BY RICHARD WEISMEYER
FGHANISTAN WAS ONCE A PLACE only a few westerners vaguely knew
about. Most people could not locate this intriguing country on a world map.
Today, the realities of 9/11 have brought images of this landlocked country
into households around the world on an almost daily basis.
Slightly smaller than the state of Texas, Afghanistan is bordered
on the south and east by Pakistan, on the west by Iran, and on the north by
Turkmenistan, Uzbekistan, and Tajikistan. Afghanistan's recent history is a
story of war and civil unrest. The Soviet Union invaded the country in 1979,
but was forced to withdraw 10 years later by anti-Communist mujahideen.
Subsequent fighting among the various mujahideen factions gave
rise to a state of warlordism that eventually spawned the Taliban, which seized
power in 1996. Following the September 11, 2001, terrorist attacks on New York,
the United States, assisted by Afghani Northern Alliance forces, toppled the
Taliban regime.
A Long Relationship
For most of its 100-year history Loma Linda University (LLU) has been involved
in international health-care initiatives,* and the roots of the Adventist health
message in Afghanistan began shortly after the turn of the twentieth century.
As early as 1920 Pastor J. E. Fulton of India, writing in the September 1920
issue of the Loma Linda Medical Evangelist, reported that one of the
leading officials in the Afghani government had urged members of the Seventh-day
Adventist Church working in India to come to Kabul to investigate the opening
of a limited sanitarium in the Afghani capital. In his article Pastor Fulton
noted that "this Afghani delegate is an influential man and has promised
to help us in various ways to get our health work started in his country."
In 1962, more than 40 years later, Loma Linda began its official
involvement in Afghanistan. Anchored by G. Gordon Hadley, M.D., dean emeritus
of LLU School of Medicine, and assisted by Loma Linda physicians (including
Bernard Briggs, Roy Jutzy, Benjamin Herndon, and John E. Peterson), this effort
(including World Health Organization support) has provided faculty and consultation
resources to the leading medical school in the country and other similar facilities
throughout Afghanistan. When the Soviet Union invaded Afghanistan in 1979, Loma
Linda's involvement temporarily stopped.
In 1996, at the request of national and medical school leaders
in Afghanistan, a team from LLU headed by Joan Coggin, M.D., M.P.H. (immediate
past vice president for global outreach for LLU Adventist Health Sciences Center);
and Michael Ryan, Ph.D. (director of Global Mission for the General Conference);
and Dr. Hadley returned to Afghanistan to assess the needs of the medical school
curriculum and see what help could be provided.
Maranatha Volunteers International (with funds from the Euro-Africa
Division of Seventh-day Adventists, private donors, and Global Mission) constructed
a four-bedroom home, and three one-bedroom apartments for Loma Linda in Kabul,
about a 15-minute drive across town from the medical school complex. A teaching
center, named the Loma Linda Center, was also remodeled by Maranatha. This center,
opened on July 4, 2001, consists of teaching laboratories, a tissue laboratory,
a medical library, and a student laboratory facility with 45 computers and 30
microscopes donated by LLU for use by faculty and students.
Loma Linda's efforts progressed rapidly. Previously, the medical
school's library consisted of books and journals dated prior to 1972. This is
now being changed. Books and journals have been donated by various governments
and publishers and are vastly improving the holdings in the medical library.
After the Attack
On September 11, 2001, all efforts in-country came to a halt. "Fortunately,
no Loma Linda personnel were in Kabul during the time of the terrorist attacks
on the United States," says Richard H. Hart, M.D., Dr.P.H. "We had
concerns about damage to our housing complex in Kabul with the invasion of Afghanistan
by the United States and its coalition forces. But miraculously, largely because
of the efforts of the Afghani staff employed by Loma Linda, the property remained
intact and unharmed."
After September 11, 2001, and the fall of the Taliban government,
the new government of Afghanistan once again asked LLU to return and assist
in the redevelopment of the medical education program in the country.
"The entire medical school complex was severely damaged
during the struggles within the country," says Hart, LLU chancellor, who
is coordinating Loma Linda's efforts in Afghanistan. "A decision was made
to rehabilitate this facility in stages as funds became available." Currently,
teams of United States military personnel, using local contractors, are restoring
the medical school and other structures of Kabul Medical University.
"The primary need of the health-care system is for qualified
personnel in multiple disciplines," Dr. Hart says. "This includes
a variety of individuals in the 'intermediate' categories such as nursing, midwives,
and other allied health support personnel.
