Afghanistan: How can you heal when drugs don’t work?

Across Afghanistan, MSF is implementing a package of services to address AMR, including strengthened infection prevention control measures to prevent the spread of resistant bacteria. We’re also creating antimicrobial stewardship committees to ensure the appropriate choice and correct use of antibiotics for patients.

MSF has also opened two bacteriology labs, in Kunduz and Khost, to help identify bacteria and select the right antibiotics to treat infections.

“We are dealing with antibiotic resistance every day,” says Dr. Letizia Ottino, an MSF infectious disease specialist working on AMR in Afghanistan. “It has a serious impact on the health care system. Multidrug-resistant infections require more resources to be treated, longer hospitalization, expensive antibiotics, and specialized doctors,” Ottino explains.

While there is limited data about antibiotic resistance in Afghanistan, Ottino says the available scientific literature indicates high levels of AMR in the country.

Correct patient and prescriber practices key to addressing AMR

The key drivers of AMR in low-resource settings like Afghanistan are poor access to quality health care, water, sanitation and hygiene services, infection prevention control measures, vaccines, and medical and laboratory supply chains, according to an MSF report on AMR in humanitarian contexts.

Patient and prescriber practices also play a significant role, says Dr. Zabihullah Fazalzoi, a pediatrician in the MSF-supported pediatric department of the Herat Regional Hospital.

“Over-prescription, overuse, misuse, and widespread over-the-counter availability of antibiotics all contribute to the growing problem of AMR,” he says.

A 2015 mixed-methods study by MSF of patients, prescribers, and pharmacists in a Kabul district hospital found that patients often had limited knowledge about antibiotics. As a result, they frequently overused and misused them, including for a wide range of conditions like common colds, infertility, and general body pain. Easy over-the-counter access of antibiotics in private pharmacies exacerbated the problem.

Vulnerable people are at higher risk of infection

Serious infections increase the risk of death, particularly for vulnerable people such as newborns, pregnant women, children with severe acute malnutrition, and those with trauma-related injuries.

New mothers at MSF’s Khost Maternity Hospital face that fear every day as they pull on medical gowns to visit their pre-term babies lying in neonatal intensive care beds.

At the first sign of infection in the ward, MSF staff send a blood sample to the newly installed mini-lab—an easily transportable small-scale standalone bacteriology lab that MSF has rolled out in low-resource settings—so they can identify the infection-causing bacteria and tailor antibiotic treatment.

Raising awareness about AMR

Health promoters in MSF projects are trying to increase public education about AMR and encourage better practices in the community.

Haji Abdul Rehman Niamatullah gathers a group of patients in the MSF-supported Boost Provincial Hospital in Lashkar Gah, Helmand. With a flipchart in hand, he explains that antibiotics fight infections caused by bacteria, but they have no effect on common viruses that cause coughs, colds, or the flu.

He explains that antibiotic resistance is accelerated every time we use antibiotics in the wrong way, such as skipping doses or not completing the entire course of treatment. Since the antibiotic cannot kill the bacteria, it becomes more difficult to treat the disease, Niamatullah adds.

Back in the Kunduz Trauma Center, Dawood has learned firsthand how difficult it can be to treat infections caused by a multidrug-resistant organism. His infection was caused by a highly resistant organism that is called methicillin-resistant Staphylococcus aureus.

After more than two weeks in the trauma center’s isolation ward, Dawood says he can tell his infection is starting to heal. While he’s grateful for the treatment from MSF staff, Dawood says he’s looking forward to going home soon.