Rehabilitating Lives in Iraq, from the Bronx

The Iraqi nation has now been at war for more than a decade. Among those affected by the ongoing violence in Iraq are children.

Huma Naqvi, M.D."While there are children who have lost limbs, we're seeing an increased number of children who have advanced developmental disabilities, such as cerebral palsy," said Dr. Huma Naqvi, assistant professor of physical medicine and rehabilitation (PM&R) at Einstein, who has been lending her expertise to address the dearth of rehabilitation services available in the war-torn nation. She added, "Although currently there's no definitive proof, we believe the rise in cases of cerebral palsy being seen in Iraq may be connected to the warfare taking place."

A native of Pakistan, Dr. Naqvi first heard about the declining healthcare system and the lack of rehabilitation services, particularly for children, in 2003. Then, in 2009, a friend and fellow physician, Dr. Batul Ladak, reported the difficulties for Iraqi children that she had seen firsthand.

"She told me about the debilitating disabilities that the children had, and that she wanted to start a disability clinic in Iraq," recalled Dr. Naqvi, who has been an attending physician in PM&R at Montefiore Medical Center, Einstein's University Hospital, since 2002. "We wondered what we could do, since neither of us could be in Iraq permanently."

Reaching Out to Lend Support

Dr. Naqvi with friend and collaborator Dr. Batul LadakThanks to technology like cell phones and video, the duo began their efforts to offer assistance by partnering with doctors at Medical City Hospital, in Baghdad, using telemedicine to consult with the Iraqi physicians about the best rehab techniques for their patients.

"We worked with Dr. Nebal Waill, a pediatric neurologist, and medical student Saja Baheer," explained Dr. Naqvi. "They would take video of patients walking and send them to me via smartphone."

"Dr. Naqvi then shared the videos with Dr. Mark Thomas, director of the PM&R residency program and PM&R residents.  Together, the group would analyze each patient's gait. "One of us would describe the disability, and then we would discuss our recommendations for addressing the problem. Sometimes we might prescribe using some kind of leg brace; other times we might suggest the use of therapeutic exercises," said Dr. Naqvi.

The collaboration has had dual benefits. "By advising Iraqi physicians and therapists about the latest rehabilitation methods, our residents are learning too, especially since, here in the U.S., we don't often see the advanced issues that many of the young Iraqi patients have," said Dr. Naqvi.  

Assessing Needs of Patients and Physicians

In 2012, Dr. Naqvi began visiting Iraq, traveling with Imamia Medics International, a medical professional organization that brings together physicians from around the world.  

She has returned each year, giving lectures and workshops on rehabilitation techniques to physicians of all disciplines and to medical students at Medical City Hospital. She also conducts disability clinics for children with physical and neurological disabilities.

"I've seen children without crutches, canes or wheelchairs who have been carried for miles by their parents so that they can access the specialized medical care that is only available in the major cities. There is such a need to fill."

Seeking Funding to Provide Training

Following her initial visit in 2012, Dr. Naqvi determined that she wanted to do more than annual visits and telemedicine consults to help meet the vast needs of the Iraqi children she had seen. Working with Dr. Thomas and PM&R residents, Drs. Hejab Imtayaz and Mohammad Emam, she sought a micro-grant from Einstein's Global Health Center to support development of a training program.

"It seemed the best way to be helpful would be to train the Iraqi medical team, including pediatric neurologists, rheumatologists, pediatricians and physical, occupational and speech therapists."

She added, "Our efforts in Iraq were aided by Dr. Waill, who distributed a questionnaire to family members and caregivers that could help assess specific patient needs. From their responses, we learned that cerebral palsy and its many complications were the most pressing issues." Complications related to cerebral palsy can include spasticity, seizure disorder, impaired ability to walk and speech problems.

Based on the survey results, from approximately 125 patients, Dr. Naqvi is developing a certificate program through which she and colleagues will teach the Iraqi physicians and therapists new techniques that could be helpful to their young patients.  In addition to working with medical staff at Medical City, the collaboration will include Kufa University Medical College, located about 100 miles south of Baghdad.

"The plan is to make physicians aware of our PM&R specialty and ultimately be able to establish a residency program in Iraq's medical colleges. And someday, when the war has ended, we hope we'll be able to offer an exchange program between our students and theirs."