prospect:

progress through opportunity

1

Issue #2February 2009

www.studentima.co.uk

Telling Tales Read first hand accounts of what

it’s like to practice in Iraq.

ediTorial:WriTTen in The sands of TimeThe role of writing in the history and the future of Iraq

inside...

2 3

From the President...

With a new edition of SIMA: Prospect, we bring to you a new fresh-faced committee ready to cement the achievements of the outgoing team, whilst constantly trying to

further the SIMA cause.

The partnerships that have been launched, must be nurtured, the projects developed and our efforts maximised to bring about as much progress as possible. Opportunities offered will be welcomed with open arms, as we continue to work to achieve our aims

both in Iraq and the UK, to the best of our abilities.

In light of the current economic climate, and the continued growth and expansion of the organisation, SIMA is also looking towards its financial future. We are looking to establish financial partners that will provide us with a relative degree of security re-

quired to continue to improve the service we offer.

Furthermore, this committee is looking towards a more inclusive outlook on our mem-bership. It has not escaped our notice that SIMA is still considered by many to be an exclusively ‘medical’ organisation. This is simply not so. The nature of medical practice, relies on effective specialisation and teamwork, a concept we hope to carry

through our society as well.

Ofcourse, none of this can be achieved without your help and support, and so we hope that we can all come together as a collective body to bring about change; a change in

attitudes, a change in behavior, ultimately a change for the better.

-Yasmin Al-Asadypresident@studentima.co.uk

www.studentima.co.ukIssue #2 • Feb 2009

a publication a publication

Editorial tEam

Yasmin Al-Asady • Georgina Butterworth • Lois Durrant • prospect@studentima.co.uk •

CONTENTS

Editorial Written in the Sands of Time

in thE Spotlight

Mesopotamian Medicine: A Brief Introduction

FEaturES The Will to Live

Mind, Body or Soul?

Building for the Future

Sima: World SIMA on the World Stage

ElEctivES

Rural Medicine: Zanzibar

Canada: Special Care Dentistry

updatES Workshop: Writing an article

Iraq Relief Networking

SIMA: North

SIMA: Wales

SIMA: London Health Awareness Campaign

4

6

10

12

14

16

18

21

24

26

26

26

27

4 5

These are the words written in the open book featured on the cover of this edition of SIMA: Prospect. The picture was drawn as part of a ‘Culture for All’ outreach project running in Al-Redha primary school, Baghdad. The children were asked to draw something that they felt represented Iraq, and young Abbas Qassim responded with the image you see before you.1 Through the eyes of this young man we gain an appreciation of Iraq’s illustrious history as the cradle of civilisation; home to the ‘House of Wisdom’ and countless scientific and mathematical breakthroughs, it stood firm as a longstanding hub of intellectual debate and discussion.

A friend of mine once told me that I should stop living in the past, that I should look past the history of Iraq and judge it by it’s merits, or rather lack of, in the present day; I prefer Abbas’ approach.

History is more than just past events. I remember being naïve enough not to study history for my GCSEs for this very reason. What could I possibly learn from studying the past? Ironically, I found myself immersed in the study of the History of Medicine at university. Armed with this knowledge, I feel much better placed to understand why the scientific world is where it is today, how we got here, and consequently how it may progress. Understanding the past, allows us to look deeper into the present day, and even project

into the future as to the number of different opportunities through which we can progress.

Professor Jim Al-Khalili’s recent documentary, Science & Islam, maps the roots of scientific advancement that lie in modern day Iraq, the centre of academic progress and endeavour during the Middle Ages. However, this was by no means the beginning of Iraq and science.

Throughout history, the land that makes up modern day Iraq has been a hotbed of wonder. Babylonian curiosity led to an emphasis on observation to complement the natural philosophy of the Ancient Greeks that remained theoretical in essence. Alongside, this new emphasis on observation, the introduction of ‘professional writers’ that continued the production of cuneiform tablets, documented the scholarly endeavours of the time. The fact that these tablets were made of clay and thus imperishable provides a direct insight into scholarly activities more than two millennia ago.

Moving forward in time to medieval Iraq, the quest for knowledge continues. The Abbasid ruler, Al-Ma’mun, had high hopes for his newly captured city, Baghdad. He is said to have had a vivid and life-changing dream, in which he was instructed by Aristotle, to seek knowledge and enlightenment. What followed was what is now known as ‘The Translation Movement’, Al-Ma’mun set out to acquire as much knowledge as he could. Seeing as the majority of this knowledge remained in the ancient texts of the Greeks, Al-Ma’mun commissioned several scholars to initiate a mass translation of all important texts into Arabic. Similar to the cuneiform tablets of the Babylonians, the recent invention and importation of paper from China, allowed this mass communication of

ideas and observations, both old and new, throughout the academic world. The importance of the communication of ideas and the formal documentation of knowledge has therefore, clearly been recognised for centuries. In fact, without writing, the foundation of much of modern day science may never have been developed into the laws and theories that define the scientific boundaries within which we live and work.

For more information, ‘Science & Islam’, is a great introduction into the history of science.2

Alongside the role of writing in the advancement of science, documenting one’s thoughts and emotions has also been linked to better mental health. In the field of Psychology, much research has been performed with regards to the importance of discussing experiences, both positive and negative, in order to develop a coherent ‘sense of self’. Several therapeutic approaches in cases of post-traumatic stress disorder utilise expression of emotions and ideas, as a form of coming to terms with their experiences, be it in the form of writing a diary, the use of illustration, sport or music. The art of writing is thus not only a means to academic success, but also psychological well-being. In light of Iraq’s recent history, the role writing may occupy in the advancement of both the country’s scientific and non-scientific populace is boundless.

Following on from our inaugural first edition of SIMA: Prospect, this issue looks to honour the writing tradition that has played such an important role in the quest for knowledge from as far back as Ancient Babylon, through the translation movement and the years of scientific endeavour that followed.

Alice Clarke’s article gives us just a snapshot of the importance of the development of Cuneiform script in informing the world of the early medical advancements of Mesopotamia.

We also have personal accounts from three Doctors practising in Iraq. The first, by Dr Farah Baha, describes some of the emotional aspects of her experience as a paediatric house officer.

In a similar vein, Dr Nabil Al-Khalisi has written an informative piece regarding the difficulties doctors face in tackling mental health in Iraq, an area of particular importance in the rehabilitation of Iraq and its population in this post-war period.

The final feature article is written by Dr Zeena Mohammed, who talks about her visit to the UK as part of the British-Arab exchange, the lessons learnt, and their potential applications in Iraq.

