March 2024: Iraq Trip Reflection Letter from Anita

Dear Friends,

As I reflect on my experience in Iraq in January, the thought I keep returning to is just how much we take for granted when we think of our healthcare here in the United States.

For example, we take for granted the many, many steps taken to prevent infections in our hospitals here in the US. In addition to standard protocols, we have specially trained Infection Control Nurses who focus their work 100% on protecting patients, as well as staff, from infection. We cannot begin to imagine the stress of their jobs during the pandemic. At the conference, there was a presentation on how nurses in specific units of a hospital were beginning to use very detailed checklists to be sure surfaces were cleaned and patients were safer, including the most vulnerable in the neonatal ICU. Because there are not standard protocols, nurses have begun taking matters into their own hands to protect their patients. This is an area where we can help by providing nurses and nurse leaders more education on improving the quality of patient and staff safety in the hospitals.

We had seen firsthand on a previous visit to this NICU and other areas of the hospital how infections such as COVID were spread due to the lack of the most basic equipment, such as inexpensive plastic oxygen masks for the infants and children. A young nurse working in the little NICU told us that one single mask was shared from child to child because it was the only one they had. For our trip this January, we brought a big box of them with us, as well as pediatric finger pulse oximeters to check oxygen levels. This is another way we can help: by providing basic supplies that these hospitals struggle to source themselves.

Something else we take for granted is that nurses and doctors are paid to do their jobs. In Iraq, this is not always the case. Over the years I have spoken to many nurses who still came to the hospital to care for patients even during times they were not being paid. Most recently when we visited the Yazidi Refugee Camp, we knew the small medical staff had not been paid for several months. We met the midwife (she is a community midwife without the education, clinical practice, and certification that Certified Nurse Midwives have here in the US) who has been caring for the pregnant women at the camp for months, also without pay. She is currently seeing over 100 women in the camp of 9,000 residents. These mothers deliver their babies at the closest small hospital, but it is very difficult for them to attend the prenatal visits—and, just as importantly, the postnatal visits—or to receive support with breast feeding, not to mention screening and care for postpartum depression and anxiety. This dedicated young community midwife is their main source of care, information, and support as they bring their babies into the difficult world of the refugee camp.

As a nurse—and as a mother who was hospitalized during my pregnancy because of hypertension and pre-eclampsia—I am concerned for these pregnant women because of the danger high blood pressure poses for the mothers and the babies. As a Certified Diabetes Care and Education Specialist, another concern I have for these women is Gestational Diabetes Mellitus (GDM). Without close monitoring and treatment, GDM can lead to dangerous outcomes for the babies and for the mothers. We were able to bring many blood pressure machines and supplies to check blood sugars to this clinic so that the community midwife and other healthcare providers can monitor these dangers more closely to protect the women and their babies. This is another area where we can help, and another area where the impact of our help can be literally lifesaving.

So, for those of you who have been with us for the past 14 years, you can see that the vision of NHTH has broadened considerably! What began as a mission to teach CPR and supply manikins to nurses in one country has grown to include educating nurses in multiple countries, funding complete nursing educations for students from the Yazidi refugee camp, providing training materials to the Nursing and Midwifery Development Centre, and hopefully funding a faculty position there as well. We have also expanded to provide nurses, community midwives, and medical staff with education specific to the areas where they currently practice, and to provide the basic medical supplies they need to do their work.

Our list of invitations has also grown, and we are hoping to say “Yes, we will be glad to come!” to as many as we can. Already in 2024 we have been asked to return teach in Iraq at the Nursing and Midwifery Development Centre and at hospitals and schools of nursing in Iraq, including the School of Nursing at the University of Nineveh and the College of Nursing at the University of Baghdad. We have also been invited to teach in Moldova and in Uganda, and we are planning to return to Mongolia. It will be a big job to figure out what all we can say yes to!

So, to summarize, I will say that our January trip to Kurdistan was absolutely wonderful. And the need for nursing education and support and even basic supplies can seem overwhelming, but it is a very exciting time for us at NHTH. We can fill at least some of the gaps our fellow nurses face in Iraq. We can make a difference for patients. And it is a great joy and honor to be able to share our hearts, our knowledge, and our hope with these nurses and midwives.

All of this might mean something for you as well. I hope you feel the same as we did during this trip—both burdened by the reality of the needs and at the same time inspired by the opportunity and ability to meet so many of these needs. I hope you will consider how you might help us say “yes” to these many needs and invitations. Nurses Heart to Heart is going to need a lot of support! We are grateful to ALL of you, and if this is where you feel compelled to help, we want to help you do that.

Thank you so much,

Dr. Anita Rich, DNP, RN, CHFN, CDCES, CGNC
President and Founder, Nurses Heart to Heart