Many Afghans started to fear the fatal outcome of then a less-known virus as the pandemic coronavirus hit Afghanistan’s western Herat city. A growing poverty, an already overburdened health infrastructure, and poor government service pushed the already desperate many Afghan families to labyrinth of concern and confusion. A growing fear began to entangle the country after the confused health authorities rushed to report the first case of Covid-19 in the western Herat province on February 24, 2020. Those who could afford began to isolate themselves at home, but most of Afghans, who were dependent on daily wage, found it difficult to observe quarantine—leaving the house to earn a living.
Doctors and nurses, however, were the the frontline soldiers in the fight against Covid-19. A large number of Afghan health workers, particularly those assigned at Covid-19 medical centers, found themselves in a critical period of history. The poverty stricken people overwhelmed by worrisome and rapidly spreading pandemic needed these heath workers on the frontlines.
In this story, Kabul Now has talked to four health workers who went through many challenges while working at the Afghan Japan and Mohammad Ali Jenah health facilities—the two largest medical centers for treatment of covid-19 patients in the capital Kabul.
Scared but determined to face challenges
It was the second month of spring in 2020 when Jamila Hassan came across vacancy announcements for positions directly dealing with covid-19 patients at Afghan-Japan Hospital. Jamila found herself fully eligible as she had already worked as a nurse for four years then at French Medical Institute for Mothers and Children. Given her related work experience and the urgent needs of the Hospital, Jamila was hired soon, unlike the lengthy employment process which has to be passed in a normal situation in Afghanistan. When Jamila graduated with a BS in nursing from Kabul University of Medical Sciences, as she put it now, she took Hippocratic Oath to respect medical ethics and serve anyone in need. “I had to live up to my swearing. The crisis had started and the people needed doctors and nurses. We had sworn to do our duties.”
Jamila started treating Covid-19 patients at the Hospital despite fears and imaginations that the health facility would be a place of deaths. “I had accepted that my decision would possibly even lead to my death. But an unknown strong force would push me forward. Perhaps, this force was coming out from the satisfaction, unburdening myself, and the pride for responding to the people’s most urgent need,” she says.
Razia Ghaffari had the same motive. With a BS degree in Medical Science from Herat University of Medical Science, she upon her graduation, worked for a while with several hospitals in Herat and then moved to Kabul along with her husband. In the third month of spring in 2020, she applied for a vacant position at Afghan-Japan Hospital.
It was for the first time in her life, as she put it, that Razia felt she could contribute to the “vital” need of the people. As Razia stated, she couldn’t remain unresponsive to the people need at such a critical time. Razia, while breastfeeding one of her two babies, started to serve part of her time for the people.
Kazim Maqsoodi, who is a doctor and a neurological surgeon, and his colleague, Sakina Rahimi, Chief Nursing Officer, were working at Mohammad Ali Jenah Hospital before the coronavirus outbreak in Afghanistan. When the Ministry of Public Health declared the hospital as a medical center for treatment of Covid-19 patients, they were not principally responsible to serve the patients. The two, however, became volunteer to serve Covid-19 patients. In addition to the volunteer service, Kazim also kept his private clinic open to the public. At the peak of the outbreak, he posted on Facebook, offering that he was ready to present instructions for whoever needed health instructions through phone-calls and online platforms. At times, Kazim would provide the required instructions for more than 100 calls he received on daily basis.
Of the four health workers, three of them faced strong oppositions by their families. For Kazim, however, it was a different case. His family supported and admired his courage to serve the people at such a critical time.
When Jamila was appointed as a nurse at Afghan-Japan Hospital, her family moved to Jaghori district of the southern Ghazni province, their birthplace, to evade contracting the coronavirus. Though her family strongly opposed Jamila’s decision, she ultimately won the heart and mind of her family.
“You are still too young to die and it will be very painful for your children to become orphans,” Razia was told by her family members when they knew that she was hired at the Afghan Japan Hospital. She could hardly convince her worrying father and mother, who lived in Herat that her work at the hospital was not a matter of concern. She asked her husband to respect her decision, if he did really love her.
Razia was a tenant in Qalai Fathullah neighborhood of Kabul when she started working at Afghan-Japan Hospital. Family of the house owner, who lived at the same compound, were traumatized by the Covid-19 related news and strictly adhered to observing hygiene. When they learned that Razia was working at the Covid-19 hospital, they became worried. Then, Razia and her husband preferred to move from the house and rent a different house.
The couple didn’t want to conceal Razia’s work while looking for renting a house. But wherever they referred to someone for renting a house, the people would avoid renting them house after realizing that she was working at a Covid-19 hospital. After roaming around the city for a long while, the couple finally found someone who didn’t mind Razia’s working at the hospital.
