Ground Report

With health professionals and medicines in short supply, falling ill in rural Afghanistan is always bad news. But it is a particular problem in Uruzgan province’s Dehrawud district, which has just two doctors to provide for tens of thousands of people. 

There one male and one female doctor and three female nurses in this part of central Afghanistan, in a province that is one of the country’s least developed.

The lack of care means sick people and pregnant women have to travel 40 kilometres east to the provincial capital Tarin Kowt, or to Kandahar to the south, though some die on the way.

“I have taken many pregnant women to Tarin Kowt to deliver babies, but sadly six of them have died in my presence during the journey,” Shawali, a Dehrawud taxi driver said.

District government chief Hajji Aminollah Khan said that he was angered by the lack of provision, and that the district might as well have no doctors at all.

“Perhaps this district is not part of Afghanistan,” he said. “Believe me, a mother dies in childbirth here every day, and the cause is the lack of doctors and medical facilities.”

A range of problems make it difficult to recruit medical staff in Uruzgan, not least security. Located next to Helmand and Kandahar, the province has a strong insurgent presence. On March 24, at least five people were killed by a roadside bomb in the province, RFE/RL reported.

Dr Akhtar Mohammad, one of the two doctors in Dehrawud, said potential recruits were also deterred by the low pay and lack of support from the state.

“I get paid 340 euros [445 US dollars] a month, which is nothing,” the doctor said, adding that he felt compelled to stay on anyway. “Since I come from this district, my conscience doesn’t allow me to leave…. There are two doctors left for these poor people and if we leave, too, what will they do?”

A local nurse who serves as a midwife said she was paid 300 euro a month, and was planning to leave due to the poor working conditions.

“The officials pay no attention to us. Security is a threat to us at every moment,” she said, speaking on condition of anonymity. “They [patients] have high expectations of us, but they don’t treat us properly, either.”

If medics are frustrated by their patients, one local resident said the feeling was mutual. Despite the acute staff shortage, the clinic could be seeing more patients, according to Jan Mohammad.

“The two doctors are in the clinic from eight until noon, and they don’t see patients after that,” he said. “Even if patients are brought in as an emergency, they advise people to take them to Tarin Kowt or Kandahar.”

Jan Mohammad recently took his uncle to the clinic after he developed pain in his back at ten in the evening. Staff there referred him to Tarin Kowt, but his uncle died on the way there. “He [the doctor] didn’t even give him a pill,” he said.

Dr Mohammad Nabi, acting director of public health in Uruzgan, believes shortfalls in provision here and elsewhere in the province stem from incorrect population data, on which funding allocations are based.

The Afghan health ministry provides medical services based on a census figure of 350,000, but that is 30 years out of date.

“That is a really big problem,” Dr Nabi said, insisting Uruzgan’s population had since swelled to more than 800,000.

Population estimates for Dehrawud, and for the province as a whole, vary wildly. While local sources gave IWPR a figure of 225,000 for this one district, the Afghan Rural Rehabilitation and Development ministry uses a United Nations Population Fund estimate of 51,000 in Dehrawud out of a population of 321,000 in Uruzgan. Following a study completed in 2009, the Liaison Office, an Afghan NGO, estimated 79,000 in Dehrawud and 500,000 in the province.

To address Dehrawud’s needs, a 30-bed hospital is to be built there. Ajab Nur, local representative of the non-government group Afghan Health and Development Services, AHDS, said the hospital was being funded by the European Union

Local officials have accused AHDS of not doing enough to recruit more medical staff. Dehrawud head Aminollah Khan said he had asked AHDS – which supports healthcare services in Uruzgan and Kandahar – to send more doctors and nurses on previous occasions , but has been turned down.

“They cited security as their excuse, but I told them I was responsible for security and that they should send medical personnel. They didn’t do so,” he said.

Ajab Nur insisted that security risks were a deterrent to doctors who might otherwise come to Dehrawud, as were the salary levels, which he said were out of his hands.

“On several occasions, we have suggested increasing their salaries, but [health in] Uruzgan is funded by the European Union and they won’t not agree to pay rise,” he said.

Uruzgan’s deputy governor Alhaj Khodai Rahim also criticised AHDS, saying, “The clinic’s generator stopped working in very hot weather last year because there was no fuel for it.. The patients’ relatives used handmade paper fans to cool them down. If they can’t hire doctors, why can’t they buy fuel for the generator?”

Dehrawud’s new hospital should go some way to address the district’s healthcare problems, but it comes too late for resident Mohammad Gol.

A month ago, his son fell down a well and suffered a deep wound to his head. Mohammad Gol said district clinic staff referred him to Tarin Kowt without providing any treatment. His son was losing a lot of blood and died on the journey.

“It’s government officials who killed my son. Their children get treatment abroad, but no one bandaged my son’s wounds,” he said.

Ahmad Shah Jawad is an IWPR trainee reporter in Uruzgan province.