Habib S. Baha, M .D., Secretory AMAA
K. Ali Siddiqui, M.D., Director AMAA
The US Department of Public Health and Human Services, during the preparation for the recent trip of Secretary Tommy Thompson to Afghanistan, requested the Afghan Medical Association of America(AMAA) and the Afghan Physician Association of America consider a joint effort to help address the current health concerns in Afghanistan.
The Department of HHS informed the AMAA leadership of the commitment of the Bush administration and specifically Secretory Thompson, to assess the health needs of Afghanistan and to be a partner in reconstruction of its health system.
The HHS saw the need for a joint effort of the said department and Afghan-American physicians and invited representatives of the AMAA and the APAA to travel to Afghanistan to be part of the discussions with Afghan officials and secretary Thompson.
In addition, they were asked to be a part of the team to assess the health needs of women and children in Afghanistan and to report on Medical Education in Afghanistan.
Homyra Behsoodi, M.D. and Qudratullah Mujadiddi, M.D. made their assessment and recommendations on maternity hospitals and women’s clinics. K.A. Siddiqi, M.D. and I (Habib S. Baha, M.D.) visited The Kabul Medical Institute(KMI).
Up until the late 1970’s and the beginning of 1980’s, Afghan Medical Schools were under Kabul University and the Ministry of Education. However, after Russian occupation theKabul Medical Institute (KMI) was created. All Medical Schools became under the jurisdiction of the Ministry of Public Health and later on the Ministry of Higher Education.
MEDICAL SCHOOLS: Currently, more then (17) medical schools are known to exist in Afghanistan but only KMI and Nangarhar Medical schools have any hope of becoming legitimate based upon the experience of the teaching faculty.
Kabul Medical Institute has the following Medical Schools in Kabul:
School of Curative Medicine 440 Females 1552 Males
School of Pediatrics 104 Females 679 Males
School of Stomatology 61 Females 349 Males
School of Military Medicine Unknown Unknown
Total(s) 605 Females 2580 Males 3185
TEACHING HOSPITALS: Ali-Abad Hospital, a training hospital located at the Kabul University campus, has been destroyed and demolished as a result of years of civil war. All of its equipment and surgical tools have vanished. A nearby maternity hospital has been transformed into a teaching hospital and renamed Ali-Abad. The afore mentioned hospital has limited tools for teaching which is why KMI Medical schools are dependent upon the Ministry of Public Health. There is a serious need for building a new teaching hospital on the University Campus.
On October 5th, all four of the Afghan-American Physicians had a meeting with Afzal Anwar, M.D., President of KMI, and its staff members. After a long conversation, and listening to their urgent needs, they toured all of the medical departments including: KMI Publications Department and library. The library has been supported financially by Loma Linda University (LLUMC California), along with medical books donated to the library by the AMAA. We noticed that the department of Publications operated with limited resources. There is only one Gestetner printing press, and it runs primitively by hand due to the lack of electricity. In the other corner of the same room, we observed a typewriter, which appears to be the only other resource for KMI’s 3,000 students.
In addition, there is also an archaic copy machine within the premises. In this institution’s prime, it was well known for having the most modern and impressive printing equipment in Afghanistan.
On October 6th, Dr. Baha met with the Dean of the Curative Medical School, Dr.Wahab Noora. He explained to him all of his urgent needs and transportation problems as well as the need for communication/information technologies such as; telephones, fax machines, and personal computing/Internet. This request also includes the obvious, running water and electricity. Then on the same day, he met with the Senior Anatomist, Habib Brahman, M.D. (who was one of his past students and assistants in Nangrahar Medical School, Jilalabad). He had an informative conversation regarding his needs as well as recommendations. After that, he visited the Department of Microbiology. It was fortunate to meet with a group of current (male) students as well as approximately 20 female students in the Microbiology Lab. They were doing a Gram’s stain as a part of the lab assignment. The tools and conditions that they have to work with are very inadequate. The facility is large and capable of housing many more students; however, due to the lack of resources all students have to huddle into one corner of the room. Only one technician was available to assist all students. This is partly due to the inadequate salary of the professors, who must also maintain an outside job in order to survive. Many of them are still awaiting the pay promised them months ago. Ultimately, because of this dire situation, the students suffer. The primary teacher is someone who normally might be an assistant or technician under the doctor.
Even with the harsh realities and suffering of the medical staff and students, the overall interest and desire to excel and to learn is extremely high, which is good news. Students are literally begging for a chance to learn. They show an earnest desire to get the help they need to become good physicians. During conversations with the students, it was discovered that the majority of them felt that the most pressing issues were the acquisition of more textbooks and the importance of learning fundamental English, as the need is evident in the pursuit of a higher education.