Alongside the elective accounts and updates sections that are carried through from issue #1, we have also introduced the editor’s workshop, a short article on any subject of your choice. The first in this series is a guide to writing articles, by none other than our very own senior editor, Georgina Butterworth.

Throughout time therefore one can highlight several turning points that define the importance of writing. From the revered status of the scribe in early Babylonia, through to the eminence of the scholar in medieval Iraq, and role of the printing press in shifting the intellectual centre west, to welcome in the European renaissance, one is constantly reminded just how powerful the written word can be.

The written word is forever immortalised. It can demonstartes conviction in one’s ideas, convey weight to one’s opinion, opening up endless possibilities and dreams. For some, the effect may be immediate, for others, literary prowess may not be appreciated for some time, but rest assured, with the documentation of thought, the power to effect change can only multiply.

Upon reading these articles, we hope that you embrace the spirit of writing, and are encouraged to share your own research and ideas in future editions of SIMA: Prospect. Let us learn from the sands of time, to encourage discussion and debate in order to rekindle the scientific crown that Iraq once wore so proudly.

“Knowledge is light, Ignorance is darkness,

Knowledge began here”

1www.cultureforall.org2 http://news.bbc.co.uk/1/hi/sci/tech/7810846.stm

Wik

imed

ia C

omm

ons

Issue #2 • Feb 2009 www.studentima.co.uk

Written in the

SandS of timeEdit

or

ial

YaSmin al-aSadY

a publication a publication

Mesopotamian Medicine: A brief introduction

Alice Clarke

6 7

In t

he

Spo

tlIg

ht

Cuneiform1 tablets have enabled archaeologists and historians to gain a detailed insight into many aspects of the lives of people living in Ancient Babylonia. Surviving texts also provide information about the complex level of study in medicine of the period, which detail disorders from kidney infections to migraine. These texts not only refer to a wide range of physical disorders and illnesses but also the diagnostic methods used, enabling historians to understand not only the methodology involved but the relationship between medicine and religion.

The oldest medical texts belong to the Old Babylonian period, around 2,000 BC. The best-known and most detailed text of this period is the Diagnostic Handbook, written by Esagil-kin-apli of Borsippa. This text refers in detail to methods of diagnosis, including physiological examination of the patient, prognosis, and recommended prescriptions. Also notable is the importance given to empirical processes and logical assessment, outlining how rules of observation lead to diagnosis. This text describes a range of illness, catalogued from head to foot; how to diagnose them and their prognosis. It also thoroughly details the therapeutic response to diagnosis- dressings, creams and medication. Perhaps the most notable feature of the Handbook is the establishment of axioms in the text, some resembling views in contemporary medicine; that physical examination and assessment of symptoms can ascertain the disease of

the patient, how it may develop and the likely prognosis on the patient’s recovery.

The text is also notable as it describes diagnosis as being the role of the priest, with the prescription being produced by a physician. This approach to diagnosis however does not take into the account the importance of the role played by individual medical history in diagnosis, for example while there is detailed writing about kidney disease in some texts there seems to be no reference to prior illness in the diagnostic criteria. In this case the text describes the symptom of swollen bladder and erection as a sign of kidney disorder in males, and prescribes drinking a combination of dog’s tongue with natural seeds and resins in either milk or beer. Texts also describe how to unblock the urethra by blowing into the penis with a bronze pipe, however it is not always straightforward to ascertain the condition in question or how the instrument may have been used.

More interesting to the historian in this situation is the process of diagnosis, as many tablets propose a physical complaint (such as the appearance of the penis in a patient with kidney dysfunction), followed by investigation (of the appearance of fluids for example), then a prescription of some sort.

While most of these sources are texts meant to educate physicians there is also a great amount of documented medical knowledge in the form of letters. Perhaps the most famous example

of this was the Assyrian king Esarhaddon, whose illness was extensively documented through letters passing between court officials and physicians. These descriptions refer to fever, weakness and stiffness, among other symptoms, however this may only point towards types of disorder and many theories as to what the modern diagnosis might have been exist.

Much of the surviving medical instruction is in Akkadian2, and most of the surviving tablets document prescriptions; effectively recipes for medicines to be made for the patient, with some reference also to incantation and other related magical practices. These medications were generally made from herbal ingredients, to be taken either orally or rectally, although who administered the end product remains unclear from the documents. In addition to the index of texts detailing prescriptions are tablets cataloguing plants and other natural products with medicinal uses, however these are less informative about method. The texts however provide, as well as details of medicinal products, methods for anaesthesia. The treatments described would undoubtedly be very painful

in many cases, such as forcing salves into the urethra, and so the tablets also provide methods to induce drunkenness and therefore lessened sensation in the patient. Despite the richness of diagnostic and educational texts there appears to be little textual evidence for knowledge of physiology or any surgical practices.

Another diagnostic resource is the Sakikku (‘All Diseases’), dating from 718 BC to 612BC. These tablets were discovered at Urfa in Southern Turkey, and others were not found by excavation but have been linked to the same series. The tablets are written in Neo-Assyrian and Neo-Babylonian3 text and explore epilepsy in great detail. Referred to by different names across the tablets the subject is nonetheless clear, and therefore constitute the earliest known writing about the condition. The texts display the close relationship between diagnostic practices we may identify with today, and magical religious beliefs that we may only understand as part of the larger corpus of cuneiform documentation. We see this in the manner that the texts describe investigation and diagnosis, but in order to ascertain the

The Ancient East...

http

://ra

tiona

lrevo

lutio

n.ne

t

Wik

imed

ia C

omm

ons

Issue #2 • Feb 2009 www.studentima.co.uk

a publication a publication

Discuss this article and more on our online forums

www.studentima.co.uk/forum

***

SIMA: Prospect Issue #3 ‘The Multi-Disciplinary Approach to

Healthcare’

SEPT 2009

submit your article to prospect@studentima.co.uk

any other queries secretary@studentima.co.uk

Feat

ur

es

presence of ghosts and spirits which may ‘seize’ the patient. Each epileptic episode is understood then as the seizing and release of the patient by a demon, seemingly portrayed as a particular menace to children and young brides (who the demons envy). These texts are primarily explanatory and diagnostic but less prescriptive about treatment, referring to salves, enemas and charms, perhaps allowing a certain amount of credibility to arise from the inevitable recovery of some patients.

