How Many Doctors Does it Take to Get U.S. Officials to Realize the Severity of Maternal Health Conditions in Kabul?

By Christine Cupaiuolo — November 20, 2007

Don’t even try to answer that question. You’ll just be dismayed.

Back in April, I wrote about this Women’s eNews article on Afghan American filmmaker Sedika Mojadidi and her documentary “Motherland Afghanistan.” The film looks at the deplorable healthcare conditions for women in Afghanistan, and specifically at Rabia Balkhi Hospital in Kabul, which has received U.S. government support and now features the “Laura Bush Maternity Ward.”

Far from getting better, conditions there are still a mess. As the Atlanta Journal-Constitution reports, officials at both the CDC and the Afghan Ministry of Public Health are questioning whether U.S.-led medical training “pushed Afghan doctors to perform more c-sections before they were ready and before the hospital had the necessary anesthesia, sanitation and blood supply.”

Alison Young writes:

The rate of normal-sized babies dying in labor and delivery at Rabia Balkhi jumped 67 percent last year, CDC scientists in Atlanta found. Worse, the newspaper’s analysis shows these babies were nearly four times more likely to die when delivered by Caesarean section, a potentially lifesaving operation encouraged by U.S. trainers.

Afghan mothers were in danger, too. Eighteen died in childbirth there last year; two-thirds of the deaths involved c-sections, including issues with surgical skill, anesthesia, transfusions and misdiagnoses, records show.

Among them: an Afghan Air Corps pilot who bled to death in July 2006 following a c-section.

So when Afghan President Hamid Karzai’s wife chose to give birth at Rabia Balkhi in January, the U.S. military sent an 11-member medical team and critical equipment to “backstop” the delivery, said Col. Donald Thompson, who was then the U.S. command surgeon in Afghanistan. The baby was born safely without a c-section.

In “Motherland Afghanistan,” Sedika Mojadidi tells the story through the work of her father, Dr. Qudrat Mojadidi, an obstetrician specializing in high-risk pregnancies who left Afghanistan for the United States in 1973 and who was recruited by the United States to help overhaul Rabia Balkhi. He resigns after several months, frustrated and overwhelmed by the enormous task.

Other U.S. doctors who worked at Rabia Balkhi describe problems with oversight and complain of lacking the authority to effect real change. Dr. Pamela Hyde, an Oklahoma obstetrician who was there in 2003, described the U.S. program to the AJC as “just totally unrealistic.”

It’s also become apparent that the Afghan health ministry and HHS had very different goals:

The Afghan health ministry had wanted HHS to take over Rabia Balkhi and stock it with scarce supplies, according to U.S. embassy cables.

HHS refused, saying the Afghans wouldn’t become self-sufficient that way. Internal documents note that a top priority of the project was to support the newly installed Karzai government.

As a result, nobody had full authority to reform hospital practices, U.S. trainers and contractors said. The Afghan staff lacked critical management and care skills, yet many resisted change. U.S. trainers couldn’t even require attendance at classes. […]

At times, HHS’ narrow focus on training and what it would not pay for was ridiculous, said Dr. Qudrat Mojadidi, an Afghan-American who advised Thompson on the project in 2002 and 2003. HHS refused, for example, to buy fuel for the hospital’s medical waste incinerator, he said.

“They were having 60 babies every 24 hours and all those placentas were rotting out there in the hot sun of Kabul,” said Mojadidi, who paid $200 from his own pocket to buy fuel in 2003.

“Every week I’d send two or three e-mails with pictures attached” to HHS officials, Mojadidi said. “Finally [Tommy Thompson, then-U.S. secretary of HHS] sent me a letter saying what a wonderful job I was doing and how many lives I was saving. I wrote back and said: We’re not doing anything.”

When reached for this article, Thompson said he believes the hospital “is a hell of a lot better than it was when we started.” The AJC also reports that Thompson “said he doesn’t remember hearing concerns from officials at CDC or others.”

“I thought the program was well-received by everybody,” Thompson said. “All I wanted to do was make sure women were taken care of.”

Oh. My. God.

The AJC, which deserves many kudos for this reporting, has posted emails between doctors and U.S. officials (PDF) (here’s another) that describe the hospital conditions, along with a letter from Thompson to then-Defense Secretary Donald Rumsfeld in which Thompson outlines the hospital’s “successes.”

As if all this wasn’t enough to make you want to scream, hold that thought just a moment longer and check out this companion article by Young on how the United States spent $1.3 million on computerized LeapFrog talking books instead of on hospital supplies.

Oh, yes. And here’s the best part —

Never mind that rural Afghan people have never seen touch-screen technology. The U.S. Department of Health and Human Services gave LeapFrog a no-bid contract after an offhand comment by the daughter of a supporter of then-HHS Secretary Tommy Thompson, according to interviews and records obtained by The Atlanta Journal-Constitution.

It was more than a quarter of the money Congress gave HHS in 2004 to tackle maternal and child health issues in Afghanistan.

At the same time Rabia Balkhi in Kabul routinely lacked soap, hot water, proper operating room equipment and working incubators. HHS made a policy decision to focus only on training at Rabia Balkhi and refused to buy medical supplies.

The LeapFrog books sat in a warehouse for nearly two years because — wait for it — field testing took a while. Young writes: “Meanwhile the devices’ AAA batteries died; HHS spent another $9,800 to replace them last fall.”

You are now free to vent your disgust.

Plus: Back in August, Rachel wrote about increasing the number of trained midwives in Afghanistan in an effort to reduce the catastrophically high rate of maternal death, and NPR did a story on Afghan midwives earlier this year. This is where more U.S. aid should go, along with hospital supplies. Just no more LeapFrog.

2 responses to “How Many Doctors Does it Take to Get U.S. Officials to Realize the Severity of Maternal Health Conditions in Kabul?”

  1. Everything that I see regarding the lives of Afghan women breaks my heart. I wish I had millions of dollars to help all these poor souls.

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