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28 July 2001 Afghanistan has the highest child mortality rates in the world with a quarter of all children not making it to their fifth birthday. Helping to bring these rates down is a priority for the Afghan Red Crescent and the International Federation in their health programmes across the country. Cathy Mahoney from the British Red Cross reports on a visit to one of the many Red Crescent clinics dotted across the country working to combat the problem. The waiting room at Taimany Clinic in Kabul is busy. Rows of women identical in their blue head-to-toe burqas sit on wooden benches holding emaciated children who do not squirm to get off their laps or try to run about causing mischief. Considering there are about 60 children in this hot stuffy room, hardly any of them cry. They look weak and undernourished. These are the dispossessed people, the most vulnerable in a society where the vast majority are already on the edge. We meet Doctor Roya, a confident woman in her 40s. Women are not normally permitted to work outside of the house in Afghanistan. The exception is in the health sector so that women patients can be safely seen by a woman doctor or nurse, especially at the Red Crescent clinics. Dr. Roya wears a headscarf, but does not cover her face inside the clinic. Although I have been here for five days, hers is the first female Afghan face I have seen. "I see at least 50 women and children every day," she says. "We see those in greatest need first and those that need more serious care are referred to the hospital. But mainly, we can deal with everything here. This morning we have had lots of mothers and babies suffering acute respiratory infections and quite a few cases of bronchitis. We can give them the care and the medicines they need here," she adds. Prescriptions are free, paid for by the International Federation who also pay for the upkeep and renovation of 48 Red Crescent clinics across the country, in addition to the equipment and wages of all of the staff. Mother and child health is a priority at the clinics. With Afghanistan's record on child mortality rates, it is essential to take action. Rolling workshops continue around the country teaching nurses about nutrition, growth monitoring, ante-natal care, family planning and midwifery skills. The clinic is impressive. There is a consulting room, a growth monitoring room, a pharmacy, a health education area and a vaccination room. "It's the whole process under one roof," explains Dr. Nabi of the Afghan Red Crescent. "We look after the health of expectant mothers and their unborn child right through to monitoring the growth of the child up until the age of five." he adds. In the growth monitoring room, we meet a mother bringing in her tiny baby boy, Ghafar. He looks under the age of one but in fact, he is two years old. She starts pulling off his clothes roughly so as to put him in the little hammock where he will be weighed. He doesn't complain or scream, just allows his clothes to be pulled off like a rag doll. His skin is covered in pale,dry patches. His eyes are listless and he does not even glance about the room at all these strangers. The mother explained matter-of-factly that he has had diarrhoea for the past few days. Ghafar has been on a nutritional programme with the clinic for the past two months, but he is still tiny. The scales show that he weighs in at just 6 kilogrammes. The clinic keeps a health monitoring chart on each child it treats where all kinds of pertinent details are kept. The nutritional status of a child is logged which compares weight against age. A quick glance at Ghafar's chart shows that he does not even make it into the 'serious' category. He is severely, severely underweight and his condition is critical, but it seems other children are even more critical. "It is heartbreaking," says Dr. Roya. "But children like Ghafar stay in our growth monitoring programme until we are happy that they are safe from harm." In the next room, a health education session is taking place. Swinging from the curtain rail is a carrier bag crammed full with dummies. "I take them away from the children if they come in here sucking them. Every single child has one of those in its mouth. I wish I could ban them from Afghanistan," says a nurse. Today women are learning the importance of breast feeding. Even though it is nutritional and free, many women do not like to breastfeed and nurses here have a big challenge in turning the trend around but it is important that they do for the health of the children. "As soon as the children are born, mothers put a dummy into their mouths. When it drops on the floor, they pick it up, with dirt on it and put it back into their mouths," adds the nurse. Simple health messages like these save lives: boil water to keep it safe; wash your hands after going to the toilet, give your child sugar and salt solutions when they have diarrhoea. Children should not die from diarrhoea but they do here. It is one of the most lethal killers. "Prevention is better and cheaper than cure – always," explains Dr Nabi. "Easily preventable illnesses shouldn't prove fatal as they do here all too frequently. So when a mother brings in a sick child, we use the opportunity to monitor its growth, talk to her about family planning, diarrhoea prevention and treatment as well as immunising their children. It's proving really successful because women really want to learn. Last year, more than 586,000 people attended our health education sessions at the clinics." Red Crescent clinics are a crucial haven for those who are sick, weak and poor. They are the only option for so many of the people here. Private consultations in general cost just under a dollar, but for the vast majority of the population, this is not affordable. So last year, 650,000 people walked into the Afghan Red Crescent's health clinics for treatment which is free. Eighty per cent of whom were women and children. And everyone takes away something, from a jab in the arm to a vital lesson on the benefits of breastfeeding. "With curative medicine being so expensive and essentially short term, we have to concentrate on changing attitudes and changing people's practices. It's the only way we can change the situation here," Dr. Nabi says. One leaves in the certain knowledge that the work of these health clinics is vital. But it is very difficult not to think about little Ghafar and all the other little Ghafars out there. |
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