Medical Engagements Provide More Than Health Care

By Army 1st Lt. Lory Stevens
Special to American Forces Press Service

Oct. 23, 2008 - Government officials and the medical team assigned to the provincial reconstruction team in Afghanistan's Panjshir province coordinated with local leaders in two districts to augment health care services to 563 Afghans, including more than 150 women and 320 children, during medical engagements recently. A representative from the Directorate of Women's Affairs and two Afghan National Police officers accompanied the PRT medical team to Estayca Village in Rokha district for a medical engagement Oct. 14. Inaccessible by road, the isolated Afghan village lacks basic medical services.

Air Force Capt. (Dr.) Glenn Little, chief medical officer, coordinated in advance to have local manpower waiting near the Panjshir River to transport medical supplies needed for the event across the footbridge and trail leading to the village.

"Coordination with village elders can be the most difficult aspect of conducting these engagements, but serves as a critical task in ensuring a successful outcome," Little said.

The PRT's role is not to meet all the needs of the Afghans, but rather to support the local elders as they take the lead providing essential services to people in their villages, he explained.

Working with the village elders, the team set up temporary treatment facilities. Women were seen on the balcony of a private residence, and men were seen a short distance away outdoors in the centrally located village gathering place.

The team conducted medical screenings and provided routine treatment for 202 patients and provided two referrals for Afghans requesting to be seen at the Egyptian hospital at Bagram.

"The village elder suffers from suspected carpal tunnel syndrome, and another adult male presented with varicose veins," Little reported.

Miriam Panjshiri, director of women's affairs, and the PRT medical team assisted a local midwife and nurse at the Obdara medical clinic in Anaba district on Oct. 16. The original plan was to have separate rooms inside the clinic for treating men and women. But treating men and women in the same area created a cultural issue, with men and women too close to one another as they waited to be seen by health care providers. The women were moved a short distance away to a large, open room inside a girls' school.

"The big room allowed for the medical engagement to flow smoothly," said Air Force Staff Sgt. Janine Duschka, a PRT medic with a background in trauma and emergency medicine. "There was space to work and move without being crowded, which is often the case during medical engagements."

Almost all the women complained of headaches and kidney and back pain. Many of the children showed signs of dehydration and malnutrition. The team gave them medications for their ailments, Duschka said.

But blood-pressure medications, insulin and other dangerous drugs were not offered, Little said.

Medications given to local patients are manufactured in Afghanistan, ensuring continued availability of medicines and avoiding treatment with products manufactured in the United States, Little said.

"Medical engagements empower women and children by having someone listen to them," said Air Force Maj. Jillian Torango, the Panjshir PRT's women's affairs liaison, as she explained the benefits of interacting with the local populace. Working with the Afghan Directorate of Women's Affairs is very helpful in treating the women, she added.

During medical engagements, women discuss health issues in confidence with the female providers and the DWA, Torango said, and they voice concerns they are having in their villages.

"The DWA can take the lead providing teaching on the importance of good feminine hygiene, hand washing, breastfeeding, and boiling water before drinking," Torango said.

During nine medical engagements over the past six months, the PRT medical team has built a relationship in which villagers trust them and have confidence to seek out care.

"It is notable in the conservative posture of Panjshir to have two women request my services," said Little, a male health care provider, as he reported on one woman who needed a referral for high blood pressure and another who suffered an injury to her foot.

Air Force Capt. Jason Aftanas, chief engineer, said Little is responsible for many good works in the local medical community in Panjshir.

"Previously, there had been only one clinic, and Doc identified a lot of projects totalling $1.7 million in medical construction," Aftanas said, noting the role of medical engagements in connection with four clinics built and one in the works.

"Medical engagements provide an opportunity for Doc to assess local clinics, health care providers and needs in the area, and then information is shared with local health officials, who organize efforts to improve the local medical infrastructure," Aftanas said.

In addition to the medical screenings and treatment, the PRT medical team also provided school supplies, hygiene kits and stuffed animals to the children. Women were given metal pots and pans, which Torango stressed as a great benefit in this society, where utensils are limited.