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Southern Afghanistan: a day in the children's ward at Mirwais Hospital

15-12-2010 Feature

Mirwais Hospital in Kandahar is a government-run 350-bed medical facility with over 500 staff. Christian Shuh, a paediatric nurse, is one of 21 ICRC medical specialists – nurses, surgeons, gynaecologists, nutritionists and doctors – who provide extensive support to this war zone hospital.

I work in the children's ward of Mirwais Hospital in Kandahar, in southern Afghanistan. I work for the ICRC and my job is to support paediatric nurses, especially in emergency situations, and to advise my Afghan counterpart, Miss Alia, in her daily work as head nurse of the paediatric unit.

We receive many young emergency patients here. Mirwais is the only public hospital within a radius of several hundred kilometres and treatment is free of charge, so there are great needs but help is offered to everyone.

We start the day in a convoy of Red Cross vehicles that travel 500 metres to the hospital from our compound, along with the team of 21 expatriate doctors, nurses and invaluable Pashto-speaking medical support staff. Security on this very short commute is never guaranteed.

First thing this morning: Britta, a Danish paediatrician, and I were met in the busy hospital hallway by two stone-faced men who gestured to us to enter the intensive care unit. The night shift staff, Essa Mohammed, Omar Shah and Dr Ammanullah, were gathered around little three-year-old Jacoub, who had made the dangerous journey to the hospital with his father and uncle. Their entire family had also arrived, and were waiting anxiously, seated on the floor in the corridor. Jacoub had been sick for more than a week with pneumonia and his condition was very serious. My colleagues made the diagnosis of septic shock, and we began to administer infusions and essential antibiotics.

Jacoub was breathing fast, too fast. We provided him with oxygen for additional relief. We drew blood samples for examination in the lab and gave Jacoub a half litre saline infusion. The whole team worked closely together and Jacoub's breathing, pulse and blood pressure soon began to stabilize and his family began to feel reassured after a long and tiring journey from their village.

8 am: Colleagues arrive for the day shift, eight paediatric nurses from Kandahar and the surrounding regions. Head nurse Alia is the only woman in the department, and together we make the morning rounds, review our 85 young patients and discuss their cases with their families. Five new young patients were admitted overnight with a range of injuries, wounds and ailments.

9 am: Faith, our Kenyan midwife, calls me urgently to the delivery room on my walkie-talkie. A newborn is struggling with breathing and circulation after a long and difficult birth. Faith and I manage to stabilize baby Roshana in her first crucial 10 minutes of life, bringing her breathing to normal and keeping her warm – it's getting cold in Kandahar. We transfer the tiny patient to the children's ward and into an incubator. Though busy monitoring vital signs, comforting families, and administering medications for seven newborns and premature infants, Mr Shamshullag, our neonatal nurse, has already prepared Roshana's incubator with oxygen and intravenous fluids.

10.30 am: In Miss Alia's office, we make arrangements for a staff training course. The nurses need better understanding of the safe handling of blood and the preparation of blood cultures. We agree that Miss Alia is responsible for the preparation of the training room and coordinating our colleagues, while I will prepare the training materials. I keep it simple, practical and effective: demonstration and visual learning work best. After the session, as usual for my Afghan colleagues, it's time to pray and to eat.

Every day we see malnourished children, children with infectious diseases that could have been prevented through vaccination, children with chronic illnesses that need regular treatment, or children with diarrhoea caused by dirty water. Sadly, the basic health service is not working as it should, medical staff need a lot of support, and the ongoing conflict means that simply traveling to hospitals can be both difficult and dangerous.

Why each contact with a patient is so important for me

2 pm: In the children's ward I make sure our young patients have been fed, examined and given the right medication, and that their exhausted families are fully informed. Urgent cases tend to come in during the night, so the emergency rooms and the neonatal intensive care unit require our full attention in the morning. So the afternoon allows me to visit the general paediatric ward at a more leisurely pace.

Here Khadija, a seven-year-old girl I've been attending to for almost two weeks, is waiting for me. She is suffering from meningitis and tuberculosis. This is life-threatening but her condition has been improving, although it will take time. She spent the first days in the paediatric ward trying to regain consciousness. Zinullah the nurse and I tried to draw out some response from Khadija, to help her to play and talk like other kids, but she was too weak.

Today however, in addition to the shy little smile which we have become accustomed to in recent days, Khadija speaks - a whole sentence! We look at each other, delighted. Zinullah proposes inviting the physiotherapists to help give Khadija an extra boost, a great idea. We ask the doctor to make the arrangements.

Whenever someone asks me how the work here in Kandahar is different from that in my home country, Germany, it is difficult to answer. It's much busier here, with more demands and needs, but on the other hand I appreciate the more direct interactions with colleagues, parents and patients. For example, Jacoub's recovery this morning, his family and the teamwork needed in helping him brings me closer to those in need. Unfortunately not all children have as much luck in Kandahar although every day my Afghan colleagues at the hospital make enormous efforts and unimaginable sacrifices to bring relief to those in need.


An ICRC nurse talks to Rokia, whose two-year-old son is being treated for tuberculosis at the paediatric unit of the Mirwais Hospital in Kandahar. 

Christian Shuh, a paediatric nurse, talks to Rokia, whose two-year-old son is being treated for tuberculosis at the paediatric unit of the Mirwais Hospital in Kandahar.
© ICRC / K. Holt / v-p-af-e-01650

Christian Shuh attends to a premature baby at the paediatric unit of the Mirwais Hospital in Kandahar. 

Christian Shuh attends to a premature baby at the paediatric unit of the Mirwais Hospital in Kandahar.
© ICRC / K. Holt / v-p-af-e-01659