The population of Kabul has tripled over the last 10 years. Some came from conflict torn areas seeking the relative safety of the capital, others, displaced by poverty, came in search of a better living. Returnees from Pakistan and other provinces of Afghanistan are also making their way back.

The already fragile health system, suffering from almost 30 years of conflict, has been stretched to its limit, leaving a lot of people who cannot afford to pay without access to medical care.

But, beneath her iridescent blue burka, Nasreen* from Ahmed Shah Baba Mena is smiling. Today, her one year old girl Laila, received a complete vaccination, for free.

“Here doctor is free and medicine is free. I don’t even have my own home, but still, I was able to get my one year old child vaccinated and examined in this hospital. I am happy.”

Photo: © Pascale Zintzen, MSF
MSF staff at Ahmed Shah Baba Hospital in Eastern Kabul

Médecins Sans Frontières (MSF) has been supporting Ahmed Shah Baba hospital in eastern Kabul since October 2009. This district hospital is located in an area which, like the rest of Kabul, has also seen a rapid increase in its population. However, other than private clinics, which most people cannot afford, the provision of basic health services remains lacking.

“It is written here on the card when I have to come back again, to make sure that Laila does not get sick”, explains Nasreen, referring to a card that allows doctors working in Ahmed Shah Baba Hospital to keep track of the child’s vaccination history. “There are so many people like me, who don’t have money, and can’t pay for help that they need. I used to ask people for money to go to the Bazaar (market) to buy medication, but now, I come here” says Nasreen.

For the last five months, MSF expatriates and national doctors, midwives and nurses have been working with the hospital’s medical staff to improve the quality of care being provided in this facility, with a particular focus on improving treatment protocols, emergency room and maternity services.

“Many people are coming to the hospital” exclaims the hospital director Dr.Sattar, “Because drugs free. Examinations free. Doctors free. OPD Free. Emergency 24 hours”.

Dr. Maria, an MSF paediatrician, has been part of the team supporting activities in Ahmed Shah Baba from the start: “For a doctor, this is definitely a different way of seeing a hospital. We have to balance hands off with hands on work, to combine supervision with management and direct support. The idea being to strengthen, reinforce and refresh without substitution. This is their hospital, and these are their people”.

A crucial component of the work that MSF is doing in Ahmed Shah Baba hospital involves taking the time to coach and train the staff. In the Maternity ward for example, an MSF midwife has started a series of weekly trainings for four midwives from the hospital’s team, on topics like sterilization and correct material preparation.

An average of 400 consultations and 10 deliveries are currently taking place every day. “When we started, no patients were being seen after 11:30am. The situation is different nowadays, after a break from 12:00 to 1:00 the consultations resume until 2:30pm. At least 170 patients are being seen in the afternoon daily,” confirms Dr. Maria.

In the early morning, hundreds of patients are handed out registration cards by a health promoter and a registrar who are trying to put a triage system in place. In order to ensure the quality of the consultations, no more than 60 patients are seen by each of the seven doctors working in the hospital. A quick glance reveals that women and children represent the majority of the patients. “The two paediatricians are overwhelmed,” Dr. Maria explains. “They are seeing a lot of children. It is very difficult to turn people away, but we reassure them by saying that the hospital is open every day except Friday.”

One of MSF’s top priorities has been to get the emergency services running for 24 hours a day, seven days a week with doctors and nurses on duty every day and night of the week.

Chronic over-prescription of drugs is a challenge facing the MSF medical team. “Changing prescription habits takes time. It is not uncommon for six or seven drugs to be prescribed to patients who don’t need them. Today, an average of three drugs is prescribed per patient. We are hoping to reach a stage where, if someone is not sick they are not given any drugs," says Dr. Maria Sarte." Here, a paracetamol is like candy”.

Since the arrival of the MSF drug supply in January, 10,000 patients were seen in three weeks. “It is not just about giving out free drugs”, explains project coordinator Sylvie Kaczmarczyk. “We want to provide quality treatment. The medication that is widely available here is suspect.”

Poor quality counterfeit drugs can be easily bought at the Bazaar, causing many patients to spend the little money they have on medications that do more harm than good.

In order to help the facility function as a district hospital, MSF has also been involved in repairing and rehabilitating key elements of the infrastructure. A thirty bed in-patient facility will be opening soon, with separate wards for males and females, as well as an operating theatre, which includes the capacity for caesarean section.

“In the new building, we will put a proper triage room in place,” explains Dr.Maria. “Children waiting to be seen by a doctor will be ushered into a warm room where they will be weighed and measured to help us screen for malnutrition. We also plan to work with the health promoter in the hospital in order to use the waiting room as a way to raise awareness and promote health education. This means that the time the patients spend waiting will not go to waste”.

MSF chooses to rely solely on private donations for its work in Afghanistan, and does not accept funding from any government. In addition to its support to Ahmed Shah Baba hospital in Eastern Kabul, MSF also supports Boost hospital in Lashkargah, Helmand province. In both locations, MSF aims is to provide life-saving and free medical care using effective drugs, working in all areas including maternity, paediatrics, surgery and emergency rooms.

MSF plans to extend its support to hospitals and rural health centres in other provinces in Afghanistan in 2010.

* Names have been changed to protect the anonymity of the patients.

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