FRONTLINE MANAGEMENT

Emma Forrest talks to a nursing director who left the saftey of the Isle of Wight to help rebuild the Iraqi health service When an invitation arrived at Isle of Wight Healthcare trust from the Department of Health inviting organisations to take on training in the UK for Iraqi clinical teams, it was noted with interest by the trust's director of nursing Jane Wilshaw - it was her idea.

'The original suggestion was for UK firms to go over there, but I told them it would be years before the country is in any kind of shape for that to happen, ' she says.

Ms Wilshaw (pictured above, right, in Iraq with her soldier son James) can say this with confidence because she was one of just four senior NHS managers who were sent to Iraq over a year ago to help improve the country's battered healthcare system.

'People running services over there were medics with no managerial background.

No formal management training existed. It was a real opportunity to use my management skills, ' she says.

She was offered a position working to develop the healthcare system with the department of health in southern Iraq. Hostileenvironment training was essential. In addition to what she calls 'technical' stuff about bombs and missiles, she was told what to wear and how to behave.

'For a woman it is difficult to go into that society. You have to give respect to earn respect.' However, it was Ms Wilshaw's first visit to the region, and she admits it was a huge culture shock. 'I arrived at one hospital to find sewage running down the street. The sewage system had collapsed.

There were heaps of rubbish everywhere, ' she says, showing a photograph of something covered in piles of rotting refuse. Only when you spot an Iraqi woman in the background do you realise it is a street.

Living with heightened security also took some getting used to:

'Everywhere we went meant travelling in armoured vehicles, with eight security people heading up the convoy.

The bodyguards were charming, but made it clear what they were there to do. We knew that if something happened we would be picked up, thrown in the back of a car and got out of there.

'You got used to it.' Ms Wilshaw's arrival in March 2004 was timed to allow newcomers to adapt to the climate before the oppressive heat of the summer.

'The end of July, August and September are the worst months. It is windy too, so it was like walking into the hot air from a hairdryer. Most places where we worked had air conditioning, but there wasn't any when you were out visiting hospitals.' The work done by the UK managers with the Basra team (originally made up of just nine people) was intended to show the Iraqi public that services were improving.

'The development work had to quickly put in place projects so the funding could come through, ' says Ms Wilshaw.

'A lot of good work has happened but on a small scale, such as setting up a blood bank and public health lab. We concentrated on equipping primary care centres because these were underused, and emergency units as these were being used a lot and would be the most visible.' To avoid temperatures of 55C, August was chosen as the month to take 54 Iraqis for a month of intensive management and leadership training at the King's Fund in London and at Ms Wilshaw's trust.

She then returned to Iraq in September and stayed until just before Christmas. I went back in March to do a review of progress so far.' Ms Wilshaw lived on a US army base and says living conditions were better than she expected.

Her second stay, at the British embassy compound, was enlivened by the scariest of several hairy moments, when a mortar hit the embassy's stairwell, not far from where seconded staff were sleeping.

'It was the middle of the night. The ground shook and for a moment I thought 'this is it'. I got out of bed, got dressed and put my flak jacket and helmet on and got under a table. Then I watched episodes of Friends that my daughter had sent out.' Ms Wilshaw is not certain that substantial change will be achieved quickly in Iraq, although much progress has been made.

'We were able to get a strategy developed quickly, and for once Basra was seen as a leader. Everything had been very centralised in Baghdad before that. But you cannot believe the scale of the work that still has to be done.' Since starting back at work in the UK in April, Ms Wilshaw has decided she will not return to Iraq until it is safer.

'It was an amazing experience; you learn a lot about yourself; that you are a lot stronger than you think you are. I have made friendships for life and am still having e-mail conversations with them about further ideas and hopes for the future.

'But I do not want to go out there again until I can live and work properly with the Iraqis.

'I feel deep concern for the people out there, and wonder at what they are having to put up with.'