Linda Spencer, Ph.D., MPH, interprets her mission as a public health nurse in the broadest possible sense. For "public," think "planet."

Working with the World Health Organization, the Centers for Disease Control and Prevention, International Federation of the Red Cross and USAID, Spencer has used her nursing skills in Nigeria, Liberia, Ivory Coast, Zambia, India, Indonesia, Pakistan and Russia. For her disaster relief work, Spencer has been honored by the International Committee of the Red Cross with the Florence Nightingale Medal and by the Russian Red Cross with the Solyveyev Medal.

So it comes as no surprise that the Washington Kurdish Institute would ask her to assess and train Kurdish nurses in war-torn Iraq - or that she would say yes.

"I've been working in Third World countries for 22 years," Spencer said. "This organization was new to me, but people know me."

An associate clinical professor at Emory University's Nell Hodgson Woodruff School of Nursing, Spencer fits international nursing projects into her time off between semesters and holiday breaks. In August 2003, Spencer traveled to hospitals in Dohuk, Erbil and Suleimaniyah, three villages northeast of Mosul and Kirkuk in Iraq.

"The north is a beautiful mountainous area. Not a lot of voluntary agencies have gone there because of the war, but it's not as dangerous as the rest of Iraq," she said.

The devastation she found was caused by Saddam Hussein's persecution of the Kurds. "They're a different ethnic group, not Arabs, and his regime tried to eliminate them, sometimes gassing whole villages before the coalition forces began protecting them after the first Iraqi war," she said.

The area doesn't fit the mold of a typical Third World country, Spencer explained, because at one time the health care system was functional and highly sophisticated. Cut off from the rest of the world for many years, health care workers there have seen little relief since the war, and still function fairly autonomously.

"All supplies go through Baghdad. Very few are shipped north, so the nurses and doctors can't get the medicines and instruments they need, and the nurses are not as well educated," she said. "They have managed to survive, but the system is in chaos."

Spencer's team found no specific standards of care, no job descriptions and no nursing leadership organization. Nursing training varied from a six-month program after sixth grade to a three-year college program after high school.

Spencer and her team assessed the situation by asking the nurses three basic questions. "What are the challenges you face?" "What are your duties?" "What new skills do you want to learn?"

She then designed a curriculum to be taught by teams of American nurses in Iraq.

The hospitals don't have sophisticated equipment for cancer or other treatments. Nurses deal with burns, birth defects, trauma (land mines are everywhere and the area is contaminated from the gassing), infectious diseases and a high infant mortality rate (120/1,000) without many pain medications or even sterile gowns.

"I was humbled to see their dedication and determination to care for their people in heartbreaking conditions," Spencer said. "Each nurse has 35 to 40 patients and families must provide the nonmedical needs of patients. There are so many barriers to prevent them from treating their patients the way they would like."

Realizing that fundamental nursing skills were needed, Spencer's curriculum teaches the basics of health care, including hand washing and hygiene, physical assessment, CPR training, the Heimlich maneuver, body mechanics and preventing bed sores. American nurses do the teaching through an interpreter and work to create a collegial atmosphere where there is an exchange of information.

"You can't teach in a classroom format, because they'd feel intimidated and inferior," Spencer said. "They would listen, but not learn anything, so we try to make it fun, with games and role playing."

The Washington Kurdish Institute has sent two teams of four nurses to Iraq for several months of training and is raising funds to send more. Spencer hopes to go again. "It's very satisfying as a nurse if you can look at a situation and say, 'I can make a difference here.' "