Team Supports Reconstruction of Afghan Health System

By Navy Lt. Neil Myers
Special to American Forces Press Service

July 22, 2008 - Like most of Afghanistan's provinces, Konar has historically been unable to meet the medical needs of its 381,000 residents. But the Konar Provincial Reconstruction Team is working to meet those needs. As recently as 2002 and shortly after the departure of the Taliban, Afghanistan has faced some of the worst health statistics ever recorded worldwide, including an infant mortality rate of 16.5 percent and 1,600 maternal deaths for every 100,000 live births. More than 25 percent of Afghan children die before their fifth birthday.

In Konar, nearly 60 percent of the population lacked access to any form of health services. The Konar PRT is one of 12 U.S.-led partnership organizations working with the Afghan government to rebuild the health care system and improve medical services.

Navy Lt. Gregory Monk, a Konar PRT physician assistant from Naval Hospital Camp Pendleton, Calif., has managed much of that work in the province. His team of corpsmen includes Petty Officer 2nd Class Alexander Tabayoyon from Naval Air Station Fallon, Nev.; Petty Officer 2nd Class Ixchel Mattes from Naval Hospital Brementon, Wash.; and Seaman Leo Cedeno from Branch Clinic China Lake, Calif.

Monk and his staff work closely with the provincial health director, Dr. Asadullah Fazli, to assist in the implementation of the Basic Package of Health Services. The BPHS is an Afghanistan Ministry of Public Health strategy to provide a standardized package of basic health services. The ministry, Dr. Fazli and Aide Medicale International, with input from the PRT, use the BPHS to identify districts with under-served populations and determine the location for new facilities.

Aide Medicale International is an apolitical French humanitarian organization that implements health care networks around the world. The strategy was designed to increase access for people more than two hours' walking distance from to public health ministry facilities. After selecting the locations for the clinics, Monk works with PRT engineers to solicit contract proposals and oversees the quality of construction for the new buildings. Once the building is constructed, AMI acquires the staffing, professional medical training and supplies needed to run the clinics.

With the assistance of the PRT, 15 new health care facilities are being added to the province. Fazli reported that six years ago, the Konar health network consisted of only 12 low-quality clinics. Now, the province has 24 health care facilities -- one provincial hospital, nine comprehensive health clinics and 14 basic health clinics -- and an additional 242 basic health posts.

Assisted by Afghan doctors, the PRT medical team conducted village medical outreaches in the remote regions of Konar where local clinics do not exist. On missions into the local communities, they have treated Afghans for a variety of ailments. According to Monk, worms and other intestinal illnesses were the main ailments afflicting most of the people the team treated.

The community uses the Konar River, which flows through the province, for everything: drinking, cooking, bathing, hygiene, and even recreation. But the river is heavily contaminated with pathogenic bacteria, parasites and viruses. Monk said almost everyone he sees for evaluation complains of stomach pains.

"The stomach pains are commonly caused by worms or other parasites, but chronic conditions, such as reflux disease, are just as common," Mattes explained. "Education on simple acts of washing hands and boiling water before use can prevent a majority of these illnesses."

The regular engagements became less common, thanks to the growing number of clinics and local doctors in the villages.

"It makes you feel good to go out and assist Afghan doctors in remote villages that have zero access to medical treatment," Monk said. "We hope that one day every community has its own clinic, ultimately becoming less reliant on these outreach missions."
(Navy Lt. Neil Myers serves with the Konar Provincial Reconstruction Team.)