The great relevance of magical belief in Mesopotamian medicine should not ignored, as modern attempts to congratulate physicians of the period on ‘correct practice’ are clearly anachronistic in ignoring the premises of the diagnosis. A diagnosis of a condition we may call epilepsy from a case history of the period may well accord to a diagnosis that may be made by a practitioner today, however the term in the original text is closely bound to a system of belief in spirits which differs greatly from our modern conception of epilepsy.

An example of this occurs in descriptions of epileptic symptoms, as the same phrases both describe the appearance of the eyes, and how this is brought about by the descent of a demon. The advanced methodology we see in these texts is notable, but to separate this from its context leads us to misunderstand not only the origins of this medical tradition but to deny a great part of the historical understanding that the great wealth of written sources affords us.

Clarification of terms... 1: Cuneiform is considered one of the oldest known forms of writing, and originates with pictorial representations of

the 30th century BC. This form of writing was made by impressing wedge-shaped markings on clay tablets or in stone. 2: Akkadian is the Semitic language of Ancient Mesopotamia. It emerged from cuneiform with later modifications

based on Sumerian. 3: Neo-Babylonian and Neo-Assyrian both date from the period 1000–600 BCE, emerging from the prior Middle

Assyrian but disappearing after the introduction of early Greek. 4: The Hippocratic corpus originates in Ancient Greece, and contains works of early medicine by a number of (largely

unknown) authors. The work was likely produced by students of Hippocrates, and documents medical practice in a number of forms, from case histories to philosophy and including the Hippocratic Oath.

Babylonian medicine was not lost when its related civilization ended around the year 300AD but arguably was absorbed into the Hippocratic corpus4 in the form of aphorisms of types of disorder, showing its continuation in the later civilisations of the area. The cuneiform tablets which document these practices inform modern historians about the medicine of the time, but long before this served as the educational tools of contemporary physicians. Close analysis of the language may elucidate nuances of meaning, especially where referring to distinctions within types of disorder or categories of religious belief, but it is equally important in gaining a clearer understanding of how the development of writing forms over this long history enabled the accumulation of medical knowledge.

References:

Markham J. Geller and Simon L. Cohen : Kidney and Urinary Tract Disease in Ancient Babylonia, with Translations of the Cuneiform Sources, Kidney International, Vol. 47 (1995).

H. F. J. Horstmanshoff, Marten Stol, Cornelis Tilburg: Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine, Brill Publishers (2004).

Marten Stol, Epilepsy in Babylonia, Brill Publishers (1993).

J. V. Kinnier Wilson and E. H. Reynolds: Translation and Analysis of a Cuneiform Text Forming Part of a Babylonian Treatise on Epilepsy, Medical History 34: 185-198 (1990).

Alice Clarke is a student at the History and Philiosophy of Science department at the University

of Cambridge.

Dr Farah Baha

10 11

Feat

ur

es

Shnow,I came to know her in my last ‘on call’; actually she was my first patient that day. A 23-month-old little girl with messy red hair, sad blue eyes, a funny rounded nose and blue lips gasping for life.

She was laying in the ‘oxygen room’ as the workers here refer to it. I find the ‘death room’ more appropriate, as I have yet to see a single critical case survive that cold space once admitted.

To walk out alive from that specific room would be a miracle in itself, with these dark old walls and the sloppy six beds they contain. If those beds could speak they would tell countless tales of children who passed away on them, to the sound of the tears of a million mothers’ broken hearts.

A standard intensive care unit (ICU), in the UK for example, would ordinarily contain ventilators, cardiac monitoring devices, pulse oximeters, various sizes of laryngoscopes, ABG analysis facilities and a crash cart equipped with life saving medications.

Our ‘death room’ contains oxygen containers and miserable aspirators, in the hope that these will be enough to save a sick child. Our (ICU) room is clearly severely under-equipped from the standards mentioned above. I sometimes wonder why they call it the emergency room while it looks like all the other “regular” rooms.

Here in Iraq, out of necessity, we have learned to expand upon the use of every piece of equipment. Not only do our tools need to perform their assigned tasks, but they have to handle a few extra jobs as well. For example, Nasogastric (NG) tubes, intended for feeding, delivering medication and gastric lavage have had to be modified to work as drains and aspirators. Then of course there is the Pulse Oximeter, which we are considered lucky to have, a dangerously inconsistent device that goes on and off without any reason. This inconsistency makes the recording of vital signs a challenge to doctors- especially when these seconds or minutes are crucial to someone’s life.

If you were to peer into the ‘oxygen room’, you would be forgiven for thinking that perhaps we were living in the dark ages, prior to the discovery of electricity. We are like bats in the day light- we function (if you consider it a function) by intuition, relying on physical skills and (for my religious friends) by God’s help!

These are conditions we face when attempting to treat children like Shnow. One day, Shnow was laying on one of those beds, cuddled in her mother’s lap wearing an oxygen mask and moaning weakly. I had never seen such an extent of bluish discoloration before; the tip of her nose, her little innocent toes, her fingers even her eyelids, were blue.

Her vitals were worrying. The pulse oximeter kept turning on and off making it impossible to

record her Oxygen Saturation rate (SpO2). I knew I had to do something. Years of medical training, and all I could do was put her in a ‘knee - chest position’ to improve her condition. That was the only thing I could do.

She was like a tiny kitten held so tightly in the arms of her mother, who, with tear-filled eyes, could only utter ‘she will get better, right?’

Shnow was born with a congenital heart defect, ‘Tetralogy of Fallot’ a condition named after the French physician Étienne-Louis Arthur Fallot, who described the four defects forming this anomaly, namely: a ventricular septal defect, overriding of Aorta, pulmonary valve stenosis and right ventricular hypertrophy. It is the most common congenital cyanotic heart disease resulting in the mixing of oxygenated and de-oxygenated blood within the heart chambers. As a result, the patient presents cyanosed i.e. bluish discoloration of the skin and mucous membranes and short of breath.

Fortunately, advances in medicine and surgery mean that patients suffering with this condition can be effectively cured with one or two stage surgery. Unfortunately, this requires resources that we simply don’t have here in Iraq. What a shame! One of the richest countries in the world, yet it cannot provide the minimal requirement for a decent life.

What a shame! For the country which was once the cradle of civilization.

Children here are dying for no good reason, rather, ridiculous reasons such as: insufficient laboratory investigations, ventilators to maintain respiration and as ever, medications. For years, I read and memorized hundreds of drug names and how they act in my textbooks, yet the cabinet at my hospital stocks no more than twelve different drugs. Twelve. And yet, this facility is considered one of the best in Iraq. Cases are referred to us from all over the country for treatment.

Despite of our miserably depleted facilities, Shnow was able to survive the first six days of her admission. She recovered from her hypercyanotic spell with nobody to thank, nothing other than her sheer will to live.

