The heart. This is the organ that pumps blood and oxygen to the body. It is also metaphorically the valve of emotions, whereby one usually refers to storing emotional feelings. Kurds store a strong patriotic vessel to the homeland, Kurdistan. It is a natural affinity that no human can explain, and a new strain of euphoria that is experienced for a Kurd when one thinks about independence. Apart from struggling for political independence, the Kurds are now steadily stabilising in the Kurdistan Region under the leadership of the Kurdistan Regional Government (KRG).
However, a silent killer lurks in the Kurdistan Region. The silent killer is the lack of standardised healthcare regulations and system to monitor and prevent chronic diseases. Unfortunately, the prevalence of chronic diseases in the Kurdistan Region is increasing, and could be a suggested leading cause for premature mortality. Kurdistan Region has now reached an intellectual level whereby they have had international healthcare conferences, workshops and debates on the challenges that it is faced with.
Due to political progress in the Kurdistan Region, professionals are now able to visit international institutions. This has caused the state of denial to erode within the Kurdish policy makers as they now have exposure to developed systems, thus a healthy step to trying to reform the healthcare system.
The common response from professionals for the failed attempts is 'lack of funding from KRG'. As a professional, I agree that funding is critical to reform. However, I feel that the funding is adequate providing it is utilised effectively, and compared with our National Health Service in the UK, a luxury in terms of funding. From my observations, I feel that it is universally acknowledged amongst all Kurdish Provinces that we are faced with a challenge and that we must now concentrate on solutions. The Prime Minister, H.E Nechirvan Barzani has made a pledge to remove bureaucracy in the system and to support projects that will benefit the development and growth of the Kurdistan Region.
Concentration should be on developing standardised evidence-based frameworks for the region that has clear robust governance measures pined to the national legislation, with regular auditing and quality assurance. This is to prevent for instance, any nurse assistant to open up a small shop and train on injecting patients with NSAIDs or penicillin for simple flu symptoms, not knowing the long term health risks, i.e. permanent irreversible renal failure. This should form part of the professional registrations for the professions and be monitored. Then, the most important element is training and development. There must be a system to allow training and development of healthcare professionals. This should be an integral part to the job role and be monitored through yearly appraisal and regular 1:1 objective meetings with the departmental lead. To enhance Kurdish professionals' skill set, the Trainers should be brought in from developed countries such as Britain. However, this should only be on a 'train the Trainer' basis whereby they train our local staff to then deliver the knowledge, so that the Kurdish system is not dependent on foreign support. It must be remembered that the majority of Kurds cannot afford treatment and diagnosis abroad, therefore as professionals we have ethical duties to address these issues, regardless of consequences, if any.
Good practice means having good ethics. Culture must not be mixed with good professional practice. For instance, I observed that the consultation clinics lacked privacy and discretion, especially when the doctor would shout out instructions to their secretary or assistant for all ears to hear. This can be resolved through ensuring protocols are in place for confidentiality and that a pathway is created to link to a national framework to ensure compliance. The Prime Minister office should consider setting up a national legislative independent complaints commission. This would look into complaints against healthcare professionals, in which annual reports of action would be later generated. Through this, the public will feel confidence and trust that the system is reforming and that they are being listened to. There should also be an advisory triage 'hot-line' that can act as a filter to ensure 'cold cases' are dealt with without the need of attending Accident & Emergency. It can be suggested that prevention campaigns that highlight silent killers such as diabetes need to be more prominent and more widely circulated to the Kurdish Community, including taking to account the illiterate population.
As the heart continues to pump, it is time to ensure that the flow is not disrupted, for the Kurdistan Region has had its fair share of obstacles.
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