I am attaching a few pictures from a Community Medical Assistance (CMA)
program I went on this week. These events are held on approximately a
monthly basis to provide medical care and supplies to the population,
and to try to instill a sense of trust in the Afghan police and army.
It is a daunting task to say the least. The sites for these events are
generally underserved areas (that doesn’t exclude many places) that are
considered to be at risk due to location or Taliban influence. Since
medical care and medications are extremely limited, we plan a day to
bring supplies and medical personnel to the villages and have a health
fair of sorts. For many it is the only time they may have seen a doctor
in their lives.
It is not really accurate to say that we are providing medical care, at
least by Western standards. The 6 docs present saw over 400 patients in
the 4 hours of the event, and that was with more than half the docs
leaving early (Afghan national army) because they didn’t want to work
any more. They just left the one other Afghan doc and me to see the
The departing docs were also all female, which caused a bit of a problem
since the female villagers will generally not see or talk to males other
than their husbands. The police chief made an announcement to the
remaining females that the only docs left were male, causing many of the
women to leave. Then when the women come in they are wearing Burkha’s
and any sort of physical exam is completely out of the question. I
ended up talking to the side of the head of completely draped and
covered women who spoke only to the female interpreter who had limited
command of English and no medical training. After describing their
symptoms I had to guess what condition they had and what medication to
give them from a limited checklist pharmacy. A new look at the practice
There are so many aspects to this event that I could go on indefinitely.
The facilities, the geography, the threats, the standards of care (and
cleanliness- no running water in a medical clinic)….The pictures
attached show the general area (they farm there, but it’s hard to find
any green), the clinic, and one of my better dressed infant patients
with her Burkha mother.
One last quick story. As we were pulling out in our up-armored Hummer
one of the US army embedded trainers stops the vehicle I was in to ask
if I can read EKG’s. I say sure and hop out, not knowing quite what to
expect. The chief of police is standing there with his medical
evaluation that was performed in Pakistan. He has an angiogram report
that is written in some Arabic language, but with enough blockages with
70/80/90’s on the left anterior descending to indicate severe single
vessel CAD. The echo report in Turkish seemed to indicate (through
numbers and percents) that his heart function was normal. The question
to me was “what should he do”? Well, in the US he would have had a PTCA
and stent without leaving the hospital. In Afghanistan there is no such
thing as interventional cardiology. To make a long story not too long,
I am working with the Army trainer in trying to find appropriate
treatment for this officer who is apparently very influential in an area
that is on the edge.
The things they don’t teach you in medical school.