There is something remarkable taking place today in Afghanistan. From the rubble and decay left over from a bloody civil war and the oppressive rule of the Taliban, a new nation is emerging triumphant. A reconstruction boom is underway as infrastructure develops at a dizzying pace, fueling much needed economic growth.
I had the opportunity to experience this firsthand as a medical volunteer with CURE International, one of the many NGO’s operating in the healthcare sector in Kabul. The first and only family practice residency training program in the country was established in Kabul in 2004 and has just graduated its first class of family physicians. There were over 150 applicants last year for a position in the intern class of only six, so the residents are top tier. Offering quality training locally is one way to prevent post-conflict “brain drain” in which the brightest students go overseas, never to return. “We came here to help Afghanistan,” said the CURE Hospital medical director, “and our hope is that in this training program, it is not just knowledge that we are imparting to our doctors but the attitude and values of care, compassion and integrity. We believe that the doctors who are trained here will change healthcare in Afghanistan.”
Part of the contract that the residents have with CURE is that following three years of training, they will commit to two years working as the director of a rural health district. They are expected to then train the local health providers, sowing seeds in a perpetual cycle of advancing medical education.
As a volunteer physician, I was asked to provide resident instruction, both clinically on the wards of the inpatient hospital as well as participating in resident didactics. I was surprised to discover that English was the second language of the 16 Afghan residents in training, so there was no language barrier to interfere with teaching.
What is unique about this humanitarian medical mission is that it is highly structured, conducted in English and modeled after U.S. graduate medical education programs. Most of the residents carried PDAs, would quote Harrison’s and referenced all the standard texts used in the United States. Everything from morning report to case presentations to lunchtime conferences seemed very familiar and were it not for the patients with disseminated tuberculosis, severe malnutrition and diseases of the developing world, one might forget that they were indeed outside of the States.
When I spoke with the residency program director, I inquired as to what has made this a program a success. He credited a team of dedicated volunteer health professionals, the assistance of many NGO’s from the international community, and the Coalition soldiers without whom there would be no stability.
“If it were not for the presence of the military and the security they provide, none of us could do the work that needs to be done here,” said the program director. A few Afghan medical residents were fortunate enough to receive critical care training during a rotation at a nearby U.S. military hospital, a new 17 million dollar modern facility that opened in 2006 and is the most technologically advanced facility in the country. Cutting edge medical and surgical treatment is now available and the United States is eager to transfer skills and provide medical training to Afghan residents.
Dr. A (name ommitted) is one such resident at CURE Hospital who participated in the Physician Mentorship program at Bagram in December of 2005. At that time all medical care was provided in temporary tents set up by the U.S. Army. “It was a great experience,” says A, “I had an army surgeon instruct me one-on-one and even gave me formal lectures from a laptop. The critical care
training available there can be found nowhere else in the country.”
The U.S. military physicians deployed to Afghanistan also feel a sense of purpose in their unique mission here. “The medical staff here at Bagram actually see mostly Afghan National Army soldiers, Afghan Security Guards and local nationals. A lot of people don’t know that American service members are in the minority as far as patients go” said Major Kellie Griffith, MD. “So in many ways, a medical deployment here is similar to a humanitarian mission.”
One of the challenges the military hospital faces is transferring stabilized host country patients to civilian hospitals in Afghanistan. There is such a difference in the level of care that patient placement and discharge planning becomes challenging. Very few facilities, for example, are able to manage a patient on a ventilator. This is one area where training and equipping local hospitals can make a big difference.
The medical staff at CURE Hospital currently consists of long term volunteer physicians from Scotland, Canada and the U.S. with specialty training in gynecology, obstetrics, general surgery, pathology, pediatrics, internal medicine and family practice. Developing critical care training and disaster management planning are current projects that would benefit from outside expertise. For those considering travel to the area, security is clearly a large concern. Fortunately, CURE has full time security, and multiple levels of safety precautions are maintained for each physician.
There is a current need for short term volunteers to serve as guest lecturers and to instruct residents in procedures and patient management. Emergency physicians are uniquely suited to fill such a role, as our training covers the breadth of medicine, is procedure oriented and we tend to be portable in our profession.
For further information about volunteer opportunities with CURE in Afghanistan, visit www.cureinternational.org.