Fieldset
Acclimatizing to Kabul

"Years of war and political instability have decimated the country’s economy and healthcare infrastructure. Due to this, most pregnant women are not able to access prenatal care and all too often their first contact with the health care system in pregnancy will be in an emergency or in labour."

My alarm wakes me at 6:40 am. I let the music play briefly until it’s overtaken by the “tak-tak-tak-tak” sound of helicopters overhead. For a moment I wonder if they are landing on the roof of the MSF compound. But I know they’re not, and there’s nothing to be concerned about. I’m just adjusting to life in Kabul.

Helicopters are just part of the background noise in Dasht-e-Barchi (DeB), a sprawling and densely packed corner of the Afghan capital. I’m stationed at MSF’s maternity project in this rapidly growing area. DeB was settled when internally displaced persons fleeing instability settled in Kabul following the ousting of the Taliban regime in 2001. Inhabitants come from neighbouring countries and many areas of Afghanistan. Although estimates are crude, the maternity hospital is the only comprehensive obstetrical care facility that offers care free of charge for the estimated 1.5 million people living in the district.

Posted on the hospital entrance

We are fortunate that the strict security protocols allow us sometimes to walk through the market and small shops during the daylight hours. It allows a glimpse into life in this bustling city. The morning air is crisp, not surprising given Kabul is nearly 1800 meters above sea level. The surrounding mountain ranges are impressive but often obscured by thick grey smog. Traffic crawls down the street as cars, buses, motorcycles and rusted bicycles weave around one another. The sounds of car horns and conversations over tea are muted by the humming of the diesel generators that power nearby shops and stalls. Everything and anything from locally grown fresh produce to imported clothing and electronics is available. Electricity, on the other hand, is unreliable at best.

Mountains around Kabul on a clear day. Photo credit: Christine Nivet.

I had only planned to transit through coordination in Kabul before heading onward to a maternity project in Khost. Due to delays in air transport I will now spend a week in the Afghan capitol. In a few short days I’ve been warmly welcomed into the team and have discovered that there is more than enough work to keep me busy here.

The project in DeB was inaugurated in 2014 and anticipated about 600 deliveries a month. The hospital has seen an exponential growth in patient numbers and now provides care for more than double this. It averages over 1200 deliveries a month, or about 15,000 per year. Years of war and political instability have decimated the country’s economy and healthcare infrastructure. Due to this, most pregnant women are not able to access prenatal care and all too often their first contact with the health care system in pregnancy will be in an emergency or in labour. Several organizations, including MSF, are providing the backbone for health care in several parts of the country.

MSF vehicle at the Basht-e-Barchi hospital 

My first morning of work, I’m introduced to the large team of midwives, nurses, gynaecologists and paediatricians. The 8 bed labour room is full with women in active labour, as are the 5 delivery room beds. There is never a dull moment at the DeB hospital.

Immediately after the introductions, a midwife calls us over to assess a young woman pregnant with twins. This is her first pregnancy and she has been fully dilated and pushing for quite some time. Together with the local doctors we decide to help deliver the first baby with a vacuum. We then safely deliver the second smaller baby and reunite the mom with her twin girls.

The day continues with a relentless stream of patients, some straight forward but many with complications including infections, bleeding, eclampsia, prematurity and breech presentation. On rounds at the end of the day I see most women smiling and feeding their newborn babies. But not everyone is so fortunate. In a system where preventative medicine is nearly inexistent, it is an unfortunate reality that maternal and neonatal mortality rates in Afghanistan are the highest outside the African continent.

After a busy day I’m thankful for a communal dinner with the expat team. A game of UNO follows and then I retreat to my room, warmed by the bukari (a diesel fuelled heater). It’s barely 8pm and I’m exhausted. The window is ajar to dissipate the fumes and I allow the sounds of traffic and generators of Kabul to lull me to sleep.