"The Ministry of Higher Education of Afghanistan and Kabul
Medical University are committed to producing quality physicians with adequate
medical knowledge and skills to serve the needs of the country," Dr. Hart
says. "However, to achieve this will require strengthening the educational
system at its various levels--allied health teaching, clinical activities, classroom
instruction, and continuing education of practicing physicians.
"As peace is returning to Afghanistan, medical students
are returning to school," Dr. Hart states. "Because a number of Afghani
medical students fled to their villages during the various conflicts, they have
not returned in force--nearly 6,000 (many more than the school could properly
handle in the perspective of teaching exercises)."
The medical curriculum is a seven-year program. Students may
be admitted to the medical program following completion of a12-grade equivalent
education in the United States.
Previously, any student admitted to Kabul Medical University
could choose to enroll in the new medical curriculum. The medical branch of
the university was one of the most popular areas of learning because every graduate
of the medical school is guaranteed a job with the Afghani government at $40
per month. Efforts are currently under way to institute a more selective process
in the selection of students and place an emphasis on quality rather than quantity.
A New Agreement
During Dr. Hart's visit to Kabul in 2003, a new agreement was worked out with
the Ministry of Higher Education, representing Kabul Medical University, and
the Ministry of Health.
"Our effort now will place greater emphasis on providing
faculty support," Dr. Hart says. "Some faculty from Afghanistan will
come to Loma Linda for one- to three-month periods to enhance their educational
skills. In return, some of Loma Linda's faculty will travel to Afghanistan to
help the faculty at Kabul Medical University to develop better educational materials
and implement new teaching methods in the classroom. Our computer facility has
been upgraded and is in constant use by faculty and students."
Overseeing and implementing the computer laboratory and also
teaching English as a second language to students and faculty at Kabul Medical
University is Geoff Jutzy. Mr. Jutzy, a graduate of Walla Walla College, College
Place, Washington, has been on-site in Afghanistan for approximately 18 months.
"One of our biggest challenges in maintaining the facility
will be the 'dust' factor," Mr. Jutzy says. During the dry period frequent
dust storms are seen in the area. Special precautions are being taken to protect
the computers from being damaged by dust.
The hope is that an Internet system will soon be implemented
at the school. The Internet will help the students and faculty to have access
to current medical literature. In addition to providing assistance to the basic
science teachers at Kabul Medical University, Loma Linda, in cooperation with
the Afghan Medical Association of America, will provide four- to six-week clinical
fellowships (observation only) at Loma Linda for Afghani physicians to improve
their clinical teaching skills.
"Loma Linda is also working with the Afghani Ministry
of Health to develop continuing medical education programs for the entire country,"
Dr. Hart says. "The Ministry of Health will identify appropriate topics
along with local specialists willing to participate in the continuing education
programs. Course work will focus on the development of clinical skills, using
interactive teaching methodologies. To date, three physician teams, headed by
Roy V. Jutzy, M.D., retired chair of the Department of Medicine, have traveled
to Kabul to hold continuing education programs.
"The Ministry of Health is extremely interested in developing
continuing medical education programs for the entire country that will help
to upgrade the quality of physicians who are now practicing in Afghanistan,"
Dr. Jutzy says. "Approximately 2,000 physicians currently are in Kabul
alone, but their level of training varies widely. Hopefully, this continuing
education program will help to bring the skills of physicians up to speed."
"Tremendous challenges lie ahead," Dr. Hart says.
"We are delighted that Loma Linda can be part of this educational effort."
In March 2004 a team of five health-care professionals, headed
by Dr. Hart, traveled to Kabul in response to a request made by the Afghani
ministry of health to explore the possibility of operating the major teaching
hospital located in Kabul, the capital, a city with about 3.5 million inhabitants.
The Wazir Akbar Kahn Hospital, operated by the ministry of
health, was built approximately 35 years ago. Today the hospital is located
among a cluster of medical facilities, including the Indira Ghandi Children's
Hospital, a physical therapy clinic operated by the International Committee
of the Red Cross, and an allied health educational complex. Located on an adjacent
piece of property is a military hospital operated by the Afghani ministry of
defense. Currently, the hospital is undergoing a complete renovation, according
to Dr. Hart. All patients have been referred to other medical facilities in
Kabul.
"The Norwegian Red Cross, operating under the auspices
of the International Committee of the Red Cross, is completely rehabilitating
the hospital," Dr. Hart says. "When completed later this year, the
200-bed facility will once again be ready for occupancy."
