Doctor and Midwife to an Afghan City’s Rebirth

Now Zad, Afghanistan—Three years ago, Now Zad district center had become such a hellish warzone, so riddled with airstrikes and insurgent ambushes, that the soldiers stationed there dubbed it “Apocalypse Now Zad.” No civilians remained; coalition forces and insurgents dug into the ruins of the city and tore it to pieces in a struggle closer to trench warfare than anything seen since World War I. The damage of that battle is still visible in the shattered remains of houses that litter the city, and still seem to outnumber those that have been rebuilt.

Only in the past two years have civilians started to return. The Now Zad Comprehensive Health Center, the only medical clinic for dozens of kilometers in any direction, came with them. Operated by the non-governmental organization BRAC, under a contract to the Afghan Ministry of Health, the clinic resides in two small buildings just outside the gates of the Marines’ district headquarters. They were originally housed in a larger compound next door; the district governor ousted them when security improved enough to allow him to move off the Marines’ base.

Doctor Maro Khan, a diminutive figure who seems permanently busy, is the only physician at the clinic. Farzah, a midwife who like many Afghans goes by only one name, attends to female patients. Between the two of them and a few administrative staff, they see around sixty to eighty patients each day, many of whom have travelled hours across inhospitable terrain to reach the district center. The waiting room is crowded with children, who make up the bulk of the patient population. Parents in the district seem to be conscientious about their children’s health.

“People come in mostly for gastritis, hypertension, skin disease… they get some pills, and go home,” Dr. Maro Khan explains. “I assume they follow the directions. I don’t see many come back for the same problem.”

But infant mortality in Now Zad, like the rest of Afghanistan, remains staggeringly high. Farzah, the midwife, attributes much of it to infection. “People don’t want to or can’t come into the district center, to the clinic, to give birth—they want to give birth at home. In the home it isn’t sanitized, there are lots of bacteria, and they get infections. So the children die.”

The difficulty of providing medical care in so remote a location—and with such poor access between different parts of the district—has hamstrung the efforts of the clinic’s staff. BRAC’s provincial headquarters in Lashkar Gah sends out medicine and equipment, but the clinic is still undersupplied. New deliveries take months to arrive, says Farzah. “And if the Taliban intercepts it, then they just take it all for themselves. Then it is another three months before it will be sent again.”

Access to the clinic has presented more personal problems for the clinic’s staff. “No other doctor will come here,” says Dr. Maro Khan. “If they do, then it is for four or five days at most. This place is like a prison. I have been here nine months and I have only gone home [to my family] once.”

Although part of BRAC’s contract with its workers is to provide transport home, they have relied almost exclusively on the free use of military aircraft in Now Zad. In preparation for the withdrawal, the company of Marines stationed here have begun to limit the amount of charity they dispense. “It used to be they’d call us up and be like, ‘we need a flight,’ and we’d say sure, when and how many people, put it right in,” says Hospitalman 3^rd Class Sam “Doc” Anderson. “But since we’re going to be leaving soon we’re trying to get them to deal with things themselves. Otherwise, when we do leave, everything falls apart because they’re still relying on us.”

Farzah, who is from Kabul, complains of the same problem with isolation. “The last time I went home, I paid a taxi driver myself, out of my own money. It cost me thirty thousand Afghanis. In a month here I am paid twenty thousand Afghanis. But I needed to see my family, so I paid for it.”

The isolation endured by the clinic’s staff is great, but may pale in comparison to the two ‘basic healthcare centers’ operated by BRAC in other parts of Now Zad. In the northern edge of the district, the town of Bar Now Zad has become a de facto headquarters for the region’s Taliban. They operate courts and collect taxes in the town. BRAC has managed, despite that, to open a healthcare center there.

“When we got the first report from BRAC, saying they had a CHC [Comprehensive Healthcare Center] and two BHCs [Basic Healthcare Centers] in Now Zad, we were like sure, show us the other two and we’ll believe you,” says Anderson. “But then we heard just last week that there actually was a clinic up in Bar Now Zad. Which is pretty impressive, considering the situation.”

Despite the Now Zad Comprehensive Healthcare Center’s ongoing struggles, it is expanding. The Marines have contracted with a local construction company to build a $15,000, three-room expansion onto the clinic. The expansion will be named after H.N. Ullom, a medical corpsman who was killed in Now Zad. In addition, the clinic may regain access to their old compound when the district governor, Sayeed Murad Agha, moves into a new, $700,000 compound being built for him by the District Stabilization Team.

But the trick will be getting the doctors to come, and to stay. “I am here as a favor to my friend, [the provincial director of BRAC] Dr. Mangel,” says Dr. Mosa Khan. “But how much longer I can stay here, I do not know… The life is very hard on me. I have a wife and children back home.”

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