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Journey to Afghanistan

Coud-e-Barq - Chapter 10 - Page 27

I learned more about Najma during subsequent weeks through my interpreters and the Afghan Doctors. You would have guessed her age to be much older than her 35 years. Her life had been difficult. This was her first paying job in four years. Her husband and brother had died in fighting near Kabul. Najma had three children at home, the oldest a thirteen year old boy. Food had often been scarce, provided by the kindness of friends. Hardship and grief lined her face and only one tooth remained in her brief smile. That tooth later became infected and was removed. But she was determined to do a good job, and she did. Stories like Najma's are part of most peoples lives in Afghanistan.

We saw many patients that day. My journal written that evening described several. One lady with advanced mitral valve disease had a rapid heart rate and mild peripheral edema (fluid in her legs). Her lungs were clear but heart was enlarged and ECG had typical p-wave changes, a right axis, poor r-wave progression, etc. We started her on Digoxin, diuretics and potassium and planned to see her in a few days.

Many people had gastroesophageal reflux disease (acid backing up from the stomach into the esophagus). This was surprising since almost all of them were very thin. Generally they were treated with H2 blockers, antacids, and instructed not to eat for a few hours before bedtime and to sleep with their upper body elevated.

I saw many with thyroid enlargement. Most I treated with iodized salt, available but not generally used in Afghanistan. One lady had a very large thyroid nodule. She was having trouble swallowing and demonstrated it by choking on a sip of tea. This case deserved a thyroid scan to look for cancer and possible biopsy and esophageal scoping as well as basic thyroid blood tests. However, such was not available. Later a gastroenterologist with NWMTI brought a scope and trained Dr. Rhamani to use it. No one was available to read pathological specimens, nor were the simplest of thyroid blood tests obtainable.

My journal noted that the weather was turning colder and damper and we all had colds. Bill and Neil would be going home soon, possibly also Tom and Donna Armstrong. For a while that would leave only Tom Martin, myself and our Afghan doctor friends. At that time we had expanded our activities, and with a lesser staff I wondered how well we would survive. A line in my journal described some homesickness with this line, "And so, Jo (my wife), it goes on and I miss you dreadfully much."

I spent several days at the clinic in Coud-e-Barq, both during the winter stay and upon my return in the Spring. I especially remember several patients. One had raging clinical hyperthyroidism and was started on a beta-blocker and another thyroid blocking agent. The latter was hard to procure. The two most commonly used ones in America were not available in Mazar, but after much searching a related medicine was found. Her proptosis (appearance of bulging eyes), shakiness, sweatiness, extreme nervousness, weakness and rapid heart beat were slightly better in one week and much better in two weeks. We tried to explain and arrange for long term treatment, with the very real possibility that she might eventually need control through surgery.

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