During a recent visit to Loma Linda University, Afghani deputy
minister of health Abdullah Sherzai, M.D., asked Dr. Hart if Loma Linda would
consider running the Wazir Akbar Khan Hospital and upgrading the facility to
the equivalent of an American community hospital.
"If Loma Linda University is able and willing to take
on this task, this collaborative effort could play a significant role in changing
the way the Islamic world sees the United States," Dr. Sherzai notes. "What
better way to change the worldview and the world direction than to give life
to a country that has nothing but its will?"
Prior to the closing of the hospital for renovation, Wazir
Akbar Khan Hospital could accept only the most needy patients. "Only those
in immediate need could be helped," says Mahammed Njib Haleem, M.D., vice
president of the hospital and an internist. Saleem Tawana, M.D., chief of surgery,
noted that they could schedule only elective surgeries one or two days a week
because of a lack of medicines.
The Challenge Ahead
Hospitals in Afghanistan have limited resources, according to Dr. Sherzai. Many
of those in regions outside Kabul do not have electricity or running water in
the facility. Although Wazir Akbar Khan Hospital has those amenities, the facility
lacks even basic medical equipment, such as stethoscopes, blood pressure cuffs,
and modern medications.
"We estimate that it will take approximately $2 million
worth of equipment and supplies to bring the state of the hospital up to an
acceptable level," Dr. Hart says. "We will need an additional $3 or
$4 million for staffing, construction of an outpatient clinic, and housing for
expatriate medical staff.
"We are gratified that the United States government has
now agreed to fund this ambitious project [to the tune of $3 million for the
first year]. Without external funding," Dr. Hart says, "this project
would not have been possible."
"This will be an opportune time for LLU to collaborate
with the ministry of health in operating the hospital," says Dr. Jutzy,
who with Jan Zumwalt, M.S., M.B.A., R.N., executive director for case management
at LLU Medical Center, evaluated the current medical staff needs for the hospital.
"We have been assured by the ministry of health that Loma Linda will retain
only those physicians, nurses, and other medical staff that can make a positive
impact on the hospital." Currently, most hospitals throughout Kabul and
in the rest of Afghanistan are staffed by physicians who work only part-time
at the facility.
"The pay for an Afghani physician is approximately $40
a month," Dr. Jutzy notes. "Consequently, physicians will work in
the hospital for a few hours in the morning and then operate their own private
practice in the afternoon to supplement their hospital income." The additional
income increases a physician's pay to approximately $300 to $400 monthly.
"We know that we will have to pay more to retain a qualified
medical staff," Dr. Jutzy says. "We expect to be able to increase
the pay of hospital physicians to equal what they would make in private and
public practice together."
With the increase in pay, the Loma Linda group, with the concurrence
of the ministry of health, expects that finding a qualified staff will not be
difficult.
"We will still need from seven to 10 overseas personnel
to play key administrative and medical roles in the foreseeable future,"
Dr. Hart says. "Tentatively, we are looking at supplying a hospital administrator,
a business manager, three or four physicians, one or two nurse managers, and
a physical plant operations manager."
The Wazir Akbar Khan Hospital is situated in an ideal location,
according to Dr. Hart. The facility is located in the center of extensive grounds
that can be transformed into a parklike setting for patients and visitors. In
addition, there is enough vacant land surrounding the hospital to build housing
for the expatriate staff.
"We are very interested in helping Afghanistan with this
facility," Dr. Hart says. "We have been working with Kabul Medical
University, Afghanistan's primary medical education facility, on upgrading medical
education, and recognize the additional value of establishing a solid teaching
hospital. We expect to have local medical students and residents, as well as
nursing students and other students in the allied health professions working
and learning in the facility."
Currently, many patients who can afford medical care are seeking
treatment in nearby countries such as India and Pakistan. "We hope that
many of these patients will choose to remain in Afghanistan and seek treatment
at the new facility when it is opened," Dr. Hart says. "This will
be good for the patient and good for the country.
"Tremendous challenges lie ahead," Dr. Hart says.
"We are pleased that Loma Linda can be a part of this effort to rebuild
the health-care and medical education systems of Afghanistan."
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*Loma Linda University and Medical Center, along with their alumni,
have been instrumental in developing nearly 500 health-care facilities of varying
sizes--including many Seventh-day Adventist hospitals--around the world.
_________________________
Richard Weismeyer is the director of university relations at Loma Linda University,
Loma Linda, California.