Wednesday, February 08, 2017

Afghanistan's Taliban Scourge

"I still struggle with that feeling --- why I was not able to come to the hospital that day. I am still uncomfortable [about the situation and its outcome]."
"I was nervous -- how could I go to the house of the neighbour, and their house was just 100 or 200 meters away from mine?"
"I don't have any medical equipment with me -- my hands are empty. I worked for them like a local midwife. There was no place to do a cesarean or an operation. Professionally, a cesarean was needed."
"Their logic [the neighbouring family] was this: We can sacrifice one mother, but we cannot sacrifice several family members by going with you to the hospital."
"It was very painful for me. The scene was not tolerable, as I saw a child dying in the womb of the mother, and I was not able to help him, to help him even a bit."
"That was the darkest night, and I will never forget."
Dr. Marzia Salam Yaftali, Kunduz, Afghanistan 
Dr. Marzia Salam Yaftali, the chief doctor for Kunduz Regional Hospital, visits with patients at the hospital in Kunduz, Afghanistan, December 2016. A battle in the fall trapped Yaftali at home. But the most dire test of her career appeared just a few doors away. (Najim Rahim/The New York Times)
Dr. Marzia Salam Yaftali, the chief doctor for Kunduz Regional Hospital, visits with patients at the hospital in Kunduz, Afghanistan, December 2016. A battle in the fall trapped Yaftali at home. But the most dire test of her career appeared just a few doors away. (Najim Rahim/The New York Times)

Kunduz, a city of 250,000 inhabitants, was being attacked by the Taliban, and there was active combat taking place. Afghan militiamen were defending the town, but the Taliban were in control of streets nearby the hospital where Dr. Yaftali worked. It wasn't only that deadly artillery was flying about everywhere, and it was safest to remain indoors and off the streets, but the uncertainty of what might follow if the Taliban weren't routed. At the present time, anyone seen by either combatant side on the streets would become targets of deadly fire.

And Dr. Yaftali was home with her two young children, not at the 250-bed health facility where she was chief doctor of Kunduz Regional Hospital. The reason: her director and the hospital staff remaining reasoned with her that if the Taliban entered the hospital and saw that a woman was chief of staff they would summarily execute her. They entreated her to go home and to stay there, until the situation stabilized with the Afghan forces having the upper hand and the Taliban were expunged from Kunduz.

She was called to duty, however, when neighbours knocked on her door to plead with her to help one of their family members, a woman about to give birth to twins, who was experiencing severe difficulties.  Traditionally in Afghanistan, women could be doctors and they could be surgeons, but they were only able to treat women. And even before the Taliban took power, women surgeons were expected to operate, themselves wearing full burqas. There were separate health facilities dedicated to women.

Tradition in Afghanistan held that women should know their place. Female health workers operated in an atmosphere of religious piety and cultural male domination which held that women's place was in the home. The work of female health care was fraught in a delicate balance of circumspection and the considered avoidance of drawing attention to the fact that at the hospital women came in contact with male patients.

Dr. Yaftali, a gynecologist by training, remained at home when the Taliban invaded the city. Two dozen staff members remained at the hospital working feverishly. They ran out of food, and survived by eating boiled rice. Each trip taken to a medicine depot close to the hospital near the main building was risky, bringing them under active fire on several occasions. Mortar shells hit the hospital, leading to patients being moved from exposed rooms to sheltering hallways. Over 300 wounded were being treated.

From home, Dr. Yaftali was attempting to embark on a public relations communications campaign on behalf of the hospital, speaking to radio stations, newspapers and updating on the Internet, hoping to convince each side in the fighting not to fire on the hospital. Then came the urgent plea from neighbours on behalf of a 30-year-old relative in the process of giving birth who was in excruciating pain and desperately needing assistance.

Fearful, yet professionally determined, Dr. Yaftali made the passage from her home to the house where Fatima was giving birth to the first child, on the floor, while the second was stuck in position. Dr. Yaftali's attempts to reposition the baby for delivery failed and the mother was undergoing intolerable pain. The provincial police chief responded, sending an armoured vehicle to the house to transport Fatima to hospital, but her relatives faced a dilemma.

She would not be permitted to go without them in attendance, and they would not venture out themselves in recognition of the risk involved. So the doctor sent the armoured car to the hospital to retrieve drugs and medical equipment, attempting once again to deliver the baby, but it was too late. When morning dawned and fighting died down, Fatima was taken to hospital for treatment, but only one child remained.

When the Taliban were ousted from the city, Dr. Yaftali returned to work, sending out Internet messages to all hospital workers who had fled the fighting and exited the city, to return to work.

The mostly male staff at the hospital during a meeting. The risk of attack is compounded for female health workers in Afghanistan, which still struggles with the place of women in the workplace. Credit Najim Rahim for The New York Times

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