By Zuhal Azad
Every morning at first light, Manizha* picks up her medicine bag and heads out to villages in rural Afghanistan where, if it weren’t for her and her team, most women would not see a doctor from one year to the next.
The 29-year-old, whose real name we are withholding for her protection, visits her patients in their homes, going from house to house to deliver services they would otherwise not be able to access.
For many, confined to their homes because of Taliban restrictions, family or societal pressure or a mix of all three, her visits are a lifeline. As one of the few remaining female doctors working in Afghanistan, where the Taliban have stopped all higher education and most forms of paid employment for women, she performs a crucial role.
She treats women of all ages and from different backgrounds, meaning no two days of her job are the same. Many have been internally displaced, which is common in Afghanistan after decades of conflict, and some are former refugees who’ve returned home, not always willingly.
Yet there is one common theme: most of her patients have chronic conditions that could have been treated successfully if they had been caught much earlier.
“These are women who have lived with pain for years, to the point that suffering has become part of their everyday lives,” says Manizha.
Her employer is a humanitarian organisation that we are not naming for her and her team’s security. Already, she says, she and the other women she works with face harassment by the Taliban. Their work in remote rural areas of the country exposes them to further dangers that they know the authorities would not protect them from.
In rural Afghanistan, access to medical care has always been an issue, especially for women. Now, Manizha says, the challenges of poverty and underdevelopment have been compounded by the restrictions the Taliban has imposed on female healthcare workers and by global funding shortages.
Taliban warnings
At the beginning of this year, there were 14 in her team, now there are only seven. Many of her female colleagues had to leave because they had no male guardian to accompany them while they worked, a Taliban requirement. These guardians are not paid, yet they have to go everywhere the female worker goes, meaning they cannot work or study – a tough ask in one of the world’s poorest countries. Local Taliban authorities have repeatedly told her bosses that female staff members must not go door to door without a guardian, warning that if they do, the organisation would be shut down.
On a typical working day, Manizha’s team visits more than 10 households, and she personally examines between 12 and 20 patients. Some are not allowed to leave home without a male companion. Others cannot afford the cost of travelling to a clinic. Still others have postponed seeing a doctor for so long that their illnesses have progressed, making treatment far more difficult.
That’s not always just down to poverty, but also social norms. In one village, Manizha remembers coming across a household where none of the women had even seen a doctor. Some had osteoporosis, others were suffering from chronic pain, but when she and her team went back with medicines, the men in the family refused to let them in.
“They even refused to accept the medicines we had brought,” she says. “They said, ‘Our women have been giving birth at home for generations, and nothing was ever wrong. You came here and corrupted our women. You’ve made them weak and spoiled; they’ve lost the strength they used to have.’ They would rather see their women die in pain than receive medical treatment.”
Reproductive health problems are rife in a country with a high fertility rate and one of the highest rates of maternal mortality in the world, according to the United Nations Population Fund, which has itself had to cut back on provision for women in Afghanistan because of funding shortages.
Domestic violence is also common. Manizha says she will never forget seeing a 20-year-old woman living in a migrant camp who’d been paralysed by a spinal injury. She’d been subjected to frequent beatings by her husband and in-laws because she was unable to bear a child. “Seeing her condition was deeply heartbreaking,” says Manizha. “She was in an extremely difficult situation and had no one to support or protect her.”
Bringing hope
Not all her experiences have been so negative though. Manizha remembers one patient who’d lost the ability to walk after suffering a stroke. The woman, who was 40, hadn’t left her home for two years and when she learned they could bring her a wheelchair, she cried with joy.
“I could hardly believe that something as simple as a wheelchair could restore so much hope to someone’s life,” she says.
The work poses many challenges, and it’s not unusual for community leaders to obstruct the team’s access to female patients. They start by asking the local leader to identify families that need help, but sometimes they refuse. “In those situations, we have no choice but to knock on every single door and ask whether anyone inside is ill,” she says.
Yet despite the difficulties, she strongly believes in the value of the work she does.
“Whenever I remember the smiles, the tears, and even the deprivation of the women I have visited over the years, I tell myself that I must not give up. They need even the little that I can do for them.”
* Manizha is a pseudonym
