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Special Feature of the Program In Afghanistan.
Kunar
Since the ATA/AP established the first TB clinic in Asadabad(Kunar) in 1990, the TB Control Program in that province is more developed as compared to Nooristan and Laghman. In 1994, a 15 bedded Isolation Ward (5 for men and 10 for women) was added to the clinic. The hospital was also shifted to a new location, which was a portion of a proper hospital building. Four TB Control Centres (Microscopy) and six Health Education Centres were also established that year. In 1995, EPI Program for Kunar was also organized in collaboration with UNICEF and the Ministry of Public Health - Eastern Zone.
20 vaccination centres were deployed in the area. Cold Chain and coordinating office was established in the premises of the hospital at Asadabad. This program (EPI) helped TB Control and also Health Education, as the vaccinators were also given the task of Health Education in the areas which they covered for vaccination.
The hospital has now got the following facilities:-
- OPD
- X- Ray
- Laboratory
- dispensary
- Isolation Ward
Achievement from 1990 to 1999 are:-
EPI in Kunar/Nooristan
The ATA/AP managed the EPI in Kunar/Nooristan since January, 1995 in collaboration with UNICEF, Norwegian Church Aid (NCA), and Ministry of Public Health, Jalalabad(MOPH). The UNICEF provided the equipment and vaccine, the MOPH trained vaccinators and the NCA provided funds for the pay of the staff and transportation charges. The agreement was for the three years which ended in December, 1997. The ATA/AP initially deployed 16 vaccinations centers in Kunar. By the end of 1997, there were a total of 20 Vaccination teams.
Nooristan
The ATA established a TB clinic at Bergematal in 1998. The Communication in Nooristan, whatever it was before 1978, is distrupted. During the establishment of the clinic, all the equipment and mechine had to be transported by mules, horses or even manpack. The clinic is housed in a private building donated by the locals, as no suitable Govt. building was available. At the moment the clinic has the following facilities:-
- OPD
- X-Ray
- Laboratory
- Dispensary
The achievement of the clinic in 1998 are:-
Laghman
Laghman Province lie just to the West of Ningarhar. Its boundary starts just out side Jalalabad. Laghman is relatively better developed both for agriculture and trade. The valley is well irrigated by the rivers of Kabul, Ali Shang and Alingar. Ethnically, the people living in the valley are Pakhtoon and Tajiks, but the hilly areas in the North, is inhabited by Nooristanies. The hills to the North are mostly barren and the people live on animal husbandry. Though the incidence of TB is reported to be less as compared to Kunar and Nooristan, it is still around 3% (ARI).
TB Control Program in Khogiani(Ningarhar)
A TB clinic has been established at Kaga in Khogiani area of Ningarhar Province. It will have:-
- OPD
- X-Ray
- Laboratory
- Dispensary
The clinic is likey to start work in June, 1999.
Culture Laboratory at Jalalabad
A Culture Laboratory is being established in Jalalabad, which is also likely to start function in June/July, 1999. Its main aim is to carry out Culture Sensitivity of the sputum of Resistant Cases and suggest treatment. Aport from this it will function as a referral laboratory and a training institute for microscopists.
TB Control Centres.
TB Control Centres(Miscroscopy) are established in the peripheral areas of the Province, where the Association has TB Hospitals/Clinics. These are located in an existing Health Units like BHU/Dispensary etc, run by the Govt. or NGOs. The microscopits examine the sputum of the suspected TB patients. If the patient is found sputum Positive, he/she is referred to the TB hospital/clinic, where further tests are carried out and the case is registered for treatment. Other cases, having old history of TB, even if they are sputum negative, are also referred to these TB Hospitals/Clinics.
The TB Control Centre issue drugs to the registered TB patients of the area on monthly basis to avoid frequent travel of the patients to the hospitals/clinics. These TB Control Centres also act as Health Education Centre.
Health Education Program. Health Education Centres are also established in the peripheral areas.
These Health Education Centres have one Health Educator, each. Each Health Educator is given a number of villages to cover - some monthly and some quarterly. Health education material like posters, pamphlets and leaflets are given to them for distribution in the schools, mosques or the Hujras of the elders. They also give talk on the importance of hygiene and sanitation and persuade people to take necessary precautions against communicable disease, especially TB. They also keep a record of the TB patients of their area and persuade them to complete their treatment. The Health Education Program of the ATA /AP also helped Healthnet International in distributing mosquito nets to people on subsidized rates, as a part of Malaria Control.
Special Features of Tuberculosis Control in Afghanistan
Though TB Control Program in all the developing countries in the world is problematic, the present Political, Economic, Social and Communication conditions in Afghanistan pose peculiar problems which have to be tackled in their own peculiar ways.
- Political
Though the bulk of the country, including the capital - Kabul, is under the control of Taliban, a few provinces in the North are under the opposition consisting of factions headed by Rabbani and Masood. Rabbani is their titular head. Since Rabbani was the President before the Taliban took the control of Kabul, the UN and most of the countries, still consider Rabbani as the "dejuro" President of Afghanistan. Even in the Provinces under the Taliban, some areas are either "independent" or having sympathies with the opposition. The same may be true for some areas under the control of the factions lead by Rabbani. This situation has, on the one hand, created confusion of control and, on the other, the problem of coordinated efforts to continue a program to its logical conclusion.
This lack of control often pose law and order situation which interrupts developmental and social activities of the NGOs in particular, thus frustrating the efforts. In this situation the Govt, whether of the Taliban or the Opposition, is not in a position to impose its writ in the areas under their control.
- Economic
The Govt can hardly generate their own revenue though taxation or export and whatever little they do, goes to the Defence and maintenance of law and order. Very little, if any, is allocated for economic activities or social sectors. All such activities are, by and large, left to the UN agencies and NGOs who, undoubtedly have done a lot in this field, even in the most trying conditions. TB is a poor man's disease and as such the treatment has to becompletely free. In the situation prevailing in Afghanistan, the incentive of free treatment to TB patients is inescapable if one has to seriously and sincerely tackle TB Control Program.
- Social Conditions
Afghanistan is an Islamic and highly conservative society. Most of the population live in rural areas, mainly dependent on agriculture or animal husbandry. Literacy rate is very low, especially in women - the current restriction has further accentuated the situation. In such a situation the general awareness of people about Health Education is also very limited. Health Education Program along with any Health or General Education program becomes very necessary. If properly conducted, it furthers the aim and objectives of such health programs like TB Control and also make such efforts more cost effective.
- Communications
Apart from the few paved roads like Peshawar - Jalalabad-Kandahar - Herat, Kabul Mazar etc. the rest of the roads are all shingle or "Kacha" where sturdy vehicles like jeeps, 4x4 pickups etc. can ply. In some areas like Nooristan, very few places are connected by any road, forcing people to travel by foot, horses or mules. Again, in towns or centers of communications there are no hotels or Sarais, where people can stay with families. Most of the people stay with their relatives, and if relatives are not there, people will not travel, especially with females. This situation of communication and lack of facilities in the towns, force the people to leave their female patients to Gods Mercy ! In many cases even the male patients are no better. While planning Health facilities, one has to keep this in mind. The Health facilities will, therefore, have to be as near to the patients as possible and mobile services provided to such remote areas.
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