Sunday, October 4, 2009

Downtown Public Hospital

Yesterday was another 'get out and see the city' day. Actually we have been trying to coordinate a visit with the Regional Mazar e Shariff hospital since our arrival here. Finally we were able to track down a point of contact at the hospital and arrange for a patrol to take us there. It was quite a production as we had folks from our Police medical mentoring team, the Afghan Army regional hospital mentoring team, The CO of the Afghan army hospital and several others with us. After an uneventful drive down to the area we parked the MRAPs and our 'away team' went into the complex.

We were met by the Regional Medical Director. For those who may not know, Afghanistan has three medical systems. The Afghan Army under the Ministry of Defense, The Afghan Police under the Ministry of the Interior, and the Ministry of Public Health(MoPH). So the Regional Director reports to the Minister of Public Health in Kabul and supervises all MoPH facilities in the 9 northern provinces of Afghanistan which includes at least nine hospitals and 85 clinics. We were ushered into his office for chai. I must say it was the most opulent office I have seen in this country. There was a marble desk, ten leather couches, and a large plasma screen TV. The Director, who actually spoke and understood English excedingly well, told us through an interpreter how the old regional hospital had burned down several years ago. So currently they occupy about 10 buildings in a complex until the new German sponsored four story building can be completed. They also get support from our State Department via the USAID organization and some help from Johns Hopkins University.

After chai and conversation time we took a tour of the facilities. There were two sections to the womens and maternity ward. There was a pediatric building complete with an entire ward for malnourishment and a Neonatal Intensive Care Unit with several tiny premature babies in serviceable incubators. The Director told us of their difficulty trying to get new mothers to breastfeed their children since it is tradition not to breastfeed until their third day of life. Dangerous cultural practices such as this have earned Afghanistan a 50% mortality rate for children under 5 years of age. With the help of education, vaccines and material support from Donors this concerning downward spiral is now turning around. We also took a tour of their Emergency Department and ICU/Surgical recovery area. It was perhaps the most troubling of the wards to observe. Unfortunately we only had time to visit 6 of the buildings before our time to press onwards arrived.

Of course most Americans who have never seen a struggling hospital in a third world country would probably have a very difficult time processing what we saw. But after a day to reflect on everything my partner Steve and I, who are sort of conneisseurs of third world hospitals, concluded that we have seen worse. Me in some parts of Asia, he in Africa. But for a country that is in the midst of a war and in temporary buildings for the most part it seems to be operating very well. It was depressing seeing the disparity between the Directors Office and the peeling paint and bare wires in most of the buildings. There is still a lot to do in this country.

One more word about the Afghan Health system. It is easy to be critical and see all that needs improvement here. But there are caring doctors and nurses who daily treat both insurgents and soldiers alike. They see them all as countrymen. In their consitution, free health care is a right of all citizens. So there is no cost to be seen or treated in any MoPH hospital. I find it odd that we are dictating how the Afghans set up and run their health system- "first remove the log from your own eye, then you will be better able to see the speck in your brothers eye"- a famous quote comes to mind. Perhaps there are things we can learn from Afghanistan.


  1. I read that Iraq's constitution also says healthcare is a right. Funny how the two countries we are "fixing" are being set up to have healthcare like Europe and not like us. If
    our system is SO much better, that says one of two things:

    1. "We don't think they deserve the best."
    2. "We secretly know Europe's system is better than ours."

  2. The Thunder Run has linked to this post in the blog post From the Front: 10/05/2009 News and Personal dispatches from the front and the home front.

  3. With all due respect, it isn't what you have a "right" to, it is what you can actually obtain.

    Paul Hirsch