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US OB/GYNs helping to create residency program in Kabul March 2005 issue of ACOG Today
As part of the effort to reconstruct Afghanistan’s medical infrastructure, nine ACOG Fellows have gone to Afghanistan since 2003 to work at Rabia Balkhi Hospital, one of four women’s hospitals in Kabul. Each ob-gyn works at Rabia Balkhi for at least three months, as part of a project to train female Afghan ob-gyns, nurses, midwives, and hospital staff.
Launched in November 2002, the program is run by the nongovernmental organization International Medical Corps and funded by the US Department of Health and Human Services.
The program began under the leadership of Fellow William H.J. Haffner, MD, immediate past chair of ACOG’s Committee on Health Care for Underserved Women, and was continued by ACOG president-elect nominee Douglas W. Laube, MD, MEd. Dr. Laube developed the initial curriculum outline after a site visit to Kabul in 2003, in anticipation of developing a more formal US-style residency program.
ACOG Fellow Jeanette E. Akhter, MD, immediate past chair of ACOG’s Maryland Section, worked at the hospital from November 2004 through January 2005. Dr. Akhter described the complexity of the project: “In addition to training residents and establishing a four-year curriculum, we train other hospital personnel—nurses, midwives, OR staff, administrators, equipment handlers, and so on. And support services need to be set up for a residency—lab, X-ray, sonogram, medical records, cleaning services, etc. Definitely, it’s all about teamwork.”
Saving Mothers’ Lives
In 2002 Afghanistan’s nationwide maternal mortality rate was 1,600 out of every 100,000 live births, according to the Centers for Disease Control and Prevention. The IMC reports that for deliveries at Rabia Balkhi Hospital, the maternal mortality was about 600 per 100,000 when the US project began. The maternal mortality rate at the hospital has now dropped to about 200 per 100,000, and some months have had no maternal deaths.
“On average there are 35–50 deliveries a day,” Dr. Akhter said. “About 70% of the deliveries are normal, and the woman goes home in a few hours. Women who have had a cesarean delivery, about 10%, stay at the hospital a week.”
Establishing a Medical Library
California Fellow John J. Ryan, MD, worked at Rabia Balkhi Hospital for six months beginning in August 2004. Working with two US librarians, he created a medical library at the hospital after noticing that medical books and journals were kept locked up because hoarding and theft were common.
“It’s good to see residents and the staff carrying books now,” he said.
Dr. Ryan summed up the Kabul project: “Progress has been made, thanks to the help of volunteer ACOG physicians, midwives, nurses, and IMC staff, who have taught and helped the Afghanistan residents to join the modern age. Very many countries, large and small, have been contributing to Afghanistan. It is truly a world effort.”
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