MSF nurse practitioner Georgann MacDonald blogs about the difficulties of working in Helmand Province, Afghanistan.

Afghanistan 2012 © Francois Dumont/MSF

An MSF car arrives at Ahmad Shah Baba district hospital in the eastern outskirts of Kabul.

MSF nurse practitioner Georgann MacDonald

Georgann MacDonald, a nurse practitioner from Canada, has extensive experience in the emergency department and flight medevac.

Before joining Doctors Without Borders/Médecins Sans Frontières (MSF), she worked as a family nurse practitioner. She started her first mission with MSF in December 2012 to work in Boost Hospital, Lashkargah, Helmand province, Afghanistan. She is responsible for the female inpatient ward, emergency, and the outpatient departments. Read her Field Blog here.

Today I saw the worst case of breast cancer I have ever seen. The chief of medicine asked me to come and see a patient with the surgeon, as the patient appeared to have a large abscess on her neck. On examination, we quickly discovered that this was actually a metastatic growth, with the primary tumor being in the breast. The patient was also suffering from extreme shortness of breath, and I am sure we will find that the cancer has also invaded her lungs. There is really nothing we can do for this patient, other than make her as comfortable as possible. Her mother was devastated with this news, and as a mother myself, I can completely understand. We just hugged each other, and I cried with her.

Sometimes, the seeming futility of this job overwhelms me. We see so many diseases – both chronic and acute – that we are unable to do anything about. When I considered coming to Afghanistan, I felt I was prepared to see malnutrition, wounded patients, trauma, etc. I did not realize the amount of chronic diseases and other conditions that we would be helpless to treat. At home, this woman would have had a mammogram and ultrasound when she first noticed a lump in her breast. She would have received free health care that would have, in all likelihood, saved her life. We have no chemotherapy, radiation therapy, mammography, or indeed oncologists here in Helmand. MSF provides free medications and treatment, as much as we are able, but our resources are limited, and we cannot treat these sorts of illnesses. While I understand that on an intellectual basis, it frustrates me to know that in my country this woman would probably survive, but here she will have no chance. Why was I lucky enough to be born in a rich country? Why wasn’t she?

In the past couple of weeks we have had a rough time, with the attack on the ICRC [International Committee of the Red Cross] compound in Jalalabad resulting in a decrease in some activities in Afghanistan. Movements have been restricted in some areas of the country, although we are still able to work here in Helmand.

I will admit that the war, with all of its consequences, is wearing on me. I can’t help but wonder . . . if we just took the money that has been spent on all of the bombs and guns, etc., and spent it on health care, would we have been able to save this patient’s life? Could we afford to give free medications for chronic diseases, so that the people here could have permanent treatment, instead of the “patching up” work that they get now?

I know that I am just a dreamer, but what if . . . ?