With the goal of joining his family in the USA and Canada, a young Iraqi medical graduate left his turbulent home country behind and headed west – except he discovered an island en route that he found he favoured more than anywhere. In the second part of our series celebrating the contribution of doctors who have come to the NHS from overseas, Tim Tonkin talks to Glasgow consultant Mohammed Al Haddad
‘There were a lot of reasons to come to the UK – the main one was that I felt I didn’t fit into my homeland’s society [Iraq] and I suppose I was always going to leave to go to a more open, tolerant place.’
For the UK, 1996 was a year that was, in many ways, marked by an undeniable, underlying sense of optimism and promise.
The country had found its way out of the unemployment and recession that had blighted the start of the decade, while technological and scientific advances such as the Channel Tunnel and the cloning of Dolly the sheep had, or were about to, make their mark.
Along with the heady excitement generated by the UEFA Euro 96 football tournament, the cultural phenomenon of Britpop providing the nation’s soundtrack, and a growing anticipation of the new millennium, expectations of a bright future abounded.
This was the UK that a 27-year-old Iraqi medical graduate, Mohammed (Mo) Al Haddad, found himself in, following his arrival in February that year.
Despite having already spent four years of his childhood in the UK during the 1970s, Dr Al Haddad had spent much of his life growing up in southern Iraq.
Part of a medical family – his father and siblings are also doctors – he completed his medical training in 1980s and early-1990s Iraq, against a backdrop of successive military conflicts and economic challenges.
‘The health system in Iraq, up until the late 1970s, was a leading national health service in the Middle East,’ Dr Al Haddad explains.
‘The universities in Iraq were well established, and people would actually come to Iraq for their medical training. It really started to go downhill after the war with Iran which, for me, was the first war I saw [prior to the Gulf War].
‘During the 1980s things started to deteriorate, and when the sanctions kicked in, in the early 1990s, the health service and the whole country was on its knees.’
UN sanctions were imposed on Iraq following its invasion of Kuwait in 1990. In addition to the effects of the eight-year Iraq-Iran war, this had left the country’s health system barely able to function.
‘In the health service itself there was very little in the way of basic medical supplies such as cannulas, gloves and syringes,’ Dr Al Haddad recalls.
‘We used to have to reuse disposable needles from patient to patient because we didn’t have enough to go around. There was no paper to write on and no up-to-date books – often someone would bring a [medical] book from abroad and it would be photocopied and distributed to the medical profession.
‘I was looking after patients with renal failure at a time where there were effectively no reliable lab results. With things such as kidney failure, you are relying on lab results to check on things such as potassium levels. Things can go horribly wrong without these – and they did, with patients dying for reasons that would have been very easily avoided [with the right resources].’
'I came to realise I liked the balance that the UK had between socialised and private healthcare'
Being unable to offer many patients the care and treatment they required owing to technological and material limitations was compounded by the nature of the country’s political regime, which meant doctors, on occasion, did not practise medicine in accordance with medical ethics.
While Dr Al Haddad and his colleagues struggled to care for the vast majority of the people they saw, the nature of Iraq’s ruling elite meant that doctors were often put in a position where they would be expected to compromise the most basic and sacred tenets of their profession.
‘You were obliged to treat certain kinds of patients in a different way because they were connected to the regime,’ he says.
‘One of the things that the regime did as a punishment to those who had deserted from the army, was to cut a bit of that person’s ear off, to mark them as traitors as it were, and they were asking surgeons to do that.’
By the time the Gulf War had come to an end in 1991, Dr Al Haddad’s desire to move abroad had reached a tipping point.
‘At that point in my career, I became very, very disillusioned with medicine because of the way I was being forced to work and the lack of resources.
‘I also saw the value of my salary, for example, go from a few hundred a month, to the equivalent of £1 a month by the time I had graduated.’
Following his arrival in the UK, Dr Al Haddad worked for eight months as a phlebotomist at the Royal Brompton Hospital, while studying for his PLAB (Professional and Linguistic Assessments Board) exam.
