Hospitals Failing Afghan Mothers

A few months ago, the director of the Malalai maternity hospital in Kabul was operating blind. Because the Taleban's strict regulations forbade him to look at a woman's flesh, he would stand in the hallway and gave instructions to a junior doctor through the operating theatre door.

Although the Taleban have gone and clinical procedures relaxed, pregnant women continue to be denied basic care. Afghanistan has world's second highest rate of stillbirths and alarming levels of maternal mortality.

According to the World Health Organisation, WHO, 1700 out of every 100,000 babies delivered in the country are stillborn, while around 45 women die in childbirth every day.

WHO is now helping to rebuild the health system in Afghanistan but say that huge financial input is needed and has called for an initial package of 150 million US dollars.

Institutions such as Malalai have suffered from decades of under-spending and although the Taleban can be blamed for letting the health care network run to rack and ruin, the system they inherited was already rundown.

Patients at Malalai, who come from the capital and neighbouring provinces, all complain of the low level of care, the poor hygiene and the lack of qualified staff. They say that they often have to get hold of their own medicines and sometimes even have to secure basic medical equipment necessary for operations. The lack of a blood bank in Kabul also causes terrible problems for patients.

As if this wasn't bad enough, there are frequent power shortages. "Sometimes, when there is no electricity, we have to conduct deliveries by lantern light. It can be done - but when there are complications we'd prefer to have electricity," said one doctor.

On visiting the hospital, it is clear that one of the overriding concerns is the lack of qualified personnel. The wards echo with cries for help. On any given day, eighty to a hundred pregnant women are admitted and doctors say they are just not able to cope.

"The doctors come to visit at 10 am and then they disappear along with the nurses until 2 pm," said one patient who also told IWPR how she had seen two women give birth unattended in a waiting room. Another patient described how she had stumbled across a woman delivering her child in one of the hospital's filthy toilets.

In Afghanistan as a whole, it is estimated that 90 per cent of deliveries are unattended by medical professionals.

Staff at Malalai agree that the hospital is overwhelmed and that they just do not have the capacity to look after the large number of patients who come here. The numbers of doctors and nurses plummeted under the Taleban regime when many, frustrated with the strictures imposed on them, upped and left. Many women were simply banned from working by the authorities.

Since the fall of the student militia, doctors, especially female ones, have been steadily returning to work. "Otherwise our hands are tied. We have limited resources and just do the best we can," said Malalai's president Fahima Sekandary. "We are facing many difficulties. The Red Cross has been providing us with some medicines, serum and fire wood for heating but its insufficient for our needs."

The ill-equipped laboratories in the hospital are only able to carry out very basis tests. "We have three semi-functioning X-ray machines," said one doctor. "One of these machines has been around for sixty years and the other two are completely run down."

But the patients keep coming as they cannot afford to go elsewhere.

While Malalai's vice-president, Hafiza Omarkhail, acknowledges that much needs to be done to get hospitals here up to a decent standard, she is adamant that many of the problems faced by local women and mothers-to-be have nothing to do with medical care. She said that maternal and infant deaths usually resulted from primitive and superstitious practices.

Omarkhail claimed the patients let local midwives interfere unnecessarily with the delivery while others took local medicines without seeking professional advice. And, in other cases, patients only come to the hospital when their condition has turned critical.

In an effort to improve medical care for pregnant women, the Afghan Red Crescent Society has been training Traditional Birth Attendants, who serve remote regions of the country, educating expectant mothers and providing them safe delivery equipment. Just over two hundred TBAs are working around the country - the goal is to eventually have about a thousand.

"For women's health to rapidly improve, it is essential that international efforts focus on training female health practitioners - many of whom have been unemployed for the past several years, " said a World Health Organisation spokesperson.

The United Nations childrens' agency, UNICEF, has already begun a training programme at

Malalai, aimed at instructing female doctors from various parts of the country in emergency obstetrics "They will then go back to their regions where they will in turn train more doctors, " said a UNICEF official.

Farkhundah Khan is the pseudonym for a Kabul-based Afghan journalist