By Monica Campbell,
Kabul - On a chilly morning, Maimoona, a 41-year-old Afghan nurse, headed down a muddy path on a hill overlooking Kabul. It was a poor neighborhood. Tiny houses clung to the rocky terrain. There were stray dogs and men pushing wheelbarrows filled with plastic bottles for recycling.
For Maimoona, who stood out in her professional dress, a purple wool skirt and blazer, it was the start of a typical day. For nearly a decade, she has spent her days traveling to the outskirts of Kabul, to homes in the city’s poorest areas, to treat people left immobile because of spinal cord injuries. “They are the most vulnerable,” Maimoona said. “Not only is it tough to live in Afghanistan. But imagine being paraplegic in a place like this, up a hill without basic services. These people could easily be forgotten.”
For more than 20 years, the ICRC has trained nurses like Maimoona to provide home-care medical services to Afghans, particularly for those with spinal cord injuries. Since the program’s start, over 6,200 patients have been registered. And nearly all patients have received care, such as braces and other aides, at one of the ICRC’s seven orthopaedic centers in Afghanistan.
In all, home-care nurses have carried out nearly 6,900 visits to Afghans with spinal cord injuries, according to the ICRC.
Maimoona’s first patient was Naheed (*), a 36-year-old mother of seven and paraplegic who wore a bright red scarf and green pants. Both of her legs were in braces and she maneuvered around her family’s two-room home on a cushioned, wooden board with four wheels, using her arms to push herself along.
Four years ago, Naheed fell into a well near her home that had been long abandoned. It was hidden, overgrown with weeds. For nearly five hours she lay crumpled at the bottom of the dark hole until neighbors heard her shouts. A severed spinal cord left her legs paralyzed.
At first, Naheed, who only went by her first name, thought that she would be confined to her bed for life. Like many of her neighbors, Naheed migrated to Kabul seven years ago to seek safety from an intensifying war in the countryside. She left behind her village and community. In Kabul, there would be few caregivers and no extra cash to pay for treatment.
Afghanistan is one of the world’s poorest countries. No public hospital offers leg braces or the extensive rehabilitation that spinal cord injuries require. There is no Afghan government-run program that involves home visits or nurses trained to treat people like Naheed. It’s a gap that humanitarian and medical groups like the ICRC try to fill by working with and training local nurses like Maimoona.
“It’s important to have good hospitals and equipment, but it’s also important to have the the right people inside homes delivering basic care,” said Bart De Poorter, the ICRC's Health Coordinator for Afghanistan.
Naheed first met Maimoona after she was released from the hospital and referred to the ICRC’s orthopaedic center in Kabul. She was fitted for leg braces and started the rehabilitation process. Ever since, every two months, Maimoona arrives to Naheed’s home to test her flexibility and mark any progress.
Because of general deterioration, Naheed’s legs have withered dramatically, to about the size of her ten-year-old daughter’s arm. Like all of her visits, Maimoona talked any of the family members present—in this case, the oldest immediate relative at home was Naheed’s 10-year-old daughter—to inform them about why she is seeing the patient and why continual treatment is crucial.
Maimoona then proceeded with physical therapy. Naheed worked at stabilizing herself, biting her lip as she struggled to bend her leg with her hands. “It’s important to keep moving,” Maimoona said. Naheed smiled, but then looked worryingly at her ankle. “I think the brace is getting worn down here. It’s rubbing my skin.” Maimoona took a look and agreed that it was time for new braces.
During the examination, Naheed’s 10-year-old daughter also helped by steadying her mother while she went through exercises. “That’s great,” Maimoona told the girl. “You can also help your mother by shifting her from side to side, changing her position. It will keep her from swelling.” Naheed had bedsores and they were at risk of becoming infected. The girl nodded. Maimoona also told Naheed to remind her husband, who was out working at a construction site, to remain vigilant, too, and to make sure that Naheed’s sores were cleaned regularly. Naheed left behind a new supply of bandages.
Maimoona also worried that Naheed could contract another illness because of smoke exposure from the old drum-shaped stove that she sat near most of the day. The living room air was dusty with flecks of ash. But the nurse knew that the family’s living condition would not change radically. Indeed, even Naheed’s family of seven living in a tiny, cinderblock home was better off than the refugee camp within view at the base of the hill—thousands of Afghans living in tents after fleeing the volatile Kandahar and Helmand provinces in the south.
“From a humanitarian standpoint, people should not live like this,” said Maimoona. “But I face limits about what I can do. I can’t offer people a better home or cash. But I can try and make sure may patients get basic treatment.”
She then accepted tea from Naheed’s daughter and took a short break before heading to her next patient.
(*): The patient’s name was changed. She did not want to offer her full name.
Monica Campbell was commissioned by Intercross to report from Afghanistan. This is her fourth Dispatch for the blog. Ms. Campbell's work has appeared in The Christian Monitor, The Chronicle of Higher Education, The Boston Globe, The San Francisco Chronicle, Public Radio International's The World and Newsweek. From 2009 to 2010, she was a Nieman Fellow at Harvard University.
More reporting by Ms. Campbell, ex-Kandahar: