Being an ear, nose and throat specialist in Iraq doesn't feel so dangerous anymore for Kareem, one of 27 Iraqi medical doctors who spent the past month learning about health care in the United States.
Amid the violence in his country, he often traveled in larger groups, tried not to stay on the job too late into the night and varied the roads he took to work. The Iraqi government sometimes sent security guards to watch his home.
Because of security concerns, he is comfortable talking to a reporter only on the condition that his last name and hometown not be identified.
U.S. officials report that an estimated 8,000 Iraqi doctors stopped practicing medicine in the past five years because doctors became targets for murder and kidnapping in an effort to discredit the American-supported government.
Improved security and renewed hope
But recent months have brought improved security, a return of hundreds of doctors and a sense of hope.
"Our spirit is now changed. This is the point," Kareem said in an interview in Washington.
Kareem and a second Iraqi doctor, a psychiatrist named Hamood, recently spent three weeks at Henry Ford Hospital in Detroit as part of a joint venture between the Health and Human Services Department and Iraq's Ministry of Health.
Both doctors described huge workloads at home. Kareem said he typically sees 50 to 70 patients a day in the outpatient setting and 10 more patients in the emergency room. Sinus infections, tonsillitis and cancer are conditions he regularly treats.
Hamood is the lone psychiatrist for a region with about 800,000 residents. Demand for his services has soared in recent years with many patients suffering from the fear and hopelessness that can accompany extreme trauma. Also, the stigma of seeking help for mental illness has waned, and that is driving demand.
"I think the open media has played a role in this," Hamood said.
Iraq needs thousands more doctors
U.S. health officials say Iraq probably needs about 100,000 doctors to meet the needs of its population, but has only 15,000 now.
The two Iraqi doctors emphasized that they found the practice of medicine is much the same in the two countries. Doctors in both countries ask patients the same questions. They record and chart a patient's symptoms the same way. They prescribe similar treatments. The main difference is the lack of high-tech equipment in Iraq. Iraqi doctors simply do not have access to the latest in imaging machines or robotic surgery.
Spread out across the U.S.
Health and Human Services Secretary Mike Leavitt said the visits came about because of a discussion he had with the Iraqi health minister, Dr. Salih al-Hasnawi, a psychiatrist.
"In the course of the last 15 years they've been cut off from any information in their areas of discipline. Even during the Saddam (Hussein) era, they were not able to communicate with people outside the country, and they feel like they're completely behind," Leavitt said. "What we need is for them to have access to people who are practicing at the state of the art. He asked if we could arrange shadowing experiences for physicians so they could learn and just form relationships."
The two Iraqi doctors said their time in the U.S. was devoted to observing patient care and attending lectures. They said it is hard to learn a great deal about medicine in such a short time, but they are excited about the contacts they made.
Doctors at Henry Ford are "ready to answer any questions or consultations," Kareem said.
The 27 Iraqi doctors were spread out throughout the U.S. Some went to Johns Hopkins Medical Center in Baltimore, some to Children's National Medical Center in Washington, while others went to community health centers and Indian Health Service hospitals.
Helping the doctors feel at home
Dr. Kimberlydawn Wisdom, who helped set the visiting doctors' itinerary at Henry Ford, said the region's large Arab-American population helped ensure the doctors felt more at home.
"We tried to link them not only with physicians who could provide them with the clinical expertise they were looking for, but physicians who knew their language or were of Middle Eastern descent and could continue the dialogue long after they returned to their country," Wisdom said.
U.S. doctors were extremely curious about what it's like to practice in Iraq. Wisdom said she was struck by the reduced role of nurses there.
"In our country, nurses are a key backbone of the health care delivery system. They work very closely with physicians. However, in Iraq, the understanding is that nurses were the lowest ranked profession," Wisdom said.
The Iraqi doctors said they often got questions about security and pay. The pay was sure to startle their U.S. counterparts. The two said that doctors during Saddam Hussein's rule made as little as $3 a day, forcing many to have side practices. The pay now stands at about $1,600 a month, they said.