Author: Jennifer Jamieson

A Journey to the Frontline: Humanitarian Healthcare in Afghanistan

This article is a transcript from a recent interview with Prue Bentley on 774 ABC Melbourne Radio, Australia. Prue interviews doctor and humanitarian advocate Dr Jenny Jamieson about her recent 6-month mission to Afghanistan with Médecins Sans Frontières. PLOS Translational Global Health is proud to have Jenny as a guest blogger.

 

There are few places in the world that appear as inhospitable as Afghanistan. The news from there is almost always awful and I think in many ways we have become inured to the images of people there that we see from there  – the dead, the injured, the military, all against the backdrop of the desert. There are these recurring images of Afghanistan that we take for granted and we place as automatic when we think of the country.

Today we are going to find out what it is really like being there. Jenny Jamieson is an emergency doctor from Melbourne who has just spent 6 months working in Kunduz in northern Afghanistan for Medecins Sans Frontieres.

Jenny, take us to Afghanistan. You are a woman from Melbourne. You fly there, you get off the plane and you go to a trauma hospital where you are going to be working for the next 6 months. What’s your first impression?

My first impression is that Kunduz is a very mountainous area, with this staggering backdrop of mountain ranges which are placed in amongst the desert as well. It’s dry and dusty, it reaches these extreme temperatures in summer with temperatures of 49*C and drops down to -15*C in winter. So you’re sort of struck by the climatic extremity first of all! And then you have to deal with the day-to-day medical practice of the trauma hospital. So it’s a lot to take in at first, that’s for certain. 

What is the day-to-day routine like in a trauma hospital? Is it anything like you experiences here?

Well, no! It’s quite different. The trauma hospital there was set up initially to provide trauma care and assistance to war-wounded patients, those affected by violence and the consequences of the conflict. But it also provides standard trauma care to patients who have been injured in road traffic accidents, domestic violence and falls.

When I read about this, I was actually quite surprised, because I immediately assumed that this is all about the conflict, all about the war going on there. And you do forget that people forging their own lives and they may have a trauma that has nothing to do with the conflict there.

Absolutely, that’s true. Due to the poor infrastructure in parts of Afghanistan, there are a lot of road traffic accidents from cars, rickshaws, motorbikes and pedestrian accidents. 

What was the main thing that you were doing there? Was it a constant stream?

Yes, it was a bit of a constant stream! Actually my role was quite interesting. As many people know, Medecins Sans Frontieres is a humanitarian medical  organization and most of their field projects will work in emergency epidemics, nutrition programmes and vaccination campaigns. The trauma hospital in Kunduz was something a little bit different, particularly because they decided to set up a small intensive care unit. Intensive care units in low-income countries are usually viewed as a bit of an unaffordable luxury. Because critical care is so integral to trauma care, MSF decided to do a small trial with four ICU beds and I was actually there to oversee that and work as the intensive care doctor.

How many other people were you working with?

We had quite a big team in Kunduz. We usually had two surgeons, a general and orthopaedic surgeon. We had an anaesthetist, a surgical nurse, an emergency doctor & nurse, two inpatient nurses, a physiotherapist. plus the intensive care nurse and myself. Additionally, we then had a large team of national medical staff whom we were working alongside and helping. Then there were all the non-medical people who are integral to many of these medical missions – the logisticians, the supply team, the administration team and the field coordinator.

When it comes to hospital services and trauma services, how does Afghanistan stack up? Is there anything there at all without the services of MSF or international organisations?

Yes there are, but these have been adversely affected by years of conflict. Many people think of Afghanistan as coming on the map simply after 9/11 but the country has been plagued by conflict, both internal and external, for decades.  This has had quite a devastating effect on many of the healthcare facilities there. The government hospitals are quite poorly run and poorly staffed and a lot of the medical doctors working at these institutions have left the country. As well as that, the hospitals are not necessarily neutral. As you know, MSF is neutral and impartial. We are not affiliated with any government or military organizations. We don’t take sides in the war or discriminate against patients. So this means that a member of the Taliban were injured and they turned up to a government hospital they might be turned, they may be actively discriminated against and turned away, not receiving any medical care in Afghanistan. Because MSF is there and we practice this neutrality and impartiality, we were treating anyone and everyone.

