Medical Treatments That Do More Harm Than Good

Untrained or under-trained individuals claiming to be doctors are at work all across Afghanistan prescribing drugs and even carrying out surgeries at unregulated private clinics on unsuspecting patients.

In some cases, the treatments performed by these so-called doctors have led to permanent injury or even death, according to interviews with patients or the relatives conducted by IWPR.

Government officials admit that the problem exists throughout much of the country.

"There are lots of unlawful clinics and pharmacies all over the provinces,” said Abdul Manan Saidi, the deputy president of law and assessment in the ministry of health. “Even those people who were hospital cleaners in Pakistan and Iran have opened their own clinics."

But with trained medical professionals in short supply, especially in rural areas, many feel they have no choice but to turn to these unqualified and unregistered individuals.

Some of the cases discovered by IWPR include:

* A patient in Chak, Wardak province, who was suffering from malaria but was treated for typhoid by a so-called doctor who admitted having received only three months of medical training;

* A child who died in Said Abad, Wardak province, after being treated by an individual who acknowledged having only nine months of medical training.

* A women in Logar province who said she lost the use of her leg after being treated by a so-called doctor who left school at 13 and had received only three months of medical training;

* A man in Helmand province who lost his sight after receiving an injection in his eye by an individual who allegedly had received only brief medical training;

* A 12-year-old boy in Kabul who required medical treatment at a public hospital after having received an injection in his penis from a so-called doctor who allegedly had no higher education background.

Most legitimate doctors in Afghanistan have undergone seven years of university training before receiving their medical degree.

But many of the so-called doctors have taken as little as three months of medical courses, often when they were refugees in Pakistan. Others received some basic first-aid training when the mujahedin were in power in the late 1980s and have simply declared themselves doctors since then.

Ghulam Mahmood, 29, of Chak, said he began to suffer from stomach pains three months ago. On June 4, he said he went to see a man who identified himself as Dr Jalal, the only health-care provider in his village.

Mahmood said Jalal provide him with medicine but his condition worsened.

"My illness became worse and worse and when I returned the second day to his private clinic, he told me to show him my tongue,” Mahmood said. “And then he looked at my eyes and told me that I had typhoid.

"He then gave me some tablets and a bag of saline infusions and he said ‘In the evening I will come to your home and administer the infusions.’

"But my sickness grew worse. I wasn't able to even walk, so my father took me to Kabul and there I learned that I had malaria.

“When I took medicine [for malaria] I did get better, but I still can’t eat properly, because of the strong medicine prescribed by [Jalal}." Mahmood said.

Jalal, 33, told IWPR that he had studied pharmacy and nursing for six months in Peshawar, Pakistan, and said he has been treating patients for nine years.

"In these nine years, I have gained enough experience and I challenge a professional doctor [to see who is best],” he said.

Jalal denied he had misdiagnosed Mahmood’s illness. "This accusation is wrong. They want to defame me,” he said.

Gul Mohammad, from Said Abad district, is still mourning the death of his only son, Omar, 17, whom he had taken to a local practitioner when the youth was suffering from a fever.

According to Mohammad, the practitioner, who called himself Dr Akbar, was unable to diagnose Omar’s illness but still prescribed drugs for the boy.

But the teenager grew worse and died. “That ignorant doctor played with my son's life. He killed my son," Mohammed said.

Akbar, 39, told IWPR that he had received nine months of medical training.

"In 1991, I studied a six month medical course and then took a three month course in health education," he said.

Akbar said he used to have a pharmacy and now runs a private clinic. He denied the allegations made by Gul Mohammed.

"I've never prescribed medicine for illnesses that I do not know," he said. "In those cases, I send patients to the health centre."

In the Barak-e- Barak district in Logar province, Gul Botta, 30, lies in the corner of a dark room and cries.

Two years ago, she sought treatment from Asadullah, a local medical practitioner, whom she said provided her with an injection with performing any sort of medical examination.

Botta said the needle used for the injection broke off and became embedded in her leg.

"Ever since I received that injection, I have been in pain,” she said. “I couldn’t walk for some days, and finally this caused me not to walk at all and to become lame. My life is so confined I would prefer to be dead."

Asadullah is now dead, but his cousin, Hajji Shah Wali, his cousin, told IWPR that his relative had a sixth-grade education and had taken a three-month medical course while he was Peshawar, Pakistan.

Wali said he was unaware of Botta’s case.

While there are no national statistics on the number of unqualified individuals practicing as doctors, most medical professionals in the country contend that the problem is getting worse.

"The number of illegal doctors is on the increase and we have established lots of commissions to check and investigate the work of these doctors,” said Dr Shafi Rahmani, a deputy in the ministry of health for specialist training hospitals.

Dr Mohebullah Zer, the deputy for specialist medicine in Logar’s Barak-e-Barak hospital, agreed that the situation seems to be getting worse.

"There are more than 10 unqualified doctors in this district that I know – maybe there are some others who don't have private clinics and treat people at their homes,” he said.

Dr. Mohebullah, who works in a 52-bed hospital, said, "Most of the patients coming to this hospital have first gone to an unqualified doctor.

“These doctors don't have higher education. They have just completed a three-month course, and now they wear a white coat and play with the lives of people in order to make money.

“They cannot diagnose diseases. They prescribe medicine randomly, and when the patient’s condition becomes dangerous, then they send him to the hospital."

Saidi of the ministry of health said that his department receives a lot of reports about ill-qualified doctors and that the government has sent letters to local health departments in the provinces urging them to act – but they have received no replies.

But Mohebullah questions whether the government is being aggressive enough in attempting to shut down unqualified medical practitioners.

"Some officials of the ministry of health don't want to stop these unqualified doctors from treating people… If they really want to stop these doctors it's not so difficult," he said.

Sayed Najemi is a freelance reporter for IWPR in Kabul.