Focus on maternal health care

Wasin Gul was nine months pregnant when she travelled from Afghanistan's central Lowgar Province to the Malalai maternity hospital in the capital, Kabul, only to find on arrival that her baby had already died in her womb. "I feel so weak. I can't get up," she told IRIN as she lay on her hospital bed attached to a drip. A few metres away, Anisa, who is blind, was to have been a first-time mother, but she had been admitted 15 days earlier and her child had also died before birth. Due to the dire health care on offer at state hospitals, stillborn babies are one of the most common maternal problems women face in Afghanistan. Already at the hospital for seven days, Gul was still waiting for the dead foetus to be removed from her body. Afghanistan has the second-highest maternal mortality rate in the world. "There are 1,700 maternal deaths for every 100,000 live births in Afghanistan," a medical officer for the World Health Organisation (WHO) in Kabul, Dr Abdi Momin Ahmed, told IRIN. That's about 45 women dying daily due to pregnancy related causes. There has been very little emergency obstetric care available and, until recently, aid agencies had only been able to give limited support to the poor health-care system, Ahmed said. Following the fall of the Taliban, WHO has been assisting the Interim Administration's Ministry of Public Health to rebuild the health care system in the country. But Ahmed warned that unless there was a huge financial commitment from donors, no rapid improvement in the situation could be achieved. "We have made an appeal for US $150 million," he added. Malalai is one of many hospitals in Afghanistan which is inadequately equipped and unable to offer patients proper treatment. "The situation of war has led to the deterioration of the health system, and vulnerable groups such as women and children have been affected the most," Ahmed said. According to the UN, six million Afghans have no or very little access to health care in the country. Some 200 patients walk through the doors of Malalai every day, and between 40 and 80 babies are delivered daily there, highlighting the urgent need for updating the hospital. "Equipment is old and outdated and has been in use for the past 20 years," Dr Fahima Sikandari Khalid, the director of the Malalai hospital, told IRIN. "The majority of women give birth without any anaesthetic, so you can imagine how painful it is," she said. The most common complications during birth were stillbirths and deformities. The doctor added that there was no surgical equipment to use to operate on newly born infants. Facilities to improve hygiene at the hospital were also urgently needed, Khalid explained. "UNCHS [United Nations Centre for Human Settlements - Habitat] was temporarily helping with the disposal of the placenta, but this has now stopped, and it is being dumped in the grounds of the hospital," she complained. Equipment to monitor a baby's progress once it is born is virtually nonexistent. There are no machines to check the heartbeat and only two out of the four incubators are working at Malalai. "There is no ultrasound machine either," she said, reading out a long list of problems the hospital faced. Khalid did acknowledge that they were now able to provide 80 percent of medication at the hospital with the help of the International Committee of the Red Cross (ICRC). However, there was an immense need for more ambulances, and doctors from abroad to visit Afghanistan to offer assistance in training medical staff, she said. During the Taliban era, the number of doctors at the hospital was reduced by half. "There were two male doctors working for us, too, which the Taliban did not know about," Khalid said, adding that silly rules and regulations were also imposed on them. "The Taliban told us that we should not be wearing our clean uniforms, that we should be wearing old clothes, so that we don't look attractive," she explained. There are 45 doctors at the hospital, but she hoped that another 45 would be recruited to cope with the increase in patients. "More women are visiting us since the Taliban left," she said. The need for trained staff is a priority, according to Ahmed, who explained that there was a huge loss of manpower in the country after the Mujahidin started fighting in the early 1990s. "One of the best strategies to combat the high maternal-mortality rate is to train traditional birth attendants," he said. "Their main aim should be to conduct a clean delivery, and to recognise complications straight away," he added. Although aid agencies were present in Afghanistan for some years and were supporting the system, it was still far behind what it should be, Ahmed said. The Taliban inherited a poor health care infrastructure, but they added to its downfall by restricting women from working, even though females were "exceptionally allowed " to continue working in this field, he said. "There would have been more female doctors if the Taliban had not stopped them." Ahmed said the poorest health care on offer was in the rural areas, citing an example where a baby was delivered headless after getting stuck and detached from the body. "The mother was living in the Hindu Kush, and travelled for three days to get to Jalalabad, and was operated on to remove the head from inside her," he said. Women living in rural areas also faced the problem of being unable to afford transport to reach a hospital. "The woman will just lie there and die," Ahmed said. Poor nutrition is one of the main factors exacerbating complicated births, according to the doctor, who said that, culturally, men were always the first to eat in Afghanistan, a country where there could be no food left on the table before it was time for the woman to eat. In order to combat this problem, Ahmed said, there was a need for health awareness and education. Afghans needed to know how to control diseases and improve health care. "Without health there is no development, and a healthy society can provide a healthy future for the country," he added.