A member of the Community Health Planning and Policy Development Section was assigned work with the Iraqi Health Ministry, and others, to support medical and public health infrastructure development sent in this report. This narrative recounts an experience with getting a maternal child project off the ground. Part I describes the assessment process and how funds were approved. Part II, to be published in the spring issue, describes the process of transferring the funds to a non-governmental organization.
Shortly after I arrived, I learned I was the only person addressing public health issues in my unit. I served with a Civil Affairs Brigade near Baghdad. As this unit had responsibility for all areas in Iraq from a civil affairs perspective, I was free to consider all geographic regions in the country. The possibilities became even more enticing when I determined that my boss and the commander of the unit had little interest in determining what public health should accomplish, and simply asked that I stay safe. Of course, I needed to keep them informed, and they would probably prefer something that made the military look good, but for the most part I was free to pursue any area I desired.
Within a few days, I made good use of the superb military communication capabilities and was able to assess available information about Iraq, identifying critical public health needs. As you might imagine, there was virtually no end to the public health issues that needed to be addressed. The very high maternal, infant and child mortality rates stood out prominently and spoke to my heart. Having plentiful supplies of safe water and basic sanitation could be considered more critical, but our engineers were addressing those issues with ample resources.
Once I had determined the important areas I wanted to address, I retrieved and reviewed documents from the World Health Organization that described ways to remedy these problems in a country like Iraq. Fortunately, many people had assessed appropriate interventions for similar circumstances, often focusing on common problems that routinely emerge during conflicts. There was no shortage of proven interventions suitable for maternal and child health. Many promising avenues existed to greatly reduce the extent to which young mothers die during childbirth, and there were basic, simple and inexpensive strategies to dramatically decrease the number of children who succumb to preventable infectious diseases.
I had one final task to perform before I began to explore the bureaucratic components of this process – identify/develop a survey instrument. This was needed to establish baseline capabilities. That is, I needed data to describe how things stood before the interventions began so I could hopefully demonstrate how things improved following program implementation. Even in these circumstances, the Army prefers to objectively demonstrate how its resources have served to ameliorate suffering. This task was a little more difficult and time-consuming, but I was not deterred and was soon ready for the next step.
It was now time to identify an non-governmental organization that would be suitable for such a project. After consulting with the medical command in Iraq, I found an organization that seemed ideal and arranged a meeting. They agreed with the approach and recommended a location that was very pleasing to me – the area south of Baghdad where Babylon once stood. The latest information indicated this was the area with the greatest need. Finally, they identified key items they would require in a contract to ensure their safety.
At this point, I felt I was ready to brief my commander in the Civil Affairs Brigade and arranged a time through his aide. I first described the logic I used to identify the most critical public health issues, and then outlined the programs and interventions that were planned. Subsequently, I pointed out the critical contractual issues that were important to the NGO, including the need for military personnel to avoid the sites where the interventions were established. They felt this was necessary for their safety as experience indicated insurgents would make them targets if they knew the military was involved. Here is how the meeting unfolded.
“What?” resounded the commander after I completed this point. He stared at me resolutely and then continued brusquely, “Are you goin’ native on me, Charley?”
My pre-planned presentation came to an abrupt halt as I quickly searched for words to respond. All the while, possible interpretations of his query roamed through my mind. Fear intervened when I soon realized my involvement in this process might be in jeopardy if I failed to provide an appropriate, brief response in a timely manner. I became anxious as his gaze became more intense and I could almost see the suspicion form in his furrowed brow.
Soon I calmly and softly relayed what I thought he might want to hear, hoping that humility and subservience would pleasingly drip from each word. “Of course not sir. I understand fully the importance of assuring our visibility and making certain that people appreciate our efforts. However, I also felt it was important to abide by your primary directive – staying safe.” This seemed to assuage him as his visage relaxed. I completed the briefing a short time later and received permission to proceed. The required documents were then immediately placed in front of him and his signature was acquired. I subsequently left the briefing room as quickly as possible.