Hospital Shortages Take Their Toll

Imagine a hospital where you have to bring your own medicines with you, there is no food, the staff don't even have basic equipment like scissors and dressings and you sleep two or sometimes three to a bed.

This is the situation in Kabul's three main children's hospitals, where conditions are deteriorating so rapidly that the death toll among patients is rising. "We now have four to six deaths a week - roughly double the rate a few months ago," said Bismillah Bismil a nurse at the Indira Gandhi Hospital in central Kabul.

He said the main causes of death were patients not being brought to the hospital on time, but also a dire lack of medicines and blood for transfusions.

In theory, the Indira Gandhi, founded in the 1960s, has the sort of departments one would normally associate with a big city hospital. The problem is that few have the equipment or the drugs they need to function properly.

"I have been here with my child for six days, but we have not been given any medicine so we have to buy it from the drugstores," said the mother of a child named Aziz Gul. They had traveled from Maidan, in Wardak, two hours drive to the west.

Patients from the provinces around Kabul, where there are no advanced medical facilities to speak of, increase the pressure on the hospitals to bursting point. Indira Gandhi's medical director, Mohammad Tawoos Moahid, said they were now receiving between 500 and 600 patients a day.

But at other hospitals the situation is even worse. At Ataturk Hospital, in Kabul's Third District, the wards simply stank, and there were two patients to every bed.

Shamia, the mother of a child patient from KhairKhana, said meals were irregular, even for patients suffering from malnutrition. "Food consists of rice, beans and milk. Fruit is bought for the children (by the hospital), but never given to them," she said.

Although Ataturk's malnutrition department is supported by Save The Children, Zmarai Husain, the hospital supervisor, said other departments - such as those for surgery, antenatal clinics and epidemiology - were effectively out of operation. "We can't help these patients and have to send them to Indira Ghandi hospital," he said.

At Maiwand Hospital, which dates back to the rein of Nadir Shah in the 1930s, Gul Pekai sat weeping by her sick child.

"My child is in a serious condition - he hasn't eaten anything for the last three days, not even milk. The doctors come once a day for a visit. Every time I go to their room they behave harshly and throw me out," she said.

Because doctors are so badly paid in public hospitals, many unofficially only work part time, leaving in the afternoon to run private clinics where they can make more money.

A number of the hospital wards were in a mess, with old and dirty blankets, and two, sometimes three patients lying on one bed.

At the Indira Gandhi, Doctor Mohammad Lais Nawabi said although it was technically illegal to put more than one patient in a bed, they had no choice.

"During the summer, we get more patients because of diarrhoea and we have to put extra beds in the reception areas and halls of the hospital, in order to deal with the flood of new people," he said.

The vast majority of Afghans have no access to refrigeration facilities so there is a higher degree of contamination of food and drink during the hot summers.

Mir Azam Mehraban, a health official in the transitional government, said he had commissioned an inquiry into how food and medicines were distributed in hospitals. "We will also investigate the attitude of hospital personnel towards patients," he said.

The problems in the medical system are such that the government is planning to improve the capacity of current hospitals rather than build new ones.

It is an enormous task. A woman doctor called Ishaqzai said it wasn't just expensive equipment like electro-cardiac and ultrasound machines her unit needed. "Even ordinary equipment such as scissors are lacking," she said.

Sultana Farkhanda is an IWPR journalist trainee.