“It is hard enough for the men to afford or access treatment, and generally it just will not happen for the women.”
Cat is a medical student who previously served with the army as a Medical Support Officer in the Joint Forces Medical Group in Bastion, Afghanistan.
Her interview reflects that experience; they are personal opinions and do not necessarily reflect MoD policy.
Why is access to safe surgery an important issue for women’s health?
Afghanistan, after Chad, has one of the highest infant mortality rates in the world and giving birth there is an enormous risk to each woman. Many in the poorer areas, e.g. Helmand, have no access to hospitals. Medical care must generally be paid for (unless there is a charitable hospital), and when living in a hand to mouth existence (on the absolute limit of survival), paying for hospital treatment is simply not going to happen.
Does gender play a role in accessing treatment?
It is hard enough for the men to afford or access treatment, and generally it just will not happen for the women. As a result they are seen by other women in the village, who may or may not have any medical training. More likely they are the older women in the village and just have more experience with birth.
For a woman to receive care she would need to be escorted by a male relative (sometimes these were young boys – perhaps aged 8 years old), and that means he’s not able to contribute to the earning/survival of his family while he is chaperoning the woman.
What is the reality of the situation faced by a woman in need of surgery when she lives in a conflict zone?
It was pretty much all trauma – we were in Helmand in 2009. Our remit was to treat coalition forces, including Afghan National Army and Afghan National Police.
While we, the Coalition, would make every effort to help those (men, women, children) who were injured in any cross fire that they were involved in, the reality is that most women would not get surgical care and certainly not long term follow up care.
Life is pretty brutal, and often short.
What role do women play in delivering surgical care in the low-resource setting countries you’ve worked?
The women are key. If you can teach women some basic obstetric care you can make a huge difference to mother and baby survivability. Teaching them about hygiene: hand washing, toilet siting etc, and basic care for burns (very common in open fire cooking), minor wounds and sickness will do a great deal to improve the health of the whole village. However, you need approval from the village elders first and then need a suitable team to deliver the teaching, which can also be very difficult to achieve.
And in the long-term?
You can also achieve wider aims – which are of relevance in a conflict setting, such as improved relations and cooperation – in turn this can improve the lot of the village and help install relative peace.
Successful surgical care must be delivered at multiple levels, tactical and strategic. From the women in the villages, improving the local hospital standards and ensuring useable equipment is available through to decisions on how to ‘grow your own’ medics, keep them in country and develop national policy on health care.
It needs to move beyond focusing on helping a few mothers in a few villages, without a longer-term view on how to stabilise and build a health care service. Survival will never improve if you focus on one level only.