We have a big challenge to overcome!
Badghis is a province in the northwestern portion of Afghanistan. Like much of Afghanistan, the province is rural. And, like much of the country, it suffers from a lack of health facilities and trained health professionals. In fact, three of the six districts in the province have no physicians at all, despite the fact that it is home to an estimated 72,000 people.
Parwana, 55, is sitting on the floor of the pediatric ward feeding two premature babies with milk bottles. There is no health staff in the room. The babies look around 900 and 1000 grams. “They [were] born five days ago and as there wasn’t a room for [their] mother, we sent the mother of [the] babies home to rest,” said Parwana, the aunt of twins.
In other places babies with this low of weight are kept in an incubator and fed with a nasal tube, using the mother’s milk with a trained midwife or nurse and a neonatal specialist observing the babies in each moment. But, in Qala-I-Naw hospital there is no neonatal unit and no trained staff.
Mothers or relatives are responsible for taking care of their premature babies and they have less hope for children to survive.
“We have to feed the babies with cow milk. I am sure they will die.”
“We have to feed the babies with cow milk. I am sure they will die,” says Parwana. “I pity for their mother.
[She] carried them for eight months with difficulties [as] she had to work on [the] farm and take care of her other children as well. But, if they die, I don’t know what I should say to her,” she says, hopeless and tired.
Conflicts, insecurity and a lack of growth have caused Afghanistan to be one of the worst countries in the world when it comes to appropriate and accessible healthcare.
Over the past few years, there had been important and vital improvements, especially in the area of decreasing the child and maternal mortality rates in some areas. But, poverty is still common at the same time that health staff and social services remain scarce.
“The father of babies is [a] shepherd. He had to sell his sheep to provide transportation to transfer his wife to hospital and now he came back to our village with his wife to sell more sheep to buy milk for babies.
"If we transferred [the] mother to hospital 10 minutes later, [the babies] would have been delivered in our neighbour’s car,” says Parwana.
“Last night while I was feeding one of the babies with the bottle...
“Last night while I was feeding one of the babies with the bottle, her colour suddenly changed and got cyanotic.
"She breathed with difficulty and her chest made sounds.
"I [was] afraid and called the nurse loudly but she was alone and busy helping a 5-year-old. I cried and requested her to help the baby, but she looked at me and tried to calm me.
"I understood that there is no way except waiting, so I started to pray. After about five minute, she came to my baby in [a] hurry and helped her to breathe,” she remembers.
Badghis is a province in the northwestern portion of Afghanistan. Like much of Afghanistan, the province is rural. And, like much of the country, it suffers from a lack of health facilities and trained health professionals.
In fact, three of the six districts in the province have no physicians at all, despite the fact that it is home to an estimated 72,000 people.
The capital city of Qala-I-Naw has the only hospital in the entire province. Primary health care is provided through a system of basic health units (BHUs), small and simple facilities that provide primary care.
The graph below indicates comparison of deliveries in two years
If we look deeply [at] the other province of Afghanistan, hospitals in general not only suffer from a lack of health staff, they also often lack the necessary supplies and equipment. In Qala-I-Naw the situation is completely different.
They have sufficient neonatal equipment, provided by other NGOs. The problem is the equipment is stored in a small room as there is no provisional staff with the knowledge and training necessary to use them even though 14 per cent of the babies are born in complicated situations and really should be kept in neonatal units.
“The equipment is sitting there, available to be used, but is not being used,” say Firoza, a doctor in the Qala-I-Naw maternity hospital.
It is worth mentioning that although there is enough space to establish a neonatal unit in this hospital to date no one has done anything.
In some provinces, such Qala-I-Naw, there is a serious shortage of qualified medical staff to provide care in the health centres. This is the case here.
“Some new doctors and midwives, after graduation, come to this province for working. But, after two or three months they resign and prefer to work in a foreign NGO or leave [this hospital] due to lack of ease of life,” explains Dr. Mohammadi, head of Qala-I-Naw hospital.
“Many times we tried to have a neonatal unit but each time as we didn't have a trained midwife in the neonatal unit, we had to transfer complicated babies to the pediatric ward, where all children with different illnesses and ages are being [watched].
"Even the pediatric ward is severely understaffed, with just one doctor,” said Head of hospital, Dr.Mohammadi.
The vital care a small baby receives in the first few hours, days, and weeks of life is crucial to their chance for a bright future. Any inattention or insufficiency during this period can cause irreparable damage to the minds and bodies of the babies.
“Midwives and neonatal nurses provide a vital service supporting mothers and babies and more money needs to be invested in neonatal services and staffing to give the most vulnerable babies the best start in life,” says Dr. Mohammadi.