The fifth day of Shnow’s admission remains indelible in my mind. I entered ‘the room’ and saw her wearing a cute red jumper, with her amazing straight red hair combed so neatly; holding a toy in her hand.

I offered my hand to shake hers to salute the courage she had displayed to overcome her spell, but she did not give me her hand back. Her mother told me ‘this hand hurts her- it was the site of the canula, try the other hand?’ I did as instructed, Shnow offered me a shake back.

She put her tiny blue hand in mine. Her fingers looked like drumsticks, severe clubbing as a result of her defect, yet her nails, ironically, were adorned with a red nail polish- a sign of her continuing desire to live normally and to feel beautiful. Her nails were innocently messy (you know how awful they look when a child insists on painting their own nails). Such a painful contrast! On one hand, a crawling illness trying to suck life out of her and, on the other hand, an unyielding will to live adorned in a strange form of elegance, a childish class. Shnow proudly wore her ‘red polish’ as if to say, “I do have the right to live”.

Shnow’s mother gave me permission to take a photo of her daughter. I kept trying to make her laugh or at least smile but I failed despite making all the funny faces I knew. Instead, she gave me a look as if to say “for what reason should I smile?!”

Shnow passed away on 24/02/2008 after having another, fatal, hypercyanotic attack.

The will To live

Dr F

arah

Bah

a

Issue #2 • Feb 2009 www.studentima.co.uk

Dr Farah Baha MBChB is a House Officer at the Sulaimani General Hospital.

a publication a publication

Dr Nabil Al-Khalisi

12 13

Feat

ur

es

suffering a hard one; it makes psychiatrists feel unsatisfied all the time because all of their intensive study and thorough examination goes in vain. Looking in both directions, the patient in many times is never benefited from treatment and has no faith in his physician’s abilities and considers treatment as an experimental one or something like that; while the doctor thinks that treating such patients is a waste of time because they have neither compliance nor understanding for their own diseases.

Financially, the private sector is never

willing to invest in mental health. In Iraq it is a cloudy area that no one is happy putting his money in it. To be honest, such an investment is a real waste of time and resources in the short run. People here consider a psychiatric illness like OCD a disease that entails prayer rather than treatment so that nobody is willing to pay a real sum of cash in exchange for treatment. This renders such investments deficient and incompatible with financial success.

The patient also has his own set of financial

dilemmas. An ordinary Iraqi patient can barely afford $2 as a single payment for cheap forged antibiotic course for treatment of a chest infection. No one can persuade a patient with chronic depression to buy Prozac ($4 per Packet) for life. This will be a heavy burden on the patient’s family. Eventually the same old story repast itself time after time as I witnessed with my own eyes ; the patient comes asking for help , he has depression, he is given Prozac

Being a psychiatric patient in Iraq means only one thing “an endless misfortune”. Such patients are facing many challenges on multiple levels making their healing process almost impossible. There are social, medical & financial issues that are really influencing the outcome of such patients’ treatment & prognosis. Discussion of these factors really makes me feel sad because the final image of the whole process is a very gloomy one.

for 6 months maximum , then he omit the maintenance dose by himself either because of lack of proper funding or because of ignorance , then the patient comes having a relapse and asks for treatment again and a again and this really makes people’s life here as a family a sad one especially if having a psychiatric patient as a family member.

Social discussion of this topic is incredibly

distressing. It seems that nobody here wants to help psychiatric patients even themselves. The whole society is in denial state for the time being regarding such disease entities. A regular Iraqi family can easily consider their son drunk all the time or inhabited by an evil soul but they can not imagine even for a short while that he might simply be schizophrenic. Psychiatric illness in the middle east is considered a social stigma; this makes the patient’s family bear a double burden, the burden of treatment obstacles and the sense of shame that is hunting every family member. The entire society prefers to quarantine such patients instead of re-incorporating them again after treatment, they are all considered to be scary and aggressive and unpredictable even after they are cured, no one will value their abilities or their talents, no one can offer them a job or accept him/her as a future husband/wife. In other words, they are less human than others; they are more close to an alien or an animal than a human being.

As part of my investigation I visited Ibn

Rushud Hospital (the grand mental health institute in Iraq). I heard very scary tales about patient’s abuse and neglect. ECT is done under simple sedation instead of GA. Female patients are raped very often simply because no one will believe them when they complain, the society considers them totally insane and can never regain their sanity, and also nobody cares for a psychiatric patient when she is raped because she became less human than others as I explained formerly. Patients were starved to death in many instances, especially during war times and during the embargo. As a final conclusion this happened because the Middle Eastern societies including the Iraqi society

considers such patient less human and they can be abused, manipulated or neglected with no remorse.

Lastly I think that this issue is a complex one

indeed and it has multiple factors. Ignorance, poverty & lack of adequate expertise are the main players in this sad game. The health system as a whole should be re-evaluated in order to achieve real steps forward. In my opinion, no serious action has been taken in area and so the screams of such victimized patients will continue to be ignored again and again. I am aware that I may seem to be pessimistic but sadly, this is the mere truth, witnessed with my own eyes.

Hopefully, as time passes by, things will be better. Someday.

Medically, Psychiatry as a medical specialty is an unwanted one. Only doctors with bad records & low scores study such a specialty. As a matter of fact, Psychiatry is a qualification free medical specialty, you just need to apply for it and you have a 100% chance to be accepted. This situation of low standards regarding this field of study made the Iraqi Psychiatrists of low competitiveness and productivity because of lack of proper drive and sense of competition.

On the other hand we cannot blame the

physicians only; the patient has a key role in the process. The patient is a top ignorant one; never sticks to neither an instruction nor any set of medications. The patient can not understand that many psychiatric medications can not show any benefit only after 2 weeks of continuous treatment, so he gives it up and has a relapse and considers the medication a curse instead of blaming his ignorance; then he switches to a new medication and so on. This vicious cycle makes any effort to alleviate patients`

www.studentima

.co.ukinfo@studentima.co.uk

Issue #2 • Feb 2009 www.studentima.co.uk

Dr Nabil Al-Khalisi MBChB, is a House Officer at the Medical City Complex, Baghdad

a publication a publication

Del

ux P

hoto

grap

hy

Mind, Body or Soul?

14 15

Feat

ur

es

British-Arab Exchanges (BAX) has more than 30 years’ experience of arranging exchange visits, with the aim of building trust and respect between future decision-makers of the Arab countries and the West. Over these years BAX has arranged exchange visits involving young people from the Lebanon, Palestine, Egypt and Sudan, Britain and other European countries. The purpose of the visits has been to create and maintain a network of bridge-builders, train future opinion-leaders, provide space for dialogue, and focus on shared moral and spiritual values.

