Pharma

U.S. Medics Reach Out In Afghanistan - Matt Mientka

Army Medic Stacey Osterhoubt
Army Medic Stacey Osterhoubt
KABUL, AFGANISTAN-Though the Department of Defense's (DoD) Central Command in Tampa, Fla., continues to prepare for a possible war with Iraq, American civil affairs officials here said they are staying for the long haul to help rebuild the country and inoculate the population against terrorism.

The United States began a dual military and humanitarian mission last year in which combat medical support teams began to conduct medical and dental outreaches into the local populations. This year, reserve civil affairs teams began to replace the combat medical providers to help rebuild the country's medical infrastructure and to conduct outreaches far into the Afghani countryside, away from the relatively sophisticated medical infrastructure of Kabul.

Currently, the U.S. deploys approximately 300 medical and non-medical civil affairs personnel-a higher number than at any other time during the war. These so-called Coalition of Joint Civil Military Operations Task Force teams include physicians, nurses, medics and other non-medical specialists, some of whom coordinate work with the many non-governmental organizations (NGO), such as the International Red Cross and Doctors Without Borders, that operate here. The vast majority of the task force members are reservists.

Away from the greater Kabul area and the U.S. base in Bagram, seven medical teams composed of various specialists live in safe houses in the countryside, from which they launch medical outreaches to remote villages, providing clinics and meeting with village elders to assess medical needs. The teams also build water wells and restore schools.

Col. Elizabeth Steadman, NC, USA, told U.S. MEDICINE last month that DoD continues to play a leading role in rebuilding the country, assessing needs and coordinating the inflow of equipment and supplies from governmental and non-governmental donors. "The [Afghanis] have good plans," she said. "It's just really a matter of getting the resources to work with and the U.S. has helped significantly with that."

Col. Steadman said she has worked with the new Afghani minister of health, a female surgeon and retired four-star general, to plan Afghanistan's medical infrastructure. "Their focus now is on primary care and preventive status," she said.

Medical Infrastructure
Most hospitals in Afghanistan have not had the money to purchase new equipment and refurbish their buildings for the better part of two decades, Col. Steadman advised. "So most of the equipment is 20-30 years old in many cases and they don't have the high-tech things that we have in the U.S.-there are no CT scanners in Afghanistan, except one at the Army hospital," she said.

Officials interviewed by U.S. MEDICINE agreed that, although medicine is practiced in a Spartan, low-tech environment, the country has a wealth of talented, dedicated physicians who often work without pay. In contrast to a report from the American Forces Press Service that Afghani physicians treat everything with "egg yolk and spit," Col. Steadman advised that the primary difference between urban Afghanistan and U.S. medical care is technology.

"At Kabul, the treatment is basically the same as in the U.S. but without the high technology," Col. Steadman said. "They have the same medications that we do and they treat with [virtually] the same antibiotics that we have. Basically, if they had the supplies and equipment the treatment would be the same," she said, noting that a lack of radiology and other equipment precludes physicians from performing certain procedures.

Col. Steadman, who was at the tail-end of a nine-month tour last month, said she had traveled a few times from Kabul to Bagram and other points in the country but had worked primarily in Kabul. Among other tasks, she worked with officials from the Kabul Medical Institute, a medical school that, like the two sole pharmaceutical plants in the country, was ravaged by the civil war and the Taliban.

"After the Taliban left, there were no medical books in the library" at the medical school, Col. Steadman said. Since then, American personnel have obtained approximately 16,000 medical, dental, veterinary and nursing textbooks, as well as monetary donations for the school. "We rebuilt the library at Kabul Medical as well as the dental school and we've also sent a lot of [textbooks] out to some of the remote areas and villages to the physicians there," she said.

The Kabul Medical Institute was reopened in late October with U.S. and coalition help, according to DoD.

Currently, the task force is working to restore Afghanistan's pharmaceutical production capacity, which was greatly slowed when warring factions during the civil war stole scarce machine motors from the only two plants in the country. While one plant once employed 702 pharmacists, it is now down to 80 total employees manufacturing only two or three drugs. Col. Steadman said the task force is hopeful they will soon procure machinery to restore the pharmaceutical output to 25 per cent of its former capacity, allowing the country to reduce its import dependence on Pakistan.

Afghanis Receive American Personnel
Though American civil affairs teams have been well received in Afghanistan, military personnel continue to exercise caution because Taliban and al Qaeda sympathizers remain in the area. "There's a level of danger. Going out, we're always armed, we are always in uniform," said Col. Steadman. "I don't feel threatened, but I'm very cautious because we are still considered to be in a war zone."

Upon arriving in Afghanistan, Col. Steadman said she had doubts about how she would be perceived by the local male physicians because of her sex. "I have to say there has not been the first issue," she said. "They've been incredibly gracious and it's just amazing how wonderful they are and how much they appreciate us."

Working in Kabul, Col. Steadman said she has seen the "good parts" of Afghani society and has observed that, in just the last three months, fewer women are covering themselves with burkas. "It seems to be their choice now," she said. Currently, women are returning to school across the country, including the nursing school in Kabul, where there are now 25 female students among the 325 students. The task force is also refurbishing a women's surgical hospital that had long been neglected.

A Medic Teaches Afghanis
Likwise, Staff Sgt. Stacey Osterhoubt, USA, a medic, told U.S. MEDICINE last month that she and her colleagues have been well received in Afghanistan. "They're very curious about us, as we are about them, and I'd say that [medical outreach] has been very welcome."

Sgt. Osterhoubt, who is a nurse in the civilian world, said she and her colleagues commonly treat patients that suffer from the common cold. "They're very prone to [colds] as well as stunted growth simply because of malnutrition," she said. "So a lot of what we're trying to do is work with volunteer groups, furnishing vitamins in the area, doing teaching in schools to help along the way."

Although infectious diseases such as tuberculosis are common here because of poor sanitation and medical infrastructure, the most common ailments stem from malnutrition, and obesity is equally rare. "What we've done is go to villages outside of the city and spend a few days with them, treat them," said Sgt. Osterhoubt.

In a remote village far from Kabul, the hub of Afghani medicine, she once spent the day with a local midwife to reinforce the teachings she had done with the local women there. Sgt. Osterhoubt said she believes, as military leaders have been saying, that civil affairs forces will remain in Afghanistan for the near future to get the job done.

Last month, assistant secretary of defense for public affairs Torie Clark outlined the recent actions of civil affairs personnel over the course of "just a few days." Among their accomplishments, they provided medical care for 1,400 civilians-half of them children-in Kandahar. In northeastern Afghanistan, they treated 900 civilians for minor medical conditions and provided veterinary care for 700 area sheep.