In black marker, Muwafak Ali outlined the anatomy of his patient's knee, wrapping gauze and plaster to make a cast for a prosthetic leg. • The Iraqi technician worked quickly, feeling his way with materials unavailable at his clinic in the country's southern Basra region. • "You've done this before," observed the mock patient, John Scarfi of Seminole, an amputee who helps to train students in the prosthetics and orthotics program at St. Petersburg College.
"If you don't make a mess, you didn't do a good job,'' instructor Tim Fair told an examining room packed with Iraqi health care workers and their American hosts.
As Ali wiped bits of plaster from his beard, the unlikely international classroom erupted in laughter that needed no translation. For three weeks, SPC is hosting a training program for two doctors and two technicians from the Basra Prosthetic and Rehabilitation Center.
Thursday marked Day Four of their whirlwind seminar. The Iraqi students, who speak English well but also have a translator, came to class with spiral notebooks, hand-held video cameras and scores of questions.
"We're hoping in our training to update our knowledge," said Kamal Y. Yousif, a physician who directs the Basra clinic that designs prosthetics for 45 to 50 patients every month. "We get from this as much as we can to help our people. We have a lot of amputees in our country."
Years of warfare in Iraq have created as many as 80,000 amputees, said Linda Smythe, chair and founder of a Rotary clubs project sponsoring the training mission. She said the Basra region is home to at least 7,000 to 8,000 amputees.
Iraq's medical system, already outdated and needing development, has been further derailed by years of war and neglect. For instance, reports show that rates of immunization against key diseases, such as polio and measles, have fallen during recent years.
Meanwhile, violence has created horrific injuries and scores of new medical needs. Many of the amputees are women and children injured by land mines that exploded when they were playing ball or gardening. Once a child can't walk up stairs, Smythe said, she may have to leave school.
"Mobility is very difficult. It's not a wheelchair friendly environment,'' she said. "There is a small clinic and a large territory. If you can, imagine (people from) four counties in Florida trying to get to one little clinic."
With so much need and limited resources, Iraqi patients can wait for six to eight months to see a doctor after an amputation to start the process of getting a prosthesis, she said.
The situation prompted Smythe, a former Greek diplomat now living in the Washington, D.C., area, to create B.A.S.R.A. (Bringing Assistance and Support to Recovering Amputees) Prosthetics for Life Inc. A volunteer project involving Rotary clubs, it has received $1.7 million from the U.S. State Department to help supply prosthetic components, equipment and training.
This month, organizers embarked on their first U.S.-based training mission in partnership with SPC, which has the only orthotics and prosthetics bachelor's program in the Southeast. It's one of just four in the nation.
During their stay, the Iraqi team will study the latest prosthetics for upper and lower extremities. They will also receive training in orthotics, such as braces to help people with certain birth defects.
The Iraqis "are definitely experienced professionals, but their educational background is dated," said Fair, the SPC instructor. "We get to play around with what we can put on an amputee — what works and what doesn't. They don't have that luxury."
The Iraqi doctors welcomed the exposure to new technology, materials and methods to take home to their state-run clinic.
Kamal Yousif, the clinic director, eventually hopes to create a training program for technicians in Basra, which has none. And he would like to open smaller clinics in remote communities. "It's difficult for patients to come 200 kilometers to our center," he said.
And along with detailed diagrams in their notebooks, the Iraqi medical team plans to return home with stories about the famous Pinellas beaches, and the people they're meeting.
"Everything is amazing," said Muslim A. Yousuf, a physician from the Basra clinic.
"Everything," echoed Yousif. "The people. The water. Especially the food."
Times researcher Shirl Kennedy contributed to this report. Letitia Stein can be reached at email@example.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.