Mosul: the invisible burden behind wounds

Mosul: the invisible burden behind wounds

Suck Saad[1] His bed stared at the window, taking advantage of the moment with the dim light that escaped from that window. He is alone in the isolation room and the doctors have just finished their daily medical consultations. They told him that he would undergo a new surgery, the fourth surgery since the accident.

Saad, 46, is from Mosul, where his family has lived for generations. But Saad's life changed dramatically when a shell fell on his neighborhood while he was heading to his car for work. "It was very hot and the morning was cloudy, like so many days," he recalls. "But suddenly, I was hit by an earth explosion and lost consciousness." The blast was not close enough to kill Saad, but his leg was seriously injured and suffered a fractured leg bone and lunge. Saad was taken to the hospital for surgery. "An internal fixator was placed in my leg during the first procedure so that I could walk again," he explains. "But the healing process was very painful and the complications got worse."

When MSF opened the post-operative care center in Mosul in April 2018 for people seriously injured by violence or accidents, Saad was admitted to the center. A biopsy showed that the internal fixator had to be removed and replaced with an external stabilizer and that it had a multidrug-resistant infection.

A major public health issue

Saad's case is not unique, about 40 percent[2] Among patients admitted to the post-operative care facility in Mosul, patients infected with MR have arrived. Antibiotic resistance is a widespread problem throughout the country. While the rate of antibiotic resistance is high in Iraq and the Middle East, this phenomenon is also present in many countries of the world where the organization is active. Antibiotic resistance is not a new phenomenon, but there is an urgent need to tackle this problem so that it does not become one of the major public health problems of this century.

When a patient is infected with a bacterial infection, he is usually treated with antibiotics and is the only effective antibacterial drug available. But bacteria are able to adapt to drugs to ensure their survival. This ability of adaptation and antibiotic resistance can be caused by the excessive or abusive use of antibiotics. In many low- and middle-income countries, antibiotics are often available over-the-counter. The problem of their excessive or abusive use is therefore a common problem. In the long run, antibiotics have a huge impact on people's health. If antibiotics lose their effectiveness, the completion of medical procedures is extremely dangerous. Antibiotic resistance also complicates the healing of seriously ill patients as a result of violence or accidents, such as those treated by the organization in Mosul.

Treatment of the problem of antibiotics in Mosul

When WHO opened the post-operative care center last year, measures were put in place to control antibiotics and prevent and control infections to reduce the impact of drug-resistant infections. "It is necessary to prevent the spread of multidrug-resistant infections among patients in the facility," said Ann Kaluertz, WHO consultant for infection prevention and control. These steps can be as simple as making sure people wash their hands properly. "Hand hygiene in health facilities is one of the most important measures to prevent and control infections to prevent this transition." "Hand cleaning done in a timely manner can prevent the spread of resistant or sensitive organisms in our environment and in our bodies."

It is also essential to take "precautions against contact contraception": patients with multidrug-resistant infections are entitled to single rooms rather than open wings to prevent transmission to other patients and medical staff. Use of personal protective equipment such as medical gloves and gowns, reduction of transport and transport of patients, use of patient care equipment and careful cleaning and sterilization of patient rooms.

The importance of mental health and health awareness services

Due to the isolation of patients with drug-resistant infections at the hospital, these patients are more likely to experience psychological difficulties related to what they have experienced and difficulties related to their treatment. "Isolated patients have higher levels of anxiety, depression and anger than other patients," says Moser's psychologist Müdecins sans frontières (MSF) in Oliva Novakovic. "Many of our patients have had painful and traumatic experiences and have more time to think when they are in isolation rooms," she says.

But the staff of the organization is ready to help them cope. "We develop individual psychological programs based on age and level of education," Novakovic said. "Psychological education is a crucial step because if the patient understands why he is in the isolation room and how resistant he is, he will automatically be more involved in the treatment," she says.

At the same time, WHO's health awareness makers are sensitizing patients and caregivers to multidrug-resistant infections. "Antibiotic resistance is a serious threat to public health and should not be underestimated," said Health Education Officer Karam Yassin at the end of the meeting. an awareness session at the hospital.

The data indicate that antibiotic resistance rates in Middle Eastern countries, including Iraq, are dangerously high. MSF recommends health professionals and paramedics avoid the unnecessary use of antibiotics. WHO also strongly recommends that the Ministry of Health of Iraq take all necessary measures to sensitize the Iraqi population to the serious consequences of the abuse or abuse of antibiotics on health.

MSF in Iraq

MSF has been working in Mosul and surrounding areas since 2017 to provide life-saving services to victims of violence. From 2017 to 2018, WHO managed a number of adult trauma treatment facilities in the east and west of Mosul and worked in four hospitals providing a range of services including emergency care, intensive care, surgery and maternal health care. In April 2018, WHO opened a comprehensive postoperative care center east of Mosul for people suffering serious injuries due to violence or accidents.

MSF, which employs more than 1,500 people, provides basic and specialized health care, services for pregnant women and new mothers, treatment of chronic diseases, surgery and rehabilitation of war-wounded, psychological support. and health education activities. The organization currently operates in the governorates of Erbil, Diyala, Nineveh, Kirkuk, Anbar and Baghdad.

[1] The patient's name has been changed to protect his identity.

[2]A confirmed microbiological infection was diagnosed in 40% of patients admitted during the period (April to mid-November 2018). Of these, 90% of patients reported having multiple disease-resistant infections. The infection was not confirmed in 60% of the patients who were brought in (they showed no clinical signs or showed signs of infection but the condition was not confirmed).

Source: MSF Office in Jordan

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