Dr. Jamshi, specialist physician, agrees. Just one year ago, many critical patients had to travel long distances for emergency treatment, and some didn’t survive. “Now, we have trained doctors here every day, every hour and we are well equipped to face many challenges,” he says. “Critically ill babies, children with appendicitis, motor vehicle accidents, we can handle so much more.”
These improvements have occurred through the Ministry of Public Health’s efforts, with support from the World Bank and Afghanistan Reconstruction Trust Fund (ARTF)’s System Enhancement for Health Action in Transition (SEHAT) program. The program’s objective is to expand the scope, quality and coverage of health services provided to the Afghan people, particularly the poor, women and children in Afghanistan, and to support the Ministry of Public Health’s efforts at stewardship.
The programs transformed the Rukha facility in early 2012 from a basic comprehensive health center to a 40-bed district hospital. On average, the hospital currently serves at least 100 patients a day, says Dr. Jamshi. But with an estimated population of about 150,000, a multitude of patients can arrive at any moment.
“We are always ready now because life here can be difficult,” says Dr. Jamshi, gazing across a mountainous landscape that has held off centuries of invaders.
Mohammad, advisor for the Ministry of Public Health, says numerous improvements have been made at the hospital. The program now helps purchase equipment, medicines, and train staff. Currently, the hospital employs two surgeons, two general physicians, three midwives, a specialist physician, an ear, nose, and throat specialist, and a dentist. But the gynecologist left a few months ago.
High staff turnover has been a problem, notes the hospital’s head, Dr. Karamkhil, who arrived recently at the facility. In fact, Dr. Jamshi, also started at the hospital only a few months ago. “It is government policy to send doctors out of the city to work in rural areas where they are most needed,” explains Karamkhil. “But it can be a challenge for some because of the schools and lack of other things.”
Karamkhil, who is married with three children in Kabul, plans to commute three or four hours to the capital daily. Jamshi is single and lives with family in Panjshir, while other doctors, like Dr. Amir, stay at the hospital during the week, then drive to Kabul for days off. Khuram has been with the hospital since its upgrade.
“Because of Dr. Khuram, this is now a very, very good hospital,” says Karamkhil, nodding at the surgeon whose solemn eyes and steady hands conducted 190 operations last year, and managed almost 80 more procedures in recent months.
“When we first came, no one knew that we were here and what we could do,” recalls Khuram. “Before, it was a building with very little equipment and staff, but slowly we have watched it grow.
“Although it is still a small hospital, I think we now offer higher quality service than many others. Some patients even come from Kabul for our help,” he points out. But keeping staff in remote areas is a challenge, the surgeon acknowledges. This is also because government regulated pay levels are low compared with some other provinces where non-governmental organizations still implement health care services. But Khuram is adamant that money shouldn’t be important.
“Do you think if we receive less money then we shouldn’t help our people?” he asks. “This should be our duty.” The surgeon is satisfied at the hospital, he says. He is only waiting for a proper scrub room and new anesthetics machine. The equipment delivery is delayed because paperwork was burned during a recent suicide attack at the Panjshir Governor’s compound.
Counseling and care
In a hospital annex where local mothers receive counseling and deliver their babies, midwife Zhila says she has watched the facility’s transformation with satisfaction, and is also pleased with her job. She is only concerned with the need for a new gynecologist. Just two nights ago, a heavily pregnant woman left the hospital because no one else could operate the ultrasound machine.
“I could not hear her baby’s heartbeat and I suggested that we deliver the baby quickly, but the husband took her to the next hospital miles away, even though I told him this was very dangerous.”
Back at the children’s ward, Freshta, mother of two-month-old Yalda, says she has watched the hospital improve over many recent visits with each of her five children. At the moment, Yalda is sick with pneumonia, and an intravenous tube, strapped to her tiny, waving fist, is medicating her. “Now they have more beds and the doctors are here all the time,” says Freshta, 28. “We couldn’t afford to go somewhere else. My husband is just a police officer. I think we would be left sitting at our house and hoping the children got well.”