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TODAY news for Thursday, March 9, 2006

Loma Linda University news

Health care standards rise in Afghanistan

With a gruff voice, the gatekeeper to Wazir Akbar Khan Hospital blocks a man from pushing past him into the spotless hospital corridors.

“Shoes off,” he says in a no-nonsense voice, handing the man a pair of plastic sandals and a ticket to identify his shoes.

A United States-funded program run by Loma Linda University has transformed this major trauma and surgery hospital in the center of Kabul from a nightmare of squalid wards and filthy corridors into a place where even the very ill find dignity for their suffering.

Habibullah, who uses only one name, lies back in his bed with an IV in his arm dripping fluids and medicine to combat his heart troubles. He is 60 but looks 80 with his wrinkled face, swollen arms, and wispy white beard.

The former baker has been fighting heart disease for some time and knows from experience what this place used to look like before the USAID health project began to upgrade the hospital.

“I came two years ago,” he says resting against a white pillow on clean sheets as his son, Ahmed Dada, 21, sits nearby in front of a small electric heater. “Now it is so clean, so well-equipped, and so good.”

His son said the old man pays nothing for his care or his medicine because he is poor. Food is also provided but his father prefers food from home.

Until recently, most Afghan hospitals were on the level that might be expected from the country listed as 173rd out of 178 on the 2004 United Nations human development index.

Just two years ago,  hospitals in the capital, the most developed place in the country, revealed a shocking scene. Patients lay in their street clothes on straw mats, filthy mattresses, or soiled sheets.

Dim lighting came from a handful of fixtures that were not broken. The horrid smell of overflowing toilets and soiled bandages permeated the air. Patients groaned in pain and medicine was only given when their families went to the pharmacy in the market outside and sold their belongings to buy it.

No more at Wazir Akbar Khan. Aside form cleanliness, hospital administrator Mike Mahoney has used the $3 million USAID grant to provide basic medicine; fix or install basic medical devices such as ventilators, heart monitors, defibrillators, x-ray and other machines; upgrade the emergency room; and “introduce changes to bring this up to speed,” he says in his office.

Admitting he’s never worked in a country as poor as Afghanistan, Mr. Mahoney says he is awaiting a container of cleaning materials to strip and wax the floors so they can more easily be kept spotless. Reducing infections, gastroenteritis, and other diseases spread by dirt is key to raising health standards.

He has also brought a team of surgeons who have been teaching the Afghan doctors in the morning and working side-by-side with them in the afternoons caring for patients in the 210-bed institution.

He shows a visitors list called “essential package of hospital services” that tells what surgeries and other interventions the facility should provide to anyone who walks or is carried in the door of this primary trauma center in the capital of 4 million.

Mr. Mahoney says he is already able to fulfill about 30 percent of the services on the list and is working on the rest.

Part of the reason for his success is a tough-looking former mujahideen fighter against the Soviets, Mohammed Ayub, 46, who is the country director for the project. “He gets things done,” says Mr. Mahoney.

The bearded ex-fighter smiles when he hears this and tells how he works. “I saw a relative of a patient rushing out the door with a prescription in his hand,” he says with a slight smile.

“So I grabbed him and said: ‘Stop. Why do you go out for medicine? We have it here for free. If you go out, don’t come back.”

He wants to discourage a return to the old ways when doctors sent patients out to buy drugs because hospital pharmacies were looted or simply nonexistent.

To keep its pharmacy up-to-date, the Loma Linda team has created a filing system that includes patient care and other aspects of management seen as key to modern organization and efficiency.

Up on the second floor ward, although Habibullah is clearly unwell, he reclines on a real hospital bed, in a hospital gown, lying on clean pillows and sheets in dignity, a new beginning for medical care in  this ancient land.

By Ben Barber, USAID News Service

TODAY news for Thursday, March 9, 2006