As a volunteer pediatric cardiologist for several nonprofit organizations, Lt. Col. (Dr.) Kirk Milhoan has screened children with congenital heart disease in Mongolia, Kosovo, Uzbekistan, Mexico, Tibet and Sudan. When he deployed to the Air Force theater hospital at Balad Air Base, Iraq, in 2005, he was able to continue helping children.

“During the four months I was deployed to Iraq, I was able to see two children from the local community who had serious heart problems,” said Dr. Milhoan, a pediatric cardiologist with the 859th Medical Operations Squadron at Wilford Hall Medical Center here. “The first child was a very ill 7-month-old infant who, unfortunately, died two months after I saw her. The second child had Tetralogy of Fallot, a heart disease that prevents the blood from getting sufficient oxygen. This was an operable condition that we were able to correct.”

Toward the end of his tour in Iraq, Dr. Milhoan was invited by the Iraqi Ministry of Health and the National Iraqi Assistance Center to do a large-scale screening of children with known congenital heart disease to determine eligibility for surgical repair.

“I was originally invited to screen at the Al-Bitar Cardiology Hospital in Baghdad, where all pediatric cardiac surgeries in Iraq are performed,” he said. “However, due to the previous targeting of aid workers for abduction, Multi-National Force Iraq wanted the screening to take place within the International Zone in Baghdad. This allowed me to screen the children at the NIAC building, where patients are evaluated for medical care that requires referral out of Iraq. This made it safer for me but more difficult for the locals.”

Dr. Milhoan evaluated 57 children in two days. The evaluation included an exam with vitals, an electrocardiogram and an echocardiogram.

“I had a portable echocardiography system and one Air Force medical technician to assist me,” Dr. Milhoan said. “A number of Iraqi doctors were also present to help with translation and observe the examinations and echocardiograms. The patients came from a pool of about 1,000 children known by the NIAC to have congenital heart lesions that could not be operated on in Iraq.”

Dr. Milhoan said he expected to see children with relatively benign diseases; however, as he started screening, he realized the children brought in for evaluation were some of the sickest children with the most complex heart diseases.

“Of the 57 children I saw, 27 needed and could receive surgical repair without any further studies,” he said. “There were 21 children who, due to the complexity of their disease and/or their age of presentation, would require a cardiac catheterization prior to deciding whether surgical intervention was appropriate. There were six children who were poor surgical candidates and three children who did not need any intervention.”

Dr. Milhoan was very impressed with the knowledge, professionalism and diagnostic skills of the Iraqi physicians.

“During the screening, I spoke with the chief physician and the chief of pediatric cardiology from the Al-Bitar Cardiology Hospital about the state of congenital heart care in Iraq,” he said. “The main problem with the provision of congenital heart care in Iraq is not from a physician training or ability standpoint, but rather from a limitation of equipment and supplies. Shortly after the fall of Saddam Hussein, many of the governmental hospitals, including the Al-Bitar Hospital, were looted, leaving them unable to perform even the most basic of services.

“Many nongovernmental organizations came in after stabilization and started helping to refurbish and refurnish the hospitals. However, once aid workers started being abducted, most of the (organizations) pulled their staff from Iraq,” he said. “The U.S. military hospitals often take care of emergency Iraqi civilian cases, but are not designed to care for children with complex congenital heart disease. The Iraqi surgeons are willing to do most pediatric cardiac operations except on the very young or very small, repairs requiring conduits, or complex multistaged procedures.

“I do not think that we will need to assist the Iraqi physicians and their patients for very long. Their motivation and the desire of the international health community to bring Iraqi medical care to world class standards are very strong.”

Dr. Milhoan found his experience very rewarding and humbling.

“I was able to provide some degree of hope in the midst of a very difficult and dangerous transition in Iraq’s history,” he said. “Through the work of the nonprofit organization Gift of Life, five children from the screening were brought to America, received medical care, and returned to Iraq. Many more should be coming soon with the help of other nonprofit organizations that specialize in finding care for children with congenital heart disease.”

After he finished the screenings, Dr. Milhoan was informed that the parents who brought their children into the International Zone put their families at risk, as the insurgents often target those Iraqis who come and go through the International Zone checkpoint.

“In all my previous travels, I have seen many parents suffer much hardship and raise amazing amounts of money for their children to receive heart surgery,” he said. “This was the first time I witnessed parents risking their very lives to save their broken-hearted children. I hope to return.”