Emergency in Afghanistan: Beyond an Ordinary Hospital

THE EXPERIENCE was indeed a rewarding one. I have just returned from
Afghanistan where I was visiting Emergency hospitals in Panjsheer and Kabul.
The Emergency hospital in Panjsheer was built in one of Afghanistan s mountainous
territories in the village of Anaba: a remote and impoverished area. Emergency
maintains the only hospital in the area and provides excellent medical care while
respecting the dignity of patients and the culture of the region. Panjsheer, due to its
vicinity to Kabul and its strategic value, was plagued by war during the past twenty-five
years. It is located northeast of Kabul. The people of the area̶mainly civilians̶have
suffered tremendously. In spite of the painful history of this region, when I arrived I was
greeted at Lion Gate, the entrance to the valley, by old and young faces, warm faces of
children, some tired, some scared, but each person ever inspired and hospitable. At the
Emergency Panjsheer hospital, I noticed first the sign NO WEAPONS painted in red
letters on a white board and a little further on, I found the sign WE TAKE CARE OF
PATIENTS FREE OF CHARGE.

As a physician I specialize in Obstetrics and Gynecology. I spent the majority of my
visit in that department where I had the pleasure of meeting an international group of
professionals, skilled and caring physicians, midwives, and nurses. The hospital has a
first-class operating room, an immaculately clean delivery room, a welcoming and
comfortable postpartum ward for new mothers, and a well-equipped nursery for
newborns. I was particularly amazed to see the degree of careful attention to detail in
this hospital since it is located in a remote and impoverished part of the country. In
contrast, during my time in Kabul I visited some non-Emergency maternity hospitals that
were reportedly funded by millions of dollars.

With frustration I observed that the hospitals were badly managed, and sadly in shambles. During my recent trip, as well as on a previous trip, I discussed this with authorities in Afghanistan and colleagues in
the USA, informing them that the Emergency hospitals provide ideal models of how to
build and run a hospital and how to provide quality care to patients who need it.
As I spent time in the Obstetrics and Gynecology wards of the Emergency hospitals,
it gave me great joy to speak with women who had received prenatal care from the
eighth or ninth week of pregnancy to the baby s birth. They had enjoyed access to
prenatal follow-ups, ultrasounds, nutrition consultations and were given advice about
caring for a newborn. In this country 90 percent of pregnant women lack prenatal care
partly due to culture but mainly due to decades of war resulting in the absence of
hospitals and clinics. The women I met at the Emergency hospitals celebrated every
aspect of their care and kept each appointment until delivery. As a result, they had a
healthy pregnancy, and a healthy baby. In addition, I was encouraged to see ongoing
training of national staff and midwives at the Emergency hospitals.

The valuable professional skills gained by the national staff will contribute to the growth of a
healthcare system in Afghanistan’s future.
Emergency serves several other villages in the area of Anaba with first aid and
primary health centers where no other medical facilities exist. Emergency provides
medical care to the nomadic Kuchi people who migrate through the Panjsheer valleys
as they move to the high country for the summer, in my conversations with some of
them I learned that they stay longer in the area in order to have prenatal care and have
a delivery in the hospital. This is particularly unusual for Kuchies, since they have never
had access to medical or prenatal care.

Every single pregnancy and birth is different. As an -experienced physician
practicing in the United States, in a state-of-the-art hospital, I have faced catastrophic
obstetrical cases and have seen limits of our modern medical abilities tested by
complex emergency cases. I also witnessed such cases in the Emergency hospital in
Panjsheer and saw that they were taken care of effectively and efficiently. Unexpected
cases arrive every day and night in the obstetrics floor . One case was that of a young
woman who was brought to the hospital one night during the eighth month of her first
pregnancy. she had been carrying bread from a bakery to her house through an area
that had been inspected and declared free of mines. However, a mine had evaded
detection by inspectors and as she stepped, she triggered an explosion and was
severely injured. Her case demonstrates that even today roads remain littered with
badly rusting tanks, obstacles, weapons and mines.