The Kubba Foundation.is a non-profit, non-governmental organisation that promotes the social development of the Iraqi people and supports the rebuilding of a strong and viable civil society in a land ravaged by war, violence and dictatorship. The Foundation supports educational projects that directly benefit the people of Iraq, regardless of religion, ethnicity or background.

The specific purpose of this visit was to build links of trust and understanding between young Iraqi professionals and their counterparts in the UK. The Iraqi delegates and their British hosts were encouraged to learn from each others’

In the autumn of 2008, British-Arab Exchanges (BAX) in association with the Kubba Foundation, hosted the visit of six young professionals and their mentor from Iraq to the UK.

experiences, challenges and cultural heritages, with a particular focus on developing strategies, leadership skills and collaboration to support the work of reconstruction in Iraq now and in the years ahead.

My Trip...One day, I was surprised by my supervisor

in the hospital where I work who told me about a trip to London with the BAX exchange scheme. In what seemed no time at all, I found myself at Baghdad airport with my new friends, ready to depart on a new stage of our lives.

Unfortunately, nothing is as simple as it should be, and we found ourselves stranded in Lebanon as we waited for our visas to come through. Despite the trouble and frustration this caused us, we found that our friendship became stronger, and once ten days had passed, we had our visas ready to embark on our project to learn what exactly is needed to rebuild Iraq.

After arriving in London, we were immediately taken to Northern Ireland, visiting Belfast and Derry. On the way, I remember wondering about what we were going to experience, of all the bloody history that we knew about these places, what were we going to see and find?

In fact, this was just the beginning of the great trip. On our morning in Derry, we met with a group of activists who had given everything they had to stop the violence, and re-build their city. We heard them tell their stories, and flicked

Building for the future

through photos in disbelief that we were looking at the same place… It was definitely Derry.

We were then taken to the Clonard Monastery where we met Mr Jim Lynn, and the Deputy First Minister Mr Martin McGuinness. Clonard was an amazing place to visit. The Monastery has been instrumental in the peace process in Northern Ireland. Often considered as the cradle of the peace process, every breath I took felt at peace. Mr McGuinness, also shared his experiences of Iraq with us, drawing parallels between the peace process in Northern Ireland and the progress that can be made in Iraq.

It was a truly joyful experience that has definitely changed my attitude towards the future. All of the negativity that I had has now been replaced with hope and a new insistence to change the outlook for my country, just as our hosts did in Northern Ireland.

On returning to London, we were given the opportunity to discuss the issues we face in Iraq with a number of different people, from different aspects of society. We, being a diverse

group of professionals, were able to pool our thoughts and understanding to address a range of projects and how we can each contribute to forwarding our society towards a brighter future.

Due to our unforeseen extended stay in Lebanon, our time in the UK was limited. Nevertheless, these ten days were filled with so much, so many facts learnt, and as many dreams created, as we turned a new page in out lives.

I would like to thank BAX and the Kubba Foundation for everything they have done for us and all the new friends we have made who were and continue to be so welcoming. With our newfound hope, I am sure that we will soon lay a new cornerstone upon which we can build the future of Iraq. So help me, my friends, to look to our future and restore the cradle of civilisation.

Visiting the Derry Peace Mural...

Dr Zeena Mohammed

Dr Zeena Mohammed is an Obstetrics and Gynaecology SHO at Hillah General Hospital

Yasm

in A

l-Asa

dy

Dr Z

eena

Moh

amm

ed

Issue #2 • Feb 2009 www.studentima.co.uk

a publication a publication

16 17

SIM

A: W

or

ldwww.studentima.co.uk Issue #1 • July 2008

Zahra Al-Timimidescribes her experience of specialist dentistry in

Canada. page 21

SIMA: UK continues to grow...

Established in London, Wales and the North of England, regional SIMA groups are

furthering the SIMA cause. SIMA: Wales have shown great initiative in collabortaing with Cardiff University student union to bring SIMA to Wales. SIMA: London have also embarked on the first of many outreach projects in the form of the SIMA

Health Awareness Campaign. page 27

Marwa Al-Seaidy shares her experience of the contrasts she saw on

her trip to Zanzibarpage 18

SIMA continues to biridge

connections between students in Iraq and around the world.

Our Iraq Relief networking evenings aim to bring together like-minded organisations to facilitate a co-

ordinated effort to meet the rehabilitation needs of Iraq. Check our website for updates

www.studentima.co.uk page 26

Wikimedia Commons

a publication a publication

18 19

ElEc

tiv

Es Ru R a l Me d i c i n e Za n Z i ba R

I spent the duration of my elective in the Mnazi Mmoja hospital in Zanzibar’s largest settlement, Stone Town. It is a government run, 500+ bed hospital covering a range of specialities from paediatrics to ophthalmology. Unexpectedly, I was pleasantly surprised by my first impressions. The hospital site comprises several different buildings; a collection of white washed, red-roofed, rectangular blocks backing out onto the stunning sandy white beaches that Zanzibar is famous for. The hospital grounds also boasted towering palm trees, a chaotic thoroughfare of ambulances and a public car park, housing several new, among the disused, tractor jeeps decorated with the logos of international charities. Hoards of people gathered in the hospital grounds added to the hustle and bustle of the hospital, which seemed to double as a focal point for the community. Combined with the midday sun and perfect blue skies, nothing could prepare me for what I would encounter inside.

Despite the open plan and the breeze of warm air through the ward, the stench of vomit and other bodily fluids drifting from the collection of beds was often unbearable. There was a distinct film of dirt covering all the surfaces. The patients were lying on beds with no sheets

I set off for my elective full of excitement and apprehension, not knowing what to expect from this beautiful group of islands just off the east coast of Tanzania. After a very long flight from the UK and a ferry journey that would leave even the most resilient of people nauseous, I finally made it to Zanzibar in one piece.

or blankets, the mattresses often stained with blood and grime. The overhead fans were only switched on at night, leaving the patients suffering with the almost unbearable African heat during the day. Attempts at sanitisation often consisted of a basin with a leaky tap and rationed hand-wash stagnating in the doctors’ mess, which conveniently also served as the ward reception and outpatient clinic. The lack of medical equipment anywhere highlighted just how underfunded this hospital was. The hospital monkey was often found lurking around the TB clinic and the cat in the maternity ward didn’t seem to faze anyone.

