MSF provides healthcare in Ahmed Shah Baba, Afghanistan

“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.”

Médecins Sans Frontières (MSF) has been supporting the district hospital of Ahmed Shah Baba in Eastern Kabul since October 2009. The population of Kabul has tripled over the last 10 years. Some people are fleeing conflict torn areas to the relative safety of the capital, others, pushed by poverty, are trying to make a living in Kabul. Returnees from Pakistan and other provinces of Afghanistan have also made their way back to the city. As a result, an 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.  

“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.”

Beneath her iridescent blue burka, Nasreen* from Ahmad Shah Baba Mena is smiling because today, her one year old girl Laila, received complete vaccination for free.

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 seen a rapid increase in population over the last ten years. 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. All the necessary information is included in a card that allows the 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 expatriate and national doctors, midwives and nurses have been working together with the hospital’s medical staff to improve the quality of care that is being provided in this facility, with a particular focus on improving treatment protocols, emergency room and maternity services. 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 of the hospital. 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. Dr. Maria explains that “The two paediatricians are overwhelmed; 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 working in the hospital. “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. Here, a paracetemol is like candy”. The poor quality and counterfeit medication that is easily purchasable at the Bazaar, the word used for market, means that a lot of patients are spending the money they have, on medication that does more harm than good.

Since the arrival of the MSF drug supply in January, 10000 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”.

In order to get the hospital to function fully as a district hospital, MSF has also been involved in repairing and rehabilitating key elements of the infrastructure. Still, addressing the logistical challenges of the building has not stopped the medical work from taking place; both construction and consultations are ongoing.

Soon, the introduction of a thirty bed in patient facility, with a separate ward for males and females, as well as an operations theatre, which includes the capacity for caesarean section, will be launched. MSF is also looking to introduce a mental health component to the services provided at the hospital. This means that approximately 200,000 people surrounding Ahmed Shah Baba will be able to receive a more comprehensive package of health care. “In the new building, we will put a proper triage room in place. Children waiting to be seen by a doctor will be ushered into a warm room where they will be weighed and measured. This will help us screen for malnutrition” explains Dr. Maria. “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”.

“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”.

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, our aim 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.