August 25, 2016

Dr. Erlend Grønningen from Trondheim, Norway is a Doctors Without Borders/Médecins Sans Frontières (MSF) supervising medical doctor at Boost Hospital in Lashkar Gah, capital of Afghanistan’s Helmand province. Dr Gronningen arrived in Afghanistan in April, 2016, and primarily focuses on internal medicine, as well as the diagnosis and treatment of tuberculosis (TB). This is his second assignment with MSF, having worked in South Sudan in 2014. Back in Norway, Dr Grønningen works and trains as a specialist in respiratory medicine.  

Here, Dr. Gronningen describes how the conflict in Helmand has prevented people from reaching the hospital:

Over the last few weeks, fighting in Helmand province has intensified, coming closer to Lashkar Gah than usual. As the conflict has encircled the city—and even though fighting has decreased in recent days—we’ve seen a significant drop in patient admissions at Boost hospital, a 300-bed facility we run in partnership with the Afghan Ministry of Health. The hospital is normally overwhelmed with patients, but lately, we’re seeing fewer people than normal coming to the Emergency Room (ER).

For our team, it’s really frustrating to see how the conflict directly affects people’s ability to access medical care. The beds in our pediatric ward and intensive therapeutic feeding center (ITFC) are almost always full of noisy children and young patients, often two to a bed, getting treatment for malnutrition or other life threatening conditions. But recently, those wards were eerily quiet, and many of the beds were empty. Empty beds are the face of war.

As the fighting has calmed over the last week, we’ve seen the pediatric ward and ITFC start to return to their normal busy levels, but admissions to the ER are still fluctuating every day.

Around a week ago, a 15-year-old girl from Nawa district came in with meningitis—always a grave disease in need of immediate medical attention. Her parents told us she had been sick for at least a week. They knew it was serious and wanted to bring her in immediately, but they couldn’t. Nawa district is very close by, but has seen intense fighting recently. We admitted her knowing it was probably too late already. Twenty-four hours after she started treatment, she fell into a coma and passed away.  

Read: Patients Struggle to Reach Hospitals in Helmand

We also had a seven year-old boy come in with severe respiratory distress. His family told us he had been showing symptoms for 12 days. We examined him and found he had a life threatening lung condition called tension pneumothorax. This is essentially a buildup of air in the chest cavity caused by some sort of injury to the lung. We put in a chest drain and his condition improved soon after, although he will need a chest tube for a while longer until his lung expands fully.

We gave him X-rays and his results showed he was also suffering from undiagnosed tuberculosis (TB), which is a significant public health problem in Helmand province. We started him on TB medication and he soon recovered enough to walk around the hospital like any other curious seven year-old. But as he moved he was in some discomfort, and a medical examination revealed his left hip was dislocated. His parents hadn’t had a chance to tell us when he first came in—due to the emergency nature of his condition and because their son was in such distress—but he had actually been in a car accident 12 days before, which caused both his lung and his hip injury. His hip was put back in place and he is currently in traction (a set of mechanisms for straightening broken bones or relieving pressure on the spine) while he recovers in the MSF-run pediatric intensive care unit.

This young boy’s case shows that even when a case is serious and a patient reaches the hospital late, there is still hope. But delays are putting lives even more at risk. People need to be able to make the journey to us sooner. 

MSF started working in Afghanistan in 1980. In Helmand, just as in the rest of Afghanistan, both national and international staff work together to ensure the best quality of treatment. MSF supports the Ministry of Public Health in Ahmad Shah Baba hospital in eastern Kabul, Dasht-e-Barchi maternity in western Kabul and Boost hospital in Lashkar Gah, Helmand province. In Khost, in the east of the country, MSF operates a maternity hospital. MSF plans to open a multi-drug resistant tuberculosis diagnosis and treatment facility in Kandahar later this year. MSF relies only on private funding for its work in Afghanistan and does not accept money from any government. 

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