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20 October 2003 by Jessica Barry in Herat province Set in a scorching, dusty brown landscape, the village of Mubarak Shah, a sprawl of sand coloured adobe houses surrounded by high mud walls, is home to 3,500 people. Times have always been hard in this corner of western Afghanistan, the parched fields yielding just enough wheat to stave off real hunger, and the slopes higher up the valley producing water melons that, when dried, provide a few vitamins during the long winter. But the real problem is water, or the lack of it. A sustained drought has devastated large parts of Afghanistan and in Mubarak Shah, it did not rain properly for three years. The villagers’ habit of digging crude wells, lining them with plastic and channelling rain water into them was of no use at all. They turned, instead, to their other traditional coping mechanism, storing snow-melt. But the water was dirty and the villagers fell ill. As usual, they suffered their sickness and infections, their anaemia, and their aches and pains stoically, being both too poor to afford the cost of medicines in the private pharmacies in Qala-e-Nau, the nearest town, and too sick to risk the three-hour donkey ride to get there so they could attend the health clinic run by the Afghan Red Crescent Society (ARCS), where the medicines are free. It was with surprise and anticipation therefore that the people of Mubarak Shah heard from Mohammed, the village leader, that an ARCS emergency medical team (EMT) from the provincial capital, Herat, was to visit them the following morning. At the appointed hour a crowd of coughing, wheezing adults and runny-nosed children stood waiting expectantly in the compound of the elder’s house for their arrival. Among the throng was Aadinah, a 40-year-old mother of five. She knew very well what was wrong with her. She had once been to the hospital in Qala-e-Nau where the doctors had taken X-rays and discovered kidney stones. They told Aadinah she needed an operation, and had gone home troubled. She knew she could never afford to go into hospital, but equally wondered how she could bear the excruciating pain if she didn’t. There had to be another solution. Also in the crowd was Mohammed Murad, 60, who had walked for half an hour across the hot desert to get to the elder’s house. For a month now he had had terrible itching on his arms and legs with raw, open lesions on his forearms and a sore neck; however much he scratched, the irritation didn’t go away. Wherever they go, the ARCS mobile medical teams are greeted with hope, expectation and an unswerving faith in their ability to cure even the most serious ills. In chronic cases, such as Aadinah’s, there is little they can do but repeat what she was told at the hospital and prescribe painkillers. But for others, like Mohammed Murad, a course of antibiotics and some antiseptic ointment can help. There are currently eight Afghan Red Crescent EMTs working countrywide. Each one is composed of a doctor, driver, pharmacist and male nurse. The teams mostly work in pairs, and each pair forms an Emergency Medical Unit, or EMU. The EMUs’ vehicles and equipment as well as the medicines they distribute are financed through the International Federation by different donors, including the Norwegian Red Cross. When not on call for emergencies the EMTs, which were first established in 2000 to respond to emergencies such as the latest drought, travel to isolated rural areas where villagers have little or no access to medical care. Conditions are rough, but what keeps the medics going is knowing that they provide a real service to the poorest of the poor. “For me, the best thing about this job is the chance it gives us to work at the heart of the community,” says Najibullah, the doctor with the team visiting Mubarak Shah. On loan to the ARCS from the Ministry of Health, he finds his work far more appealing than sitting in a consulting room at the government-run clinic in Herat. “You can get far closer to the people out here,” he says. Each tour of duty lasts a month, during which time the medics live out in the villages and may see up to 100 patients a day. They then return to their base in Herat for seven days rest, before setting off again on another tour. The villagers awaiting the team’s arrival in Mubarak Shah were a motley crowd of young and old. The women in colourful, patched clothes and voluminous shawls looked careworn. The children were mostly barefoot and unkempt. The babies were wrapped in swaddling clothes. Only the elderly men, with gossamer beards, immaculate garments and snow-white turbans, appeared spruce and dignified. The team set themselves up in the village leader’s two front rooms. While the men lined up to see the doctor in one, the women gathered in the other for some health education, given by the team’s 19-year-old nurse, Ahmed Aziz. Far from placidly sitting through the lesson, they were quick to point out the many difficulties facing them. “It’s all very well telling us to take sugar and salt in water as a cure for diarrhoea,” remarked one women, “but the water here is bad, and there is not much of it anyway.” “Boil the water before using it,” Ahmed replied “and if you don’t have water, then sprinkle the salt onto a water melon instead. It will still work.” After the men had been seen and received their medicine, it was the women’s turn. Out on the doorstep, Aadinah sat with her daughter-in-law and two-month-old grandson. In her hand she clutched the telltale X-rays of her kidneys. “Do you think the doctor can do anything to help?” she enquired of the EMT’s supervisor from Herat. “I was told by a neighbour to drink tea made from maize,” she continued without waiting for his answer, “but it didn’t do any good.” Close by sat Mohammed Murad, his meeting with the doctor over. Clasping three small packages of pills he, too, was anxious to talk. “I don’t own any land and I am too old to work,” he ventured when asked how he provided for his shy young wife, Tazah, and three children. “At harvest time, each family in the villages gives me around four kg of corn, and we live on that,” he explained. “We have nothing else.” In truth what keeps the villagers of Mubarak Shah from total destitution is that most of them are carpet weavers, and it is by this wearying trade that they earn their meagre livelihood from year to year. In all that day, Dr Najibullah saw 88 patients, two thirds of them women and children. After the consultations were over, Mohammed, the village leader, drew the team aside. “Ninety per cent of the families here are poor,” he told them. “The lack of water is a huge problem, but what we need more than anything else is medical help. Please try and come again whenever you can. Our people are counting on you.” Related links: Activities in Afghanistan Improving health services in the community Make a donation |
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