The complete lack of privacy was also surprising. Even in the maternity ward, which was probably the best-equipped part of the hospital, there were no curtains separating the beds. Vaginal examinations were performed in front of the whole ward. The labour room was very basic, with three simple beds, a washbasin and weighing scales. The babies who didn’t survive were often left in the corner of the room, covered by a towel; in fact, it wasn’t uncommon

MaRwa al-Seaidy

The operating theatre at Mnazi Mmoja.

to see a procession of people carrying a coffin hurriedly out of the ward.

There was an overwhelming sense of contrast at Mnazi Mmoja. The natural beauty of the sun setting over the ocean littered with romantic dhow sails seen from the back of the hospital, compared to the suffering of the patients inside the hospital.

Most patients at the hospital had advanced stages of disease with various signs to elicit. The wards were dominated by cases of TB, malaria, HIV, heart failure and liver failure to name but a few. Sadly, these patients were expected to contribute towards their treatment. For a lucky handful, there were programmes for treatment in the US or the Netherlands, however more often than not, the $2 required for a chest x-ray was too much for patients to afford.

Most days started at 8.30am with the ward round. We would follow the team of nurses, clinical officers (an intermediary between a nurse and a doctor) and international medical students on elective as they saw the patients in turn. The doctor would briefly comment on each patient and give us the opportunity to examine.

By 11am the ward round was over and we would go to a clinic such as the HIV clinic or head to the maternity ward. Other days were spent observing in theatre, although during my stay there was a chronic shortage of anaesthesia leading to the cancellation of all the elective surgeries. The hospital closed at 2PM, but most doctors seemed to disappear at 11.00AM

I will never forget the first patient we saw on my first day, Surrounded by a mass of nursing students, clinical officers and medical students on elective, lay a middle aged man, suffering with cirrhosis of the liver. He had massive ascites and was clearly uncomfortable. The doctor supervising us encouraged us all to feel the fluid thrill and shifting dullness without the patient’s permission, adding to the patient’s discomfort. This was my first experience of the doctor patient relationship in Zanzibar- almost non-existent. Over the next few days, we would see the patient on the ward round every morning, clearly deteriorating every day, yet no action was being taken. I soon came to realise that the doctor was simply waiting for the inevitable. We asked about the possibility of paracentesis for the patient to make him more comfortable, but the doctor replied that he would be dead in

Some of the team

Issue #2 • Feb 2009 www.studentima.co.uk

a publication a publication

Mar

wa

Al-S

eaid

y

Mar

wa

Al-S

eaid

y

20 21

a few days anyway. Sure enough, he slipped into hepatic coma and had disappeared from the ward the following day.

As a medical student in the UK, we are taught the importance of making patients as comfortable as possible whatever stage their illness, so I was horrified by this approach to patients. Unfortunately during my time there I saw minimal effort to make patients feel at ease, even though a few kind words from the doctor could have made a big difference. The doctor spoke little Swahili, prodding the patient when he wanted his attention.

A more positive experience was my trip to the island of Tumbatu, a remote island off the northern tip of Zanzibar, where I accompanied a team of ophthalmologists from mainland Tanzania, sponsored by Sightsavers International as part of an ophthalmology outreach clinic. The poverty-stricken conditions were apparent from the moment we set foot on the island. However, despite the children adorned in their various rags, there was a new purpose built clinic on the island.

It was clear that the people of Tumbatu were not used to visitors and many people came along just to see us. Almost the entire population of the island were screened for eye disease and a handful of those who required surgery were brought back to Mmazi Mmoja for treatment.

Overall, it was an eye opening experience which left me with a much greater appreciation of the problems faced by hospitals in poverty stricken countries. I encountered a wide range of diseases that I had not come across before in the UK. Although there was limited hands-on practical experience, all the patients had various signs to elicit providing a good opportunity to brush up on examination skills. The language barrier made it difficult to clerk patients independently, although there was usually someone nearby to translate.

More importantly, there are many things to see and do in Zanzibar and Tanzania: going on safari and climbing Mount Kilimanjaro, and I am very thankful that I had the opportunity to take part in this elective. I have gained so much from it that I feel it is my duty to return one day and give something back to Mnazi Mmoja.

Left: Tumbatu Island Below: The opthalmology outreach clinic on Tumbatu Island

ca na da

Sp e c i a l ca R e de n t i S t Ry

ZahRa al-tiMiMi

For my elective, I was keen to observe work in the field of Special care dentistry, which for me, is the most challenging yet rewarding branch of dentistry. The institute I chose to carry out my elective at was Bloorview Kids Rehab, the largest children’s rehabilitation hospital in Canada, affiliated with the University of Toronto.

I came to know about Bloorview through my late cousin who was an inpatient at the hospital. The facilities catering for special needs children are next to nothing, and the staff members’ play an important role in the well-being and rehabilitation of the children as many of the patients spend more time at the centre than at home with their families. My cousin sadly died this year, but I know that he was provided with excellent care, and it was because of him that I chose to undertake my elective at this centre.

The main role of the dental department at Bloorview, is to provide dental care for children and adolescents with special needs whose treatment is best managed in a multidisciplinary outpatient environment. The conditions treated at Bloorview range from autism to amputation, spanning conditions such as cerebral palsy, acquired brain injury, muscular dystrophy, epilepsy, spina bifida, arthritis, cleft-lip and palate, developmental disorders and chronic conditions that require continuous medical care. The dental department sees approximately two thousand patients a year, offering a wide range of services from paediatrics, orthodontics, prosthodontics to oral maxillofacial surgery.

My aim was to observe dental work carried out in special needs children, including: General

Dentistry, Orthodontics and Cleft Lip and Palate Surgery. I spent a considerable amount of time attending a Hypodontia Clinic where I was able to observe a multi-disciplinary approach in restoring function and aesthetics to patients with this condition. I spent two weeks shadowing Dr Robert Carmichael, the Coordinator for Prosthodontics at Bloorview and Assistant professor at the University of Toronto, gaining an insight into the nature of special care dentistry.

Hypodontia is a term used to describe the lack of one or more permanent teeth. Disruption of tooth development can be due to genetic or environmental factors, or a combination of both. One of the patients I saw at the clinic was a six year old boy missing eight upper deciduous

Zahr

a Al

-tim

imi

The Bloorview Kids Rehab Centre!

