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Afghanistan: Strength and kindness on the maternity ward

Gynaecologist Katharina Thies introduces some of the patients at Khost maternity hospital, as they face tragedy and joy together...

Shakila is feeling better now, still a bit pale, but sitting upright on her bed in the obstetric ward. When she arrived at Khost Maternity hospital two days ago, she had severe hypertension and life-threatening bleeding.

Shakila

She was expecting her sixth child, but unlike the other mothers in the ward, she won´t be taking a baby home. Her little baby had already died in her womb when she reached the MSF facility.

Shakila lives in a small village over an hour drive from our hospital, without access to free antenatal care and without enough money to pay a private clinic for check-ups. This meant, her high blood pressure went undiagnosed and untreated – until the bleeding and the pain started, due to a premature separation of the placenta.

Upon seeing that the baby was hungry, Shakila offered to help in an instant

Our team was able to treat the hypertension and give blood transfusions to save Shakila’s´ life – but it was too late for her baby.

Sadly, we see these cases on a regular basis in Afghanistan, many of which could be avoided with proper and free-of-charge antenatal care.

Amina

Being a woman in Afghanistan is undeniably hard in itself, even without having to grieve the loss of your child. However, during my assignment as a gynecologist at Khost Maternity Hospital, the women I have met here handle whatever life puts them through with acceptance and grace.

When I visit Shakila for ward rounds this morning, I find her breastfeeding a newborn baby. Confused for a moment if I have the right patient, I double-check the file in my hand. But then the midwife standing beside us fills me in.

The baby belongs to Amina, whose bed is next to Shakila’s and who doesn´t have enough breastmilk yet. Upon seeing that the baby was hungry, Shakila offered to help in an instant. Without second thought and regardless of her own grief.

This seems extraordinary, but is just a small example of how I experienced the women of Khost. I believe many of them would do the same act of kindness for another woman. They support each other in any possible way.

Fatima

And they are incredibly strong. Fatima is young, I would estimate not more than 20 years, but no one really counts their birthdays here. She is nine months pregnant with her first child and when I meet her, she´s already in labor.

However, her right leg is immobilized with an external fixator, leaving her unable to bend her knee, let alone walk. She has tied a cord around her foot with which she lifts her leg to mobilize at least within the bed. But professional orthopedic aids like crutches or a wheelchair were not accessible for her.

Fatima’s mother was able to bring her back into the house, not without being shot herself

Fatima’s mother, who is accompanying her, tells me the horrifying story. It happened in September last year, shortly after she had found out that she was pregnant. Fatima had just left home to run some errands when fighting broke out right in front of the house.

Fatima got caught between the lines and her leg was severely wounded by gunshots. Fatima’s mother was able to bring her back into the house, not without being shot herself luckily not as severely as her daughter.

What followed for Fatima was an odyssey of visits to doctors, several surgeries and months of immobilisation during which her pregnancy progressed.

In awe

The midwife in the labor room is concerned whether Fatima will be able to give birth naturally since she cannot leave the bed. But Fatima is motivated to try. For a woman in Khost Province a caesarean section is often not the best option, considering the average number of children is six or more.

Childbirth has never been easy or pain-free, but commonly used pain relief like laughing gas or epidural anesthesia is simply not available here. Women here usually deliver without any analgesia at all. And Fatima can´t even stand or move during the contractions like the other women in labor do to cope with the pain.

I am very proud of her and in awe of her strength – which without doubt she will teach her little daughter as well...

Her mother is sitting behind her in the bed though, supporting her upper body, and between contractions Fatima rests her head on the mothers´ shoulder. Whenever the labor pain is too intense, she simply bites in her scarf to endure it.

And her motivation and endurance pays off – after nine hours of labor, Fatima delivers her baby girl vaginally. I am very proud of her and in awe of her strength – which without doubt she will teach her little daughter as well.

Gul Meena

Another woman who will forever stay on my mind is Gul Meena. The first time I meet her is in the labor room, she is pregnant with twins and treated for pregnancy induced hypertension.

I estimate that Gul Meena is in her late thirties. She is already a mother of eight children and like many Afghan women, she also manages the entire household at home. She speaks loudly into her phone, and although I don’t understand the words, my guess is that she’s giving directions on how to run the home in her absence.

Many mothers would probably be a bit overwhelmed by the prospect of raising twins, but I see no such sentiment in Gul Meena´s expression

All the while she´s smiling, as if she knows already that it will be a mess anyways upon her return. It´s not surprising that her blood pressure is a bit high this morning. Either way, she gives the impression that the impending arrival of  twins is not really her greatest concern.

Twins

I found this kind of “not a big deal” attitude in many women here. Giving birth is just something you do, no need to think about it too much.

Gul Meena delivers her twins the following day, assisted by a trained midwife – without any complications. When I visit her in the obstetric ward on my rounds, she´s sitting cross-legged on the bed, smiling her broad smile and wrapping up the twins, two little girls, in the traditional Afghan baby outfit, which looks like a cute sushi roll.

Many mothers would probably be a bit overwhelmed by the prospect of raising twins, but I see no such sentiment in Gul Meena´s expression. She´s looking forward to returning home, where she will have to manage her big family no doubt, but where taking care of children is also a communal task.

Kindness

After I sign her discharge papers, Gul Meena has one final request: she asks me to give a name to her second-born twin. Although I have heard plenty Afghan women´s names by now, I have no idea what would be a beautiful name for a girl – so I hesitate.

No worries, Gul Meena says, and asks my name. She says she will just name her daughter after me. I have been very kind to her, she says. But, I think, this is just a reflection of the kindness the women of Khost have shown towards me.

Gul Meena makes my day and my week with this, and I am so honored that one of these cool women now carries my name.

The Afghan women´s strength and compassion are inspiring as well as their acceptance of life as it is and how they try to find some joy in it. I am forever grateful for everything they have taught me.

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