January 3, 2008

Update on Afghan Maternity Hospital

Following up on ongoing coverage of shocking conditions at the Rabia Balkhi maternity hospital in Kabul, Afghanistan, Atlanta Journal-Constitution journalist Alison Young reports today on new U.S.-led initiatives to improve care at the facility. Please see our previous posts for background and links to Young’s prior stories on the hospital.

Briefly, concerns include neonatal and maternal deaths, sanitation, lack of supplies, spending priorities, and the U.S. administration’s touting of work with the hospital as a success despite evidence to the contrary. Rep. Waxman has called for investigation of the situation, requesting numerous documents to demonstrate what was known about the situation and how it has been addressed (or not).

In today’s piece, Young reports:

“The U.S. Department of Health and Human Services, which runs the program, plans to send teams of obstetric and pediatric experts to Rabia Balkhi Hospital in Kabul this month or next to begin working alongside Afghan doctors, bolstering their training. Meanwhile, the department is developing a joint quality assurance program for Rabia Balkhi and three other Kabul maternity hospitals.”

She also notes that the U.S. trainers already in the facility may have pushed an increased c-section rate before the hospital was equipped to deal with them, contributing to increased mortality, and that reducing c-section-related mortality will be an area of focus for the new trainers.

I think it’s fantastic if real improvements for Afghan women and babies occur due to the investigations and new approaches. However, I have a few questions. If problems have been reported since at least 2003 (including concerns expressed by CDC officials), and 2006 and 2007 data continue to suggest safety concerns, why did it take one reporter’s persistence and a formal request from Waxman to initiate change in 2008?

Likewise, if U.S. trainers have been in the facility for some time, to what extent will sending a new group of U.S. trainers solve the problem? Is it the”training” of Afghan physicians that is the root of the problem, or the more unseemly concerns about the HHS approach to the project?


One Response to “Update on Afghan Maternity Hospital”

  1. Deanne Williams Says:

    It is risky to comment from the privileged settings where most of us give birth so I want to start by acknowledging just how hard it is to be successful in these difficult conditions. But when you train obstetricians to be surgeons first, when OB residency programs give little or no opportunity to learn how to manage labor (even complicated labor) in a way that promotes a vaginal birth, and many MDs believe (in spite of the evidence) that c-section is always safer than vaginal birth, this result is predictable. Sadly, we cannot export our women’s healthcare system and expect to improve the health status of women in the high need countries especially where gender of the provider matters. I know that nurse-midwives from several countries have been involved with these efforts to reestablish a safe setting for women but often midwives (both local and consultants) are not included in the planning, are treated like servants and/or are pushed into a medical model of care. The reality is that without well educated and empowered midwives as partners in the planning and implementation and a system to educate more in the future, the outcomes will not change.

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