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RESEARC H Open AccessIraqi health system in kurdistan region: medicalprofessionals’ perspectives on challenges andpriorities for improvementNazar P Shabila1*, Namir G Al-Tawil1, Rebaz Tahir2, Falah H Shwani2, Abubakir M Saleh1, Tariq S Al-Hadithi1AbstractBackground: The views of medical professionals on efficiency of health system and needs for any changes arevery critical and constitute a cornerstone for any health system improvement. This is particularly relevant to IraqiKurdistan case as the events of the last few decades have significantly devastated the national Iraqi health systemwhile the necessity for adopting a new health care system is increasingly recognized since 2004. This study aims toexamine the regional health system in Iraqi Kurdistan from medical professionals’ perspectives and try to define itsproblems and priorities for improvement.Methods: A survey questionnaire was developed and administered to a convenience sample of 250 medicalprofessionals in Erbil governorate. The questionnaire included four items; rating of the quality of services andavailability of resources in the health institutions, view on different aspects of the health system, the perceivedpriority needs for health system improvement and gender and professional characteristics of the respondents.Results: The response rate to the survey was 83.6%. A high proportion of respondents rated the different aspectsof services and resources in the health institutions as weak or very weak including the availability of the requiredquantity and quality of medicines (68.7%), the availability of sufficient medical equipment and investigation tools(68.7%), and the quality of offered services (65.3%). Around 72% of respondents had a rather negative view on theoverall health system. The weak role of medical research, the weak role of professional associations in controllingthe system and the inefficient health education were identified as important problems in the current health system(87.9%, 87.1% and 84.9%, respectively). The priority needs of health system improvement included adoption ofsocial insurance for medical care of the poor (82%), enhancing the role of family medicine (77.2%), adopting healthinsurance system (76.1%) and periodic scientific evaluation of physicians and other health staff (69.8%).Conclusion: Medical professionals were generally unsatisfied with the different aspects of the health system inIraqi Kurdistan region. A number of problems and different priority needs for health system improvement havebeen recognized that require to be studied in more details.BackgroundThe major objective of a country’s health system is toassure the health of the general public through offeringgood quality and prompt services according to theneeds of the population [1]. The health system needs togo through a process of continuous changes andimprovement in order to be able to cope with differentchanges in the health and population environments andto appropriately respond to different challenges andneeds [2].The history of formal health care system in Iraq beganin early 1920s, but the Iraqi Ministry of Health (MoH)was established in 1952 and its organizational structurewas formalized in 1959. This organizational structurehas changed little since its establishment [3,4]. Thehealth care Theoretical Perspectives on Health and Medicine Theoretical Perspectives on Health and Medicine Bởi: OpenStaxCollege Each of the three major theoretical perspectives approaches the topics of health, illness, and medicine differently You may prefer just one of the theories that follow, or you may find that combining theories and perspectives provides a fuller picture of how we experience health and wellness Functionalism According to the functionalist perspective, health is vital to the stability of the society, and therefore sickness is a sanctioned form of deviance Talcott Parsons (1951) was the first to discuss this in terms of the sick role: patterns of expectations that define appropriate behavior for the sick and for those who take care of them According to Parsons, the sick person has a specific role with both rights and responsibilities To start with, she has not chosen to be sick and should not be treated as responsible for her condition The sick person also has the right of being exempt from normal social roles; she is not required to fulfill the obligation of a well person and can avoid her normal responsibilities without censure However, this exemption is temporary and relative to the severity of the illness The exemption also requires legitimation by a physician; that is, a physician must certify that the illness is genuine The responsibility of the sick person is twofold: to try to get well and to seek technically competent help from a physician If the sick person stays ill longer than is appropriate (malingers), she may be stigmatized Parsons argues that since the sick are unable to