Salaam Afghanistan

Health and Ethnic Conflict.

My first visit to the Heart of Asia -- Reflections and Photos.

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Location: Mbarara, Uganda

Internist and Pediatrician with a passion for international health.

Thursday, July 15, 2004

Getting sick and staying home: Rabia Barkhi Hospital

After my evening with Habib's cousins, I went home, ate dinner, and then went to bed as usual.  Next day, I woke up, ate breakfast, and went to work as usual.  Work was bit hectic, lots of running around making arrangements with little progress (had a meeting to arrange the semi-urban site, which was good; went over to our other office to pick up a colleague to go with me to the Ministry of Health to get a signature to take over to the Hospital to confirm permission to conduct the study -- lots of waiting, lots of no-shows -- ugh!).  I had my 3rd Dari lesson, which I enjoyed.  But that evening, during dinner, I suddenly felt faint and a bit flushed.  I went to bed early, and woke up the next morning, the first day of the field tests for my study, and was too weak to go.   I couldn't keep anything down.  I called in sick and had a colleague take care of Day 1.  I went back to bed, and basically slept the entire day until around 6pm. 

I got up and tried some bread.  No luck.  I slept another hour.  I got up and tried some soup.  Also no luck.  I went to bed again.  Next day was Day 2 of the field tests.  I had to go.  I was better, but not great.  I had breakfast (a bit of bread and juice), went to work, and lost the breakfast on arrival.   Yuck. 

We were conducting the field tests of the focus groups at a Hospital here in Kabul called Rabia Barkhi.  I am not sure if I have described Rabia Barkhi before or not.  It is in the middle of a bazaar here in Kabul.  The front of the hospital, the part that is facing the public so that people know where it is, is no bigger than any other stall or storefront on the street.  It is a tunnel with a gate about as wide as a car, with a small sign over it that says "Rabia Barkhi Hospital".  You have to know where to look to find it because it is anything but obvious.  I wish I had had my camera with me to take photos. 

You drive in, and on either side of the first part of the "driveway" are rows of men, wearing shalwar kameez, vests, and various kullaa (hats -- square ones, Uzbek ones, turbans, Panjshiri flat fuzzy ones).  They have to stand up to make room for the vehicle to pass.  Then through another gate, and there are all the women.  Most of them are wearing burqas, some of them have the fronts of their burqas pulled back over their heads like brides' veils.  We pull into the parking lot.

Rabia Barkhi is one of the best hospitals in Afghanistan.  It is one of the biggest, with the most resources.  And, as I walked around feeling very sick, I thought, "I'd rather stay home, too."

Like most buildings in Afghanistan, the building is made of cracking and crumbling concrete, with dust and sand in all the crevices and holes.  There are a few old, dirty benches that are still just strong enough to hold weary patients as they wait outside before being seen.  There is some standing water here and there in the "yard" and a bunch of pieces of old metal rusting in corners against buildings.  Flowers grow among the weeds.  Off to one side, there is the OPD waiting room, where pregnant women wait to be seen.  The door has been patched, and on the adjacent wall there is a dark patch of dirt and oil where hundreds of hands have sought to support the weight of pregnant bodies.

Inside, I stumble weakly up the stairs to the office of the woman we will see to confirm our arrival.  I have to be careful not to stumble into the pile of rubbish in the corner on the landing.  At the top, in the hallway, there is an old metal gurney.  It doesn't have any mattress or bedding on it -- just the wires of the metal frame, and a woman laying in the fetal position, either asleep or unconscious.  No one seems to take note of it, so I assume she has been taken care of.  In the hallway, I sit down on some chairs to rest.  Across from me, there is a whitish cloth stretched between two wooden bookshelves.  It is an examining room.

I put my head down, and as the earth shakes with the tiny rumblings of the earthquake going on kilometers away (like how I use kilometers here?), I see the little chunks of dirt and pebbles vibrating on the concrete floor below me.

I get up when my colleagues return and we head back downstairs to recruit women to participate in our study.  We pass several labor rooms, with five or six beds side-by-side, and very pregnant women looking very uncomfortable.  The rooms are crowded and the doors are open.  I understand the delivery rooms are similar.  Several women in one room laboring together.  When one baby comes out, it is taken to a different room and put on a shelf, still naked, with several other babies.  They tie a little identification label with string to their wrists.  Some of the Afghan people believe that if you deliver a son there, there is a chance that another family will pay to have their daughter switched with your son.   Many people complain that you have to pay the doctors to attend to you.   I can understand why so many women would rather deliver at home.  If you are going to deliver in an unsterile place, and you believe you might not be attended to properly anyway, why come to a hospital where you have to share your dirty room with a bunch of other women?  I'd rather stay home, where I know the rooms, and I have only the people closest to me around.  It's no wonder maternal mortality is so high here.  Hard to convince people that the hospital is the best place.

We had our morning session with women who had delivered a child in the past 18 months in a health facility (shafa khaana).  Although I of course did not understand, I think the discussion was good.  One woman asked me how to stop having children.  She was 28 years old and had 6 children already.  She said they were making her tired and old.  I asked her if she used birth control pills or if she would take injections.  She said the medicines gave her hemhorrage (a common misconception here -- because of all of the births and miscarriages, and also because often the placenta is not fully removed, many (most?) women here bleed continuously after childbirth).  I asked if her husband would consider using a condom.  She said that he agrees with her desire to limit their children, but that he was a rural man, and he would not use a condom.  She was there, as I understand, for an IUD.  As she was leaving, she told me I did not advise her well!

We went back out to the waiting areas to try to recruit the women for the second session of our study, but because the hospital closes at 1:30pm on Thursdays, no one was there anymore.

What happens if a woman goes into labor on Thursday afternoon?  She delivers at home.


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