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Journey to Afghanistan

Khorasan - Chapter 9 - Page 24

One patient walked to the folding chair with difficulty. Her breathing was labored and near her ankles I could see badly swollen legs. She had been increasingly more short of breath for several months. At night she was now having to prop herself up with what meager belongings she and her children could stack together in their tiny tent. Her husband was dead.

As was appropriate in this culture, a female friend accompanied her as I and Doctor Abdullah went behind the blue drape to the privacy of the end of our room with its wooden table. Her lungs were full of rales (many tiny crackles) about halfway up on both sides and tapping over the bases of both lungs with my fingers showed abnormal dullness. This indicated fluid accumulation. A loud holosystolic murmur (abnormal heart sound as the heart's ventricle contracts) was heard over her heart anteriorly. It did not radiate to her neck. Her heart rate was rapid, near one hundred and sixty, but had a regular rhythm. Looking further up her lags we found extensive pitting edema. A dent left after we would press a finger on an area for a few seconds.) This thirty year old lady was obviously in congestive heart failure. Probably her mitral valve had been mostly destroyed by rheumatic fever.

Using diuretics, potassium, digoxin and temporarily gentle afterload reduction with an ACE inhibitor, I hope for improvement. A week later she was feeling much better, had lost her edema and lungs were almost clear. On further follow up two weeks afterward she was doing even better and informed me that she was going back to her own village. I made sure she knew what medications she was taking and my translator wrote out in detail the dosages and frequency of meds. We hoped she would someday be able to buy more. Even though medicines can be purchased without a prescription in Afghanistan, the realities are that pharmacies may be distant and when you have no money.... I have often wondered what has become of this young woman and her children.

Gastroenteritis was common even though the weather was cold. This was part of each clinic day. Can you imagine walking through a portion of the huge encampment where there had been no toilets and people squatted either inside their tiny tent or on the adobe mud nearby? Thankfully Tom, the Emergency Medical Technician-Firefighter working with us, had arranged for several toilet pits with screens around them to be built within the camp. He had hired several Afghan men. This would help.

I especially remember a slight of build thirteen-year-old girl in a ragged dress and heavy jacket. She did not look up while trying to pull away from her father who had a firm grip on her wrist. Her father explained that a few years before the girl had been alone in their house when a fierce battle broke out with the house caught between warring parties. She had never been the same since, was continually trying to run away from home, even at night, and had regressed in her learning. She wasn't now able to count or read. I asked Doctor Neil, a superb pediatrician with NWMTI, for his thoughts. He talked at length with the father. There being no psychiatric help in that part of Afghanistan our suggestions were limited. Even as we talked the girl sneaked away and hurried toward the outer gate.

"He or she is sad," was often a large component of the illnesses we saw that day in Afghanistan, and many times in the weeks that followed. What to do? Were our efforts like throwing tiny pebbles into the ocean? Only God knows.

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