The Challenges of Providing Cancer Care in a War-Torn Nation

Aug 10, 2010

August 2010: We’ve all seen the news coverage of the war-torn nation of Iraq. You would never know that this country — a historically prosperous, well-civilized country with a rich, ancient heritage — was once making its way to the forefront of oncology care. And although Iraqis are currently facing a vast array of problems — security is volatile, the economy is struggling, and the hardships of a war-torn nation continue — there are still those that persevere, as cancer continues to be a considerable health problem in Iraq. One such person is ASCO member Dr. Layth Y.I. Mula-Hussain, whose journey began many years ago and has led him around the world to better cancer treatment and care in his home country.


Dr. Layth Y.I. Mula-Hussain

Dr. Mula-Hussain’s interest in medicine started at a young age when he witnessed first-hand the pain and suffering that comes with a diagnosis of cancer. One year after his brother was diagnosed with osteogenic sarcoma, he succumbed to the disease. “The loss of my brother still inspires me to fight cancer as much as I can,” he says. Following the death of his brother, Dr. Mula-Hussain successfully progressed through school at the top of his class and eventually chose medicine as a career. “I felt I had personal experiences that made me fit for this difficult job, and that I could make a positive impact on my community, my family and me, personally,” he says. Dr. Mula-Hussain completed medical school in 1999 and after a short internship with the Teaching Oncology and Nuclear Medicine Hospital in Mosul, decided on oncology as his specialty. “I decided to choose oncology as my career path because I saw many people suffering from cancer, similar to my brother, with limited services and facilities in my country.”

In 2002, Dr. Mula-Hussain began his career as a research assistant in the Clinical Oncology Department of the Mosul University Medical College and as a resident at the Teaching Oncology and Nuclear Medicine Hospital in Mosul. Two years later he was nominated for and received the Japan International Cooperation Agency (JICA) Training Award and in 2005 received ASCO’s International Development and Education Award (IDEA). “After I received the IDEA, my approach to practicing oncology changed dramatically,” he says. “I became more intimately knowledgeable about evidence-based medicine and resources, and established strong relationships and networks with colleagues in many areas in the world.”

As part of the IDEA award from ASCO, Layth was able to travel to the United States to attend the Best of ASCO in Dallas and join his mentor, Dr. Charles Brown, at the University of Pittsburgh Medical Center (UPMC) for five days. He met and trained with UPMC researchers to improve his overall knowledge of cancer treatment and care, and accompanied their physicians on several talks to UPMC patients about the benefits of enrolling into clinical trials. After returning to Iraq, security concerns prevented him from relaying the information he learned to his physician colleagues, saying that “although I visited the United States for scientific reasons, I was worried people would think it was with the wrong intentions.” However he did share teaching materials confidentially with his supervisors and dean.

Dr. Mula-Hussain wrote an editorial for the June 5 edition of ASCO Daily News that provided his unique insights on the background of cancer care in Iraq. He wrote that in the late 1960s and early 1970s, the government health system in Iraq began to support the field of oncology through the establishment of two oncology institutes in Baghdad and Mosul. Both institutions were supplied with Cobalt teletherapy and superficial X-ray machines and were managed by Iraqi physicians who received government sponsored scholarships and underwent training in the United Kingdom. These initial steps to provide free health care to patients with cancer were supplemented in the 1980s by the establishment of a low-dose–rate brachytherapy facility and the acquisition of three linear accelerators at the Baghdad institute. However, by the late 1980s, because of the wars and their related issues, progress in oncology care came to an abrupt halt.

Additionally, Dr. Mula-Hussain wrote that hyperinflation as a result of sanctions after the second war in 1991 led to doctors earning approximately $3 to $5 a month from their work at government hospitals, despite busy oncology wards and burgeoning clinics. “Some medical professionals left the country years ago, and the new generations did not suitably fill the workforce gaps. Insufficient equipment and interrupted electrical power supplies cause disruptions to treatment; the linear accelerators and the brachytherapy machines have stopped operating, and the cobalt teletherapy units work without source replacement. There is a lack of well-equipped facilities for bone marrow transplantation, and availability of cytotoxic drugs is essentially determined by a lottery, regardless of whether the need is basic or critical. As a result of stalled progress and travel restrictions, medical knowledge is outdated, the cancer registry is weak and palliative care and research efforts are poor.”

After 2003, the security environment in Iraq forced many medical professionals to leave the country and many others were threatened or killed by corrupt groups, Dr. Mula-Hussain recounts. Still others left purely because of barriers to their development and the development of medicine as a whole. Despite these challenges however, Dr. Mula-Hussain, who is currently on a study leave at the King Hussein Cancer Center in Jordan, spent just over five years practicing medicine in Iraq, three of which were spent treating people with cancer.

He also explained that more than 70 percent of patients diagnosed in Iraq are in an advanced stage of cancer — an alarming rate with multiple causative factors including war pollutants, the deterioration of medical services, overall low socioeconomic status, and denial or cultural misperceptions about cancer. Patients with potentially curable cancers receive only the drugs available at the time of their treatment, which has led to a relative average cure rate of 10 to 20 percent; this rate can be 60 percent or greater in developed countries.

Dr. Mula-Hussain saw many patients during his years as an oncologist in Iraq, but one particular patient whom he treated in 2002 when he was a resident in Mosul stands out. The man was an older patient with advanced skin cancer on his scalp who neglected to seek treatment because of the distance he lived from the city. Under his care, the man’s condition improved a little, “and I was happy because I had a good impact on this man. However, one day, his son asked me permission to return back to his home to await a call about his father’s death. I was sad about this and asked that he not ask me permission to return home and that he should stay by his father’s bedside in this difficult and critical period in his life.”

Dr. Mula-Hussain is grateful for all of the experiences and knowledge provided by ASCO over the years, “I would like to thank the entire ASCO staff and to let them know the mission of ASCO is invaluable in order to control cancer worldwide.”

—By Danielle Potuto, Manager, ASCO Corporate Communications
This article was reprinted in part from the June 5 edition of ASCO Daily News.



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