Sunday, June 22,2003

I was born in Kabul , the capital of Afghanistan . I lived there until I was a young adult, receiving my medical degree from Kabul University . I then had the privilege of becoming the first Afghan woman to study medicine in the United States , where I currently work and live.

This past April, I decided to return to my war-torn homeland to see the conditions there firsthand. What I saw saddened me.

Despite promises by the international community to help reconstruct Afghanistan after decades of war and neglect, the country’s largest city, Kabul , remains in shambles. It only gets worse in the countryside.

As a visiting physician and an expatriate, I felt compelled to use my skills during my four week “vacation” to help women and children in need of medical assistance in the city. I chose to work with female doctors in the department of obstetrics and gynecology at the Rabia Balkhi Hospital in downtown Kabul where I could practice my specialty.

This hospital, I was told, had been visited six months earlier by representatives from the U.S. Department of Health and Human Services who promised that it would become one of the most modern women and children’s medical facilities anywhere. So on April 21st, I was honored to be present when officials from the Afghan Department of Public Health, the U.S. embassy, the U.S. Department of Health and Human Services and a host of dignitaries came for a ribbon cutting ceremony and tour of the hospital.

What I saw in the hospital, where I was to begin work within two days, however, showed me that ribbon cuttings and visits by dignitaries are not the solution to the health care problems of the Afghan people. A spruced up facility for one day does not make the cut in the long run. The quality of the medicine that I was a part of 35 years ago had deteriorated significantly.

Forty-eight hours later, I began work in my tiny corner of this hospital and was confronted with the real condition of Afghan medicine. The delivery

rate for newborns was 55 to 80 per day. There were times when 20 to 30 women were in active labor, some with high risk and complicated pregnancies, giving birth with very little care, some on cold and naked steel delivery room tables of which there were few. Others, with sad and wizened faces, lay on the cement floor or with one or two of their countrywomen on a flat cushion, wrapped only in their shawls. These were the lucky ones.

I say this because the vast majority of Afghan women receive no prenatal care. Also, most deliveries still occur at home because women may be unable to get to a hospital or may not have the permission of a male family member to “go out.” As a consequence, the mortality rate for mothers and their infants is unacceptably high by any standard.

What I saw in the operating room was equally disturbing. It was not unusual during a major operation for my scrub nurse to tell me “I’m sorry, there are no more sutures.” Patients coming to this hospital often had to bring sutures, blood and antibiotics for their own surgeries. If the supply of sutures was depleted in the middle of an operation, the patient’s relatives would be sent out to buy more, if they had the money.

Electric power was also a frequent problem. This “model” hospital did not even have a back up generator, so surgery sometimes had to be performed by candlelight when the antiquated power grid in Kabul would collapse.

Why should we care about this situation? In many ways, it is a simple matter of integrity. As part of the war on terrorism, Afghanistan was promised much and has received little. It seems as though this country was  lost in the wake of the war in Iraq .

The sorry state of the medical system is just one example of the neglect by the international community that I observed during my tenure. Yes, some small progress has been made, but in my view, it would be a big mistake to  let this incremental approach continue, if the world wants a stable and peaceful Afghanistan in the future.  As for the five women who died unnecessarily while I was present, because simple medical protocols and basic precautions were not adhered to by poorly trained staff, the tragic consequence is that the many women and newborns who follow will continue to be in a life and death struggle until appropriate aid and education arrives.

Having been there in person, all of what I observed and experienced has motivated me to do my best to bring the world’s attention back to this seemingly faraway, but hugely important country.

Anyone who saw the suffering and chaos that I did could do no less.

Nafisa Abdullah, M.D., practices Obstetrics and Gynecology at the West Los

Angeles Kaiser Permanente Medical Center