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Journey to Afghanistan - Chapter 7, page 19

The Civilian Hospital

The Cardiac Care Unit for men was a room with about six patients. I did see one I.V. pole, but otherwise there were not cardiac monitors, defibrillators, respirators or even oxygen tanks. In listening to the stories of various men and later women, it was good to see that the physicians had an old ECG machine and were reading the strips accurately. Certainly lack of other equipment made it impossible to practice ideal medicine, but they were doing very well under hard circumstances. Lab work commonly used in much of the world to verify cardiac injury was unavailable. Tests to help evaluate risk, such as blood sugars and serum cholesterol were generally unused. Families were required to go to nearby pharmacies and purchase medications or I.V. fluids as prescribed by their doctor in order to receive them.

I especially remember one elderly man who had a large anterior infarction (heart injury) as shown by his ECG. In returning a week later I asked how he was doing. "Oh, he died of sudden death," was the answer. Without a cardiac monitor they could only guess at the cause of his sudden death, and treatment was limited.

In another room we saw a frightened young man with a distended abdomen. It was full of ascites (fluid) and he was mildly jaundiced. The Afghan doctors felt it was most likely cirrhosis but with little lab work available, no scanning equipment, and no pathologist to inspect the ascitic fluid from a diagnostic tap, they were very limited as to possible diagnosis and treatment. I was told that the most common causes of cirrhosis and ascites in Afghanistan was due to chronic hepatitis from several types of infections. I wondered.

Under rumpled covers in an old rusty bed we found a very ill lady. Her respirations were rapid, she was pale and extremely thin. The resident physician presented her as being just over forty years of age, though she looked much older. She had been coughing for two years and her chest x-ray showed bilateral lower lobe infiltrates. She had much peripheral swelling (edema), was emaciated and very weak. A dip stick in her urine showed pus cells and three plus protien. Blood pressure was low. It was felt that most likely all of this represented tuberculosis, both pulmonary and renal. The hospital had no ability to culture or stain body fluids. She had really been brought to this facility far too late. A day later she died.

On my second visit to Afghanistan in the Spring, we Americans were not near the curiosity we'd been initially during that winter. Various Non Government Organizations were paying visits. NWMTI had been able to teach some procedures such as ultrasonography and upper gastrointestinal endoscopy and to furnish some medical textbooks. In talking with Doctor Yawsi and others at the Civilian Hospital there was frustration that several promised items for diagnosis and treatment were very slow in materializing. We too felt the frustration. Initially we talked in terms of two or three months for orders to arrive. Much later we understood that it would take a half year for many things to make the trip, clear customs and finally arrive for distribution. I yet wonder at so many delays.

In the Fall of that year I voiced some of my concerns by mail to President Bush and was pleased that he responded. I thanked him in return. These letters follow.

Dr. Magee's Letter to President Bush
President Bush's Reply
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