Among the tiniest of the premature babies slumbering in incubators at the Mirwais hospital, one bore a name chosen by hospital staff. At five days old, “Fatima” had been abandoned by her mother after being born so early that her family assumed she was destined for the grave.
Had her relatives grasped the welcome transformation unfolding at the government-run medical centre in Kandahar, the largest city in southern Afghanistan, they might have held their newborn a little tighter.
Where once children crowded three to a bed, single occupancy is now the norm. The number of nurses making the rounds among the rows of infants has doubled, and new incubator units help neonatal specialists nurture the most fragile of lives through their first, vulnerable days.
While much of the news from southern Afghanistan over the past year has been dominated by reports of Taliban advances, the creation of a new paediatric unit at Mirwais hospital has opened a new front in a different campaign: the struggle to reduce extremely high mortality rates among Afghan infants.
Luis Tello, a Spanish paediatrician seconded to the unit by the International Committee of the Red Cross (ICRC), said the expanded facilities had already helped to persuade more Afghan mothers that, with the right care, even the weakest babies might survive.
“For me, the most astonishing improvement is with [premature] newborns. Before, nobody was taking care of them,” said Tello, speaking in a ward where young children lay on crisp white sheets, mothers at their bedsides. “But we’ve managed to change people’s minds.”
The new unit, which opened in September, is housed in a former nursing clinic in the hospital grounds, converted in a year-long project funded by the ICRC. It has 186 beds, including 15 for mothers – twice the number in the old paediatric wing.
The number of incubators has risen from six to 10, while another new ward caters for children suffering from thalassemia, a hereditary, incurable blood disease prevalent in southern Afghanistan that can be ameliorated with transfusions and medication.
By reducing overcrowding, the unit has dramatically cut the risk of contagious diseases skipping between patients. Staff who might previously have had to discharge barely improved infants to make room for even sicker children can now allow everyone time to recover.
“We won’t force them to go home early,” said Dr Muhammad Sidiq, the unit’s director. “We can let them stay here until they are completely cured.”
The unit is a tangible sign of broader progress in improving infant and maternal health. In contrast to the bleak picture on the battlefield in much of Afghanistan, years of painstaking efforts by the government and donors to improve access to basic healthcare, and train community midwives to assist at births – the vast majority of which take place at home – are yielding significant results.
I’m better off than some people – they’ve lost both their legs and arms
In 2000, Afghanistan had one of the highest infant mortality rates in the world, with almost 10% of babies dying before their first birthday, according to UN data. Since the overthrow of the Taliban in 2001, the picture has changed.
According to a comprehensive health and demographic survey, published by the Afghan government in May, the nationwide mortality rate for all infants fell from 66 to 45 deaths for every 1,000 live births between 2001 and 2015. Similarly, for all children under five, the death rate per 1,000 fell to 55 from 87.
Despite these achievements, infant mortality rates still remain high in many areas, partly due to a lack of basic education about the importance of hygiene during births. Tello explained that deadly sepsis infections could result from the common practice of using a knife to cut an umbilical cord on the sole of a shoe.
Beyond Mirwais, meanwhile, large numbers of rural women have no access to even basic clinics. Some of the mothers arriving at the unit with infants swaddled in shawls had travelled hundreds of kilometres from remote areas. Escalating violence in many parts of Afghanistan has also made facilities harder to reach: a UN study published in April documented reports of 125 security incidents affecting access to healthcare in 2015, compared with 59 in 2014 and 33 in 2013.
While the fighting begins to intensify each spring in Afghanistan, paediatric illness also follows a seasonal cycle, with diarrhoea more common in the summer and pneumonia and other respiratory diseases rife in winter. Doctors have witnessed a marked increase in malnutrition this year, possibly tied to the increasing numbers of people uprooted by fighting in the south. Some of the victims have been brought to a new therapeutic feeding centre in the unit for the most severely underweight.
Making a brisk round of the new wards, checking on patients and issuing rapid-fire instructions to nurses wearing gowns and surgical masks, Tello soon encountered one of the deadliest killers. Holding up a chest x-ray from a tiny boy named Hekmatullah, he scrutinised an image of a ribcage dotted with hundreds of tiny lesions – telltale signs of miliary tuberculosis.
“He’s lucky because he has this x-ray, which is very clear for TB,” Tello said, before hurrying to the next ward, where another listless child was battling pneumococcal meningitis.
That such children can even reach Mirwais hospital reflects the shifting contours of the war in the south. At the height of the US troop surge in Afghanistan in 2010 and 2011, intense fighting in Kandahar province flooded wards and corridors with casualties bearing blast and gunshot wounds. As the vast majority of western forces withdrew ahead of a security handover in 2014, the locus of the conflict in the south shifted into neighbouring Helmand and Uruzgan provinces, which continue to provide the hospital with a steady stream of war-wounded.
In the main hospital, a 22-year-old student named Abdul Matin was undergoing treatment after losing his right arm when a mortar round crashed into his family home in the district of Marjah in Helmand province a month earlier. Sitting up in a bed near other patients lying swaddled in bandages concealing even more grievous wounds, he greeted his injury with a certain degree of resignation.
“This is the situation,” he said. “I’m better off than some people – they’ve lost both their legs and arms.”
Despite the overwhelming challenges many patients face, Tello and his colleagues are starting to offer hope for sick children that many families might once have imagined possible. Though young “Fatima” did not survive, many more Afghans may one day look back and thank the staff at Mirwais hospital for giving them a second chance when they were most in need of help.
Fresh hope for Kandahar newborns as Afghan healthcare gets a shot in the arm | Matthew Green
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