From January to June 2004, Major John V. Smith worked for the Coalition Provisional Authority (CPA) and served as the senior health facility advisor to the Iraqi Ministry of Health, responsible for helping the Iraqis rebuild their healthcare system and focusing specifically on physical infrastructure, mainly the renovation of existing hospitals and construction of new clinics countrywide. "I was there when we were developing scopes of work for the actual projects to begin implementation," he explained, "working on designs and hiring the overall contractor we would need to administer all the projects. We determined that the focus would be on the at-risk populations and on making as big an impact as quickly as we could on the health of the Iraqi people. We determined the at-risk populations would be the women and children who had historically been neglected throughout that country's history." Overall, the priorities were to renovate 19 hospitals, build 150 clinics, conduct medical training and purchase medical equipment. Among the challenges Smith recounts were an abundance of bureaucratic hurdles, the CPA being too "timeline driven" and that fact that, "We worked for some politicians at CPA whose priorities, I think, were not the same as ours. I think they had their own agendas. It's not that they were bad people and didn't want to see it succeed," Smith continued, "but I think, throughout CPA, that they felt they had to look good no matter what happened. Bad things could not happen." "The guys I worked with were card-carrying Republicans (and so was I when I got there)," Smith confided, "but when I left I felt that all politicians were bad - it didn't matter what party they were." It was also difficult for Smith and his colleagues to get the Iraqis to "take ownership" of things, which he explains as partly resulting from so many years of creative thought not being rewarded under Saddam Hussein. He also discusses his close working relationship with Iraqi doctors and engineers, including the expatriate minister of health, Dr. Khudair Abbas, and a number of significant security events he experienced on his way from his headquarters in the Green Zone to the Ministry of Health. "In a lot of respects," he joked, "it was very similar to many of the jobs I've done before with just a really crappy commute." Smith believes overall that we "brought in the politicians too soon"; and had we left the military in control of Iraq "for maybe a year and a half or two years, Phase IV would have gone a lot better."

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