If there were ever a health care challenge, it is in the rugged, remote rural areas of Afghanistan, a fiercely independent nation, plagued by decades of conflict and political turmoil that have stunted development and saddled its people with some of the world’s worst health indicators.
It is here that International Medical Corps began its work over a quarter of a century ago by doing what we still do today: delivering health care to victims of conflict and disaster wherever they are, whatever the conditions, and in the process passing the skills and tools to local communities so they can begin their journey toward self-reliance.
Nearly a generation later, the legacy of those goals and the years of training that have flowed from them in Afghanistan is astounding. Today, an extraordinary number of bright young Afghan men and women we have trained are influential players in the development and delivery of their country’s health care.
They shape policy in the upper echelons of Afghanistan’s Ministry of Public Health (MoPH) and other important ministries. They lead successful private sector national non-government organizations (NGOs) working in the health care field. They advise western contractors working to rebuild the country. And some still remain important members of our current country team, helping us continue our mission to strengthen Afghanistan’s drive towards self-reliance.
No matter where they are today, those who have worked for us invariably commented that they count their time with International Medical Corps as a seminal growth experience, one that provided skills upon which they still often draw.
“International Medical Corps became not just a health care organization, but an academic environment for health professionals in this country,” noted Dr. Javid, a contract consultant in the MoPH in Kabul who worked for us as a master trainer from 2001-2004. “Most of the managerial and communications skills I have I learned from International Medical Corps.”
Collectively, International Medical Corps veterans and “alumnae” represent an unprecedented achievement in capacity building—a treasure chest of experience for a desperately poor country whose impact, while centered in the health care sector, extends beyond it to other areas of the economy. For example, Dr. Ahmed, a former hospital director, who fled the Taliban with his family to Pakistan in 2000 and returned with International Medical Corps in 2002 as a master trainer, now applies the teaching skills he learned as a “trainer of trainers” to a new job helping the Ministry of High Education usher in curriculum reform.
Dr. Ahmed’s wife, Dr. Fatima, hired together with her husband, remains with us after nearly a decade, serving today as quality assurance manager of our program supporting Afghanistan’s largest medical facility for women, the Rabhi Balkhi Women’s Hospital in Kabul.
Dr. Anwar, who was a refugee in Pakistan when he began an 18-year stint with us in 1988 and rose to the position of country director, is today president and CEO of Ibn Sina, a prominent Afghan national NGO that began with a focus on health care, but has since branched out to emphasize education and professional training programs.
“It was International Medical Corps that gave me the opportunity to start my career and make a difference in my country,’’ Dr. Anwar said.
At the MoPH, Dr. Ahmed, who joined us in early 2002 as a health management information systems (HMIS) manager, helped shape national HMIS policy once he joined the government. Today he supervises a department that oversees funded health care development work valued at about $100 million.
While it was the HMIS skills he learned at International Medical Corps that helped him gain clout in his initial work at the MoPH, Salehi says he often draws on wisdom gained during his early field experience with us when weighing policy decisions during high-level meetings at his ministry.
“Understanding the dynamic at the field level is crucial,” he said. “If I’m at a meeting and there’s a discussion about a local community, I can feel it. I don’t need to read a report to know if I’m right or wrong.”
Several factors have magnified the impact of our work, but one stands out: for the better part of a decade and a half, we were either alone or dominant among international groups in our commitment to train Afghans for work in the health care field. These efforts took on even greater meaning with the departure of Afghanistan’s own medical professionals after the 1979 Soviet invasion. A survey by the Union of Afghan Doctors in the mid-1980s estimated that within five years of the invasion, all but about 200 of Afghanistan’s 1,200-1,800 physicians had fled. The natural mentors to the next generation of Afghanistan’s health care professionals were gone.
As turmoil dragged on through the 1990s, many Afghan physicians resettled in and around Peshawar, Pakistan. Some found work –and received training–at our clinic in the Nasir Bagh Afghan refugee camp, near Peshawar. Others were quickly recruited for programs we established inside Afghanistan immediately after the collapse of the Taliban in the fall of 2001.
With a talent pool drawn either from Afghan physicians in the Peshawar area or the estimated 500 medics we trained in the 1980s and early 1990s, International Medical Corps quickly became a leading provider of primary health care in the years following the Taliban’s 2001 defeat.
“International Medical Corps became very well known in the country very quickly, so everyone wanted to join,” Dr. Javid recalled in an interview. “It was an exciting time.”
The speed of the build-up was driven in part by concerns about the impending return of one of the world’s largest refugee populations from neighboring Pakistan. When he began his work for International Medical Corps in 2002, Dr. Anwar said he conducted health care assessments out of a tent in the Qarabagh district of Kabul Province, where about 5,000 returnees had settled in search of a new life. Within 18 months, the number of returnees had swollen to more than 100,000 and the small makeshift clinic set up to handle the returnees had been replaced by a district hospital.
Expanding programs quickly was crucial.
In Aug. 2003, International Medical Corps established a joint training center with the government in the basement of the Ministry of Public Health’s main building in central Kabul. The center offered schooling to both male and female master trainers for the first time inside the country.
“The training component of our activities was so deeply ingrained, we felt we were trainers as well as managers,” recalled Dr. Anwar of his years with International Medical Corps. He recalled it was our attention to quality outcomes that separated us from other international groups that had begun working in Afghanistan during the early post-Taliban years.
“Quality made International Medical Corps distinct,” he said. “Personally, I learned a lot because of that focus—I learned which interventions can make a difference.”
It is a tradition that continues today with strong training components built into hospital management programs at the Rabia Balkh Women’s Hospital and Wazir Akbar Khab Hospital in Kabul as well as midwifery training programs in eastern Afghanistan’s Khost and Paktika provinces. Our Khost program recently won a national award for excellence.
Preparing local nationals through formal training and on-the-job experience to assume greater responsibility for important programs constitutes part of our efforts to help Afghanistan achieve self-reliance. Although difficult security conditions have kept Afghanistan’s key health indicators among the world’s worst, there is hope they may soon begin inching in the right direction.
“In some ways, we’re here to put ourselves out of business,” says International Medical Corps Country Director Robert Lankenau. “We’ve graduated a strong group of health professionals, many of whom are now working in the MoPH. We expect others to follow.”