ZABUL, Afghanistan - With snow-capped mountains and baby-blue skies, northern Zabul province is picturesque. The early morning sunrise casts harsh shadows across the deep valley as light dances across irrigation ditches zigzagging across the countryside. Though this scenery is striking it contrasts harshly with the poverty stricken and uneducated population that makes up the city of Shinkay; a city that relies heavily on the Afghan national army and Afghan national police stationed near the Shinkay bazaar to provide security.
In an effort to build cohesion with the population and promote the abilities of the Government of Islamic Republic of Afghanistan, a US Special Forces Operational Detachment Alpha team working in Shinkay thoroughly planned and facilitated a local government-led medical seminar, or MEDSEM.
"The goal of the medical seminar is to increase interoperability within the Government of the Islamic Republic of Afghanistan and facilitate local national doctors so they have more direct contact with patients through public health education classes given to local villager students," explains a USSF physician assistant. "Simply put, it's designed to connect an isolated villages to their district doctors and enhance medical infrastructure with an area."
Surrounding villages are invited to send students to attend a three-day seminar covering basic health and preventative medicine topics. Basic women's and children's care is emphasized, said the USSF PA.
A MEDSEM is a medical operation that builds upon the concept of the traditional medical civic-action program, or MEDCAP. The MEDSEM enhances the MEDCAP by adding education, promoting self-reliance and improving sustainability of medical interventions.
The MEDSEM promotes local governmental interoperability by requiring collaboration between local medical providers, governmental leaders, host-nation forces and USSF. The graduating students are also taught to serve as informal assistants to the local national doctor and facilitate medical visits.
A MEDCAP is typically a single-day event that provides medical or dental care and can vary in size from a handful of patients to a few thousand. It is a medical operation used by commanders on the ground to engage a given population or geographical area in order to gain initial access to or maintain a relationship with that population.
The PA says the MEDSEM differs from a MEDCAP in that "we [coalition forces] teach the village to fish versus providing fish to the village."
Two months before conducting the seminar, USSF facilitated multiple Shuras with local elders to explain the MEDSEM and encourage attendance. The Afghan national police and Afghan national army are also informed, volunteering to provide security for the seven-day event. Issues, such as a potential lack of female participation, are addressed during planning and expected by the Special Forces soldiers.
A clinic in Shinkay was the site where the MEDSEM was conducted. The clinic is run by Afzal, a nurse practioner, and his wife Neema who serves as the mid-wife. It is designed to support the entire Shinkay District, comprised of about 300 villages. Afzal, who is called doctor by his patients, is unable to travel out to all the villages regularly because of the threat of insurgents and transportation issues. This forces villagers who need medical assistance to travel to the Shinkay clinic on their own accord.
"The goal is to get local national doctors, like Dr. Afzal, linked up with villagers in this district so they can develop a relationship through education presented in this medical seminar," explains the USSF team leader who helped organize the MEDSEM. "Then, we can push those medical seminar graduates out to their villages. When the local national doctor arrives, they can work together to treat the people. The idea is to have local national doctors, assisted by the trained local national villagers, treat the people in isolated areas while the Afghan national army and Afghan national police provide security. It offers the people of this area an opportunity to see all of their government services at work and have faith in the system."
Care for Women
The Shinkay clinic, a one-level concrete building, which has two examination rooms and a government-funded pharmacy, is strategically located in the center of the Shinkay bazaar. A white cloth sign with "Female Site" inscribed in Pashto and English waves with the breeze, welcoming passersby to a segregated part of the building blocked off for women.
Neema sits inside searching through the laptop containing her classes, looking for the basic hygiene class she thinks should be taught first.
"I'm nervous," she exclaims, finding the class she will instruct. "I hope we get a few students today," she gushes.
The mother of five is conservatively dressed in a floor-length burqa, her hair covered by a Pashmina white scarf.
She sits on one of the wooden benches recently brought in for the MEDSEM and crosses her legs. Leaning in, she whispers, "I wasn't always like this you know." Neema explains she's originally from Kabul and only after arriving in Shinkay did she don her burqa.
"The insurgents do not allow us to dress in skirts," she explains, her eyes shifting nervously to the door. "But soon, we'll be back in Kabul and I'll once again wear my colorful skirts."
Reflecting on her reasons for instructing, Neema says she does it for her family.
