“And it came to pass, when Joshua was by Jericho, that he lifted his eyes and looked, and behold, a Man stood opposite him with His sword drawn in His hand. And Joshua went to Him and said to Him, ‘Are you for us or for our adversaries?’ So He said, ‘No, but as Commander of the army of the Lord I have now come.’” Joshua 5:13-14

I’m flying back from my first trip to Kurdistan, Iraq. Kurdistan is an autonomous region within the country of Iraq, located in the northwest. This was Kirk’s third trip there and his fifth time to Iraq in general, as he served there in the U.S. Air Force on tours in 2005 and 2007 (experiences he wrote about in his book “Thoughts from the Cradle”). What an incredible opportunity to finally share in going to this region with him. It really is true that, despite the best explanations in the world, you can only truly understand by experience. It was a week of lots of lessons, both political and spiritual.

We went to examine children with heart disease. Our team consisted of me, Kirk, and our good friend, Allison Cabalka, a pediatric cardiologist from Mayo that we have worked with many times before. Allison is an interventional cardiologist and we had hoped to do some diagnostic and/or therapeutic heart catheterizations, but, as usual on these trips, the Lord had different plans. We had made our plans with the local individuals working on this project and bought our tickets before we all realized it was election week in Iraq. We arrived on Saturday, the day before the elections. The usual weekend in Iraq is Friday and Saturday. The elections were Sunday, so it was a holiday. Monday and Thursday were also holidays, so the only real “working days” in the week where we could have used the cath lab were Tuesday and Wednesday. It, however, was booked with adult patients so there was not room in the schedule for us to do kids. We always accept on these trips that the plan is the Lord’s. He was either protecting us from something or just had other things He wanted us to be about. The real reason I went on the trip was so I could provide general anesthesia in the cath lab. The Lord did not use me in this way, but I firmly believe He just wanted to get me there for a variety of reasons: to see and be touched by the need, to understand so much more about the region than I ever did before, and to report back to others that the Lord is calling to this area that I felt completely safe.

While I am not a historian, I’ll explain my best general understanding of what I learned from observation and questioning of those I met. The Kurdish people group have their own language. Their religious background is primarily Muslim. They reside in Iraq, Iran, Turkey, and Syria. In the autonomous region of Kurdistan, Iraq, March is full of many holidays for them, largely marking different dates in their struggle for autonomy. Later this month is their new year, on which they celebrate a day 2700 years ago when they believe a Kurd killed an oppressive Persian king. Their recent history in Iraq is one of struggle with Saddam Hussein’s regime. They have their own army, the Pershmerga. There have been life-threatening consequences for being part of this force. Our driver’s father was a member and he describes his family being forcibly moved to the south of Iraq for a number of years. One of our translators described a similar experience for his family. Another one of the dates they celebrate is when they won a victory that allowed them to move back to the Kurdish region. The 1980s were particularly bad for the Kurds in Iraq. This was the time of the Anfal, where over 200,000 Kurds were killed and 4,500 villages were destroyed. Another day they commemorate, for example, is March 16, a day in 1988 where Saddam Hussein’s regime killed 5,000 people in the village of Hilabja with blister gas. I saw horrifying pictures and I also met an orphaned double-amputee survivor of this day. Many of the Kurds survived this time frame by fleeing into the mountains. I met an American nurse who was forced to flee with them and lived and served in a refugee camp for at least a month during this time. In an attempt to prevent the Kurds from being able to hide in the mountainous, Saddam systematically tore down thousands of trees. I went into these mountains. They are bare, except for small saplings or trees that have been recently planted.

They mark 1991 as a year when things started to get better. That was the time of the first Gulf War, when the U.S. started to enforce a no fly zone over the Kurdish region. The killing slowed, but they were still under Saddam’s regime. We were in the town of Sulaymaniyah. There is a building there they called the security building, where Saddam’s forces were stationed. It was a prison. Men (and women and children who were part of their families) who were suspicioned or falsely accused of being part of the Pershmerga were taken there for questioning, torture, and/or killing. Our driver told us if you got taken there, you did not expect to live. People would not drive or walk down this street out of fear, nor would they even look in the direction of this building for fear of being summoned. They mark 2003, the beginning of the second Gulf War, as “liberation.” This building fell then, in terms of being under Saddam’s control. They have left it as it was as an equivalent to a holocaust museum. We got to tour it. One of those things you do like eating your spinach. You know it’s good for you, but you sure don’t like it. I saw pictures, re-creations, and real conditions. It causes tears and a turned stomach. They are now the second people group I’ve met (the first being the Kosovars) who do not hesitate to express their love and gratitude to Americans for saving them. It is indescribably humbling to witness such gratitude.

