The Afghan Medical Association of America (AMAA) is actively pursuing the goals that have been put forward by the founders of the Association before the year 1992. This year we are approaching the 20th anniversary of our association.
In 1992 there was chaos and war inside Afghanistan and the warlords were jockeying for power and there were gross human rights violations with loss of life, dignity and property. The infrastructure of the government disintegrated as Afghans continued to take refuge in other countries. The hope for peace after the defeat of the Soviets and communists evaporated. Subsequently, the health of the Afghans further deteriorated.
The AMAA has tried to provide humanitarian aid to Afghanistan by helping to support refugee camps, sending funds to the Children’s Hospital in Jalalabad and by, supplies and educators to improve medical education inside Afghanistan. During this era the AMAA and Loma Linda University (LLU) also sent teams to Herat and Jalalabad to explore the possibility of establishing links to the medical school since these were the only relatively stable states in Afghanistan at that time. The Dean of Nangarhar Medical School was able to travel to the US and visit with the AMAA leadership and LLU. The AMAA was able to start helping the school by providing monetary funds and material help.
After the Taliban acquired power with governance there was no budget for much needed medical education and health services. As fighting continued, the health and human rights of the Afghan people deteriorated further. However, the relative calm and security in Kabul gave the opportunity for the members of the AMAA and LLU to again travel to Kabul and Nangarhar to provide humanitarian help. The AMAA was able to send funds to multiple hospitals inside Kabul and together with LLU participated in teaching, establishing a medical library and donating books to the library. Furthermore the AMAA extended humanitarian assistance to basic science teachers and rewarded the best students for their academic accomplishments.
The AMAA through repeated resolutions, which were forwarded to the Taliban, disagreed with their policies with regards to human rights violations, religious edicts, cultivation of poppies, their terrorism, and condemned the destruction of the Afghan heritage.
Although unfortunate, the tragic events of 9/11 brought the Afghan people a new found hope because it helped oust the oppressive regime of the Taliban out of power.
The AMAA and LLU delegates traveled to Afghanistan after 9/11 and visited the Minister of Public Health, the Minister of Higher Education, the President of Kabul University and the Dean of Kabul Medical Institute. Quality of care and education, a balanced and structured curriculum for the medical schools, restrictions on the overexpansion of medical facilities and universities due to sparsity of resources were some of the topics that were addressed during these meetings. In addition The AMAA also provided funds for basic science teachers.
The AMAA has conducted another study regarding the medical students’ level of English and medical knowledge. This study will be published in the Afghan Medical Tribune, which is an AMAA publication.
The events inside Afghanistan are unpredictable and only the future will tell what is going to happen. Most of the warlords with questionable histories are in power and we are hoping the current government will put aside the past differences and together be the servants of all people without consideration of their ethnicity or religious beliefs
In the medical field, many universities and medical institutions are opened but they are lacking qualified teachers, medical personnel, teaching materials, and medical curriculums. Many hospitals have substandard quality of care, a lack of well qualified technicians and medical personnel. In addition, medical records in most hospitals either do not exist or if available, are very primitive. To make matters worse, physicians, nurses and medical personnel are graduating without a good education and training as a result. Pharmaceutical drugs are manufactured in neighboring countries by un-licensed, and illegal sources and smuggled into Afghanistan. Flooding the market without any efficacy, this poses a threat to the well being of many people. Thus far there is no effective communication between the ministry of public health and the ministry of higher education which need to work in synergy to solve some of these pressing problems.
Furthermore, there is no planning to balance the number of physicians that are graduating. There are too many students graduating from many private and governmental institutions. The number of positions available exceeds the number of those that are available in the medical job market. This has created the unfortunate consequence where the supply is much higher than the demand. These are the major concerns that need to be seriously addressed, so we can find a solution for a better tomorrow.
In spite of all these concerns, there are some positive changes that need to be acknowledged. Most of all Kabul Medical University has changed significantly. One of its branches, Aliabad University Hospital was completely demolished and other medical facilities became so ravaged that they became almost non-functional, now however many of these institutions have been repaired and rebuilt.
The mortality rate of children under the age of five has dropped from 250/1000 in 1990 to 199/1000 in 2009. Infant mortality rate also has dropped from 167/1000 in 1990 to 134/1000 to 2009.
48% of the population is now using improved sanitary drinking water in 2008 (78% in urban and 39% in rural areas).
In the field of immunization under one year 82% had TB/BCG vaccine. 94% had DTP, and 83% had polio. 76% had Measles and 83% had HepB. New born against tetanus was 89% vaccinated.
The above mentioned reported figures by UNICEF.
However, for a fundamental change, in the most important aspect of medicine, the AMAA leadership has the following recommendations:
1.) To attract the new generation of physicians and other health allies to join us and to make our voice stronger, and our efforts more effective.
2.) To establish close communications with other medical organizations here in the US and other parts of the world.
3.) To communicate and support medical association in Afghanistan, mainly in Kabul, hoping to be our advocate and be our voice to make positive changes by communicating effectively with the public health and the ministry of higher education.
4.) Helping to create a medical curriculum for medical schools and helping to modernize the medical record system for the hospitals.
5.) Suggesting to create an independent authority similar to the board of quality assurance to oversee and to regulate the licenses of physicians, medical allies, and to monitor the quality of care for the hospitals and pharmacies.
I do fully understand the limitations of our medical association and the magnitude of the problems. But someone, some organization from somewhere should start this dialogue and discussion and I am proud that the AMAA leadership shall take this lead.