When she arrived at the Emergency hospital, she was taken immediately to surgery where the findings were
grim: her uterus was perforated, her unborn baby did not survive, and her right leg had
to be amputated below the knee. After her surgery as I sat near her bed, I could not
then, and today still am not able to find an adequate word of comfort to offer her. A
senseless landmine explosion had taken her leg and her baby. I am still haunted as I
remember the pain she experienced in her loss while her mother sat nearby,
speechless, pale and frozen. By saving her from certain death, the surgery provided by
the Emergency hospital communicated to her a message more powerful and hopeful
than any of my words ever could in the face of such loss.

Emergency in Kabul has a tremendous number of trauma cases that arise from a
variety of causes. It is located in a busy section of the city. The hospital is again
meticulously clean, with dedicated and skilled international staff. This is the only
hospital in the country with six beds in a first-class intensive care unit, and the only CT
SCAN in the country. I happened to meet a family that brought a relative to the hospital
with a life threatening gunshot wound to the head. Their injured family member
underwent a 12-hour operation by a neurosurgeon, and survived.
The life-supporting medical care doesn t stop after the patient leaves the operating
room table. At Emergency, care is continued with excellent postoperative treatments.
Sometimes children have to stay in the hospital for several months.

Emergency provides physical therapy, a rehabilitation program, a playroom for children, and even a
classroom with books in the native language. Teachers read and write with patients as
they recover. For some amputees after recovery, Emergency even provides social
services and opportunities for employment.

Among many wonderful and memorable experiences I had during my trip was an
afternoon spent with a group of women ages seventeen to sixty as they wove carpets
as part of social program of Emergency s hospital in Anaba, Panjsheer valley. In the
room where the women worked, the essential elements of calm and safety that these
women experienced were a beautiful contrast to the violence and struggle that they had
each experienced. We talked for a good many hours, and slowly and tentatively they
opened up to me in their own way. They talked to each other and to me bravely of their
grief, pain, the war and the hurt. Their voices were resonant and comforting to each
others, and in the midst of it all, they laughed and they told their happy stories too. We
all laughed together at times, just like all happy people in the world laugh. The
redemptive power of that laughter spoke for itself while their artistic expression as they
wove those beautiful carpets was made precious by the touch of their care-worn hands.
Some of them were just learning this skill, showing creative drive and human dignity
preserved. That was a lesson to me: no matter what circumstances they had gone
through, they were discovering hope there, and it was palpable. We lifted each other s
spirits with hugs and kisses and a shared human experience, and that is how I lift this
human village. No matter how much I write I will still feel inadequate to complete this
message. There are so many stories, some painful some delightful.

I’m thankful to those who help me to be a small part of this grand organization
Emergency that gives high quality medical care to patients in the most difficult situations
and consistently recognizes the dignity, life and humanity of each individual. You would
do no less, if you saw what I saw. Please help; keep safe these gnarled and nimble
hands that weave the many-colored tapestries. Regarding support of this organization,
my message is simply Do it and the time is now.
Sincerely
Nafisa Abdullah , MD
July 2006

This article was originally published at: http://www.emergencyusa.org/

EMERGENCY USA supports construction and management of international projects for medical care:

• Hospitals specifically dedicated to war victims, providing skilled surgical intervention in emergencies

• Physical and social rehabilitation centers for victims of anti-personnel mines and other war injuries

• First aid posts for emergency treatment and healthcare centers for primary care

• Hospitals offering specialized therapy in places where unmet needs are demonstrated

By building high quality, sustainable regional medical centers (rather than temporary, or minimal-care facilities) EMERGENCY partners with the local population in war torn communities to provide health care services that reach beyond walls to heal communities.

Since 1994 EMERGENCY teams have provided assistance to over 4,668,900 people.