2. Afghan Ministry of Public Health. Afghanistan health survey 2006 - estimates of priority health indicators for rural Afghanistan. Kabul: The Ministry; 2006.Simple, reality-based solutions seemed to have been forgotten. Training community health workers in "hygienic" deliveries, for example, would be highly appropriate. It could potentially mitigate existing harmful practices and promote useful ones. Since 20 000 community health workers are already trained to provide basic health information and services, schooling them in the correct basic care of expectant mothers seemed logical. Granted, such training is a temporary measure in a resource-poor setting with insecurity and a destroyed health system, where maternal and neonatal mortality are huge. But it is doable. Unfortunately, it's against a Ministry of Public Health policy spearheaded in 2002 by international organizations, which promoted well-intentioned goals while being seemingly oblivious to the extreme poverty, remarkable illiteracy rates, neophyte government, predominantly rural population, insecurity and foreign cultural rules.
Salon CMAJ Shame and simplicity in Afghanistan W hile working in Kabul this workshop that left me frustrated by the past November, I had an en- blindness educated urbanites seemed to lightening conversation show for village politics and the futility with an Afghan doctor, an intelligent of using financial incentives to motivate man who excelled in his work with in- community health workers to do our bid- ternational organizations and had re- ding. I wanted to cry out, “How about in- cently moved from a remote village to spiring them by helping them to success- Kabul. He told me about the birth of his fully accomplish what is valued in their son and how he had acquiesced to fam- communities: bringing healthy newborns ily demands and recommendations into the world and saving women’s from international colleagues that his lives?” They were doing it anyway. expectant wife seek care from a doctor. Simple, reality-based solutions After settling into the maternity ward, seemed to have been forgotten. Training her labour stopped and did not restart by community health workers in “hygienic” nightfall. His suggestion that she remain deliveries, for example, would be highly in hospital was met with scorn: “I refuse appropriate. It could potentially mitigate Fred Sebastian to give birth in this filthy hospital! Take existing harmful practices and promote me home!” she cried. In the privacy of useful ones. Since 20 000 community their home his mother boiled string and health workers are already trained to pro- gauze and his wife happily gave birth, vide basic health information and serv- surrounded by a loving family. I sympa- ices, schooling them in the correct basic needed is large-scale implementation of thized with her. Given the contrast be- care of expectant mothers seemed logi- low-technology, simple solutions in ru- tween Afghan homes and hospitals, I cal. Granted, such training is a temporary ral areas where the majority of the pop- would have done the same. measure in a resource-poor setting with ulation lives and a plan for stepwise The story came after a discussion insecurity and a destroyed health system, improvements to eventually achieve in- about community-oriented strategies to where maternal and neonatal mortality ternational standards. Defining reality address maternal and child health. I are huge. But it is doable. Unfortunately, and maintaining simplicity are too often lamented the vast resources invested in it’s against a Ministry of Public Health forgotten prerequisites for success in facility-based care when women valued policy spearheaded in 2002 by interna- such a challenging environment. delivering at home.1 Most funded ac- tional organizations, which promoted tivities involve training midwives and well-intentioned goals while being seem- Maureen Mayhew MD MPH doctors. Training uneducated village ingly oblivious to the extreme poverty, Technical Consultant women, who have facilitated deliveries remarkable illiteracy rates, neophy
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