The contrast between UK hospitals and those that Dr Al Haddad worked in back in Iraq was notable, not simply in terms of equipment and resources, but in the ethos and workplace practice.
‘The main difference I noticed when walking into an NHS hospital was the role of teamwork, and the role of nurses. Nursing in the UK held a much more prominent position and role within the team compared to Iraq.
‘Training, job prospects and career progression and being able to realise your dreams and professional ambitions were much more likely to happen in a place such as the UK compared with Iraq.’
Adjusting to the NHS and clinical practice in the UK was just one of the changes that Dr Al Haddad had to contend with.
As he soon discovered, the chasm between everyday life in Iraq and the UK often entailed a steep learning curve.
‘I grew up in a place in Iraq that was completely isolated and cut off from the rest of the world. When I returned to the UK as an adult, there were so many aspects of day-to-day life that I had no knowledge of.
'I saw the value of my salary go from a few hundred a month, to the equivalent of £1 a month by the time I had graduated'
‘There were a lot of things I couldn’t get my head around, the tax and legal systems, rent, VAT, it was all very, very different.
‘I’d never had a bank account while in Iraq, as these weren’t in common use, it was all cash and keeping your money hidden in the freezer and things like that. Just getting to grips with things like opening an account and debit and credit cards, I just went into banks and picked up leaflets and read through them.’
The difference in social attitudes in the UK compared with Iraq also came as a surprise.
‘I’d come from a society that was quite prejudiced, bigoted and judgemental. There’s obviously a little bit of that everywhere in the world, but the difference [between Iraq and the UK] was stark.’
After completing his PLAB, Dr Al Haddad took a job in emergency care in Doncaster, where he worked for a short while before moving to Scotland in 1997.
‘I knew I didn’t want to do surgery,’ he says. ‘My dad was a physician and I was probably influenced by him in veering towards those specialties. At the time, there was a need for anaesthetists, and I decided that that was what I wanted to do.’
After successfully applying for a training post in Dundee, he spent nearly a decade in the city before moving to Glasgow in 2005 to take up a consultant post, a position in which he continues to work.
Having lived continuously in the UK for more than 20 years, Dr Al Haddad has now become established in his career and raised a family.
One of his daughters, Nadia, is at school and enjoys singing and acting, while the other one, Susan, who Dr Al Haddad describes as a ‘proud Scot’, has represented her nation in hockey at an international level.
Other than the cuisine, Dr Al Haddad says that he personally misses very little about life in Iraq, adding that he is happy and proud to work in the NHS. Yet at one point in time, a life and career in the UK was not a foregone conclusion.
‘When I left Iraq, I thought I would come to the UK, get some training and then maybe move on to the USA,’ he explains. ‘My brother had emigrated there, and my sister and the rest of my family all went to Canada.
‘I came to realise, however, that I liked the balance that the UK had between socialised and private healthcare, and living in a place where everybody can access healthcare.
‘I liked that better than what I was hearing [about healthcare] from my brother and friends who had moved over to the states.
‘The way we deal with things in the UK is to see what is needed for the patient. You make your [professional] decisions based on that rather than your personal financial interest.’
Dr Al Haddad’s life and career are now a world away from his days as a medical student in 1980s Iraq; training under a repressive political system and within a health service that was increasingly living hand to mouth.
‘I don’t think the NHS would have existed or managed to function over the past few decades, without international medical graduates.
'I don’t think the NHS would have managed to function over the past few decades, without international medical graduates'
‘That’s partly just in terms of filling in the posts but obviously international medical graduates bring in a lot of other things to it, such as diversity in the working environment and diversity of professional experience.
‘I think all [IMGs] international medical graduates, just like UK graduates, have all contributed in their own way to training, education and research.
‘However, I do think it’s a bit more difficult for IMGs to make those contributions and get recognition for it, in terms of career progression and things like that.’
He says that although this had improved in more recent years, certain biases remained.
‘I think the NHS is a fantastic institution, it is probably the envy of the world.
‘I think we do need to look after it, and I do think that valuing staff is really key to the success of the NHS.
‘I think this has been somewhat eroded in recent years to the detriment of the NHS.’
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