Lalwa-Sarejangal District is in the Hazarajat central mountainous region of Afghanistan. The IAM has a Community Health Project in this very remote area that consists of a small hospital, busy central clinic, and an extensive outreach to villages in the District. The government of Afghanistan has adopted a major reform of the health care in the country called the Basic Package of Health Services (BPHS) to reach even the most remote regions. The HCHP has incorporated this BPHS programme into their long-range plan to reach all of Lal District with basic health information and support.
Background
In the early 1970’s when IAM was beginning as an organisation with a blind school and NOOR, it also started the Medical Assistance Programme (MAP) in the Hazarajat. In 1974 team members had to leave the area but continued to work in Afghanistan. They prayed that there would be a way to return to Hazarajat and the people they had grown to love. Likewise the Hazaras they had worked with in Lal wrote many letters inviting them back to the area. In 1999, after years of surveying and planning, a team of 5 left Kabul to establish an IAM project once again in Lalwa-sarjangal. They lived with a local family for about 4 months until an animal stable was expanded to become their home!
The original plan was for health teaching in villages and corresponding development projects. However, the combination of the drought, the lack of medical services and a meningitis epidemic turned the focus of the team toward curative medical services and relief-type projects. The local government gave a deserted clinic building to the project which ICRC helped to renovate.
Current Activities
The Referral Centre
The clinic in Lal Bazaar, given by the Government in 1999, is growing continuously. We want Afghan doctors to staff the Referral Centre but haven’t been able to obtain them, so currently all physicians are foreign. The expatriate doctors and nurses/ midwives care for patients in outpatient and inpatient settings, monitor complicated deliveries, perform operations, and share in the teaching/training in the centre. The
Afghan assistant nurses, who received their training in the centre, are seeing clinic patients and staff the hospital.
Village Work
The village work combines health and community development theories to improve the health and living conditions in the villages. Teams of health trainers go to the villages to train local women in basic preventive health practices, clean deliveries and treatment of simple illnesses. The teams, including men, work with health committees in the village to form projects for environmental and public health improvements, such as building wells and outhouses, planting kitchen gardens and providing animal vaccines.
Basic Health Centres (BHC)
Two satellite clinics are starting to provide basic outpatient care to people in villages far from the referral centre. Staff members (married couples) travel to these clinics once a week but eventually they will be more permanently based in these villages. The BHCs are also a base from which the village team trains Community Health Workers (CHW).
The BHC statistics for 2005 are shown in the table. However, there are benefits to the community that may not be measurable or obvious. These include such things as improved standard of living of the 68 employees who receive full-time work and benefits, and the employment of short-term workers for specific projects. Assistant nurses who used to work for us still live in the Hazarajat and continue to use the valuable skills and knowledge they gained while working with us.he Mother Child Health Project was renamed in 2004, to include the overall concepts of Community Health and signify its opening of services to men. The Referral Centre hospital continues to function well, specializing in difficult deliveries, and minor surgery, and other ailments that need more nursing care than is available in the home. The clinic services include: paediatrics, maternity, primary care, vaccinations, minor wound care, pharmacy, and patient teaching. These two facilities come under the Comprehensive Health Centre (CHC) of the government BPHS system. In August, 2004, the project branched out to 2 cluster areas in Kirmon and Garmao, initially renting buildings for the teaching of Community Health Workers (CHWs) from 5-10 surrounding villages. Within 6 months, it is hoped to base a Health Educator in these rented rooms to establish a Basic Health Centre (BHC) which will see patients and if necessary refer them on to the CHC.
The HCHP is also involved in CD activities which include helping to increase literacy in the region and building central latrines.
Future Plans
One of the greatest needs in the remote areas of Afghanistan is for Afghan professionals. Currently the project is staffed by 3 expatriate physicians, and 4 nurses, with 13 Afghan Health Educators, who have been trained in basic health care and function as Assistant Nurses in the hospital, clinic, and the village teaching. It is hoped that the project can train the Health Educators who qualify in more foundational Nurse knowledge, and build on that to get them certified. This will take some years as the Health Educators basic schooling is at a 6th grade level and the government certification requires 12th grade. Afghan physician coverage of the hospital/clinic may take several years. Very few professionals are willing to leave the cities to re-locate to a remote area. It is hoped that the Referral Centre (CHC) can eventually become a District Hospital that would support a physician training facility for newly graduated Medical Students. |
