Institute for War and Peace Reporting | Giving Voice, Driving Change

Major Hospital in Afghan East Struggles to Cope

Nangarhar doctors overstretched by swelling patient numbers and dearth of equipment.
By Hijratullah Ekhtyar

Mobin Khan’s 12-year-old son Samiullah clearly needs specialist medical help. Both his legs were broken in a car crash in 2010, and two years later he remains confined to a wheelchair. 

After a recent visit to the run-down Jalalabad Public Hospital in the eastern province of Nangarhar, however, Khan has little hope that Samiullah will make a full recovery.

There is hardly any medicine available at the overcrowded hospital, he said, and patients’ relatives are expected to pay for gauze and bandages themselves.

“This hospital does not resemble a hospital at all,” Khan said bitterly whilst pushing Samiullah’s wheelchair. “So I am taking my son home.”

With shortages of medicines and trained doctors, healthcare provision in Afghanistan remains poor. (See Unregulated Pharmacies Prompt Health Fears in Afghan Province, and Healthcare Crisis in Central Afghan District.) But patients and medics say Jalalabad’s hospital, which caters to a sizable chunk of the southern and eastern areas bordering Pakistan, stands out for its poor facilities, crowded wards and overstretched staff.

To the untrained eye, the hospital could be mistaken for a market or bus station. Cars, motorbikes and rickshaws are parked outside; water spills out from beneath a restroom and broken pipes leak into empty gutters overgrown with shrubs and weeds. Only the staff in white coats and people clutching prescriptions give away its true function.

Constructed 60 years ago, the hospital’s main building was designed to hold 100 beds. Today, it often has around 500 inpatients. Patient demand has outstripped the hospital’s capacity, but it still has roughly the same amount of staff and medical equipment as it did when it opened.

Dr Nawroz Shinwari heads the orthopaedic ward, which has ten doctors and two nurses on duty in the daytime, and only two doctors at night. Staff lack the supplies they need to mend broken bones, such as plaster and pins, and patients have to buy most of the medicine and materials they need, he said.

“Sometimes patients remain on the operating table for hours because of a lack of personnel, medicines and equipment,” he added.

Shinwari says his staff numbers have shrunk while admissions have spiralled – a result, he says, of more accidents since the roads in Nangarhar were paved and cars started driving faster.

Another orthopaedic doctor at the hospital, speaking on condition of anonymity, agreed that

“Even compared with hospitals in Kabul, let alone in other countries, we have very little equipment,” he said. “We’re still using carpenters’ drills for drilling bones.”

Nevertheless, the doctor said, medics had conducted over 700 major surgical operations and applied nearly 1,000 plaster casts in the past month. His own ward saw nearly 50 patients a day.

Dr Moqadasa Meraj, the hospital’s deputy director, says that in a typical month, between 5,000 and 6,000 patients are admitted and treated by the 32 specialists and 123 general doctors working there.

Dr Meraj says the hospital has seen some improvements thanks to help received from the Provincial Reconstruction Team, a joint military-civilian force run by the NATO-led International Security Assistance Force. It now has wards for children and sections for ear, nose and throat complains, eye problems and mental health, she said.

But she acknowledges there is still a long way to go.

“In terms of medical equipment and personnel, our hospital cannot be compared with the average hospital in other countries in this region,” she said. “Our equipment is 30 years old... and the staff are not capable of using more advanced equipment.”

Dr Sahel Nasrat, who works on infectious diseases, is exasperated by the lack of facilities to test for hepatitis, or to conduct CAT and MRI scans.

“There is no intensive care unit and no medicine for emergency cases,” Dr Nasrat said. “Nor do we have lab equipment for diagnoses.”

Doctors are supposed to receive additional training, but are hampered by the lack of either a library or internet access at the hospital, and there are no plans to send them abroad to go on courses. Given these problems, Dr Nasrat asked, “How can one learn?”

Dr Meraj sees little hope of radical improvement because HealthNet International, a non-government group that supports the hospital, has a limited budget.

Dr Homayun Zaheer, HealthNet’s director at the hospital, said out-of-date census figures hugely understate the size of the population served by the hospital.

Official numbers show the province with a population of 1.6 million, and this figure is used to determine the budget, Dr Zaheer said. But these numbers are out-of-date, and he believes Nangarhar now has as many as three million residents, nearly twice the official estimate.

“Donors approve our budget according to the province’s population. If Nangarhar’s statistics department put the population at three million, the hospital would get a bigger budget,” he said.

As well as Nangarhar, the Jalalabad hospital also serves the Laghman and Kunar regions, as well as parts of Kabul and Logar provinces.

HealthNet gets its funding from the European Union provides, and the NGO is currently operating under an agreement with the Afghan health ministry running from November 2011 to May 2013.

Under the agreement, HealthNet agreed to provide for 420 beds, but 50 more than this are in use, and 27 more staff are working there than the 527 stipulated.

“Even now, we are providing services that are not covered by our budget,” Dr Zaheer said. “This an extra financial burden that our NGO has shouldered.”

Not everyone is unhappy with the hospital’s services. Allahnazar recently admitted his one-year-old son for a two-week stay and the boy has since been discharged in good health.

“I am grateful to Dr Abbas – my son had a lung ailment and he treated it,” Allahnazar said of the doctor involved. “Without that, I would have had to take him to Pakistan, where I’d have needed to pay a lot of money to doctors and the police.”

Hijratullah Ekhtyar is an IWPR-trained reporter in Nangarhar province.