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Kristen Lindsay

03 Sep 2013

This article first appeared in the September 2013 edition of Médecins Sans Frontières Australia's quarterly magazine, The Pulse.

It is two months that I have been in Afghanistan. Time is flying but at the same time my ordinary life seems like a book I read once about a girl who looks like me! I am glad to be here and there is a huge need for medical care, particularly paediatrics. I am handling the challenges well but one thing is certain: it is definitely not easy here.

Boost Hospital is a 240 bed secondary level provincial hospital in Lashkargah, Helmand Province, which is in the heart of the conflict between the Afghan National Army and international forces and armed opposition groups. Médecins Sans Frontières' team of 20 international staff and about 400 Afghan staff support the emergency, inpatient departments, isolation department, maternity, operating theatres, laboratory and radiology. The Ministry of Health hospital also offers outpatient services, dentistry and a tuberculosis (TB) clinic. There is an estimated population of over 1 million in the region and a huge demand for quality health facilities. As an example, the mortality rate in children under five is estimated to be as high as 30 per cent.

Afghanistan has experienced more than 30 years of conflict, which has impacted on health education and access to healthcare, so there are poor hygiene standards, antenatal care, vaccination and breastfeeding rates. There are many private clinics run by local doctors who unfortunately suffer from the same lack of education as the rest of the population. Patients receive bags of drugs with no quality control and many patients use home remedies that contain opium. Since Médecins Sans Frontières has been working at Boost, mortality rates have improved but still many people die because they are too sick to help by the time they are brought to hospital.

"I have also seen patients with chronic diseases that we see in Australia like asthma and diabetes, or cancers such as leukaemia. These always make me sad, as they are just so difficult to manage in a place like this."

So I have a very big, physically and emotionally demanding job! I work alongside 10 Afghani doctors; four employed by Médecins Sans Frontières and the rest by the Ministry of Public Health. Most gained medical qualifications decades ago in Kabul or Pakistan and have limited knowledge, so a big part of my job is bedside teaching, making protocols and running training sessions. I am the sole expatriate doctor for the general paediatric ward, the therapeutic feeding centre, the paediatric intensive care unit and the neonatal intensive care unit. Aditionally, there are paediatric patients all over the hospital - in the male medical ward, the isolation ward and in the adult ICU. The paediatric department is usually at about 250 per cent capacity, which means 2-3 families on each bed. At any one time we have about 100-150 patients, so we are all working flat out. Most of my time is spent with the most critical patients in the intensive care units. I'm lucky to work with some wonderful nurses in paediatrics, including Emma and Concetta. Together we are working very hard to improve the quality of care in the paediatric department but we have a long way to go.

The biggst problem I see is severe malnutrition and the complications that it comes with. The other main illnesses are severe gastroenteritis, pneumonia and other infections. Afghanistan does not have the exotic tropical diseases that Médecins Sans Frontières is famous for working with in Africa, but it does have some diseases I had little experience with prior to coming here. There are many children with thalassaemia (a genetic disease with abnormal red blood cells that break down). These patients have dozens of blood transfusions throughout their life and have enormous spleens that feel like they could rupture. There are cases of neonatal tetanus and measles every week. I have seen a lot of TB and suspected TB meningitis. There are also a lot of congenital abnormalities and very late presentations of surgical problems like ruptured appendixes and bowel obstructions, which are sometimes misdiagnosed as gastroenteritis.

I have also seen patients with chronic diseases that we see in Australia like asthma and diabetes, or cancers such as leukaemia. These always make me sad, as they are just so difficult to manage in a place like this. One day I found a child who was unconscious with acidotic (deep, irregular) breathing on the general paediatric ward. But his doctor did not realise the seriousness of this child's condition. Suspecting diabetic ketoacidosis, a complex condition which is difficult to manage in a tertiary paediatric hospital, let alone Boost, I jumped into action and carried the child to intensive care. It was an exhausting day explaining how I wanted insulin and glucose given at the same time and that we needed to monitor very closely. I was so worried the child would die overnight but the next morning I was elated to see the child awake, eating bread and playing with his sister! Some days are tougher than others, especially being exposed to so many sick and dying children. But I'm lucky to be working wtih a great team and we always find inventive ways to alleviate the stress! Plus, I think in the coming seven months I have the potential to leave behind some sustainable, positive changes for some of the world's most beautiful, desperate children.