In Mazar-i-Sharif, there is a general hospital, a military hospital and a University Medical school. Over the many years of war the physicians in this location (and others around the country) have had inadequate and interrupted training and practice, with some outside support from various NGOs. Various IAM Team Members since 1993, have visited patients and informally advised Medical Practitioners regarding care and treatment. Since 2002, a General Surgeon with hand specialty skills, has been assigned to the hospitals and demonstrated and taught the resident surgeons. Each morning the doctors in the surgical department visit each patient’s bedside reviewing their case. The IAM Surgeon accompanies these ‘Rounds’ and quizzes the newer doctors (and sometimes the older surgeons) who are specifically assigned to that particular patient, about their history taking from the patient, what tests they obtained, what was the list of possible diagnoses, and how they determined the end diagnosis. Further discussion involves the advised treatment, what surgery was performed (or planned) and how it was done. At times, different doctors join in the discussion, so that ‘Rounds’ can take some time, and seems like a classroom with lots of ideas being discussed and reviewed. Even mistakes are reviewed and conclusions sought to avoid similar problems in the future. Lively interaction is the key to this type of teaching.
Since 2004, 2 additional Surgeons with general surgery and some specialty surgery have been assigned to these Mazar-i-Sharif hospitals. As doctors in the area learn of the specialty services, they seek out the IAM Team Members for consultation on difficult cases. During demonstration operations, teaching opportunities are sought to review normal surgical procedures, and teach new procedures that previously Afghan surgeons have not had access to. At times, other short-term surgeons have visited to teach, advise and operate with the purpose of reinforcing good surgical practice and expanding the capabilities of the local surgeons. The IAM’s interaction within the governmental hospital system has become more accepted as the years pass, and some Afghan doctors are actively seeking to spend time with the IAM Team Members to learn more.
Beginning in 2005, an internist will also be assigned to these 2 government hospitals and has already been welcomed by the medical side of hospital treatment (not surgical). She will spend time with a specific group of new doctors, reviewing patients with them in a teaching/dialogue manner as above. Her goal will be to supervise and evaluate newly graduated doctors and 1-2 year doctors for history taking, testing requested, diagnosis, and treatment.
Another exciting aspect of the IAM Team Member doctors in Mazar-i-Sharif involves their interaction at the University with Faculty and Medical Students. A weekly Journal Review is conducted in a small group setting, where everyone reads the selected article prior to the meeting, and then one selected individual will review the article and discussion will center around its applicability (or not) to the Afghan setting. While not all the students participate, those that do seem excited about what they are learning.
In 2006, a new Team Member joining the IAM in 2005, will present the results of a year-long evaluation of the Medical Training in Afghanistan. As the IAM has been involved in health care and the direct training of Eye Doctors since its inception, it was felt that we could have some impact in the rehabilitation of the training system for doctors. This research and evaluation will include universities, hospitals, relevant provincial and nationwide government ministries and departments. With this information, the IAM hopes to find ways to work together with the Medical Faculties in the long-term training of physicians.
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