Afghan Medical Sustainability

       For medical advisors, we have all heard that our actions must lead toward a medical enterprise that the Afghans can independently sustain. This is particularly important if we want to ensure that the investments we have made will benefit them far into the future. Both collective and individual actions can help make this so. Our physical and mental energies must be deployed at every turn. Determined and focused measures toward Afghan medical sustainability are required now.

     Many of us have visited an Afghan medical facility and seen equipment and supplies costing tens of thousands of dollars—even millions—that will never be used because there was a never really a need or because the Afghans were not ready to receive them. These are good for photo opportunities, PowerPoint presentations, award packages and evaluations but do not aid the Afghans. Most of us want to assist the people of Afghanistan, but is there true value in purchasing neurosurgical equipment if there is no qualified neurosurgeon to use it? Should a $200K dental suite be installed when basic dental chairs and instruments—that the Afghans can take care of on their own—will do the job? The dental suite, by the way, will require consistent electrical power, which is lacking across Afghanistan.

     Attention must also be given to processes and programs. We know the success we have had with many initiatives in the United States. They have helped organizations reach new heights in numerous areas. What has worked well for us for many years, however, might not work here. In your own advising areas, think deliberately about what you are attempting to get your advisees to accomplish. If you have been trying to get them to change their practices for several weeks or months, it might be time to significantly amend your approach or begin another project that has a good chance of being continued by the Afghans after your deployment ends.

     Given my experiences over the past six months and having heard accounts from others about sustainment, this could be a very long article. But I’ll stop and ask a few questions.

     – Can the equipment you are about to purchase or have already purchased be independently sustained by the Afghans?

     – Have you canceled equipment or supply orders that are clearly not needed?

     – What happens to the equipment, supply, housekeeping, maintenance, information systems, etc., contracts when we depart? Will your advisee be trained to manage them?

     – What actions have you taken to begin the transfer of medical finances to the Afghans?

     – What efforts are underway to gradually allow your advisees to be in complete control?

     – Are you assessing construction projects and halting (temporarily or permanently) those that are questionable? For projects that have merit, are you helping your advisee understand his role in planning and managing them?

     – If you are clinical, do you insist that the doctor, nurse or technician remain with you until the procedure or event concludes to help build essential skills?

     – Do you hold firm when your advisee persistently asks that you acquire items for them that you know are unnecessary?

     – If you are an instructor, what are your actions to have Afghans become responsible for all facets of student recruitment and instructional programs?

     – Do you ask your advisee about his role in helping Afghanistan succeed?

     Yes, these are difficult questions, but they and many more like them must be asked over the next several months if Afghanistan is to have a medical system that it can sustain through the labor of its own people.

Category: Blog - Medical