photocopies, not originals."

Each class had 100 students, reaching the maximum of 600 in the six-year program. Since medical journals from the United States and Europe had been forbidden and Internet access denied, the few journals on hand were from the Middle East, Dr. Garza said. Students shared the library's few photocopied textbooks.

A little bit of luck

Dr. Garza started thinking that a medical library would be a simple way to have a huge impact, so he asked his alma mater to donate textbooks. He got no response. But as luck would have it, while sharing his ideas with others, he met Lt. Col. Mark Gifford, MD, deputy surgeon for the 4th Infantry Division and the son of retired Col. Gifford.

The senior Dr. Gifford had begun his own search for basic science textbooks to donate to Iraq.

"I thought, 'Gee, I ought to be able to go to medical publishers and get them to donate a few dozen medical textbooks,'" he said.

His first calls went nowhere, as did his next ones and the ones after that. At lunch one day, muttering to himself in frustration, he picked up his copy of Scientific American Medicine and punched in the publisher's number. The switchboard took his request and promised someone would return his call.

"Yeah, right," he said to himself.

This time it worked. Within 20 minutes he was talking to Susan Yox, RN, EdD, editor of Medscape Nurses, owned by the publisher of Scientific American Medicine, WebMD. She had worked with a similar project collecting medical donations for Afghanistan and offered to run a story on the donation drive for Iraq.

Dr. Gifford, who was now in touch with Dr. Garza, included Dr. Yox in their e-mails, and in the summer of 2003, an article about the book drive was posted on the Medscape Nurses site. The company also made a donation of 3,000 copies of Scientific American Medicine and ACS Surgery.

The article brought an avalanche of responses. Dr. Gifford paid for a couple of small shipments himself before realizing that the scale of donations would quickly tap him dry. He started calling military friends and found that officials at Fort Bragg, N.C., were willing to fly out more than 2,000 volumes donated by the Mount Sinai School of Medicine in New York on a space-available basis. Fort Bragg shipped another six pallets of medical journals donated by Merck Frosst Canada. Then Dr. Gifford began looking for other volunteers in the military and private sector.

In Tikrit, faculty members were thrilled as the boxes of books began to arrive, Dr. Garza said. Now the medical school has not only a full-fledged library but also a room with donated computers, a live Internet connection and free online subscriptions to hundreds of journals.

Generations will benefit

Medical journals and books have been distributed to five hospitals in Tikrit that never before had libraries, and as more material comes in, the military takes it to other hospitals and clinics in the area.

"To have an impact like this is beyond my wildest dreams," Dr. Gifford said. "It's unthinkable to us in our society how they managed. What keeps coming back from our physicians who've interacted with the Iraqi physicians is that they have remarkable skills. They've had to go back to the physical exam and using their head, because they don't have the technology we do."

Dr. Garza said, "Even though we fixed a lot of things and rebuilt clinics, bringing in current, up-to-date medical information was the biggest contribution we made to the health system there. It will impact generations to come. ... They'd lived under this system of oppression for so long, then we rolled up with boxes of texts, a brand new cardiology textbook -- to them it was almost beyond belief."