fulfill their normal societal roles, their sickness weakens the society Therefore, it is sometimes necessary for various forms of social control to bring the behavior of a sick person back in line with normal expectations In this model of health, doctors serve as gatekeepers, deciding who is healthy and who is sick—a relationship in which the doctor has all the power But is it appropriate to allow doctors so much power over deciding who is sick? And what about 1/5 Theoretical Perspectives on Health and Medicine people who are sick, but are unwilling to leave their positions for any number of reasons (personal/social obligations, financial need, or lack of insurance, for instance) Conflict Perspective Theorists using the conflict perspective suggest that issues with the healthcare system, as with most other social problems, are rooted in capitalist society According to conflict theorists, capitalism and the pursuit of profit lead to the commodification of health: the changing of something not generally thought of as a commodity into something that can be bought and sold in a marketplace In this view, people with money and power—the dominant group—are the ones who make decisions about how the health care system will be run They therefore ensure that they will have health care coverage, while simultaneously ensuring that subordinate groups stay subordinate through lack of access This creates significant health care—and health—disparities between the dominant and subordinate groups Alongside the health disparities created by class inequalities, there are a number of health disparities created by racism, sexism, ageism, and heterosexism When health is a commodity, the poor are more likely to experience illness caused by poor diet, to live and work in unhealthy environments, and are less likely to challenge the system In the United States, a disproportionate number of racial minorities also have less economic power, so they bear a great deal of the burden of poor health It is not only the poor who suffer from the conflict between dominant and subordinate groups For many years now, homosexual couples have been denied spousal benefits, either in the form of health insurance or in terms of medical responsibility Further adding to the issue, doctors hold a disproportionate amount of power in the doctor/patient relationship, which provides them with extensive social and economic benefits While conflict theorists are accurate in pointing out certain inequalities in the health care system, they not give enough credit to medical advances that would not have been made without an economic structure to support and reward researchers: a structure dependent on profitability Additionally, in their criticism of the power differential between doctor and patient, they are perhaps dismissive of the hard-won medical expertise possessed by doctors and not patients, which renders a truly egalitarian relationship more elusive Symbolic Interactionism According to theorists working in this perspective, health and illness are both socially constructed As we discussed in the beginning of the chapter, interactionists focus on the specific meanings and causes people attribute to illness The term medicalization of deviance refers to the process that changes “bad” behavior into “sick” behavior A related process is demedicalization, in which “sick” ...Prevalence of respiratory symptoms and cases suspicious for tuberculosis among public health clinic patients in Afghanistan, 2005–2006: Perspectives on recognition and referral of tuberculosis cases Yolanda Barbera ´ Lainez 1 , Catherine S. Todd 2 , Ahmadullah Ahmadzai 1 , Shannon C. Doocy 3 and Gilbert Burnham 3 1 International Rescue Committee, Kabul, Afghanistan 2 Division of International Health & Cross-Cultural Medicine, University of California San Diego, La Jolla CA, USA 3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA Summary objectives To assess diagnosis and management of suspected pulmonary tuberculosis (TB) among patients with respiratory complaints attending Comprehensive Health Centers (CHCs) in Afghanistan. methods Consecutive consenting patients presenting with respiratory complaints at 24 health centres in eight provinces were enrolled between November 2005 and February 2006. Demographics, health histories, clinic provider and study representative exam findings and diagnoses, and diagnostic test results were recorded. Correlates of TB-suggestive symptoms (defined as cough >2 weeks and ⁄ or haemoptysis) were assessed by logistic regression. results There were 1401 participants; 24.6% (n = 345) were children (age 17 or under). The TB-suggestive symptoms of cough >2 weeks and ⁄ or haemoptysis were reported by 407 (31.3%) and 44(3.3%), respectively, with 39 participants reporting both symptoms. Of 413 participants reporting TB-suggestive symptoms, only 178 (43%) were diagnosed as having suspected TB; 22.0% received no clinical diagnosis. Suspected TB was significantly