I was in Tehran last week teaching a workshop on cost effectiveness and cost benefit analysis at the invitation of the Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences. The students in the workshop included physicians, pharmD students, and epidemiologists, the majority of whom were women. But the gender slant of the workshop was not because a woman was teaching, as the overall enrollment at the medical school is 60% women. Education is valued with gender, cultural or religious practice not seeming to be an impediment to achieving higher degrees.
Maryam is the sister in law of a colleague in Boston; she has worked for many years as a nurse at one of the primary teaching hospitals in Iran. She is in charge of risk management and clinical governance at the Cancer Institute, Imam Khomeini Hospital. She was eager to have me meet her colleagues and see their work. For my part, I was very interested in learning about nursing practice in Iran.
The Imam Khomeini Hospital complex is a 1200 bed facility, the major teaching and training facility of Tehran University of Medical Sciences. The hospital complex contains national research centers for cancer, HIV/AIDS, Reproductive Health, Neurology, Brain and Spinal Injury, and the Iranian Tissue bank. Nursing comprise ~ 52% of the overall staff at the facility.
While there are no dispensing nurses or nurse practitioners, the general nursing workforce has a very solid education. Since the late 1980s’, all registered nurses in Iran are required to have baccalaureate degrees for practice. This stands in stark comparison to the US workforce with approximately 55% of nurses practicing with a baccalaureate or above yet no specific degree requirement for basic practice.
At the hospital, nurses wear uniforms in differing shades of blue while nurse auxiliaries, assistants with 3 years of vocational training, wear light brown. Woman and men are cared for on separate wards and all female staff, regardless of profession, are in long sleeves and a scarf.
The seven bed ICU in the cancer center had a dual use as a short-term post anesthesia care unit and a full ICU with patients on ventilators. I asked about infection control and the nurse manager of the ICU presented the log of cultures taken on their unit and throughout the hospital to assess for nosocomial infection. The ICU was clearly well run from a clinical and managerial standpoint but the physical plant in poor condition. A surgeon I spoke with expressed a view that I heard a number of times throughout my visit – that the hospital wanted to make improvements but US and international sanctions against Iran curtailed their ability to do so.
This theme arose again when touring the HIV/AIDS research center two days later; the staff expressed concern about the quality of generic ARVs and other drugs available in Iran as access to pharmaceuticals was restricted because of sanctions.
The current atmosphere is a hopeful in that the new political administration is a moderate one that wishes to open up communication and exchange with the west. Women drove independently, walked in the city, and took the subway alone. In private conversation, it was clear that the practice of hijab was highly variable. While some women would clearly drop the practice of hijab if the laws changed, others would not. But I had to keep in mind that Tehran tends to be liberal, so the loosening of restrictions may have been far more extensive here than in the rest of the country.
Everyone I met was gracious, patient and kind to me; they all expressed a sincere desire to re-establish educational and research exchange with the US. Nurses, physicians, and all healthcare staff were highly competent and engaged with recent initiatives for health care reform. The research staff had excellent quantitative training, skills that we are sometimes lacking in the US. Nurses had a solid generic foundation for providing care throughout the health care system. In my very short time there, I saw much potential for fruitful exchange of ideas which could improve both of our health systems. I hope to begin work there on initiatives on health system reform and if I do, will update you more at that time.
Elizabeth Glaser MSc, MA, ACRN, RN-BC
GNC Board of Directors