Through twenty-six years of war and repression, Afghanistan has lost its ability to meet its public health needs. The efforts to rebuild health care systems continues, with mixed results.
This was illustrated for me yesterday, when I read Asne Seierstad's The Bookseller of Kabul. Though Seierstad's book focused upon family relations, disease just kept cropping up over and over again as a barrier to progress, a root cause of desperate acts–in short, a contributor to a poor environment for reconstruction. One story in particular in Seierstad's work had a father who stole from his employer in order to feed his family: two daughters had polio, and medical treatment was out of the question. He ended up in prison, which is a great place to pick up tuberculosis, and an impossible place to try to feed your already starving family.
In industrialized societies, we frequently get our immunizations and vitamins as a matter of course; we don't have to know these diseases in the way that Afghanistan's citizens do. Therefore, I’ll discuss the diseases and eradication efforts in alphabetical order:
Leishmaniasis:
Cutaneous leishmaniasis reached epidemic proportions in Afghanistan and was targeted by the UN's World Health Organization (WHO) in 2004. In 2004, and estimated 200,000 people were infected, 67,500 of whom resided in Kabul. A protozoan infection [Thanks, Ms. Clark: see comments below] from Phlebotomus sergenti, a sandfly, infest the skin, making “active lesions”, primarily on the face and hands. Later, the scars remain, and can be as much as one inch wide. The flies are active from April to October, which gives them plenty of opportunities to cause this parasitic disease.
As in malaria, the insect vector itself is not strong; it has increased its habitat by living in the cracks of walls. Therefore, it is most likely to affect those who are house-bound in regions with poor or decaying construction–this would include women, children, and the aged all over Northern Afghanistan. A Belgian grant of Euro 200,000 in 2004 enabled a program to combine drug treatment and the purchase of anti-insect bed nets. This was to be the beginning of a national eradication programme. So far I have not found any information after 2004 on this programme. Since the disease is not life-threatening, it does not have the priority of other public health efforts. However, the disease does affect the quality of life, particularly for women, as there is a social stigma attached to the scars.
Polio
Polio has been endemic in Afghanistan, and programs to eradicate it started in 2002. The disease is caused by the poliomyelitis virus and first enters the body by mouth, multiplies in the intestine, and causes paralysis, sometimes total paralysis in five hours. The conditions favorable to it are primarily poor sanitation. Vaccination efforts continued, and in 2005, only 9 new cases were reported.
In 2006, however, 29 additional cases were reported. The disease especially affects the Southern regions of Afghanistan, where fighting had been most concentrated; which also hampered health care efforts. The combined 2006 efforts of Afghanistan's Ministry of Health, the WHO and UNICEF planned to immunize 5 to 7 million children in 3 days, in all 34 provinces of Afghanistan. Previous to that effort, immunization was estimated at a 66%. It was thought that this new effort would halt indigenous polio transmission in Afghanistan. The three-day push was repeated five times in 2006. The effort was funded by the World Bank, USAID, Rotary International, the State of Japan, and the UK's DFID. The children were also given Vitamin A, which is considered a major aid in battling children's diseases. This year, Taliban activity and edicts against accessing medical aid has halted polio immunizations in Uruzgan province.
Rickets
Vitamin D is essential to bone growth, the movement of Calcium and other minerals through the bloodstream. Children born with vitamin D deficiencies are prone to “soft bones” and bone deformation from rickets. One primary way humans manufacture Vitamin D is through exposure to sunlight. Therefore, most of Afghanistan's women, enjoined to stay indoors or go outside clad in a burka are especially at risk. This becomes more acute in homes that do not have walled backyards, so that the women may get no exposure to sunlight at all, and their infants are especially prone to the disease.
Tetanus
Tetanus is an extremely painful bacterial disease: its painsful symptoms are caused by a nerve poison produced by the bacteria Clostridium tetani. Its onset usually comes from untreated wounds of all sorts, but particularly puncture wounds. Last month, 300,000 mothers and children were immunized against tetanus and measles in Kabul, along with efforts in other parts of Afghanistan. Not all of those eligible for vaccination chose to accept the invitation for treatement, but anywhere from 50% to 70% of mothers were treated in all regions, and 55% to 70% of children were vaccinated. Measles is a highly contagious viral disease, causing very high fever, cough, and conjunctivitis. It's high contagion makes epidemic fast able to outstrip hospital resources in states all over the world.
Tuberculosis
In 2003, IRIN news reported that Afghanistan had one of the highest TB rates in the world: and estimated 70,000 cases annually–of which only 15% were treated. Of TB-related deaths, 65% were women. The symptoms of TB usually include cough, fever, and wasting away, but it is a very complex disease. The culprit is primarily poverty and malnutrition.
There are a lot of subtexts here, including the present and future conditions of Afghanistan's women and children; the urgent need for reconstruction and the rebuilding of education systems; the future social costs of today's disease; and the ability of Afghanistan's people to move forward economically. For the moment, I want to focus on another aspect: many are interested in reviving public health systems in Afghanistan–and to their great number, many more need to be added.
A real friend is one who takes his hand in a time of distress and helplessness. –Afghanistan proverb
Further Reading:
The Bookseller of Kabul by Asne Seierstad is available (See Worth Reading page-Afghanistan). A portion of book proceeds go to Afghanistan's reconstruction.
See also the WHO Web site for Topic Information and Country Information; UNICEF Country Information portal page
Rotary International's Polio Plus Program worldwide
Photos: Doctors without Borders; IRIN