Issue #2 • Feb 2009 www.studentima.co.uk

Marwa Al-Seaidy is a final year medical student at Guy’s King’s and St. Thomas’ Medical School

a publication a publication

Mar

wa

Al-S

eaid

y

22 23

ElEc

tiv

Es

(primary) teeth and seven lower deciduous teeth. Radiographic examination revealed missing permanent dentition. The primary concern was appearance and function, as well as a speech impediment. The treatment plan therefore consisted of constructing an upper and lower acrylic partial denture as a short term measure to restore form and function. The acrylic teeth on the denture were made to be spaced in order to mimic the normal deciduous dentition. As the patient grows older, the denture will be replaced so that the teeth reflect his chronological age. Once he is fully developed i.e. his maxilla and mandible reaches the maximum height and width, an implant supported prosthesis will be fitted.

Another condition that was common amongst the patients at Bloorview is Amelogenesis Imperfecta, (AI); a group of developmental conditions, which affects the structure and clinical appearance of enamel of all or nearly all the teeth in a more or less equal manner. The enamel may be hypoplastic, hypomineralised or both and so affected teeth are often sensitive, discoloured and prone to disintegration. AI may show autosomal dominant, autosomal recessive, sex-linked and sporadic inheritance patterns. Diagnosis can be made based on the family history, pedigree plotting and clinical observation. The condition affects function and can cause discomfort but may be managed by early vigorous intervention, both preventively and restoratively, with treatment continued throughout childhood and into adult life.

An 18 year old patient presented with AI Hypomaturation type, autosomal recessive. Her main complaint was the fear of losing her

teeth with age. Due to the brittle nature of the enamel, her posterior teeth were crowned in order to protect the remaining tooth tissue

against stresses caused by masticatory forces. The definitive treatment plan was to provide full mouth all-ceramic crowns in order to restore aesthetics and function.

One of the more complex cases I saw involved a 30 year old patient presenting with a double cleft palate. Cleft lip/palate not only affects facial form but also has significant functional consequences, affecting the patient’s ability to eat, speak, and breathe. Rehabilitation involves a multidisciplinary approach and must be staged appropriately with the patient’s development.

The patient had chosen not to have corrective surgery for the palatal defect but elected to receive an implant-retained prosthesis. The treatment options given to her were therefore: edentulate and place an implant retained prosthesis or retain the posterior teeth and place implants after bone graft surgery.

The patient expressed wishes to retain her teeth and opted for the second, more conservative option.

It is not unusual to see patients with a desire to retain their teeth regardless of the quality/appearance, as many people regard the loss of teeth a sign of ageing and are worried about the consequences following tooth loss.

Aside from the clinical aspect of my elective, I took this opportunity to explore Canada. This was my third visit to the country and my impression has not changed except to improve each time. It is a beautiful country and the people are friendly, Hypodontia

Zahr

a Al

-tim

imi

Acrylic prosthesis of the upper central incisors to treat a patient with cleft palate

Zahr

a Al

-tim

imi

Before After

Discolouration in patient with Amelogenesis Imperfecta (AI)

Zahr

a Al

-tim

imi

sociable and very welcoming. I was lucky enough to visit Niagara Falls, which is always an amazing experience. Also, each summer the Canadian National Exhibition (CNE) is held in Toronto and is the largest annual fair in Canada. I had a brilliant time seeing live shows, international stalls (representing every part of the world) and of course, the petting zoo. The Bata Museum is also a must-see, housing some of the world’s most iconic shoes.

I am very grateful to Dr Carmichael for allowing me to observe him and other members of staff at Bloorview Dental Clinic; they are truly brilliant at their jobs. The clinical work I saw was awe inspiring and innovative. They make a big difference to the lives of the children at the hospital, and to their families. I hope to visit them again in the future, hopefully this time as a qualified dentist!

Thankyou to Dr Carmichael and all the staff at Bloorview

Zahr

a Al

-tim

imi

Issue #2 • Feb 2009 www.studentima.co.uk

Zahra Al-Timimi is a final year dentistry student at Guy’s King’s and St. Thomas’ Medical School

a publication a publication

24 25

Georgina Butterworth SENIOR EDITOR

Who?What?

Where?When?

Why?How?

workshop:writing an article

Each edition of SIMA: Prospect will end with a workshop- a response to your requests from the editorial team or a relevant expert. We have started with the simple task off

writing an article. Here we explore the different phases of the article, in the hope that it will encourage more of you to dabble in the art of writing. So get in touch with us at prospect@

studentima.co.uk with suggestions for future workshop subjects...

Why would anyone choose to write an article about writing an article? And who am I to give advice about it? Why would anyone want to write an article at all?

The answer to the first question is this: because I want to encourage people to write for SIMA Prospect, to show them that writing articles can be rewarding and that it’s not as daunting as it might seem. Secondly, I’m not really. I’m just someone who dabbles in editing, loves to read newspapers and journals and who has a very unsociable interest in grammar. And the third question has many answers. Some people write articles to tell the world about an issue they care for, some use it as an excuse to research something they are mildly interested in. Others do it as way to let off steam about things that annoy them, or even just for writing experience. Whatever your reason for writing, it’s probably a good one so read on for a few tips to get you started.

Let’s assume first of all that you have chosen a subject that you care about. It doesn’t have to be a lifelong passion or hobby but something that you have an interest in strong enough for you

to give the time and effort needed to research, write and edit a good article. A reader can tell when a bored writer has churned out a piece of writing only to meet a deadline or to fill pages about a subject he lost interest in before he even wrote them. The first step to writing an interesting article is to be interested by the article yourself.- so choose wisely.

The next step is actually getting down to

writing it. Where do you start? When it comes to writing, everyone has his or her own way: longhand or laptop, a silent library or a Starbucks in the city centre. However there are a few things that anyone writing an article cannot avoid. For example, you need to start by knowing what kind of article you intend to write. It might be mainly a news piece, mostly information on a particular subject or just a chance to express an opinion. Of course, most articles combine elements of all three but it is worth taking a moment to think it over. Another thing that no article can be without is lots and lots of research! There is no (legal) substitute for spending several hours on the Internet, in the library or even interviewing experts in order to gather material and evidence for your article and, of course, your argument.

It will mean that your article is packed with relevant information with useful references and an informed, balanced viewpoint that your reader can rely on.

For example, when writing this article I researched what the internet and university library had to say on the subject of article composition. Most of it wasn’t helpful, a lot of it was a bit patronising and some of it was long and boring but I found several recurring points of advice that I can now pass on to you: avoid using jargon even if you are assuming that your reader understands technical terms, check your grammar carefully or ask someone to check it for you, check your references thoroughly and above all, don’t go off the point. Finally, be clear and direct, making sure that each sentence has a purpose and is not simply paraphrasing a point that has already been made elsewhere.

