By: Ellaha Rasa
Ghor provincial hospital has only two female obstetricians – nowhere near enough for the demands of the province. Sometimes up to 30 women per day give birth at the hospital, overcoming roadblocks due to weather and other challenges to travel the mountainous region for specialist support.
Dr Khatira Jehesh Achakzai goes to the hospital every morning and usually works for eight hours straight before she has a break. She says the time passes quickly due to the high demand. “The people of Ghor are really deprived and need doctors and health workers,” she says.
While there are 20 midwives to support the women in labour, the women in labour who turn up at the provincial hospital have often made the journey because they have a more challenging situation. Some women require a caesarean section, requiring specialist attention.
Dr. Khatira says the midwives are under enormous pressure. “They do their utmost to save mothers and babies,” she says.
But the demand means she herself cannot take a break from work because her absence could be life or death for many women. “Especially in the cold season, due to the lack of sufficient facilities in the hospital, there is a lot of pressure on doctors and employees,” she says.
Sources at the hospital, who spoke on condition of anonymity, say that due to the lack of facilities and sufficient workforce, they would estimate at least 20 percent of patients in need of obstetrics and gynaecological support do not receive the necessary health services. This is turn increases the probability of death of both mothers and babies.
Under previous governments before Taliban rule, doctors from other provinces would be seconded to work at the provincial hospital to help meet the demand. But since the return of the Taliban, that practice has ceased and many of them, especially female workers, no longer travel for work.
In Ghor, a mountainous and extremely cold region in winter, snowfall often blocks the roads linking the districts to the provincial capital Ferozkoh. It can become impassible for weeks at a time. Dr. Khatira worries especially about the women and children in the provincial districts. “The weather is cold in Ghor province for eight months of the year, and sometimes roads are blocked because of the amount of snow. It means it’s more quiet in Ghor provincial hospital (as fewer patients can travel.) But there are many more problems in the districts and villages, where we don’t have female doctors and specialists.”
Why did Dr. Khatira sacrifice her comfortable life for the challenges in Ghor?
Dr. Khatira was born in Herat. She grew up in a middle class family and studied at one of the best schools of her province, Goharshad High School. She studied medicine at Herat University and graduated top of her class. She worked as a doctor in health centers and was living comfortably in Herat with her family. Then one day, she came to Ghor for a one-year secondment. “I agreed to help the poor people of Ghor,” she says.
During that year, Dr. Khatira witnessed so much deprivation and suffering of women that she decided to sacrifice her comfortable life in Herat to help the women in Ghor. It’s been five years since she made that decision and has been working in Ghor provincial hospital’s gynaecological department ever since. She’s also met her husband and been married in Ghor.
“Working in the gynaecological department is controversial and difficult, but I like to help women,” Dr Khatira adds.
After eight hours in the hospital, Dr. Khatira’s work doesn’t end – she goes with her colleague, Dr. Jahantab, to continue to treat sick women in private clinics.
The lack of female doctors in Ghor means some families send their female family members to neighbouring provinces for treatment. But in the colder months, this is not as possible due to the blocked roads. For this reason, Ghor is one of the provinces with the highest the maternal mortality rate.
The Taliban have imposed many restrictions on women and girls in Afghanistan. The right to education, work, travel, and freedom of movement has been mostly denied to women under threat of arrest and punishment of them or their families. While the Taliban has permitted women to continue some work in the health sector, the restrictions have had an impact on women travelling to the provide services in the province or of university graduates able to support the demand.
Maryam Mohammadi*, 42, has been working in Ghor provincial hospital as a midwife for seven years. She walks for at least 30 minutes each day to reach the hospital.
In an interview with Rukhshana Media by phone, Maryam says that sometimes due to the lack of specialists in Ghor hospital, she ends up doing the work of both a specialist and a nurse. “Sometimes a nurse’s shift is 24 hours in the hospital and we have to be in the hospital during this whole time,” she says. “In the absence of the doctors, we do everything we can.”
“Sometimes between the two assistant midwives in the provincial hospital, we’ll help 25 patients give birth in 24 hours,” she adds. “And on days when there are fewer clients, we’ll help about 10 women.”
Residents of Ghor province know the midwives well. Maryam says sometimes when they’re not at the hospital, people will come to their homes. “Clients call me and come after me to help with their childbirth and will take me to the hospital.”
Officials at the hospital say, according to their data, they receive up to 150 female patients per day for tests and health services, some of whom come to the gynecological ward.
Maryam says in addition to the severe shortage of female doctors, there is a dire lack of beds. “The condition of the maternity room is not good. Of the beds we have, three are damaged – when the number of patients increases, women have to give birth on the floor of the ward.”
There is a shortage of medicine, and the Taliban’s ministry of public health has not been able to help. “The problem is extreme,” Maryam says. “The equipment, medicine, technical equipment, and hygiene kits are simply not enough.”
“When there is not enough doctors, patients are not treated properly. Some need to be transferred to a hospital with equipped facilities. But some cannot get their patients to the hospital and they take the patient home and they die.”
One of the former public health officials of Ghor, who did not want to be named, told Rukhshana Media that the health sector is facing a shortage of doctors and specialists, especially for women, and that the problem is more severe in the districts.
He says that the problem requires female doctors from other provinces to be dispatched to Ghor province and the training of more medical professional at university is vital. “Universities must be opened (for women),” he says.
Under the current rules of the Taliban, with no more women being educated and trained, the problem is only going to get even worse. For people like Dr Khatira who have committed everything to save women’s lives, she just focuses on what she can do for women now. “I am very proud of my work in Ghor and we all have to think about our people,” she says.
