24 June 2022

A journey of friendship and collaboration to strengthen medical education in Iraq

For the past 13 years, Professors Nigel and Deborah Bax have played an instrumental role in helping Iraqi medics and health organisations develop medical curricula and training programmes.

Professors Nigel and Deborah Bax
Professors Nigel and Deborah Bax

To honour their work rebuilding and enhancing the provision of medical education in the country, both Nigel and Deborah have had a lecture hall in the ministry-accredited Warith al-Anbiaa College of Medicine named after them. 

Alongside this, Nigel, who was the former Head of the Academic Unit of Medical Education at the University of Sheffield, has been awarded the Iraq Higher Education Medal from His Excellency Professor Dr Nabeel Al-Sahib, the Minister of Higher Education and Scientific Research. 

Deborah, who is an Honorary member of the University's Department of Infection, Immunity, and Cardiovascular Disease, has also received the Gold Decoration of Honour from the Union of European Medical Specialists for her work in assisting Iraq to join the organisation as an Observer Member, providing the country access to training curricula in over 40 specialties across Europe. 

They have been looking back on their tireless work in Iraq which began in 2009 and their achievements over the past decade. 

Over the past 13 years, we have learned so much from colleagues in Iraq and beyond, and it has been such a thrill to have developed close and enduring collaborations with them.

We feel greatly honoured to have had a lecture hall at the Warith Al-Anbiaa College of Medicine named after us and to receive the various accolades for the work that we hold close to our hearts.

Professors Nigel and Deborah Bax

Emeriti Professors at the University

How it all started

One afternoon in early autumn of 2009, the telephone rang and a voice said: “I am Hilal al-Saffar and I have been advised to contact you to ask for your help in developing the medical curriculum in the Baghdad College of Medicine.” 

The advice had been given by a university not too distant from Sheffield, which was a rather reassuring comment about our work in the Medical School in Sheffield.

In 2003, we had watched in horror as missiles exploded in Baghdad and Iraq was invaded and agreed that one day we would try to do something about this. The opportunity had come.  

Until then, our understanding of Iraq, and Mesopotamia was limited. We knew of the Sykes–Picot line that had been drawn with a ruler across Mesopotamia one hundred years ago to separate the areas that were to be controlled respectively by the British and the French.  

We knew about King Hammurabi, who ruled Mesopotamia 4,000 years ago, who had created a method of assessing doctors’ performance, with punishments for those who caused harm to patients.

We then started learning about the appalling legacy of the wars in Iraq. Teaching in universities had all but collapsed, as had teaching in primary and secondary schools. 

Many senior academics in universities, together with their families, had been and were in great danger. Assassinations of senior medical staff occurred regularly. Many left Iraq, and we were so fortunate to engage two academic refugees in the medical school in Sheffield – one a Professor of Medicine, the other a Professor of Anatomy and Surgery.

Postgraduate medical training had also largely disintegrated. There was a sense of numbness and exhaustion throughout the medical practice.  

Despite this, it was so apparent that the students, staff at medical colleges, and medical trainees demonstrated huge abilities and enormous resilience, as well as an overwhelmingly strong desire to make things better. 

It was inspiring and humbling to see what was being achieved with almost no resources other than enthusiasm, hard work, and a cheery and heartfelt smile.

Nigel and Deborah Bax and a protection officer at the College of Medicine, Baghdad
Nigel and Deborah Bax and a protection officer at the College of Medicine, Baghdad
Our initial steps

After a number of visits to Baghdad, our work to help develop the medical curriculum expanded to include other medical colleges in the country.  

Since the start of our work in Iraq, we have delivered a two-day course on the fundamentals of medical education, called the Gateway Course, to over 200 academic staff from 16 medical colleges from Basrah in the south to Erbil in Kurdistan, and we are delighted that senior staff from the Ministries, including ministers, have also attended. The course is based on the University of Sheffield Medical School’s training programme for staff and adapted for Iraq.   

We had always wanted Iraqi medical colleges to adapt the course and teach it themselves, and we are thrilled to know that this is now what is happening.

The two main postgraduate training organisations in Iraq and the main one in Kurdistan have also been engaged with the course as has the Iraqi Ministries of Health and of Higher Education and Scientific Research.

The progress of our work

Initially, our work was supported by the International Medical Corps (IMC), which is linked to the State Department in the US.  

We used to travel around Baghdad in a nondescript and rather elderly and much dented car with two large individuals in the front seats. They obscured us in the back, from which the seats had been removed, thus lessening the chance of us being seen. Uncomfortable, but effective.  

After a while we were contacted by the IMC and told that we were the only individuals they were sponsoring as regards medical education in Iraq. However, we weren’t US citizens, so their support was going to cease.  

The British Council immediately stepped in and continued covering our expenses for a period of time. But shortly after we were told that their support was dependent on our completion of a training course at a remote site in central England. Run by ex-special forces individuals, this training course taught us how to recognise and hopefully avoid threatening situations, and was a real eye-opener.  

The course helped us learn so much about the psychology of terrorists and why they behave in certain patterns. Since then, travelling through St Pancras railway station in London or checking into hotels has never been the same again.

The British Council continued being incredibly supportive. They enabled us to stay at the British Embassy in Baghdad where the staff, the ambience and the food were simply excellent.  