To assess teaching material K. Ali Siddiqui, M.D. visited the Department of Pathology and Histology, while Dr. Baha visited the Departments of Anatomy, Physiology and Microbiology. Dr. Said Abdullah Hashemy, Professor of Pathology, was kind enough to show Dr Siddiqui his department. It presently consists of six assistants and two technicians. Needless to say, the findings are disappointing. There are only a few microscopes and not one single textbook of Pathology or Histology. There is no atlas of Pathology in the department other than in the library.
No tissue processing machines were present other than the ones provided with LLU assistance. It is apparent that students are forced to learn by relying on memory. This brings to mind the Afghan expression, ” anything written in the ice and exposed to the sun will melt away”.
During Dr. Siddequi’s visit to the Department of Surgery at Ali-Abad Hospital he met with his old classmate Dr. Said Hassan Manawi, who is presently Chief of Surgery. The findings at this site are also discouraging. The condition of the scrub room and operating room are desperately below standard. Contamination was everywhere. Dr. Manawi revealed that patients are admitted with infection, as a result of prior inadequate medical care, and discharged with infection due to hospital contamination. There is no reliable data as to patient mortality after discharge. The patient rooms are overcrowded. There are no restrictions for visitors. They sit on patient beds and most of the time one cannot distinguish between patient and visitor since patients wear their own clothing during their hospital stay.
Dr. Manawi, who trained in England and practiced surgery in Ireland for five years, stated that he could not operate because of his allergy to latex. There are no latex-free gloves available in the hospital. Dr. Siddiqui promised that either the Afghan Medical Association or he would send him latex-free gloves.
The team visited with Secretary Thompson on the grounds of the American Embassy in Kabul for a working lunch on Tuesday, October 8th, 2002. During the meeting, assessments of the KMI and Maternity and Pediatric Clinics of Kabul were presented. Mr. Thompson requested the team’s presence at his meeting with the Afghan Secretary of Public Health, Dr. Sohaila Sidiq. In this meeting, Secretary Thompson presented the following recommendations to the Department of Public Health:
To build a modern pediatric and women’s clinic in Kabul. This clinic would not only deal in pediatrics and woman’s health, but would also be a teaching institution for doctors, nurses and midwives. These trainees would then serve other provinces and communities. This plan was exciting and welcomed by Dr. Sidiq.
Secretary Thompson stated that some American Universities, including Johns-Hopkins, have expressed a desire to affiliate with KMI. Dr. Sidiq however clarified that at the present time KMI is operating under the Department of Higher Education. She is now a part of the process of including KMI as part of the Department of Public Health. Only then could an affiliation with Johns-Hopkins (or any other American medical school) be considered.
The meeting concluded and a press conference was then held in the American Embassy.
Dr Baha and Dr. Siddiqui addressed ways to fulfill the Medical Schools needs with Dr.Anwar, the president of KMI. He indicated that he would welcome foreign professors to teach the students if they would teach for at least one semester and administer a final exam for their course(s). If a Professor could not stay long enough to complete a semester, then he would be welcomed to teach the faculty.
Loma Linda University has been affiliated with KMI for many years. This affiliation however, has basically been limited to the teachings of Dr. Gordon Hadley, Professor of Pathology, a limited rejuvenation of the pathology laboratory, improvement of KMI’s library and the building of the LLU compound for visiting professors. This has been a great effort on the part of LLU, but certainly not even close enough to meet the needs of KMI.
Dr. Nadir Omar, the French-trained physiologist and past professor of Kabul Medical School, came from France and was present at the meetings. He discussed the long and historic affiliation that France’s University of Lyon has had with KMI and the desire to continue it. Although, he admitted the involvement had been somewhat limited in recent years.
Other Universities have expressed interest in affiliating themselves with KMI. But, no significant teaching or material aid has been provided.
In all departments that the AMAA members met with, the needs were consistent. It would be trivial to list the departments and their needs individually since they are nearly identical (and lengthy). Below is a list of the most general and urgent needs:
Teaching environment: The most important needs are basic classrooms and the equipment and supplies needed to conduct educational programs including, but not limited to textbooks, lab equipment (basic chemicals, storage/measurement tools, lab stations), audio/visual components like projectors, monitors, charts, writing utensils (pencil/pen, paper, folders, etc,) computers and printers.
A Teaching Hospital in close proximity to KMI: Immediate help to rebuild and resurrect the Ali-Abad Hospital.
The urgent need to update the current curriculum for medical education.
The availability of foreign or AMAA qualified professors to teach the existing teaching faculty and to establish a program to update the teachers as priority in addition to student education.
Continuing medical education for Medical Staff.
Experienced foreign medical school advisors to set up the administrative structure and to assist with the ongoing administrative needs of the medical schools.
A drastic reduction in the number of medical students to a level proportionate to the needs of the country and the currently available teaching environment.