associated with having a household member residing in a refugee camp within the last 2 years (OR = 6.0; 95% CI: 4.1–8.7), seven or more people sleeping in the same room (OR = 1.9; 95% CI: 1.4–2.6) and cooking with a wood fire in the sleeping room (OR = 1.6; 95% CI: 1.2–2.2) in univariate analysis. conclusions Diagnostic sensitivity by the health worker for possible cases of pulmonary TB was low, as 22% of persons with suspected tuberculosis received no diagnosis. Further, some common ⁄ chronic respiratory ailments were under-diagnosed. There is great need for improved practical training and continuing education in pulmonary disease diagnosis for clinical health workers. keywords Afghanistan, tuberculosis, respiratory symptoms, cough, sputum smear accuracy Introduction Globally, respiratory disease accounts for 19% of deaths, many avoidable through risk behaviour reduction and prompt diagnosis and treatment (WHO 2000). Among nine developing countries surveyed, respiratory problems comprised 18% of presenting complaints in primary health clinics (WHO 2004). Most reflect acute respiratory infec- tions, responsible for 25% of infectious disease deaths in developing settings (Scherpbier et al. 1998). Pulmonary tuberculosis (TB) is the leading cause of infectious disease mortality globally, with 80% of cases concentrated in 22 low-income countries (Corbett et al. 2003, World Health Organization 2004). Diagnosis of pulmonary TB is a multi-step process, requiring clinical acumen and diagnostic procedures. Criteria for TB-suggestive cases (productive cough >2 weeks and ⁄ or haemoptysis) may be non-specific and result in diagnostic delay by either providers or patients in initiating appropriate investigations (Ward et al. [...]... Association (BMA) (1993) Complementary Medicine: New Approaches to Good Practice, London, BMA Cant, S and Sharma, U (1999) A New Medical Pluralism? Alternative Medicine, Doctors, Patients and the State, London, UCL Press Doel, M and Segrott, J (2003) ‘Beyond belief? Consumer culture, complementary medicine, and the dis-ease of everyday life,’ Society and Space, Vol 21, pp 739–59 Gabe, J., Kelleher, D and. .. understand illness in the context of the whole person (Campbell, 2002, p 7) That is, a person is not just a physical body but can be seen as having several levels—mind, body and spirit— which need to be considered together to understand and treat illness and disease Many CAM practitioners believe that consultations should include more time to discuss with an Perspectives on complementary and alternative medicine. .. your health and wellbeing is a daily and a substantial task Most people spend considerable time working on their own feelings about health and wellbeing but in different ways Lifestyle, consumption and consumer health Along with mixing and matching ideas in personal philosophies and choices in life, there is a general trend towards diverse consumption The term ‘patterns of consumption’ is commonly used... observation and a professional system of training, ethical standards and careful regulation Through its close connections to the powerful knowledge of science, biomedicine could claim a monopoly over knowledge about the body, health and disease Medicine developed with close connections to the state and soon became the authoritative voice on how disease and ill health should be managed and treated These... consumption goes beyond what people buy to how they see themselves Students often talk about themselves as consumers or customers of the educational system Being a consumer is about embracing a set of values—being in control and buying what one needs and desires In modern society, health care services, including complementary and alternative, is a growing area of consumption Many commentators on complementary. .. and treatment that are commonly regarded as non-conventional at present This does not mean some CAMs will not be, and indeed are not being, integrated into more orthodox health settings and services The definition and understanding of CAM used here focuses on how particular therapies or medicines are regarded by the majority of people There are many non-conventional types of medicine The most common... along CAM as traditional CAM medicines are often claimed to have a long history of healing or links and connections with allegedly older ideas of medicine and health Some forms of CAM, such as traditional Chinese medicine (TCM) demonstrate a heritage of healing going back thousands of years Campbell (2002, p 6) draws attention to how traditi[...]