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Horses, not Zebras

by Captain Michael Maddox, MC, USN
Force Surgeon, MNF-W
Tuesday, 17 June 2008
Continuing the work to improve Fallujah's lack of public health programs and its shortage of medical staff will create a healthier medical system and a healthier city.

Fallujah, Iraq—There is an old medical saying: "When you hear hoof beats, think horses, not zebras." The Baltimore Chronicle, in its 13 June 2008 article, "Written on the Body: The Reality of War," notes that some Fallujah residents think that depleted uranium and phosphorus have caused illness and deformities in babies. What is common is common, and though they are not exotic, the well-known, and far more likely causes of birth defects in Fallujah children are poor prenatal conditions and difficult deliveries.

What makes a healthy baby? A healthy mom, good genes, good nutrition, clean water that has no lead or heavy metals in it, immunizations to prevent infections during pregnancy like measles and rubella, regular prenatal visits to detect and treat problems like diabetes, and adequate time in a mother's uterus to enable a fetus's lungs to grow to maturity. A smooth delivery is important. Rapid and correct intervention is necessary to resuscitate the newborn if he or she is not breathing, has a cord wrapped around its neck, has aspirated meconium, is a yellow baby, or has a host of other conditions that can compromise oxygenation. Without a qualified obstetrician to correct these conditions quickly, the newborn can suffer brain damage in minutes.

For many years Fallujah had few medical sevices. It suffered from poor infrastructure, lack of prenatal care, lack of doctors/nurses/and paraprofessionals, lack of obstetrical equipment, and lack of resuscitation equipment. Additionally, lead water pipes, sewage spills, and plastic bottles burning in fires have exposed mothers to toxins and infection. It's not surprising...and it is sad...that when Fallujah's mothers bring their children to see our Navy/Marine Corps doctors, that some of their children have cerebral palsy, deformed limbs, or mental retardation.

Fortunately, this city has turned a corner. Peace is breaking out and doctors are returning and clinics are being rebuilt. Americans have done a lot to help it along. They have built clinics, built operating rooms for Fallujah General Hospital, delivered incubators, built a labor deck, provided delivery tables, provided critical care and resuscitation equipment, contracted for trash and sewage removal, restored electricity, inspected water sources, and conducted many other projects to bring health to the city of Fallujah.

The Ministry of Health of Al Anbar Province is contributing money to help equip the hospital, has started a rural health program in Al Anbar, hosted a province wide immunization program, has filled the medical school at Ramadi that will produce the future doctors of Iraq, and is working to attract doctors back to Iraq.

Lots remains to be done, but chasing zebras will not help. Continuing the work to improve Fallujah's lack of public health programs and its shortage of medical staff will create a healthier medical system and a healthier city. A healthier city of Fallujah will lead to healthier children of Fallujah.

[Floyd responds to this letter: Horses AND Zebras in Falujah]

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This story was published on June 18, 2008.