"I want my children to get an education," she confides. "I want my two daughters to choose their husbands. That's why I'm excited to teach these classes."
As she finishes explaining her reasons for teaching, two burqa-clad women discreetly enter the room. With four children in tow, they sit on the benches closest to the door before lifting their burqas, revealing angelic green eyes and raven black hair. Neema rushes to them, patting the children on the head as she asks the women questions.
"They're from the Kuchi tribe," Neema explains, rushing into the back room and returning with a blood pressure cuff and a stethoscope. After checking the women's vitals, Neema listens to her patients. She determines the head and stomach aches they suffer are a result of a lack of water and vitamins in their postnatal diet.
"I told them to drink more water and prescribed vitamins and pain medicine," says Neema.
As the women prepare to leave the clinic, Neema convinces them to stay for a class.
As Neema begins her class, the children quietly sit on the tile floor, their eyes focused on the projected slides displayed on the dirty white wall. The women nod in understanding when Neema speaks about washing their hands before eating and after using the restroom. The eldest of the two women stands when Neema begins speaking about bathing.
"We bathe once a month," explains the woman, pointing toward the two cleanest children.
"Water is scarce," Neema interprets and translates into English, motioning for the woman to sit back down. "They don't think they should waste their supply on baths."
Neema finishes her class and the children are rounded up. Clinging tightly to their prescriptions, the women said they would try to return for more classes in two days. Halting at the door, the women pull their black scarves over their dark hair and green eyes, exiting the room as quickly as they had entered.
The next few hours continue in the same manner; women arrive for medical treatment and Neema convinces them to sit for one or two classes before leaving.
"This part of Afghanistan keeps their women under wraps, literally and figuratively," says a Special Forces team leader. "We, however, took this problem and created an opportunity [by showing the men how teaching women can help them]."
A Special Forces medic added to the team leader's comments.
"Realizing the men might not allow their women to attend the classes, we introduced male education, from basic hand washing, food preparation, water collection, boiling, food processing and basic storage of food and meat," said the medic. "We started off with 28 male students and by the third and final day of classes, we our numbers had increased to 35. We broke the classes down to mid-level care and after the men received the general classes, they said they understood the importance of the women receiving the classes that were specific to female and child care needs."
As a result, female participation increased during the following two days of the seminar.
"I believe the women are the heart and soul of the Nation of Afghanistan," said the USSF PA, who served as the lead planner of the seminar. "If we can educate the women through general healthcare education, Afghans will have a stronger and healthier nation."
Continued Care
With the conclusion of the medical seminar in Shinkay, USSF implemented a plan to accompany the ANA, ANP and Shinkay healthcare providers to two different villages. The first village, only five miles from the Shinkay clinic, contained seven medical seminar graduates. With the ANA and ANP providing security, Afzal and his wife, with the assistance of the Special Forces soldiers, set up two separate examining rooms to provide health care.
"Dr. Afzal was able to set up shop to see some villagers and the medical seminar graduates were able to assist with setting up lines and documenting what's wrong with the patients," explained the team leader. "The more they do without our assistance, the more they will grow and have faith in their own government and medical providers. Essentially, we're working ourselves out of a job."
In just three hours, 90 villagers are treated. The medical seminar graduates rotate working with Afzal, offering their opinion and learning to assess illnesses and basic treatments. After receiving medicine, the villagers are given humanitarian aid, such as shampoo and blankets with instructions from the students on proper hygiene.
"This program will be able to endure past all our rotations as Soldiers," exclaims the team leader adamantly. "Essentially, we are teaching the Afghans to rely on their own resources to take care of their people."
The MEDSEM, the first in Afghanistan, was a success and also a learning opportunity, said the Special Forces PA.
The team leader summed up the seminar in his own words.
"Things tend to work out when people are given just a little bit of know-how, and that's what these medical seminars are designed to do," the team leader concludes.
Afghan national security forces, along with their Special Forces mentors, plan to continue providing medical care, assistance and advice in Shinkay and the surrounding areas in the following months.
Sgt. 1st Class Andrew Kosterman contributed to this story.
| Date Taken: |
03.28.2010 |
| Date Posted: |
04.01.2010 07:21 |
| Story ID: |
47524 |
| Location: |
ZABUL |
| Web Views: |
132 |
| Downloads: |
107 |
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