Thanks to the protection of the U.S.-enforced no fly zone, the Kurdish autonomous region has had a head start on the rest of the country in re-building, as this started for them in 1991. In general, conditions are much better and the area is much safer than the rest of the country. They are serious about maintaining safety. Suspicious cars are not tolerated. Those who own cars told us they only park them where they are known. They put their name and phone number in the front windshield. If they park in a new area, they will explain to a local person that that is their car and when they will be back. Or they simply don’t leave their cars unsupervised. We had a driver for the week. He would drop us off at the hospital in the morning and then stay there all day with the vehicle waiting for us. (He is a former member of the Iraqi special forces. His career ended when his vehicle got hit by an I.E.D. (improvised explosive device) and he broke his shoulder and collar bone. He had lots of stories and information, as well as lots of respect for the U.S. and the coalition forces.) We walked through the open air market in the center of town, on streets near the hospital, ate in restaurants, and stayed in a hotel. We were treated with nothing but respect and I never felt unsafe. We were also there during election week, which I think is a great test of the safety of the region. Cars were not allowed to drive on the streets until after noon on election day. There were no bombings in the Kurdish region on this day, nor have there been any in something like two years. I was really impressed with the incredible levels of airport security when I left, like nothing I’ve experienced before. I absolutely respect and appreciate all they are doing to keep themselves safe.

The entirety of the country is not safe. Kirk and I had an opportunity to meet with an Iraqi government official, who is not a Kurd. He was arrested in the 1980s for attending the funeral of someone Saddam had executed. He survived his tortuous questioning without confessing any crimes, so he was freed with the knowledge that if he were arrested again he would be killed. He fled the country and worked from the outside in opposition to the regime, at the cost of seven family members being killed because of his work. Knowing the controversy in the U.S. media, he argues support for the Iraq war on three counts: 1) use of weapons of mass destruction (e.g. Halabja, 3/16/88, 5000 killed with blister gas; this incident is only one example; this gas has been found in the country since the start of the war and U.S. soldiers have been treated for exposure to it); 2) crimes against humanity (over 200,000 Kurds, Iraqi citizens, killed; and 3) international terrorism (e.g. invasion of Kuwait for control of their oil fields). In his words, what has happened in Iraq is a “success story.” The fact that the current president of Iraq, Jalal Talibani, is a Kurd, a member of a formerly oppressed people group, is a demonstration of the success of democracy equivalent to the U.S. electing its first black president. There are more women in the Iraqi parliament, on a percentage basis, than even the U.S. congress. Other nations in the Middle East are starting to elect women to their governments. He acknowledges the instability and says it comes from former members and supporters of Saddam’s regime. I read an excellent editorial in the 3/12-14/2010 issue of the “USA Today” by Don Teague talking about the cost to Iraqis of supporting regime change. Many have had to leave the country. Those that don’t have the means to leave the country have paid with injury or death, of themselves or their loved ones. One of the mom’s of the children we saw this week told us her husband had just been killed. Another told us her brother had just been killed. As Don Teague argues, there is going to be a cost to turning our backs on what we helped start. U.S. history is filled with examples of paying the ultimate sacrifice for a higher good. No World War II, no defeat of Hitler. No Gulf or Iraq Wars, more Kurds killed and the good that this official enumerates so far would not have occurred. Interestingly, there is a relative of Saddam now working in the Kurdish region in order to protect himself that people we met work with. He has had the scales lifted from his eyes and by now living and working with the Kurds, he admits much he believed to be true about them was a lie.

