One morning we had a group visit to children’s hospital here in Kabul. Our team has been supporting them a bit with much needed equipment and supplies. This year we were giving them several surgical set which we had carried all the way from the US in our luggage..

We arrived and were initially greeted by the president of the hospital. He welcomed us in to his office and told us a bit about the hospital. The numbers he shared were astounding. The hospital had 300 beds and at times they have more then 400 children. That means sometimes there is 2 to a bed – can you even imagine that in the states! Through their OPD (Out Patient Department) or clinics they see about 1000 kids a day. Their ER sees about 200 a day and admits 50-100. And this is only children remember. We were served the ceremonial tea and cookies

I was most curious to hear about some of their common clinical problems. Trauma is huge! As he began to list them off I thought to myself, “how many of these are preventable?” So many of the issues are related to safety! Road traffic accidents (RTA – AKA MVC) are common. Falls from roofs or window and burns are frequent. With the traffic conditions being terrible, little children are being hit as a pedestrian all the time. The congestion of cars, lack of adequate curbs or sidewalk and absence of clear cross walks are to blame. One doctor on the trauma floor was explaining that they have elevated crosswalks, but no one uses them because they are inconvenient. He says people don’t want to walk 20m up, 40 m over and then 20m down. He says that in India they construct underground passages for crosswalks and that they are more accepted/used by the people.
He also talked about foreign body aspiration being a common problem. He proudly told us about the fiberoptic bronchoscopy they have, but that the grasper is broken right now. I asked a bit more about that because even thought it happens in the US, it is quite rare thankfully. Reportedly there is a whistle like toy available to children that can have a piece break off and then become easily aspirated. The first thing I thought – Close down the company that is producing this health hazardous toy. That happens all the time in the US – recall it!!! This problem could be so easily preventable.

We then began our tour of the hospital. My first impression was, “I am sure their press ganey score for aesthetics would be low”. No nature sounds and soothing décor to welcome the patient to their hospital experience – just gray concrete everywhere. We were taken to their theater and boy was it bleak with virtually no equipment. Currently their anesthesia machine was down as they had no halothane. They were using ketamine and only had one laryngoscope blade.

We visited the NICU, burn unit, surgical ward and head injury ward. Minimalistic is generous in describing the setting here. One of the first observations was the lack of screens on the burn unit. Flies were everywhere; both airborne and perched on people and wounds. Just like in other developing countries I have visited, family members stay with the children through out their stay to help provide care.





Finally our tour ended in the ED. There was absolutely nothing there other than different designated rooms for different kinds of patients. I tried to encourage our guide by pointing out many of the similarities. Just as we were about end our tour, one of our Afghan staff came and whispered to our leader something in his ear. “Gotta go”, he said. We had been instructed that if at any time you heard those words, drop everything and follow the staff. Obediently we did and returned to our guesthouse. Later we heard that where had been some protest/riots in the Kabul that day. I just read that they were in response to the mistreatment that Afghans refugees were getting in Iran. Ultimately, no harm and I am safe