Sylvia's Journal

Some weeks ago a team went out to Farah Province; one of the provinces considered insecure. Farah borders Iran; Herat province is on its northern border, relatively secure, and Nimruz province, a dangerous place, is to its south. Travel in Farah is risky. There is also, as far as I know, only one female doctor in the entire province. This combination leads to often lethal consequences for those who are seriously ill, who are victims of accidents or violence, or simply having a baby.

The team was looking at the hospital there that is barely functional and thus not helping to build confidence in the country’s government to care for its people. It is teetering on the brink for all sorts of reasons. The US government has stepped in and is making a significant amount of cash available to upgrade this critical part of the health system for the citizens of Farah Province.

According to the report, several of the single story buildings have been built by different agencies and donors for different purposes and following different standards. They are not fit for hospital services and what is there cannot benefit from proper maintenance as there is no plan nor are there resources available to fix what needs repair. There is no drainage, no waste management system, no septic tank and no water supply.

It is hard for us who are used to gleaming hospitals to imagine having to rely on a place like that for our survival. And I haven’t even mentioned the staff. Salaries and benefit are greatly inequitable and a source of friction between those paid by the government and those paid by the NGO that runs part of the hospital.

The staff list attached to the report lists all of the hospital staff; there is a column named ‘designation’ which lists each one of them as ‘mercenary.’ This makes me think of the Hessian mercenaries that fought on the British side in the revolutionary war. It is true that this country is steeped in warrior imagery, but hospital staff as mercenaries?

Still, not all is about war and destruction here. Today I visited the Blood Bank which has made a remarkable turnaround in its ill-fitting and deeply depressing Russian built bastion. There are still traces from the Russian days: its elephantesque architecture, and the habit of closing everything for lunch time. But the legendary Russian disregard and disrespect for the people who come through its doors, either to give or to get blood, has changed a hundred and eighty degrees.

In large flowing Dari script on the walls all who enter are reminded that blood is not for sale and that, if someone claims the opposite, a particular mobile number should be called. Corruption used to pervade the practice of this organization but now all is transparent. Some people don’t like this and are using heavy-handed techniques to throw the current leadership out.

The 60 odd staff members, from the lowly guard at the door to the young and energetic director and his many female staff in between, have all been transformed into ‘managers who lead.’ I got to give them their certificate that proclaimed they had successfully completed a course called ‘Leadership for Infection Prevention.’ And then I got to see what their leadership looked like.

This was not a hollow term: I heard and saw several examples of creative thinking and taking initiative: from getting Afghanistan’s president and vice president to give blood (and photographs to prove it) to cubbyholes at the entrance with plastic indoor shoes so that the muddy street shoes stay at the entrance to the building.

The best part was how the Blood Bank team, as part of their effort to raise voluntary blood donations, had been able to convince the Shia leadership to counsel their flock to donate their blood to the Blood Bank rather than letting it spill on the ground during their annual self-flagellation ritual. In my book that is leadership!