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Afghanistan: a day in the children's wards at Mirwais hospital

17-06-2011 Feature

It is the season for summer illnesses, and the children’s wards in Mirwais regional hospital in Kandahar are overflowing with toddlers and babies suffering from diarrhoea. The ICRC's Jessica Barry recently spent a day there.

The children who make it to Mirwais are the lucky ones.  Plied with oral rehydration salts or hooked up to saline drips, most of them recover quickly and leave with their relieved parents or guardians back to their villages, often several hours away along dusty, unmade roads made dangerous by fighting.

Others are not so lucky. Last month, a newborn with a rare condition called Anophthalmia – being born without eyes – was admitted to the hospital, and then abandoned by his parents. The child, who has a mass of dark hair and long lashes, lay asleep in his cot next to other children in the paedeatric ward, a bewildered scowl on his face.  Finding a foster home, or even an orphanage that will admit a child so young, will be difficult in conflict-torn Afghanistan, where people, especially rural dwellers, have enough to do struggling for their own survival without adding to their problems by caring for a child with a lifetime disability.*

Long waits due to huge demand

In another ward, 60-year-old Mohammad Raouf was itching to go home. He had brought the second youngest of his 13 children, a girl called Madina, to Mirwais for surgery to straighten two bent fingers. But other, more pressing operations were taking precedence, and she was having to wait her turn.  Her father, who has two wives, was getting fed up.

“I miss my wives,” he remarked, sharing a quick smile with the man sitting on the other side of his daughter’s bed.  “I want to go home, but my neighbour here – he pointed to the man whose son lay in bed with a broken leg – persuaded me to stay.”  

Asked about his large family, Mohammad Raouf shifted his grey turban more comfortably on his head, and admitted that in addition to his 13 living children, he was the father of another 18 babies who had either died at birth, or soon afterwards.  “We need large families,” he said. “Our boy children will help us in the fields, and our girl children will go to their husband’s home.”

Mr Raouf’s family is no stranger to Mirwais. Another of his six daughters spent time in the female ward a year ago, after accidentally burning herself with boiling water.

Children with chronic illnesses and blood disorders fill wards along with the injured

In addition to the many victims of accidents and patients with seasonal diseases -- some of which reach epidemic proportions during the hot dusty Afghan summer -- children with chronic maladies and blood disorders fill Mirwais’s busy wards as well.  

Dr Alem Shefa, a burly man with a confident voice, has been doing research for one year now into Thalassemia, a congenital blood disorder that is prevalent among children in Afghanistan.

A native of Paktia province,  Dr Shefa (53) wanted to become a doctor whilst still a schoolboy.  “It was during the time of King Zahir Shah,” he recalls, “and there was a mobile cinema which came to the school and showed films about health and education. I was inspired, and thought it would be a good way to help my people.”

His father and elder brother, an army officer, encouraged him to seek a medical career.

After graduating from Kabul university, Dr Shefa worked in many parts of Afghanistan, and then for several years in the capital, before being deployed to Mirwais by the Ministry of Public Health (MoPH) two years ago.  The hospital, which has a catchment of some four million persons throughout southern Afghanistan is run by the MoPH with support from the ICRC.  

A few days ago, Dr Shefa returned from Istanbul where he presented a paper on Thalassemia to a large audience of doctors and medical specialists from around the world.

What struck him most was the age of the patients in the other doctors’ case studies. “I found it so strange to hear about patients with Thalassemia who were 60 years old”, he said with an astonished smile. “We don’t have such patients in Afghanistan.”

Blood disorder – Thalassemia – prevalent among young children in Afghanistan

At Mirwais, as elsewhere in the country, children with Thalassemia die young. They are given blood transfusions, and their iron level is monitored, but more sophisticated treatment is rare, at least for now.  

Concerned by the high incidence of Thalassemia in young children, Dr Shefa and his colleagues began registering and testing youngsters suspected of being at risk. The idea was to gain an understanding about how to monitor their condition better and to gather material for research into the disease.

The number of sick children he registered quickly rose from 50 the first month, to 135 the next and yet higher again as the months went by. Word spread amongst the families of affected children, attracting even more to the hospital.

Difficult access to medical care means few children with disorder reach adulthood

But given the harsh conditions in which children live in many rural areas of conflict-ridden Afghanistan, combined with difficulties of access to medical care in a country upturned by fighting, few children with chronic blood disorders will live to become adults; something which prompted Dr Shefa’s research  

At the Istanbul conference, Dr Shefa explained what he and his colleagues at Mirwais are doing to help children with Thalassemia. "If their haemoglobin is below 8 mg/dl during their monthly test we give them transfusions," he told his audience. "Monitoring is also done to check for iron overload, and operations to remove the spleen are carried out on a selective basis".

Dr Shefa would like to provide chelatin (iron) therapy and regular surgical assistance. But both these interventions are far down the line, not least because of the costs involved.

Ending his presentation, Dr Shefa said “I am convinced that knowing the extent of the problem is the first step to implementing appropriate assistance.”

Those attending the conference agreed, and were so impressed with Dr Shefa's research that they encouraged him to continue, and then to share his findings again in six months time

Now he wants to get the backing of the Ministry of Public Health in Kabul, to do just that.

Conflict deprives people of most basic rights, such as access to health to care

In a country such as Afghanistan where conflict makes the most basic of people’s rights -- such as access to health care --  difficult,  and where conditions are so harsh, and education so lacking that one in six babies die at birth, it was inspirational to listen to Dr Shefa’s words.  Meanwhile, images of the babies in the diarrhea ward came to mind. And the smile on the face of Mohammed Raouf with his 13 children. And the tiny scowling face of the boy without eyes.

There were other children, too, that I had seen that day; a young girl in a blue dress lying on a bench in the hospital corridor waiting for a transfusion, and a boy of perhaps 11, lying wearily in his hospital bed after an operation on his spleen.  Both of them likely Thalassemia patients.  And I was glad that such children who have to struggle against all the odds to survive, have such a champion to fight on their behalf.

“When I told people at the conference that I had come from Afghanistan, they could not believe me,”    Dr Shefa laughs. “They said, how can that be? There is only fighting going on there. You must be a refugee. I said, no, I have come from Kandahar. And they were amazed.”

 

* Since this article was published the baby with Anophthalmia has sadly died.


Photos

Mirwais hospital, Kandahar. Dr Alem Shefa, who is working on research into Thalassemia in children at the hospital. 

Mirwais hospital, Kandahar. Dr Alem Shefa, who is working on research into Thalassemia in children at the hospital.
© ICRC

Mirwais hospital, Kandahar. Mohammad Raouf  brought his daughter, Madina, to the hospital to have her bent fingers straightened. 

Mirwais hospital, Kandahar. Mohammad Raouf brought his daughter, Madina, to the hospital to have her bent fingers straightened.
© ICRC / J. Barry