The
Dar-i-Noor valley is only some 50 km from Jalalabad, the capital
of Afghanistan’s eastern province of Nangarhar. But, lying
deep in the Hindu Kush mountains, many of its villages cling
to its precipitous slopes that are inaccessible, even by donkey.
“When a woman from one of the isolated hamlets needs medical
help, her husband or brother has to carry her on his back down
the narrow paths,” says Salma, a 30-year-old midwife from
Jalalabad who has been helping to deliver babies and train traditional
birth attendants in the remote valley for the past two years.
Salma works in the Afghan Red Crescent (ARCS) clinic in the
village of Bamba Kot. She also goes out to visit people in the
scattered communities, accompanied by her husband of 12 years,
Farooq.
“He is my bodyguard” she jokes, alluding to the
climate of insecurity in the region, and to the somewhat unusual
nature of her work, which involves travelling considerable distances
where deeply conservative traditions about women and their place
in society still hold sway among the valley’s nearly 5,000
families.
“A few days ago a mother died in childbirth because her
husband would not allow her to leave the house,” Salma
remarks.
“There are three main problems facing women in Dar-i-Noor.
The first is ignorance, the second is transport and the third
is poverty,” she adds.
Most families in the valley are subsistence farmers. Others
earn a pittance cutting wood and selling it locally. All are
poor. They can neither afford transport to take them to the
hospital in Jalalabad when they fall ill, nor pay for medical
treatment should they be lucky enough to find some way of getting
there.
It is for this reason that the ARCS clinic in Bamba Kot, although
offering only basic outpatient services, plays a crucial role
in the life of the valley, for all the treatment and medicines
are free.
It means that the health education sessions Salma runs are vital
too. She teaches family planning, monitors the growth of children
and advises women on pre- and postnatal care. During her two
years in Bamba Kot, she has trained 29 traditional birth attendants,
and supervises their work.
Their work is essential, since maternal mortality - 1,600 maternal
deaths per 100,000 live births - is among the leading causes
of death in Afghanistan. The UN Children’s Fund, UNICEF,
says that more than 40 per cent of deaths among women of child-bearing
age are caused by complications in pregnancy that are preventable.
Last June, as part of a ‘safe motherhood’ initiative,
Salma attended a month-long training at the local Ministry of
Health-run hospital in Jalalabad on how to set up a basic emergency
obstetrics centre (EOC). Her training was funded by the International
Federation.
Afterwards, UNICEF provided each participant with a basic EOC
kit containing forceps, a fetoscope, a ventouse suction cap,
instruments for minor surgery and other essentials.
Salma was delighted. “We don’t have such things
in the clinic,” she explained when she came to Jalalabad
recently to pick up the kit. “Now I can really help where
I’m needed.”
After graduating as a nurse from the Nangarhar medical institute
in Jalalabad, Salma continued her studies in Kabul. It was after
she became a midwife that a friend of her husband’s, who
lives in Dar-i-Noor, encouraged her to go there.
Asked if he minded his wife working in such a remote spot Farooq,
38, replied: “Not at all. She is helping people in an
area where the medical facilities are very scarce. I am proud
of her.”
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Red
Crescent midwife Salma with her "bodyguard"
husband Farooq, who accompanies her to the villages (p10634)
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