What was the hardest thing about living in a war-zone?

There were many many challenges. I think one of the hardest things for me was seeing the mass casualties and this is something that I don’t deal with on a daily basis here at all – in fact, I’ve never seen anything this before!  Whilst I was there, there were two suicide bomb attacks in the town of Kunduz, with up to 40, 50 or 60 casualties turning up to the MSF hospital all at one time.  Learning how to deal with that many trauma casualties turning up all at one time was definitely a very challenging thing to deal and very hard. 

Did you see positive things over there?

Absolutely. Without doubt, the positives outweighed the negatives and as you were alluding to before, we get plagued by images of the war, conflict and injuries. But there are many positive aspects. The people there are lovely and were an absolute constant source of inspiration for me. The team I was working with were all trying to work towards a better future for Afghanistan. 

It may be a long time coming though?

I think it will be.

As a woman in Afghanistan, how did you feel?


I think my role was a little bit different and I certainly can’t comment on what it is like to be a woman in Afghanistan. As an expatriate who is there in a medical role, it is probably a little bit different and I was working alongside a highly educated team of Afghan doctors, so I never experienced any setbacks as a result of my gender. The only thing that was a little bit different for me, was that instead of wearing my scrubs to work, I was wearing the long traditional shalwar kalmeez, with tunics down to my knees, and a headscarf or veil on as well, so learning how to do some medical procedures with this was a bit tricky at times.

You mentioned the expat community in Afghanistan. And I’m sure they’re probably quite tightly knit. You’re not working an all the time, so what did you do when you weren’t working?

To be honest, we did work an awful lot – 7 days a week and I remained on-call 24 hours a day. Our downtime was spent with the rest of the MSF team in the field as we don’t have much to do with the other expat organizations there, especially none of the military organizations In Kunduz. Simply for security reasons, we had quite limited movement restrictions. We had 15 other expats living in one guesthouse, so when we were not at work, we had to be at the guesthouse – you couldn’t just go for a run or a walk down the street.  So our existence could be described as quite contained. But we kept ourselves amused – we created a rooftop cinema and we had a small treadmill in the basement or bunker, so there were activities to do in our spare time. 

There is obviously going to be a culture shock going over to Afghanistan. But is there a culture shock coming back to Melbourne?

Absolutely. And I think this is something that doesn’t really get talked about very much and it’s the concept of a “reverse” culture shock. This is when you’ve actually been somewhere that is so completely different and you come back home to reality and find that you’re confronted by your normal everyday life. So for sure, there is, but as long as you expect a certain degree of this, then it is something you can come home prepared for.

Is it something you would do again?

Yes.

Why?

Because I believe in humanitarian emergency medicine. And this is something that MSF has been doing since 1971. I believe in their principles of independence (they are not affiliated with any governments or military organizations), they are neutral (so they don’t take sides in any conflict), and they are impartial (they don’t discriminate against anyone based on age, gender, ethnicity, political affiliation). So for sure, I will absolutely go and work with MSF again.

It’s a brave thing to do. We’ve spoken to a few people this week who have taken themselves out of their normal lives and gone somewhere they never thought they would go. Do you keep in touch with many of the people over there?

I do. I exchange emails with many of my MSF colleagues and ICU team quite frequently.  When you’re in such an intense environment you really do forge lifelong friendships. And I don’t know when I will return, so it’s important to keep in touch with them.

Did you get any sense whilst you were over there of the future of Afghanistan post-conflict and what it would take to rebuild the country?

That’s a million dollar question, isn’t it? Maybe it’s a multi-billion dollar question actually! I think there’s no easy answer. MSF is aware that medical assistance and healthcare provision is really only part of the answer. The answer is going to enailI think it will entail addressing the social, political, cultural and economic aspects of healthcare. I don’t think there is a quick-fix solution there. 

Thank you so much for coming in today. You’ve certainly given us all a different perspective of Afghanistan.


Dr Jenny Jamieson is an emergency doctor who has just returned to Australia after spending 6 months working in a trauma hospital in northern Afghanistan. She is a co-founder of the Global Health Gateway, an organisation dedicated to keeping young health professionals engaged in global health activities and work. She has returned to Melbourne to continue her specialty training and global health pursuits.

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