Afghanistan: The Maternity Hospital Delivering Hope

Resident of Khost say that cultural sensitivity and high numbers of local staff have been key to the success of a maternity hospital run by Medecins Sans Frontieres (MSF) in the southeastern province.

MSF opened the maternity hospital more than six years ago in an effort to address high rates of maternal mortality. Despite serious security issues – the hospital was forced to close for eight months following an attack in April 2012 – the unit has gone on to prove hugely successful, now delivering an average of 60 babies a day.

Mothers who have recently given birth at the NGO’s hospital said that they had received superb care free of charge.

 “The recent birth of my baby girl went so well,” said Gul Rahima (not her real name), a 37-year-old mother-of-seven.

“There are experienced doctors working at the hospital and everything was free of charge. Their work is a huge help to poor families.”

Her husband Akhtar Mohammad, 41, added, “Not only is the treatment free but the hospital also allows families to stay for one night and provides a free meal as well.

“If we had gone to a private hospital we’d have been charged too much for medicine. You can be asked to pay 100 Afghani (1.5 US dollars) for medicine that should cost 10 Afghani, and no one questions this.”

MSF set up its hospital in the city of Khost in March 2012. Staff hoped to raise the level of healthcare in the province without duplicating existing services provided by Khost’s public hospital located just outside the city.

Initial confidence in the plan faltered when seven people were injured in an explosion within the hospital compound just six weeks after it opened.

The attack forced the facility’s closure until December that year, with MSF using the time to strengthen its support from political and religious leaders in the city in the hope of preventing a repeat of the incident.

The hospital – with more than 400 national staff and around a dozen international workers – now has 68 maternity beds and 22 neonatal beds, as well as a surgical team dealing with more complicated deliveries.

In addition, MSF staff this year began supporting health centres in five other locations within the province. Staff at clinics in the districts of Gurbuz, Nadir Shah Kot, Sabari, Tani and Lakan aim to reduce the number of patients heading to Khost city for normal deliveries, thereby allowing hospital colleagues to focus on assisting with more complicated births.

Khost’s director of public health, Gul Mohmmaddin Mohammadi, said, “Though there are no official figures, in previous years our department was informed about the deaths of many children and mothers in childbirth each month. For many months now, we have received no such reports.”

Zahra Jalal, head of the provincial women’s department, said, “MSF have been careful to observe Afghan culture and values and this has been much appreciated.

“For instance, some people in the province used to think that only foreigners worked at the hospital and avoided using it because of this. But now they realise MSF has addressed this and almost all the workers are Afghans.”

She added, “Many women who have graduated in nursing and midwifery are now working at the hospital. Even illiterate housewives have found jobs there. The reputation of the staff is known to be so good that patients are sometimes brought from Paktia province for treatment.”

MSF figures show the number of deliveries at the hospital has increased by 40 per cent in just two years, from 15,204 in 2014 to 21,335 in 2016.

In December last year, the number of deliveries reached 1,905, an average of more than 60 per day. A marked increase has also been seen in the numbers of newborns admitted to the neonatology unit. Some 1,746 babies were admitted in 2016, a 15 per cent increase on 2015.

Speaking to IWPR, Qudratulllah, a tribal elder from Lakno village in Khost city, said he believed MSF’s satellite clinics had proved more successful than many of the bigger, multi-million dollar reconstruction projects in the province.

His remote area had lacked the infrastructure to allow women in labour to always access the medical help they needed, he explained.

“Sometimes heavy rains and flooding blocked roads meaning some women were forced to give birth in cars while they waited for the route to clear,” he said.

“Now though we have a clinic right in the center of Lakno so we don’t have these difficulties anymore.”

Khost activist Jamal Tani also praised the work of MSF’s more remote clinics.

“We’re really pleased with the quality of the healthcare and local people support these services as they’re sensitive to the cultural values of Afghanistan,” he said.

“We have consulted and monitored their activities and offered advice where needed.”

There are still serious healthcare deficiencies in Khost, particularly in the more mountainous regions. Musakhel district in the far north of Khost is one such area that medics still struggle to reach. Snow, flooding, poor roads and armed robbers has made access very difficult.

Haidar Gul, a tribal elder from the area, said, “We’ve asked public health officials and MSF to open clinics in two remote areas of the district.

“They promised us they would but it hasn’t happened yet. We’re hoping they’re able to as soon as possible.”

Ahmadullah Safi, a spokesman for MSF in Afghanistan, said, “Maternity care in the province remains our top priority.”

This report was produced under IWPR’s Supporting Investigative Reporting in Local Media and Strengthening Civil Society across Afghanistan initiative, funded by the British Embassy Kabul.