By Gulab Shah Bawer
Mazar-e-Sharif – Earlier this year at the Balkh public hospital, in northern Afghanistan’s Mazar-e-Sharif city, 24-year-old Yasin was at the side of his father, Mahmood, who had been admitted with a head injury. His fellow villagers in Badghis province, far to the southwest, had beaten him.
“My father was admitted here eight days ago, and since then the doctors have only provided him with eight IV drips,” Yasin said told an IWPR reporter. “I have purchased the rest of the medicine with my own money. Now there is nothing left in my pockets.”
It had been three days since Yasin had been able to buy the right medicine for his father, whose condition was worsening by the day.
“The doctors say, ‘If you have 47,000 afghanis ($1,000), your father will be treated,’” Yasin said, as a nurse stood by. “Otherwise, don’t waste your time and take the patient away. We cannot treat your father through our own pockets.”
Yasin, and many others like him, are facing the same problem. They must buy medicine from pharmacies to treat their loved ones. This is despite much aid from the international community meant to help the hospital and provide medicine to the sick.
Health officials and pharmacy owners say that large amounts of this donated medicine is sold by hospital workers to private pharmacies, who then sell it back to patients who were supposed to get it for free.
“Many medicines that are meant for patients in the hospital are unfortunately sold in the bazaar,” said one pharmacy owner who gave his name as Zabiullah.
“There are groups of people who sell these drugs because they are of good quality and expensive. These drugs are them sold to patients’ families at a very high cost, and some of the profit goes back to public health officials,” Zabiullah said.
Dr. Ghausuddin Anwari, the head the regional public hospital in Mazar, said that the public health system is trying to properly serve patients. But he acknowledged that medicine and equipment was being “illegally taken [from the hospital] by medical staff.”
“But it is not a major problem,” he said, adding that the poor salaries of hospital staff are a likely cause of the theft. Authorities, he said, are trying to curb the practice but Anwari could not give any examples of how this was being done.
Meanwhile, a small industry has grown around the missing medicine. Nearby pharmacies do sell medicine marked with labels that indicate they have been donated.
In one pharmacy, many packages and bottles of medicines and vitamins were clearly marked with labels indicating that they were donated and not for private sale.
Mohammad Afzal Hadid the new chairman of Balkh’s provincial Council of Orthopedic Experts said the lack of free medical services, which are supposed to be constitutionally guaranteed, is a major concern for leaders here.
Hadid, who is also a doctor, has worked at the public hospital, which he said receives a comparatively large budget each year, as well as support from donors.
The hospital has skilled doctors, he said, but not the free services that are expected.
“I have several times visited the hospital, and I have shared these problems with the hospital authorities,” he said. “The ongoing condition of the Balkh public hospital has raised concerns among all residents of Balkh province.”
Hajji Abdurrahman, director of the department of economy in Balkh, said that in addition to its annual governmental budget, the hospital received $8 million from foreign donors last year, to improve the hospital’s ability to provide free health services, including medicines.
Hamyoon, a doctor in Mazar, said that in order to improve health in the province, the corruption leading to the missing medicine and other problems must be tackled.
“There is no official oversight of these donated medicines. No officials come to check the situation in the public hospitals,” he told an IWPR reporter.
“Beside the government assistance, the funds and assistance provided by the donor organizations should be directly presented to the patients under the supervision of an impartial group,” Hamyoon added. “And such supervision might stop the misuse of the assisted medicines. Otherwise the problems may increase.”
Doctors at the hospital say they are forced to ask patients’ friends and family to buy medicine from private drugstores, because there are note enough drugs in the hospital.
“In the internal medicine service, there are no drugs for patients,” said Wakil Matin, one doctor here. “All patients from this section buy their medicine from the market.”
As a doctor, he said, the life of a patient is important to him. He writes prescriptions for medicine and whoever has escorted the patient to the hospital goes out to buy it.
Mirwais Rabih, another doctor at the hospital, agreed that the internal medicine section of the hospital, where there are many patients, was severely lacking in medicines due to their theft. But he said the hospital does provide free drugs and medication in the surgical, pediatric and general medicine sections.
Meanwhile, an industry has grown in front of the hospital. Side by side are 51 medical shops and pharmacies. Storeowners say about half their customers come from the hospital.
Mohammad Zahir, a drugstore owner here, says he in fact buys his supplies from the hospital, because the medicine is “of high quality and cheap.” This keeps customers coming back, he said, and it also means customers can avoid expired or low-quality medicine.
Doctors here say they are doing the best they can with what they have, but with limited finances, it can be difficult.
Hamida Halimi, of the Balkh public hospital, said sometimes the money does not arrive from the capital on time. “And sometimes when we do not have the budget, patients may face problems receiving free medicine.”
Sometimes, the required medicine is not in stock, he admitted. This means patients must buy from outside.
However, Shokrullah, another doctor at the hospital, said the facility has a yearly contract with a drugstore to keep medicine supplies stocked.
Meanwhile, the hospital is undergoing reform, said hospital director Anwari. Its completion will mean that many of the hospital’s problems will be solved, he said.
That is little comfort for the people whose loved ones are currently in the hospital. People like Mohammad Nabi, a resident of Mazar-e-Sharif, whose wife was recently hospitalized with heart disease.
Not only does Nabi pay for her medicine, but he also has to pay for medical examinations completed by hospital staff.
“They also charge money for some examinations and X-rays, which are supposed to be free,” he said. “And if I do not pay the money, no one will work, and then the patient will die.”
Listen to the story in Dari