... including language The bony structures of the head and face also conduct sound waves Bone conduction bypasses the outer and middle ears Sound waves instead travel as vibrations along the bones to the inner ear, where they pass to the bony part of the cochlea The vibrations of the bony cochlea pass to the endolymph, and the rest of the hearing process unfolds Sounds conveyed through bone conduction are significantly... analyzes them and creates collective interpretations The functions of breathing and swallowing share the structures of the throat The chamber at the back of the mouth and the top of the throat is the pharynx; it receives both air and food A flap of cartilage at the base of the pharynx, the epiglottis, closes across the TRACHEA when swallowing and opens to allow the passage of air during inhalation and exhalation... the mouth and push it to the back of the throat for swallowing; they also shape the flow of air and create the formation of words during speech These functions require muscular control and coordination The sense of taste is called gustation Though common perception is that the bumps on the tongue are the taste buds, taste buds are microscopic The bumps are called papillae; they contain clusters of taste... Each taste bud contains dozens of taste cells Though taste buds for the four categories of taste—sweet, sour, salt, and bitter—are present throughout the mouth, the roughly 10,000 of them on the tongue align in patterns of concentration: • Taste buds on the tip of the tongue are concentrated to detect sweet The Ear, Nose, Mouth, and Throat 5 • Taste buds on the sides of the tongue are concentrated to... Using the Facts On File Encyclopedia of Health and Medicine Each section of the encyclopedia begins with an overview that introduces the section and its key concepts, connecting information to present a comprehensive view of the relevant system of the human body or health and medical subject area For most body systems, this overview begins with a list and drawings of the system’s structures and incorporates... USE THE FACTS ON FILE ENCYCLOPEDIA OF HEALTH AND MEDICINE with its surroundings and the external environment Welcome to The Facts On File Encyclopedia of Health and Medicine, a four-volume reference set This comprehensive resource is an indispensable reference for students, allied health professionals, physicians, caregivers, lay researchers, and people seeking information about health circumstances and. .. 4’s section “Emergency and First Aid” are unique within the orientation of The Facts On File Biogeochemical, Health, and Ecotoxicological Perspectives on Gold and Gold Mining CRC PRESS Boca Raton London New York Washington, D.C. Ronald Eisler, Ph.D. Biogeochemical, Health, and Ecotoxicological Perspectives on Gold and Gold Mining This work is a reprint of a publication of the United States government (Patuxent Wildlife Research Center internal report, Gold and Gold Mining: Biogeochemical, Medical, and Ecotoxicological Perspec- tives ; available from Librarian, USGS, PWRC, Laurel, MD 20708). Reasonable efforts have been made to publish reliable data and information; however, neither the United States Government nor the publisher makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or represents that its use would not infringe privately owned rights. 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No claim to original U.S. Government works International Standard Book Number 0-8493-2898-5 Library of Congress Card Number 2004051932 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0 Printed on acid-free paper Library of Congress Cataloging-in-Publication Data Eisler, Ronald, 1932– Biogeochemical, health, and ecotoxicological perspectives on gold and gold mining. Ronald Eisler. p. cm. Includes bibliographical references and index. ISBN 0-8493-2898-5 (alk. paper) 1. Gold mines and mining—Health aspects. 2. Gold mines and mining—Environmental aspects. 3. Gold—Toxicology. 4. Gold—Physiological effect. I. Title. RC965.M48E35 2004 615.9 ′ 02—dc22 2004051932 2898_C00.fm Page iv Friday, September 24, 2004 10:38 AM Visit the CRC Press Web site at www.crcpress.com Dedication To Jeannette, Renée, David, Charles, Julie, and Eb 2898_C00.fm Page v Friday, September 24, 2004 10:38 AM Preface Over the past several decades I have been tasked by environmental specialists of the U.S. Fish and Wildlife Service with the preparation of risk assessment doc- uments of chemical and biological hazards of various compounds to wildlife. For the most part, these documents involved analysis of measurable risks associated with agricultural, industrial, municipal, military, and industrial chemicals and their wastes. Risk assessment — still an inexact science — depends heavily on well-documented databases that include the compound’s ... Perspectives on Health and Medicine Medicalization and demedicalization affect who responds to the patient, how people respond to the patient, and how people view the personal responsibility of.. .Theoretical Perspectives on Health and Medicine people who are sick, but are unwilling to leave their positions for any number of reasons (personal/social obligations, financial... example of medicalization deviance interactionist theory demedicalization Answer D 4/5 Theoretical Perspectives on Health and Medicine Short Answer Which theoretical perspective you think