The issue was that these stays were extremely expensive and the British Council, expressing great regret, had to terminate their relationship with us, as our accommodation and security were costing them too much.  

By that point, we had already developed excellent relationships with a vast array of medical colleagues in Iraq, so immediately after being informed of the British Council’s decision, we began receiving support from the Ministry of Health through the good offices of the then Minister, Her Excellency Professor Adela Hussein.  

Professor Hussein was most generous – as well as covering our expenses, she gave us an office in Medical City, a massive medical complex in Baghdad. We were the only university to have been given such privilege, and having such close access to the Medical City has been a great benefit.

Nigel and Deborah Bax Presenting HE Professor Adela Hussein with a University of Sheffield flag
Presenting HE Professor Adela Hussein with a University of Sheffield flag
Most recent activities

More recently, our support has been coming from the Medical Institute of Imam Zain Alabdeen (MIZAN), a charitable organisation based in Karbala. This has enabled us to widen our activities beyond medical colleges. 

We now work closely with the Arab Board of Health Specialisations (ABHS), an organisation that covers 22 countries across North Africa and the Middle East, an area with a population of 400 million. It is also one of the postgraduate training bodies in Iraq, as they revitalise their approaches to supporting those training to become medical specialists.  

Through our work with ABHS, we were able to help Iraq become an Observer Member of the Union of European Medical Specialists. 

Two years ago, we also helped facilitate a relationship between MIZAN and the Royal College of Physicians of Edinburgh in the form of a Memorandum of Understanding to develop collaboration in training with medical trainees and trainers in Iraq.  

The college has recently started collaborating with the whole of the ABHS to work on curriculum and staff development, with assessment being a particular focus.

In 2017, we helped drive the launch of the University's Iraq Office, with academic sites in both Iraq and Sheffield, to support the country in restoring its medical education system by delivering a modern and effective medical curriculum for Iraqi students. Medical colleges throughout Iraq have been most generous in enabling us to meet and address many of their students and they are a truly inspiring group.

This is also the year when the University held its First Iraqi Student Conference to celebrate some of the achievements of students from Iraq at the University and five other UK universities.

Many Iraqi medical students stand together at the University of Sheffield's first Iraqi Student Conference in 2017
The University's First Iraqi Student Conference in 2017

In 2019, the University also signed an agreement, which was welcomed and approved by His Excellency, Professor Qusay Al-Suhail, Minister of Higher Education and Scientific Research. The agreement stated how we wish to collaborate with Iraq in higher education and research. 

We were both part of that 2019 delegation, alongside Professor Derek Bell, then President of the Royal College of Physicians of Edinburgh, and Chris Cagney from Global Engagement, where we spent a week in Baghdad and Kerbala with Ministers of State, Sheffield Alumni, Iraqi universities and postgraduate medical training organisations.

As well as meeting with His Excellency Professor Qusay Al-Suhail, during that week we also met His Excellency Professor Ala Alwan, Minister of Health, the Health and Environment Committee of the Iraqi Parliament, representatives from the University of Technology and the Universities of Baghdad, Basrah, Kerbala and Al-Mustansiriyah, and the Iraqi and Arab Boards of Health Specialisations.

Where we are at now

Curriculum and staff development have been central to our work with Iraqi medical colleges, where many have adopted approaches that emphasise the clinical aspects of medicine as a framework for learning about the underpinning sciences.  

We have helped Iraqi medical colleges formulate their methods of assessing students, which we were able to achieve during one of our visits to Baghdad, accompanied by Dr Denise Thwaites (Bee), Director of Quality at the Academic Unit of Medical Education.

A national approach to the final summative assessment of medical students in Iraq is also now in the process of being introduced.

None of this would have been achieved without the close relationship that we have with colleagues in Iraq, particularly Dr Jawad Rasheed, Secretary General of the Iraqi ABHS and Dean of Warith Al-Anbiaa College of Medicine; Professor Sabeeh Mashhadani, Head of Assessment of the ABHS and Deputy-Dean of Warith Al-Anbiaa College of Medicine; and Dr Hilal al-Saffar, previously Head of Medical Education at the College of Medicine, University of Baghdad. 

The Covid-19 pandemic has had a profound and mainly disastrous impact on medical students' learning, as only a few medical colleges were able to deliver effective teaching online.  

Other major problems include unpredictable electricity supply and internet connectivity, and the fact that clinical teaching isn’t being delivered. 

Things are slowly improving, but there is an ongoing sense of anxiety that there will be cohorts of graduates who are not as well prepared as they should be for medical practice.  

Currently, medical graduates are not employed as doctors immediately after graduation. Typically, they have to wait longer than a year to secure employment, which poses a risk of them becoming deskilled.  

Iraq has some of the lowest number of doctors and nurses per head of the population compared to other countries in the region. With a predicted expansion of the population over the next decades, the ability of the country to provide universal healthcare is uncertain.

Our work now is focused on trying to support our colleagues through all of these problems. The friendships that we have developed over many years have led to new ways of delivering medical education and training in Iraq, which will continue being our aim. 

Over the past 13 years, we have learned so much from colleagues in Iraq and beyond, and it has been such a thrill to have developed close and enduring collaborations with them. We feel greatly honoured to have had a lecture hall at the Warith Al-Anbiaa College of Medicine named after us and to receive the various accolades for the work that we hold close to our hearts.

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