Afghan women heard at medical engagement

Published June 3, 2008
By Capt Jillian Torango
Panjshir Provincial Reconstruction Team

PANJSHIR PROVINCE, Afghanistan -- During a medical engagement in the remote village of Dah Khawak, Afghanistan, Thursday, forty-eight burqa-clad women found their voices as they were treated by female healthcare providers; some for the first time.

Each appointment started out the same. A local Afghan woman came into the woman's clinic, which was actually the sleeping area of a local family's mud home, removed the all-concealing blue burqa and sat down in front of a female healthcare provider. Two of the female healthcare providers are assigned to the Cooperative Medical Assistance Team at Bagram Air Field, Afghanistan.

Once in the clinic, a female interpreter welcomed each patient and asked her about her health concerns. Almost all the women echoed the same complaints: headaches, and pains in their kidneys and backs. Each thought her pains came from drinking the local water. Because of this belief, the women limit themselves to drinking less than one cup of fresh water per day.

Many of the women brought their young children, some of whom were still breastfeeding. They did not understand why their children were small and not seeming to grow.

Navy Chief Petty Officer Quala McGhee, a CMA provider deployed from Great Lakes, Ill., handled these issues. Through her interpreter, Chief McGhee tried to explain that the women and their children were all malnourished and suffered from severe cases of dehydration. She then provided them with prenatal vitamins so both the mother and the child would benefit from the extra vitamins and nutrients.

The Afghan women all start with common complaints, but once they are comfortable with the healthcare provider, their real medical issues or concerns are voiced, said Navy Cmdr. Betsy Myhre, a nurse practitioner deployed from the U. S. Navy Bureau of Medicine and Surgery in Washington, D.C.

"These women come to us with basic health complaints, but once we address those issues, we have an opportunity to assess them further and identify other women's health issues that can be treated and improve their overall health," said Commander Myhre.

"This might be the only opportunity these Afghan women have to be seen by women providers. We can consult with them and let them know their issues are important to us."

The engagements empower women by giving them an opportunity to seek care for themselves and discuss their health issues in confidence with a women's healthcare provider, said Commander Myhre.

"We discuss their issue and if there is a health problem that requires a capacity we do not have available, [like] radiology or surgery, we explain the issue and write a referral to the local Ministry of Public Health hospital or the Egyptian Hospital on Bagram," said Commander Myhre.

Typically, once the referral has been written, most of the women find a way to get to an Afghan doctor to be seen.

Medical engagements are also an opportunity to get the local Afghan medical providers involved. Chief McGhee said that by having local medical providers partner with the Coalition providers, they are building capacity as well.

"Working side-by-side with local Afghan health care providers helps ensure that follow up medical care will occur in the communities where we do provide medical care," Chief McGhee said.

Local providers might also then be able to assist with basic tasks such as providing immunizations or teaching about the importance of good hygiene. During the Medical Engagement, CMA teams brought teaching aids produced by The U.S. Agency for International Development, the U.S. federal government organization responsible for most non-military foreign aid. The CMA teams also enlisted local Afghan health care workers to teach the women in line for the clinic. Every opportunity was used to incorporate Afghan health care workers into the medical engagement and teach the patients.

Both Commander Myhre and Chief McGhee agreed the conservative posture of Panjshir province could potentially limit the amount of interaction they could have with their patients. Still, this medical engagement was much more permissive than their last.

"The great thing about Panjshir is that the women are coming to the medical engagements and we are able to treat them," said Commander Myhre, who just returned from a 14-day engagement in another province.

"The men from our last engagement didn't allow their women of childbearing age to be seen by the U.S. forces and they had to remain inside their houses until our mission was over," said Commander Myhre, who fought hard for the women to be seen at that earlier engagement, but the village elders staunchly said "no." Even though the practitioners were not able to treat women of childbearing age at that engagement, the door may be opened to allow it in the future.

"One man said to me that when the Coalition forces first arrived in the village, he didn't know if we were there to do good or bad," she explained. "But after he saw how we took care of their children, he and the other men knew that we were there for good -- that's just one small thing we bring to the fight."

It is a combination of logistical and cultural factors that make these medical engagements critical.

"There are so many people who will not receive any medical care just because they are in remote locations like here in Dah Khawak," said Chief McGhee. "It's not only providing on-the-spot medical care, it is providing medical and hygiene education to help prevent medical problems from happening during those times when no care is available."

Commander Myhre said that women's health starts with nine- or ten-year-old girls and education is the key.

"We can teach them hygiene at that early age and they'll use that information and have those habits for a lifetime," said Commander Myhre. "If we can treat a child for malnutrition issues, and also teach the mothers about the need for their proper hydration and nutrition for the sake of their babies, then we can start to improve infant mortality rates here in Afghanistan."

Both providers note the need to continue augmenting the local medical capacity with these medical engagements.

"As we are seeing the patients, it gives us an opportunity to get a really good assessment of the village from the patient's point of view," said Commander Myhre.

They can assess everything from the distance to the nearest basic health center; if there is International or non-governmental organizations providing healthcare in the local area; the propensity for domestic violence; and the need for infant vaccination clinics. This information is then included in the after action reports and relayed to the Afghanistan Ministry of Public Health representatives in that area.

By assisting local health-care providers through medical engagements, the CMA team can ensure Afghan women are provided for and continue building capacity within the Ministry of Public Health.

"You have to improve the mother's overall health status; otherwise the children of Afghanistan will never have a fighting chance to succeed," said Commander Myhre.

It takes a village...