You’ll notice I’m trying really hard not to give away sources and specifics. That is because I’ve come to appreciate the real cost and danger to those who are trying to do good in the midst of these dangerous politics. At the risk of not giving credit where it is rightly due, I’m not going to tell you all the people, countries, and organizations involved in taking care of these heart kids that we went to evaluate. I will tell you I believe they are heroes. You can imagine that health care has suffered greatly in Iraq under the past regime and under the current political instability. Due to previous laws greatly restricting or even forbidding education of Kurdish physicians, there has never been a Kurdish physician trained officially as a pediatric cardiologist…until now! He went to medical school in Baghdad before the fall of Saddam. Can you imagine being part of an oppressed people group and leaving a fairly safe area to go to an unsafe area ruled by your enemy to get training? Boggles my mind! But many Kurds did it, so they would have the education to help their people. Many Kurdish physicians also left the country. Now many are coming back. There is very limited pediatric heart care in the city of Erbil in Kurdistan, but at great expense to the families. There are several organizations involved in getting these children cared for out of the country. This has often involved having these children and families travel out of the country simply to be evaluated to see if they need further cardiac care. This has cost the families, on average, $2000 per patient, a staggering amount given their level of poverty. But we’ve witnessed these families will do anything for their children. One family we met sold their family home to travel to Iran simply for a diagnosis…and their child has yet to be treated!

Our objective for the week was to screen children in Iraq, preventing them from having to leave the country for diagnosis. We saw over 160 children this week. That’s a lot of money we saved those families. If we saved just one family from having to sell their home, it was worth it! 72 of the children will receive procedures out of the country, likely over the next year.

Our ongoing objective will be to return to screen children, but also to help them establish pediatric cardiac care in Sulaymaniyah. They have built a cardiac center and are in the process of outfitting it with appropriate equipment. A surgeon has returned from over a decade of practice in Australia to head this effort (another “can you imagine?’ moment). Other physicians have pledged to return. There is currently no adult cardiac surgical care in this area, so they are going to start there, within the next few months. After a couple months of experience taking care of adults, they wish to start taking care of children. That’s when our team has pledged to be back to work alongside them, just as we have done in Mongolia and Kosovo.

It’s important to note that they are not taking care of only Kurdish children in this area, but all Iraqi children. I asked the physician who is working alongside Saddam’s relative what that was like. He said “we are showing our enemies we are different. We don’t kill our enemies.” Instead, they take care of the children of their former enemies.

We saw a total of 162 children with known cardiac disease. Thankfully, we were able to reassure 25 families that their children do not need any further procedures. 113 need surgery or other diagnostic procedures, including caths. Sadly, we had to tell 26 families that it was too late and their children were inoperable. One of the children was likely to die within days. Ten children that were on our list to screen had actually died before we got there. The need is overwhelming. Just when I was feeling good about seeing over 160 children, the pediatric cardiologist told me he had 1400 patients in Sulaimaniyah and 3500 in the whole of Kurdistan, and that there were thousands more in the whole country of Iraq.

I didn’t get this update finished on my flight home. My computer battery died. Upon my return, I had lunch with a friend who knows me well. She said her impression was that this trip had affected me more than any other. I think her assessment is correct and, since she said it, I’ve been trying to figure out why. It is a difficult thing to have your heart broken by the things that break the heart of God. What I mean is the process is difficult. I’m not a big fan of pain. I like keeping that nice protective shell around my heart. I think each trip is another chink in that protective layer. I’m slowly, slowly getting a sense of the magnitude that the statistic that 90% of the world’s children don’t have access to cardiac care represents. And, of course, I cannot divorce the experience from all I learned about the people, the history, the region, and the current conditions in light of current political debates in this country. I yearn to explain what I really believe from what I have seen, that what we have accomplished in Iraq is good, that we are a nation richly blessed beyond comprehension in all ways, including our health care. I read the Bible verse I opened with on the plane on the way home and it struck me. The angel that the Lord sent to help Joshua did not say he was for either side. He was sent on a mission from the Lord to assist one side, but his allegiance was not to one or the other. The politics and conflicts in the Middle East (and in the U.S.) can be confusing and reasonable people obviously disagree. I heard one person put it, “There have been mistakes on both sides. We need to be fair.” Ultimately, the Lord’s will will be done and He will send His angels to fight as He chooses. But His allegiance is to neither side. All are His children. “For God so loved the world, that He gave His only begotten Son, that whoever believes in Him should not perish, but have eternal life. For God did not send the Son into the world to judge the world, but that the world should be saved through Him (John 3:16-17)”. And may we be those who continue to give to “these little ones even a cup of cold water (Matthew 10:42)” in His name.

Kim Milhoan, MD