Working at a Covid-19 hospital for Kazim was far more troublesome and resulted social isolation. In addition to his family, neighbors, and relatives, Kazim says that even taxi and bus drivers would escape wherever they spotted him. It would take a long time for Kazim and his colleagues to find a taxi in front of Mohammad Ali Jenah Hospital to pick them up. When the taxi drivers saw someone standing in front of hospitals, they would not pick him/her up thinking that the person might be an employee of the hospital.
Lack of capacity
Though the Covid-19 pandemic hit the world and put health systems of the most developed countries in jeopardy, it impacted Afghanistan far broadly as the country’s health systems was under-qualified and under-equipped in the fight against the pandemic.
According to Jamila, the situation in Afghan-Japan Hospital was turbulent when she started working at the hospital. It took, as she states, days for the hospital leadership to get the situation organized and put things in order. She says that they even did not know how to use personal protective equipment and were trained in a two-day long period by an international health organization how to use the personal protective equipment, wear protective clothes, and how to take them off. It took weeks for the health workers to learn how to operate medical machines. Pointing to the already poor health infrastructure and lack of capacity, Jamila maintains that she and her colleagues could prepare and take things under control sooner than the expected time.
Citing medical experts from the Doctors without Borders, Kazim argued that Mohammad Ali Jenah hospital was not an appropriate infrastructure for treatment of infectious diseases since the hospital was not primarily built for treating infectious diseases. “Experts from the organization of Doctors without Borders said that Mohammad Ali Jenah Hospital was built in a shape which some of its parts lack the required [sun] light, windows of some rooms are placed near or in front of one another, and such characteristics are not appropriate for a communicable disease hospital,” he said, adding that turning the health facility into a covid-19 treatment center was due to inevitability.
In addition to other challenges within the health system, Sakina describes inappropriate behavior of the Covid-19 patients as another challenges for the health workers. She reminds a case in which once relatives and companions of a patient tried to enter at the emergency ward of the hospital by threatening the relevant personnel with arms. “One of our male colleague was scared. He wanted to get out of the ward and hide himself somewhere in order not be harmed. I asked him to stay telling him that if he couldn’t, as a man, stop the armed man, then I, as a woman, could not defend myself. With patience and modesty, we could ultimately encourage him (the patient companion) to come down and avoid ourselves to be harmed.”
Once Jamila and her 10 colleagues sought refuge in a secure room of Afghan-Japan Hospital as a furious and armed man, who was attendant of a patient, wanted to enter the hospital with his handgun. “The man was furious and did shout. We were scared and defenseless. It was the midnight. One of our male-colleagues told us to hide ourselves and he would talk to the armed man. We got out of our hideouts one hour and a half later and the danger was gone.”
Infected by Covid-19
Jamila contracted the coronavirus several weeks after she started working with the Afghan-Japan Hospital. When she tested positive for Covid-19, she returned home and did her utmost efforts to walk into her home unknowingly and avoid being seen by her neighbors. Just like a criminal. She warned her sister, who lived in the same apartment, not to tell any neighbor about her infection with the disease fearing that if it is revealed, they will be forced to leave the building. After nearly a week isolation, Jamila returned to her work. Though her test became negative, it took several weeks for Jamila to recover from the side effects of the Covid-19.
While working at Mohammad Ali Jenah and dealing with Covid-19 patients, especially those in critical condition, coupled Kazim’s concerns about his 21-membered family. Although he isolated himself at home after getting the virus, but it later spread to most of his family members. He describes the time when he and his family members became ill as very difficult times. Some relatives and neighbors would avoid communication with his family which often sounded like social rejection. “I had severe symptoms and pains after infected by the Covid-19. But I would forget my own pains when saw my family [members] suffering from its pains and felt myself responsible towards them as a doctor and son.”
Razia was not that concerned about her own infection with the Covid-19 when started working at Afghan-Japan hospital. She was, however, deeply concerned about the health of her two children. “My all concern was my two children that I’ll transfer the disease to them and they would be harmed,” she said. Razia, however, had to deal with a misperception caused regarding her infection with the disease after testing positive. Razia says that head of the hospital behaved in a way as if she had deliberately made up her test positive in order to take leave. This behavior had deeply hurt the mother who had accepted all the risks to serve the people while caring for her two babies. “I got so upset for I was not understood. I cried when returned to my home,” she said, adding that head of the hospital had that misunderstanding for someone else might had changed their test result before her. “I tried to understand why he behaved that way.”
Once some residents of a close neighborhood came to Afghan-Japan Hospital, after their infections, to praise the hospital’s employees for their work and treating the people. Razia’s name was also on the list provided by the locals for recognition. “I was over the moon for my people were praising me. I felt I was helpful to them and served them,” she says, adding it was a good sense of joy and sympathy by the people toward her.
Taking people’s appreciation letter with herself, she shared her happiness with her spouse and two children. “People’s appreciation was my best memory from the time of Covid-19 outbreak and the fight against it.”
This story has financially been sponsored by the EU. Copyright of the story lies with Etilaat-e-Roz.