Open for Business

Rick Johnson, for HealthLeaders Media, January 31, 2008
Launching a new clinic or private practice must give partners and practitioners a tremendous sense of accomplishment--especially when the organization's mission is to provide for the medically underserved. With this in mind, I wonder what it must feel like to be U.S. Navy Commander Dan Cornwell, FACHE. As part of the Embedded Provincial Reconstruction Team in Camp Fallujah, Iraq, Cornwell has worked to rebuild and increase the capacity of the Iraqi healthcare system.

On the day I spoke with him, Cornwell had just returned from the grand opening of a new public health clinic in Fallujah--a place of danger and turmoil as a major battleground just a matter of months ago. "It was just a banner day," he said. "We treated over 800 people--a lot of women and children." This was the third such opening Cornwell has attended in the past year, since he began his partnership with local physicians, Iraq's Ministry of Health, and other governments.

To sum up Cornwell's mission: He provides true healthcare leadership where none previously existed. In fact, when he first set foot in Fallujah, the city lacked the basic healthcare necessities. There wasn't consistent trash removal, power supply, sewage system, and clean water. Imagine treating patients at the 200-bed Fallujah Medical Center and not knowing when or whether you'd have electricity.

Through it all, due to the credit of the local physician leaders, the hospital never shut down. It typically has 125 inpatients and treats about 1,000 outpatients a day. The medical center's staff performs about 1,000 surgical procedures per month and delivers about 700 babies. On top of all this, the training facility produces about 30 physicians per year. Cornwell says one significant change is that there are fewer trauma cases in the ED and more primary care patients.

"So it's starting to look more like a U.S. hospital," he joked.

I asked him how he benchmarked the rebuilding efforts over time, and he laughed. "A lot of things we just don't have, so it's an easy benchmark to measure," he said. For instance, the city didn't have an emergency medical system, so Cornwell coordinated with the Iraqi health system to get ambulances and technicians.

Today, many of the basic necessities are in place to maintain the healthcare system in Fallujah. It now has backup generators, clean water, and a security enclosure. In fact, the current medical center will be turned into a women and children's hospital when a brand new 300-bed facility is completed later this year. Medical professionals who fled the city are returning. Cornwell believes that soon the system will be self-sufficient.

"We've almost transitioned to them," says Cornwell. "We've taken care of the biggest show stoppers--EMS, power, renovations, expanding the OR, and opening new clinics. Today was a great example. We open this clinic to a community of about 40,000. We're gaining trust between the health system and the people, and it's a great feeling."

In the end, Cornwell's story is an example of the commonality of human need. It doesn't matter if you live in Tulsa or Fallujah when it comes to healthcare. People want access to quality care in a safe environment from people they can trust. We often knock the U.S. healthcare system's shortcomings--and it surely has them--but there is so much that we take for granted. In Fallujah, where citizens finally have access to physicians and soon a state-of-the-art medical center, there is a new sense of normalcy and security that comes with a functioning healthcare system.

Commander Cornwell said this was a once-in-a-lifetime experience that on an emotional level was life changing. I suspect that he's not the only one to feel this way.

Rick Johnson is a senior editor with HealthLeaders Media. He can be reached at
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