We were heading into Pakistan. The road through the Khaibar Pass was crowded. I did not expect all the traffic. It was hard for me to believe that this was a safe area—well known insurgent Taliban activity was so busy. It was strange and at the same time good because I felt safer.I was accompanying my father to Peshawar to a private hospital. There was something wrong in his chest. He could not breathe easily. We could not find a chest specialist in Afghanistan so we were going to Peshawar, Pakistan.
“Can I help you?” the guy behind the help desk of the hospital asked me in Dari. I felt relieved; I did not have to be worried about not knowing Urdu or Pashto. I later learned that almost all of the patients at the Rehman Medical Institute were Afghans.
“It took us three days to get here, it was a real hell but if my mom gets better it does not matter,” said Shabna, who came from Kunduz, a northern province of Afghanistan. Over and over again they voiced what I had witnessed in trying to find help for my father in Afghanistan. Many of the Afghans I met had just simple sicknesses that could have been easily treated at home. But they would rather travel a long way and spend their money at a hospital in Pakistan, than go to a hospital in Afghanistan. People do not trust the health care system in Afghanistan.
I remember when I took my father to Isteqlal hospital in Kabul. I did not know what to do, where should I go and from whom I should ask for information. There were no signs on the doors and no one to give me information. I started looking for a hospital employee—anyone. It made me mad because my father really needed to see a doctor soon.
Finally I found someone who wore a white uniform. “Excuse me, how I can get an appointment?” I said quickly.
“Sit there, let’s see if doctor comes,” he replied, and left.
If means no, I thought, and looked at my father who was sitting on a dirty chair staring at the floor disappointedly.
“Let’s go to another hospital,” I said.
“Let’s go home. It is hard for me to breathe when I walk or move around,” my father replied.
Afghanistan lacks knowledgeable and skillful medical specialists. Most doctors are general doctors, but they treat all kinds of sicknesses. Those who claim they are specialists are usually those who have had some practical experience, but they had not studied in the particular field of medicine in which they were claiming to be specialists. Afghanistan does not have educated midwifes and nurses. Most nurses and midwives take a nursing or midwifery course for a few months. They might learn some basic knowledge, but they don’t have required skills to deal with complicated situations. Moreover, there are no proper labs and required equipment for labs. Labs are not available easily, or they don’t have qualified lab technicians. The result is that there are not enough reliable labs for all doctors. They are reliable for some and unreliable for others. This causes people not to trust any of them.
After the hospital incident, I took my father to a chest specialist recommended by friends. Without even asking for his name or reading his records this chest specialist started taking my father’s blood pressure. I tried to interject, “This is my father and these are the results of his previous tests.”
He looked at me indifferently and said, “I don’t need them.”
“Why?” I asked curiously.
“Who is the doctor? You or me? I am a doctor! I know doctors of Kabul better than anybody else? A bunch of new graduated medics claims that they are doctors! Who cares what they prescribed? I know what I should do,” he said seriously.
Why should I care what you prescribe, I thought. My father left his prescription on the hospital chair and said he needed a reliable doctor more than anything else.
It is true that in Afghanistan we don’t have enough specialists and qualified medics in hospitals to treat people. But lack of proper communication between doctors and patients makes patients confused. In most hospitals and clinics there is no clear structure for patients to make them feel safe and secure. There is also a lack of clear regulations and rules to guide and advise people about what they should do with simple and serious illnesses.
These reasons, my experience, and similar experiences of other Afghans lead to a mistrust of the health care system in Afghanistan. Many Afghan families, like mine, spend a lot of money to go to Pakistan for treatment. If Afghans continue to seek medical advice and treatment in Pakistan, the health system in Afghanistan will not improve. We need basic investment to improve the Afghan healthcare system.