The quadruplets – Bismillah, Rahmadullah, Rhiniullah and Rahima – lie all together in an incubator in our neonatal intensive care unit in Boost Hospital in Helmand province, Afghanistan. The mother delivered all four of them naturally without problems. Actually they’re all doing quite well, but they are premature. In Helmand even a few weeks of prematurity can mean big risks for the child.
Many newborns, who would not face big problems in well-equipped hospitals in other parts of the world, don’t survive here. The war, poverty and the lack of development here mean that the standard of hospitals is much lower than what I was used to back home. The technical possibilities are limited, the rooms in the hospital are too small, the beds are too full and the resources scarce. We lack staff to be able to give every child the best possible care. But even hiring more people is difficult, as the number of well-educated healthcare personnel is limited in Afghanistan. In addition to that, many people in this province are poor, so malnutrition is a big problem and there’s a lack of education.
And it’s difficult for people to reach a healthcare facility. Many live far away from the city, often in areas where there is heavy fighting and any time they travel on the road there is a risk. This is part of the reason why many people come to our hospital in critical condition. For some of them, it is too late. Sometimes it’s too difficult for a family to care for a premature child because they have many other children to take care of and cannot stay in the hospital for the required treatment or cannot care adequately for the newborn after discharge.
Nevertheless and fortunately, there are many patients we can help. For example, we admitted a newborn in critical condition with severe meningitis. At the beginning I did not think he would survive, but it turned out that I was wrong. He is improving every day and I think we can discharge him soon. Our quadruplets are over a week old now and still doing well. We will do everything for them so it stays that way.
Many people in medical school have thought about working in humanitarian aid. Last year I decided to do so and I applied to MSF. Until now I was working as physician in general paediatrics and neonatology in a hospital in Freiburg, Germany. I wanted to help people in need and to go where my skills are most useful. At the same time I was looking for a bit of adventure. Since October last year I’ve been working for MSF in Afghanistan in a relatively big hospital of 285 beds.
The people here are in need because of the enduring armed conflict in the area, which has been going on almost without interruption since 1978. The poorest part of the population suffers the most from it. Five years ago MSF decided to open a project in Helmand, in the south of the country, because of the needs and a lack of functioning healthcare facilities in the area. Today we are running Boost Hospital – the provincial hospital of Lashkar Gah – in cooperation with the Ministry of Public Health.
My position here is a supervisor for the paediatric and neonatal intensive care units. It means that I am working together with my Afghan colleagues and support them with know-how and advice in patient treatment. I also conduct trainings, develop treatment protocols and my work includes a lot of management of the department too.
The wards are not what I was used to in Germany. For example, our intensive care unit is almost always overcrowded; sometimes we have to put up to three patients in one bed. But we cannot reject patients, because they have nowhere else to go to. We have a high mortality rate because patients come too late or they suffer from a condition we cannot manage with the limits of our hospital and that can be quite frustrating. But there are good moments, when you see a premature baby, whose survival was at stake two weeks ago and now it can be discharged healthy. Those are the moments that keep me motivated.
Our radius of movements is very restricted due to the security situation. We cannot leave our living compound, except to go to the hospital and back by car. On the weekend (which is Thursday and Friday here) we cannot just go for a walk, not even to the shop at the street corner. That's something I had to get used to, but fortunately the team I am living with is great which makes the constraints much easier to bear.