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Global Health
Afghanistan: glorious past, uncertain future

Editor's note: Welcome to the Global Health page. The purpose of this feature is to raise awareness of global health issues with an academic spirit to help improve the quality of care provided to patients. E-mail

by Andrea P. Summer, M.D.
This month’s feature is Afghanistan, a landlocked, mountainous country located in the center of Asia. College of Medicine student Obaidullah Aseem highlights some of the health challenges in Afghanistan, including inadequate infrastructure, ongoing security problems, and fragmentation of the health delivery system.
A fact many find surprising is that Kabul, Afghanistan’s capital, was a vibrant cosmopolitan city rich in culture and art prior to the Soviet invasion in 1979. Furthermore, in the 1970s many Afghan women were professionals and a vital part of the economy. Today, however, the literacy rate for females in Afghanistan is only around 15 percent. Unfortunately, the majority of social indicators are just as dismal, thereby affording numerous opportunities for the international community to contribute to the rebuilding of Afghanistan and the repatriation of skilled Afghans to their homeland. 

MUSC International Bake Sale: 11:30 a.m. to 1 p.m., Friday, Dec. 5, University Main Hospital, across from Starbucks. The bake sale will feature  sweet and savory goods from around the world.

Hope Lodge Dinner: 6 to 8 p.m., Tuesday Dec. 16. The dinner is hosted by International Student Association and the International Association from  proceeds raised from the International Bake Sale. MUSC international volunteers are needed to set up dinner and visit with patients and their families.
For information, e-mail or call 792-2156.

Health care: an issue of access
by Obaidullah Aseem
Student, College of Medicine
From its populous cities to its simple villages, from its sophisticated city dwellers to its traditionalist villagers to its nomadic Kuchis, Afghanistan in many ways is a country of extremes.  In these extremes, it is very difficult to talk about health care, because there are no standards. 
Health care, like many of Afghanistan’s problems, is exacerbated by years of instability, war and lack of a basic infrastructure.  While in the cities, people have reasonable access to doctors and hospitals, but in the villages where the majority of Afghans live are  isolated from this modern necessity.  Two-thirds of Afghanistan is wrapped in lofty, rugged, dry mountains that isolate villages and make them inaccessible, especially in winters.  In the Badakhshan province, for example, where one out of nine women die during childbirth, villagers have to hike through miles of the mighty Hindu Kush Mountains to get to the only hospital in the province. 
The nomadic Kuchis are another group of victims of a non-existent infrastructure. Much like the Native Americans in the past, they migrate from region to region semiannually in search of suitable climate and grazing ground for their livestock on which their living depends. Their access to health care remains as limited as it was decades ago.
When the United States and its allies ousted the Taliban in 2001, they brought many promises of a better life for the ordinary Afghans. Since then billions of dollars have presumably gone into Afghanistan for health care. Yet outside the major cities there is little improvement to show for it. Afghanistan remains a country with the highest maternal-child death rate outside Africa and one of the few places where diseases like polio have not been eradicated. Many parts of Afghanistan, a country once at the crossroads of east and west and the heart of the silk route, are isolated in every possible way. At this point, Afghanistan’s health care is a simple matter of access.  How that access is to be provided is a far more complicated matter.

Afghanistan facts
  • Afghanistan was founded in 1747 and is a mosaic of ethnic minorities: Pashtun (42 percent), Tajik (27 percent), Hazara (9 percent), Uzbek (9 percent), other (13percent).
  • The majority of health care in Afghanistan is provided by nongovernmental organizations (NGO’s).
  • Afghanistan was at the very heart of the ancient Silk Road, a passageway for riches and ideas between Europe and Asia.
  • Afghanistan is considered to be the source of the best lapis lazuli, an intense blue gemstone often referred to as the stone of friendship and truth.

Clinician’s corner
A 32-year-old male serving in the military recently returned from a tour in Kabul, Afghanistan and complains of a skin sore on his left leg. He first noticed the lesion several weeks ago and reports that it is not painful but is increasing in size. He has not had any fever or other systemic symptoms. The most likely cause of this patient’s skin lesion is:
A. Strongyloides stercoralis
B. Leishmania tropica
C. Ancylostoma braziliense
D. Tropical ulcer

The correct answer is B Leishmania tropica. Leishmaniasis is a parasitic disease transmitted by the sand fly. The disease has three forms: visceral (affecting the internal organs), cutaneous, and mucocutaneous leishmaniasis. The cutaneous or skin form is one of the most important causes of chronic ulcerating skin lesions in the world and is extremely common in Afghanistan. The lesions are usually painless unless secondarily infected and can take months or even years to heal, often leading to scarring. Treatment options are limited and while they may hasten the resolution of the lesions, they also have significant side effects, so are usually reserved for more serious forms of the disease.

Nov. 28, 2008

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