Just the facts ma'am

From the little that I have seen during my few weeks in-country, the Afghan people are a very proud lot with a rich history and culture that they rightly celebrate. Unfortunately, Afghanistan the country is pretty screwed up, especially for newborn infants and their mothers. The only imaginable scenario that could be worst than giving birth in rural Afghanistan would be if you were having a baby in a car that was actually on fire!

Here are the facts: Less than 40% of children in Afghanistan are immunized and 85,000 children die every year from diarrhea. Mother and child mortality rates in Afghanistan are among the highest in the world; a woman dies from pregnancy related complications every 30 minutes with an under-five mortality rate of 257 per 1000 live births – meaning that for every 1000 babies lucky enough to survive child birth 257 of them, on average, will die before their 5th birthday. Assuming that you are tough enough and lucky enough to live past the ripe old age of 5 - average life expectancy in Afghanistan is only 44.5 years, which is 15 to 25 years lower than all surrounding countries. Makes one think that maybe the best humanitarian aid project would be to distribute free plane tickets out of this joint! But alas, that’s not an option so we dig in and try to fix what’s broken.

The program that I’m managing has a large maternal and child health and nutrition component in addition to the agriculture side – it’s actually much larger than I realized before I arrived in-country.

The agriculture side is easier to manage in the sense that you are working directly with the community. It’s fairly easy to get a group of farmers together to discuss new strategies for growing things. Now, I say it’s easy to get farmers together to discuss new strategies, it’s hard as hell to get them to actually adopt those strategies, and understandably so. Farmers, especially the poor small scale farmers that these programs target, are extremely risk adverse because their very survival and that of their families depends on how much they grow each season. So needless to say, they are reluctant to turn over their fields to growing a new varietal of say Tasmanian sweet potatoes just cause Fred said that it was a bitchin’ idea. So you work to establish demonstration plots where you grow whatever you’re pitching and this allows farmers to learn risk free whether or not it actually works in their farming environment. Ideally it works, the farmers grow Tasmanian sweet potatoes that they sell at an unbelievable profit, they take that money - enroll their children in school for the first time, they now have money to access basic health services that they couldn’t afford before. The entire community is thriving by project end and as the project team is packing up the office big burly men are standing at our door offering up their fairest daughters for marriage as a gesture of goodwill and thanks for all of the good work that we’ve done in their community. This has never actually happened but……

Working on the health side is a little more challenging. On the health side it’s all about working through the government health care system – supporting the system! Now like most developing countries Afghanistan has a brilliantly crafted community level health care strategy that works wonderfully – on paper. The government’s foundation document is the aptly titled “A Basic Package of Health Services for Afghanistan, 2005 / 1384” brought to you by the highly educated and extremely well intentioned people that sit in the Islamic Republic of Afghanistan Ministry of Public Health. Jokes aside it is a well crafted strategy that outlines multiple levels of public health care throughout the country. At the lowest level where my program operates, you have a community Health Post which is supposed to be manned by a male and female Community Health Worker (CHW). These people are drawn from their home communities and receive training to provide basic health services to their community ranging from; growth monitoring of children under five years of age, immunizations, vitamin A supplementation, antibiotics, treatment for malaria, ante-natal care for pregnant women, delivery services for uncomplicated pregnancies, follow up treatment for tuberculosis, and referral of patients to higher level health care facilities when appropriate. So, obviously these Community Health Workers do a lot of things. Unfortunately, they don’t get paid for doing them and that’s where the system all falls apart. These people are well meaning and I’m sure want to help their neighbors as much as possible but often times they are just as poor as everybody else meaning that they need to spend their time scratching out a living just like everybody else and not providing free health services to everybody. This is where we come in – right.