Making sure that you research your topic well is equally important for ensuring that you are aware of any contrasting opinions that might exist about your subject. Even if you’ve decided that the main aim of your article is to inform your readers, there is always room for further discussion. Are there any controversies surrounding the issue? What are the consequences of events or situations? It is this debate and these questions that keep readers intrigued by your article so be careful not to neglect this part of the topic. Furthermore, don’t be afraid of showing a little character and even sharing your own unique thoughts and opinions in your writing, even when you are writing a serious article. Literary enthusiasts refer to this as ‘style’. In the words of Alexander Theroux: “where there is no style, there is in effect no point of view. There is, essentially, no anger, no conviction, no self.” However, writing your article with a particular view does not mean that your article has to be unbalanced or biased. On the contrary, it is equally important to include contrasting opinions within your article. Never leave out a crucial counter-argument just because it wrecks your point. This will only undermine your argument and it is another reason why it is so important to do plenty of research and planning before

writing your article, even before deciding exactly how you are going to present your point of view.

Finally, if I were to choose one piece of advice about how to write an article it would be to organise! Read articles in magazines and newspapers and you’ll soon notice a pattern – they are all highly organised. Planning is really important and should take up a good part of the time you’ve apportioned to writing your first draft. It can be difficult for a reader to understand the point you are trying to make if it has been split over several paragraphs and mixed in with other, unrelated comments so try to keep everything in a logical order. It seems too easy to say “introduction, middle, conclusion” but all too often an otherwise fascinating and well-written article can be spoiled because the writer has failed to actually deliver the point he has been leading up to.

No two articles, even if they are on the same subject, will present information in the same way so you will always have a chance to influence the way people think.

So now it’s my turn to write a conclusion. Get writing for SIMA!

Your message does not have to be heard only by those you interact with on a daily basis. Publishing an article with SIMA allows the entire world to read your views with a single click. The written word, as you have read in this issue’s editorial, can change history forever. Ancient Iraq taught the world the value of writing: civilisations passed, empires fell and yet this history continues to be celebrated in libraries and museums. These achievements formed the basis of science, as we know it today. Now SIMA:Prospect hopes to influence the world’s awareness of and participation in the progress

Issue #2 • Feb 2009 www.studentima.co.uk

a publication a publication

Wo

rk

sho

p

26 27

Issue #2 • Feb 2009 www.studentima.co.ukU

pdat

e

a publication a publication

SIMA: Wales Now an official society under the University of Cardiff Students Union, SIMA: Wales continues to expand its diverse membership.

Since it’s birth last year, SIMA: Wales has replicated SIMA:London’s early success with various tutorials and revision sessions. Previously covered topics include, Head & Neck anatomy, ECG interpretation and OSCE skills. SIMA: Wales is also forging ahead in forming partnerships with other university societies, with a large collaboration with the Cardiff University Surgical Society in the pipeline!

Check the SIMA: Wales page on the website, www.studentima.co.uk or get in touch at

wales@studentima.co.uk

Iraq Relief Network...With so much effort having gone into the realisation of the Iraq Relief banner, it is with great excitement that we can announce the first Iraq Relief Networking Forum, due to take place in mid-february.

As you know, one of the aims of Iraq Relief is to bring together a network of individuals, groups and organisations working for and within Iraq, in order to facilitae a more efficient response to the rehabilitation needs in Iraq.

These invitational events, will therefore feature two organisations that will be invited to give a presentation shedding light on their aims, objectives, activities and progress, encouraging discussion and development of project ideas amongst an audience of individuals, charities and organisations who have a shared vision. In so doing, we hope to bring about new relationships and collaborations that will better complement the needs of the Iraqi Healthcare system.

Alongside the networking forums, the Iraq Relief team are brainstorming new exciting new projects to take to Iraq, continuous fundraising efforts and ofcourse our anual dinner.

If you are interested in attending or hearing more about these and other events, please get in touch with us at

iraqrelief@studentima.co.uk

Yous

ar J

afar

Health Awareness Campaign...

Ayia Al-Asadi,SIMA: London Chair

We are always told that anything is possible; all it takes is self belief, hard work, passion - and a change, however small, can be made to the world we live in. Having witnessed the fearful and passive attitude towards health in the Iraqi community, we embarked on a unique mission to initiate a change in this mental-ity. Our health awareness campaign aimed to encourage a proactive approach to health management within community members, specifically in the age range of 40 and over. Through a series of short 15 minute tutorials at large community gatherings, we aimed to dispel myths and arm individuals with accurate infor-mation that empowers them, to take control of their own health and that of their families.

December 2008 saw the introduction of our Health Awareness Campaign, during the Mu-harram events at Al Khoei foundation, where for seven nights specialist doctors from around the country and a group of dedicated healthcare students volunteered their time to make our vision a reality. We chose six topics that we felt were particularly important for the Iraqi commu-nity, namely, Cancer, Diabetes, Heart Disease, First Aid, Aches and Pains and Oral Hygiene. To complement the talks, we produced simple bilingual leaflets that the audience could take home to reflect on in their own time.

As we set things in motion we quickly began to see the positive impact this was having on our community. To speak to a man who ap-proached us with recommended health prod-ucts mentioned in a talk, to watch the men taking part in our first aid demonstrations and to see the women eagerly queue for our leaflets was truly rewarding.

However success is an abstract term, and we realise that it didn’t actually matter how many

people attended or how many positive com-ments were received, it was enough that we got the important information out there for the people who were willing to learn. In reality we won’t know how many people actually changed their health behaviour as a result of our talks and our leaflets, and perhaps that is the way it should be.

What’s more, this is just the beginning! We have many more exciting and interesting proj-ects coming up over the next year, including visiting schools across London to teach children First Aid and our careers workshop, planned for the summer ahead.

We are grateful for all the support and en-couragement we have received, and we extend our warmest thanks to IWA and Al Khoei foun-dation for helping us succeed in this campaign. We hope to build on this success in the future and continue to grow from strength to strength.

If you think your community could benefit from a Health Awareness campaign, get in touch

with us at london@studentima.co.uk

ww

w.st

uden

tima.

co.u

k

The SIMA: London Health Awareess Campaign

SIMA: North Time has flown by, and so several of the original SIMA: North committee have graduated and moved on from the wonderful North. Consequently... we

are recruting!!!

If you are interested in getting involved or finding out more about SIMA: North e-mail us at

north@studentima.co.uk

Iraq thenIraq now.

Issue #2 • Feb 2009

Iraq thenIraq now.

a publication