Between tea parties and the Taliban: new life and death

Between Tea Parties and the Taliban: new life and death

(29 November 2022)

I have returned to Khost, in Eastern Afghanistan, so many times that I sometimes run into familiar faces. On my first day back at the maternity ward, while attending to patients in the room, a woman pulls at my hospital uniform. She starts speaking rapidly in Pashto, and with the help of our Afghan doctor, Zia, I got to understand her story.

Five years ago, she was here at the hospital, pregnant and in labor with twins. Apparently, I had performed an ultrasound on the babies and assured her that everything would be fine. Ultimately, she had a smooth delivery. Now, she was pregnant again, once more with twins. She was already experiencing contractions and asked me if I could please do another ultrasound so she could be certain that everything would be okay. Although she had already received an ultrasound that morning from a colleague that showed everything was normal, I couldn't refuse her request.

Meanwhile, she successfully gave birth to baby number 5 and 6, and she accepted contraception after delivery. Thankfully, it was important for both her health and the well-being of her children that she didn't become pregnant again too quickly. Now, she lies in bed with her two boys, radiating joy.

In the bed next to her is another mother with a small baby weighing 1950g. In Belgium, the baby would be placed in an incubator, but because we currently have 42 babies in 30 beds, we keep the healthiest ones with their mothers as soon as possible. The little girl is so adorable, sucking on my fingers.

Her mother has just undergone a cesarean section due to placental detachment, resulting in significant blood loss. This little 1950g girl is baby number 10 in the family, with five surviving sisters and three brothers—one of them deceased.

As customary here, the mother has no say over her own body. In the rush of preparing the patient for an urgent cesarean section (which requires a man's consent), she clearly stated that she didn't want any more children; it was enough. However, her husband was absent, and a cousin had brought her to the hospital. Considering the cultural sensitivities that require the husband's consent for sterilisation, and with him being absent, we couldn't proceed with the procedure.

The mother is now receiving her second unit of blood, and everything is going well, fortunately. She experienced a life-threatening complication during her 10th pregnancy. We will definitely propose an implant or other contraception, but we can only hope that her husband agrees. Nothing happens here without the man's permission.

Yesterday, we lost a mother in a similar situation. She delivered her tenth child at home and had a severe bleeding afterwards. It took the family two hours to bring her to the hospital, and when she arrived, she had a cardiac arrest.

We tried to resuscitate her for 20 minutes, but unfortunately, there was too much brain damage, and she didn't make it. It's so heartbreaking.

If she had given birth with us or had arrived just 30 minutes earlier, this tragedy wouldn't have occurred...

Losing a pregnant woman saddens everyone, from the janitors to the doctors, especially because it doesn't happen often. We have 20,000 deliveries here each year, and she is the fourth mother to die this year. All the deaths this year were women who were near death upon arriving at the hospital, and despite our efforts with blood, medication, and intensive care, we were unfortunately too late...

After the passing, I drink tea with overly sweet cookies with Zia and Weda, our national doctors who are also disheartened. We discuss the current situation in Afghanistan. Our doctors themselves belong to the small group of women who managed to study and now help their own people, but their daughters have to stop attending school at the age of 12 because the Taliban still keep the secondary schools for girls closed. It's outrageous. However, I hear about some creative solutions. One of our doctors secretly pays for private education for her 13-year-old daughter, and another sent her two eldest daughters to family members in Iran where they can still go to school. But the barriers for girls are insurmountable in Khost now.

Weda, one of our doctors, also said how much she loves coming to work. She feels useful, sees colleagues and midwives, and has a lot of social interaction. Outside of work, a woman is simply confined at home here.

With our foreign team of 10 people from 7 nationalities (Belgian, French, Congolese, Rwandan, Australian, Sierra Leonean, and Norwegian), we also discuss what the future holds. The optimists among us believe that the Taliban will realize in 1-2 years that there is a real need for qualified female personnel and that denying girls education is utterly foolish. The pessimists among us believe that we are in for 20 years of misery—the greatest suppression of women in the world.

I hope the optimists are right.

We will see in the coming years... Besides caring for 20,000 patients and their babies each year, the most important thing for me is to provide three hundred Afghan women with jobs and salaries. Small steps towards women's emancipation 😊

We will see in the coming years...

Séverine