Difficulty living
Difficulty being born

I arrived in the Panjshir valley in July 2007 for the reopening of the Maternity Centre after a three-month suspension of activities for security reasons.

It was my first mission with EMERGENCY.   Naturally, in the offices in Milan, I had been informed about the job that I would be doing, but I did not expect to find the village in such a state of anticipation for the recommencement of our work.

During the three months of hospital closure, it was as if the women of the valley had taken a step backwards.  Beginning in June 2003, following construction of the Maternity Centre, they had begun to pay more careful attention to pregnancy, to childbirth and the health of women -- preventive care that until that day had been unheard of.

Before that time a few first aid facilities were available, but without obstetricians and gynecologists, and not a single specialist that provided treatment free of charge.  The same situation returned again in the spring of 2007 at the expense of the health, and at times at the cost of lives, of women and their children.
 
Pregnancy, Childbirth, Women’s Health,
and New Approaches for Ancient Topics

From its reopening (July 24th) through mid-November we admitted more than 360 women and had 720 outpatient visits with patients.

Irregular bleeding, missed menstrual periods, abdominal pains and contraception are amongst the common reasons women are motivated to seek the assistance of the Centre's gynecologists.

Their requests often sound unusual for clinicians used to working in a western hospital:  menopause, for example, is an unfamiliar condition that women here are frequently unprepared to face.  Many, at the early signs of menopause, turn to us afraid that they are pregnant again.

Perhaps it’s the lack of familiarity with their own bodies, potentially the ignorance of physiology, or maybe it is the rarity of a woman living long enough to grow old…

Prenatal Assistance as Prevention
A Program to be Extended to All in the Valley

Most importantly, however, we are occupied with childbirths and prenatal care. Our patients are a median age of 25 and have at least three children that wait for them at home, waiting to become a family of four.

With the reopening of the hospital we reinstated our “prenatal care” (care during pregnancy) program.  Many of the childbirths are therefore the conclusion of a journey of advice, treatment, and check-ups accumulated over time.

Prenatal care allows us to prevent and even treat premature pathological conditions that would otherwise force us to use emergency treatments that have an uncertain outcome for the well-being of the mother and the child.

Among the women who have given birth at our hospital, 57% have attended  “prenatal care” service; among these 72% have done so at our doctor’s office.  The attention to prenatal care seems to depend on the “culture” of the village:  66% of women that go to the doctor’s office come from villages where childbirth in a hospital is a common custom.  On the other hand, women who arrive at the hospital in the later stage of their pregnancy live where it is customary to give birth at home.

Due to the vastness of the valley and the impassibility of some of the roads for a good part of the year, not all women are able to access prenatal care.

For this reason we are reinitiating provisions for mobile prenatal care. Two obstetricians, one international and one local, travel at least once per month to our first aid stations to bring aid to the women in distant villages.

In some instances, as is the case of the Anjuman village (reachable after a full day of travel) we have proposed to the woman who serves locally as a “midwife” that she set aside a day to visit our hospital to develop and update the procedures she uses to assist during childbirth.

It’s a Boy! Congratulations
A Girl? Relatives are Indifferent

From the reopening to the end of November, 236 children were born (122 boys and 114 girls).

The scene outside the waiting room is very different from what I’m used to seeing in the hospital in Italy where I worked.

The husbands, who are not permitted to assist the childbirth, remain outside of the ward, usually with some relative.  Of concern, of course, is the health of the mother and child, but above all the sex of the new arrival; if it is a boy even the female relatives ask to see him, if it is a girl they often leave, apparently disinterested.

Contrary, however, to the widespread prejudice alleging the lack of concern that Afghan men give to the well-being of their wives, I had to change my mind: each time we had to deal with a difficult childbirth in which saving the child meant putting the mother's life in danger, the relatives consistently asked us to save the mother.

This was the case with 24-year-old Rahila. She had already begun bleeding profusely in the sixth month of her pregnancy.  When we considered a cesarean section, which would not have permitted the survival of the baby, the husband did not hesitate to ask us to save Rahila, in case we were forced to choose.

Compared to the situation in Italy, pregnant women here are exposed to a greater number of risks, especially due to the high number of pregnancies.  Acute hypertension and hemorrhages caused by anomalous location of the placenta are frequent.

Miscarriages can be extremely dangerous. Women arrive at the hospital with serious hemorrhages in progress, at times unconscious.

Twenty-three year old Waheida arrived one morning in a state of shock, hemorrhaging. The level of hemoglobin in her bloodstream was 4 gm/dl, the lower limit for survival.  The anesthetist was the only person able to place a needle into the jugular, the only vein that had not collapsed.

Today she returned to the doctor’s office. She is fine and asks for advice on contraception.


Raffaela Baiocchi

Translated By Cynthia Aguiar