Supporting Mirwais hospital in southern Afghanistan
The ICRC's head of delegation in Afghanistan, Reto Stocker, talks about the ICRC's ongoing assistance for surgical services at Mirwais hospital in Kandahar and explains why the organization has upgraded its support to include the entire hospital.
What is the history of the ICRC's partnership with Mirwais hospital?
When it arrived in Kandahar in 1996, the ICRC's main concerns were to begin visits to security detainees and to support Mirwais hospital with particular emphasis on surgical services for the war wounded. Shortly after its arrival, it rehabilitated the surgical department by bringing in two expatriate teams. It established a blood bank, an X-ray department and a laundry service, whilst providing all surgical medical supplies. The X-ray department was rehabilitated again two years ago. The expatriate team members conducted training programmes for their Afghan colleagues to the point that their own presence could be reduced in 2001, though at least one surgical expatriate has remained in place to monitor progress and strengthen the knowledge and skills of local staff.
How has the local population benefited from the ICRC's support for the hospital?
Surgical services to the war wounded and other patients have increased and improved markedly over the last decade that the ICRC has been involved with the hospital. In the first six months of this year alone, surgical teams carried out more than 2,800 operations, and of these, almost 2,500 were emergency interventions.
Of course, eleven years of ICRC support for Mirwais hospital have only gone some way to alleviate the consequences of decades of conflict, a total lack of investment as well as administrative and managerial know -how and chronic social problems such as the poor level of education. These of course are all general challenges of working in southern Afghanistan. Nevertheless, the surgical department at Mirwais hospital stands as an example of positive change wrought by long-term investment and support by the ICRC. Patients now receive a good level of basic surgical care in a department run by Afghans.
Looking ahead, how do the ICRC and Mirwais hospital plan to develop their relationship?
The ICRC and the Afghan Ministry of Public Health have signed an agreement that establishes the ICRC as the principal donor and implementing partner of the Ministry in Mirwais hospital. Under the agreement, the ICRC and the Ministry are jointly responsible for raising the standards of hospital services as stipulated in nationally standardized health care polices devised by the ICRC, the Ministry of Public Health and a number of other health actors. Mirwais, however, remains a hospital belonging to the Afghan Ministry of Public Health. The agreement does not preclude other actors being involved in the hospital but the ICRC believes that improvement to hospital services and patient care will be maximized if efforts are channelled through one actor. Better needs assessment will lead to a more efficient use of resources.
How is this agreement already benefiting the hospital and its patients?
The ICRC's present focus is to ensure the hospital has the necessary equipment and senior medical staff to be able to meet patient needs in the future. Also, it aims to strengthen the ability of senior administrative management. The ICRC has therefore brought in an ex patriate programme manager, a hospital administrative specialist, a teaching nurse and an additional specialist position that is rotated every three months. A central pharmacy has been set up with branches in most hospital departments and the ordering system has been improved – the expatriate pharmacist will return later this year to consolidate the system. A specialist in obstetrics and gynaecology has recently arrived to evaluate the best way of moving forward in a particularly challenging department. Measures taken to improve the skills and knowledge of the nursing staff will continue this year and next.
In the coming months, the ICRC will replace the main hospital water tank as the existing one is about to burst. It has also started to provide non-medical items such as stationery and is currently looking at ways to improve the standard of general maintenance.
And looking further ahead?
Next year, the ICRC is planning to increase its expatriate presence which currently consists of the project manager, hospital administrator, teaching nurse, surgeon and rotational position. They will be joined by a full-time pharmacist and a specialist in obstetrics and gynaecology. In addition, a local facilities manager will be recruited to manage the installation of more technical equipment as the abilities of Afghan staff begin to increase. The positive impact on patient care will become much more visible as these measures are implemented.