Plight of "forgotten women" needing health care in rural areas

Visiting patients in an overcrowded and muddy room in Mushkhail district, southeastern Paktika province, Parwin Jabarkhail, a 38 year-old doctor, noted the bleak prospects for tens of patiently waiting women, who after long journeys had reached the only woman doctor in this conservative province of more than two million. "They [rural men] will let them [rural women] die rather than take them to a male doctor," Jabarkhail told IRIN. According to her, high levels of illiteracy, the complexities of traditional culture and a lack of female doctors meant that Paktika was experiencing high rates of maternal mortality with over 50 percent deaths among expectant mothers. "Unfortunately I witness dozens of mothers dying for simple reasons that could be prevented if there was a doctor and health care facilities," she noted. Jabarkhail, who originally comes from the capital Kabul, started her new life and new career from Mushkhail seven years ago when she graduated from Kabul medical college. She came to Paktika with her husband, a laboratory technician, hoping to address her country's top health problem, mother and child health (MCH) care. "I knew that due to ultra-conservatism and the abuse of women's rights, maternal mortality was increasing in rural areas and it was the right decision to start with the most difficult place and the most vulnerable people," she said. With increasing MCH problems, Jabarkhail has found it difficult to reach each and every women in the village. In an effort to expand her team, she has launched midwifery training for the rural women with the support of a local NGO. "I think the only long term solution is to train these women to reach hundreds of thousands of other women who are strictly banned from going out of their homes," she said. Jabarkhail has a very challenging mission with her country having one of the world's highest maternal mortality rates, according to recent studies by the Afghan Health Ministry and United Nations Children's Fund (UNICEF). It is estimated that in the most isolated parts of the country, one woman dies every 20 minutes as a result of complications in childbirth or pregnancy.

Parwin Jabarkhail examines a patient southeastern Paktika province

But according to an MCH doctor in Kabul, the problem goes beyond Paktika as traditional cultural complexities are major obstacles for mothers' health care in almost every province. "Our society is traditional and in many provinces even our educated men do not let their women go outside the home. I think the last two decades of conflict and political changes have affected our men's thinking," Noorkhanum, an MCH coordinator for an international health organisation, Terre de Hommes, told IRIN in Kabul. The MCH coordinator believes that in addition to the issue of tradition and a lack of awareness, domestic violence against women, the lack of health centres and transport problems were the root causes of increasing maternal and child mortality. "Meanwhile it is too early to solve the issue of female doctors in provinces as we do not have many educated female doctors and only a limited number of them are inside the country," she acknowledged. Jabarkhail is now leaving Paktika for the capital Kabul for her children's education. For the people of Mushkhail this is more than simply losing a community doctor, as they know that no one will volunteer to replace her for this challenging and risky mission. "No one will come to help these forgotten women," she sighs. Officials at the Afghan Ministry of Public Health (MoPH) acknowledge that finding qualified doctors to work in places like Paktika was difficult. "The government cannot afford to pay high incentives for doctors in the provinces. Meanwhile, with the security situation in the south, doctors - particularly women - may not dare to go there," a doctor at MoPH who declined to be named told IRIN.