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08 November 2009

Medica Afghanistan: Training medical specialists

The health system in Afghanistan is severely under-developed. Some 26,000 women die every year during pregnancy or birth. The maternal death rate per 100,000 births is 1,600, with an even higher figure in remote areas. Afghanistan’s figure is the second highest in the world, just behind Sierra Leone. Around 80 per cent of pregnant women have to give birth without any professional help whatsoever. Very many women live far too far from a hospital and husbands or other relatives often forbid the pregnant woman from going to hospital anyway. Of course, this lack of medical care for mother and child has a corresponding effect on the child and infant mortality rates, which are also very high. One child in four dies before their fifth birthday.

Although the situation in hospitals has tended to improve in recent years, with an increase in cleanliness and modern equipment, female patients often suffer at the hands of poorly trained staff. Respect and friendliness are often lacking and there are cases of violent harassment. Even though many medical staff themselves were traumatised during the years of war in Afghanistan, the country’s medical training still fails to include any psychosocial components.

A further complication is the fact that hardly any female patients dare to name the real cause of their complaints and injuries. They fear the stigmatisation that women in Afghanistan suffer if they were raped or subject to other forms of violence. Unfortunately, where a patient’s particular situation and burden remain unknown, the wrong treatment can quickly lead to retraumatisation.

Since 2002, medica mondiale has been running intensive further training and awareness-raising courses for medical staff in the Afghan health system. Initially, the “Doctorane Omid – Doctors of Hope” project gave Afghan women doctors living in Germany the opportunity to pass on their expertise to their colleagues in their country of origin. This enabled local medical staff to learn how to recognise their patients’ psychosocial burdens and help them accordingly.

Qualification programme for female specialists in hospitals

In order to expand the women-specific trauma work in the Afghan health system, Medica Afghanistan holds specialist seminars for female hospital staff. In regular training sessions held over a period of two years, Afghan women doctors, nursing staff and midwives learn about trauma and retraumatisation, psychosomatic illnesses and trauma-sensitive methods of examination and treatment. A total of 50 specialists have been trained in Kabul and Herat since 2006.

At the end of the seminar series, the specialist staff know much more about what they can offer patients who have been affected by violence. Just as importantly, they also learn to respect the limits of what they can do as part of their work. Where needed, they can then refer women to the psychosocial counsellors at Medica Afghanistan. The sessions also cover the issue of the womens’ right to medical care and the participants take a close look at their own attitudes to women affected by violence.

Another important aspect covered during the training is how to avoid overload at work. Participants learn how to preserve their own strength despite intense contact with traumatised patients and how to avoid secondary traumatisation – where the helpers themselves develop trauma symptoms. In addition, Medica Afghanistan offers lectures in the hospitals to raise awareness among male staff of the special issues faced by women. After the series of seminars has finished, the psychosocial counsellors and participants meet regularly to continue the skills exchange and to refresh and update what they learnt.

Trainings bring success: Many doctors and nurses reported that they were able to apply the expertise they learnt in the seminars. At work they were better able to recognise and react to signs of trauma in their patients. In spite of the stressful hospital routines, they were able to find more time for the women and girls and show them more respect. In addition, many of the female experts participating recognised the trauma they themselves had experienced and learned how to deal with this in a better way.

Consultation rooms in hospitals

Doctors and nurses have been further assisted in their efforts to adopt a trauma-sensitive way of treating their female patients by the establishment of dedicated consultation rooms in three hospitals in Kabul and Herat. This was a result of Medica Afghanistan’s efforts and provides a sheltered place they can withdraw to for a confidential conversation with their patients. This is especially necessary because female patients are often accompanied to hospital by their families, making it impossible to have a private conversation at the hospital bed. In difficult cases, the medical experts seek advice and assistance from the psychosocial counsellors at Medica Afghanistan, who can then treat the patients themselves.

“Doctorane Omid – Doctors of Hope”

In 2002, medica mondiale in Afghanistan initiated a project called “Doctorane Omid – Doctors of Hope” with the aim of showing staff in the state hospitals the appropriate way of dealing with traumatised women. By 2007, 27 Afghan women doctors who live in Germany had worked in a total of eleven hospitals in and around Kabul, in Herat, Pol-e Khomri and in Kandahar. In over 60 short assignments, the exile Afghan doctors from Germany treated over 10,000 patients. These assignments resulted in some 350 doctors and nursing staff receiving training on the topic of violence as a breach of human rights and the consequences of such violence. They could expand their knowledge of trauma and psychosomatic medicine.