The National, April 19, 2009

Kabul’s doctors face daily struggle

The government only has the budget to give hospitals throughout the country 0 a month each for medicine and cleaning materials, he said. This is on average at least four or five times below the amount he estimated was required.

Chris Sands

Patients are needlessly dying in Kabul’s hospitals because of chronic shortages in medicine and operating equipment, doctors say.

Even as the international community renews its pledge to help develop Afghanistan’s infrastructure and public services, health workers throughout the nation’s capital paint a picture of a daily struggle against the odds in conditions that have barely improved since 2001.

The lack of funding is so severe that operations are being carried out with old versions of the wrong instruments and patients must often supply themselves with medicines. In some cases, easily preventable deaths have apparently resulted.

Mustafa Izmari is a surgeon at the Indira Gandhi Institute of Child Health in Kabul’s Wazir Akbar Khan neighbourhood. Clearly disgusted at the situation around him, he accused the government and foreign donors of doing nothing to help.

After saying his salary of roughly US$200 (Dh735) a month was not enough to support his family, he added: “I am just working for the poor patients. If I go from this hospital who will work for these patients? Americans? No. Germans? No. French doctors? No, they will never come here.”

In March dozens of donor countries and major international organisations gathered at a specially convened conference on Afghanistan in The Hague. What followed were pledges to fight terrorism and rebuild a land that has been devastated by three decades of almost constant war.

But here in Kabul similar promises have been heard before and the effect in the wards, emergency rooms and operating theatres has been minimal. Despite the billions of dollars in aid money that has flooded in since the US-led invasion, doctors say little of it has been spent on providing the most basic health services.

The Indira Gandhi hospital has about 350 beds and takes patients who range in age from the newborn to 14. Families from as far afield as Kunduz and Ghorband were there recently because they were unable to get their children treated closer to home.

According to doctors, though, the only real improvement to the place since the occupation is that it now has central heating and has been painted. Apart from that, little has changed.

“The main problem is the absence of equipment, absence of medication. This is a paediatric hospital, but I am working with adult surgical equipment that is very old and not suitable for paediatric surgery. We also have to perform surgery on newborn patients but we never have the instruments for them,” Dr Izmari said.

“Assistance from the government side is zero for this hospital. When the patients need every kind of medication we have to write a prescription, then the family of the patient will have to get it from the market.”

He was not alone in expressing his anger and frustration over the conditions. Another doctor said the ear, nose and throat department should have about 24 different sizes of rigid bronchoscopes. Instead, it has two.

Meanwhile, Khalilullah Hodkhail, a senior member of staff, said some of his colleagues spent their own money on medicines for patients. Asked whether anyone had died simply because of the poor facilities, the doctor said: “It has happened lots of times.”

Across town, freshly washed white sheets were hung out to dry in the rain that fell against Ibni Sina Emergency Hospital and a dog limped along in the courtyard before crawling under a metal container for shelter.

South Korea had once provided much needed funding here. Then the money stopped coming after more than 20 of its citizens were kidnapped by the Taliban while doing missionary work in 2007.

Ahmad Zakhi Raoufi, a physician, said: “These things make it difficult for all the doctors here: Lack of instruments, lack of medicine, lack of training courses abroad.”

Rather than spend $8 or $10 on the correct antibiotics the hospital recommended but could not afford to supply, families would sometimes buy cheaper versions for $1 in the market, he said.

Staff at Isteqlal Hospital in the south-west of Kabul said its problems were less acute thanks to funding from the Italian government. However, there was still a shortage of modern equipment and training.

Dr Abdullah Fahim, an adviser to the health minister, sat in almost pitch black when The National set up an interview recently, his face just about visible from the light of a battery-powered hand-held lamp. Parts of the ministry were shrouded in darkness because of one of the city’s regular electricity shortages.

Later, he admitted the doctors’ complaints were perfectly valid.

The government only has the budget to give hospitals throughout the country $200 a month each for medicine and cleaning materials, he said. This is on average at least four or five times below the amount he estimated was required.

Dr Fahim added that patients were indeed often asked to buy their own drugs, even though the Afghan constitution states that all services should be free of charge. He blamed the problems on inadequate funding, saying the international community was reluctant to spend money on hospitals.

“If you invest in the primary health care side and the public health side, then with a smaller investment you can have more tangible results. That’s why most of the donors prefer to support the primary health care side, not the curative side,” he said.

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