Effect Measure

US sponsored Afghan hospital a hell hole

Rabia Balkhi Hospital (RBH) is an obstetrical hospital in Afghanistan that is one of the jewels in the crown of the US aid effort after the overthrow of the Taliban in 2002. Here’s the Department of Health and Human Services (HHS) website boast:

HHS activities have had an enormous impact on the quality of care at RBH, have saved the lives of hundreds of women and newborns, and have improved significantly the skills and knowledge of the doctors, nurses and midwives at the hospital. We are continually adding new improvements that dramatically expand the hospital’s life-saving capacity, such as the opening of an emergency room with 24-hour operational capacity, the outfitting of a fully functional pediatric nursery, and the institution of a basic medical records system. HHS awarded in FY 2005 a second cooperative agreement to a non-governmental organization to provide sorely needed training in hospital management. This cooperative agreement is now in its second year of operation. (DHHS)

Indeed RBH was one of former HHS Secretary Tommy Thompson’s proudest achievements:

Thompson boasted at the hospital’s gala reopening in April 2003 that “we now have a new hospital for women to receive top-notch health care and a new training program that will provide the best of medical instruction.”


Rabia Balkhi has been “an unqualified success,” said William Steiger, director of HHS’ Office of Global Health Affairs, in an interview. “Hundreds if not thousands of lives have been saved.” (Alison Young, Atlanta Journal Constitution, hat tip Stormy)

You know what’s coming next:

Many visiting U.S. doctors and health experts saw it much differently. “Things are horrible there. Worse than imaginable,” wrote Michael Gerber, visiting in May 2003 from CDC’s refugee health branch, in an e-mail a month later to CDC headquarters.

Gerber’s e-mail described “feces all over the halls, blood everywhere … no drugs, no record keeping, no signs of the refurbishment save new paint in a few spots.”


At times, HHS’ narrow focus on training and what it would not pay for was ridiculous, said Dr. Qudrat Mojadidi, an Afghan-American who advised Thompson on the project in 2002 and 2003. HHS refused, for example, to buy fuel for the hospital’s medical waste incinerator, he said.

“They were having 60 babies every 24 hours and all those placentas were rotting out there in the hot sun of Kabul,” said Mojadidi, who paid $200 from his own pocket to buy fuel in 2003.

“Every week I’d send two or three e-mails with pictures attached” to HHS officials, Mojadidi said. “Finally [Thompson] sent me a letter saying what a wonderful job I was doing and how many lives I was saving. I wrote back and said: We’re not doing anything.”

In emails and meetings, CDC officials urged HHS to either suspend the training or make the hospital functional so training could be effective.

“We are extremely concerned about the grim situation,” wrote Dr. Stephen Blount, CDC’s global health director, in a May 2003 email to Steiger, the HHS official in charge in Washington.

We’ve met Dr.Steiger here (and here) before. Very bad news, is this guy.

What difference does it make?

The rate of normal-sized babies dying in labor and delivery at Rabia Balkhi jumped 67 percent last year, CDC scientists in Atlanta found. Worse, the newspaper’s analysis shows these babies were nearly four times more likely to die when delivered by Caesarean section, a potentially lifesaving operation encouraged by U.S. trainers.

Afghan mothers were in danger, too. Eighteen died in childbirth there last year; two-thirds of the deaths involved c-sections, including issues with surgical skill, anesthesia, transfusions and misdiagnoses, records show.

The place is a medical mess, according to almost everyone who has seen it:

The years of disjointed training was evident in the care observed by Dr. Catrina Funk, an ob/gyn, and Dr. Jeff Whittall, a pediatrician, who worked there in 2006.

“Twice myself or Jeff walked into the OR and realized the patient didn’t have a heartbeat on the table, but nobody else realized it because the patient didn’t have a monitor,” Funk said. Anesthesia doctors had new equipment kits, she said, “but they didn’t necessarily know how to use them.

What is particularly galling about this most typical example of Bush administration of incompetence is the reason given for not helping more:

The U.S. program was “just totally unrealistic,” said Dr. Pamela Hyde, an Oklahoma obstetrician who was there in 2003. She said the United States needed to bring in a whole team of doctors, midwives and administrators to run the hospital and teach the Afghan staff by example.

The Afghan health ministry had wanted HHS to take over Rabia Balkhi and stock it with scarce supplies, according to U.S. embassy cables.

HHS refused, saying the Afghans wouldn’t become self-sufficient that way. Internal documents note that a top priority of the project was to support the newly installed Karzai government.

So we can’t leave Iraq before the Iraqi army and police are self-sufficient, but we can abandon tens of thousands of Afghan pregnant women and their babies on the grounds that helping them would prevent them from becoming self-sufficient?

I get it. Boy, do I get it.


  1. #1 M. Randolph Kruger
    November 23, 2007

    C’mon Revere. This sounds like the Med here in Memphis. And there are several dozen like it that have had their budgets tanked by the immigrant problem. The threat here is to close it and then what do they do?

    Its all about the perspective. What was it like during the Taliban? Well lets see, they would stone a woman to death for even having a child. No birth control, no healthcare. And they are right about the standing on their own. But it bugs everyone when someone is under that grindstone of reality.

    Its also about the money. 75 billion to Africa, 500 million to Indonesia and thats in the last year. Where does that money go? Generally into someones pocket….The gig with Supari’s “its only 20%” for corruption really put a rasp on my hickories. We have way too many missions to accomplish right now and they are antiterrorist related. You want UHC, we have to have a military, the special interests here want everything given to them for free, the immigrants DEMAND that we take care of them. So in your previous posting two back you were talking about “big spenders” you tell me what programs you want to cut, where the money will come from and I might have a bit more sympathy for the Aghans and their hospitals. Sooner or later someone will clean the floors, someone will pony up enough to allow them to eke by. One of the reasons that the dollar IS so low right now is that we have sent so many dollars outside of the US. The US is going to have to start cutting the purse strings here soon on these various countries. For what we spend in a day Revere, we could do your UHC and without touching the military budget either.

  2. #2 revere
    November 23, 2007

    Randy: With all due respect, you know nothing about bad hospitals or what they are like. I will guarantee you there is nothing like this in the US. It isn’t just the physical plant. It’s the human resources — resources we were supposed to make competent. This is a colossal failure being touted as a glowing success, another example of the unbelievable incompetence of this administration. They can do hardly anything right. In fact, I can’t think of a single thing they have done right, except perhaps by accident.

    Money? I’d raise taxes, not cut programs. You get what you pay for. That’s common sense (which isn’t that common, alas).

  3. #3 Joseph j7uy5
    November 23, 2007

    There are things like that in Iraq, too, although perhaps not as bad. You can find glowing reports of all the high-tech equipment we “donated” (at great profit for some companies in the USA, I suspect), but then there are Iraqi news agencies that point out that there is no electricity to run the equipment.

    The whole thrust of these efforts is #1 to generate favorable headlines and #2 to award contracts to US companies. It has nothing to do with helping people. Our own government is robbing us blind with this so-called war on terrorism. If we are going to cut spending, that is where we start.

    BTW Kruger needs to do some actual thinking about “the immigrant problem.” Immigrants do more good for this country than the costs they generate. There is a lot of whining about the costs of providing things for the immigrants, but no rational consideration of the costs compared to he benefits. Of course, if you only look at the cost side of the issue, it looks bad. Most things do. But a one-sided view is no way to analyze policy.

    Revere, I know you try to keep a civil tone in the discussion here. There is absolutely no place for blatant racism like the reference to “the immigrant problem”.

    Good post, by the way. People need to see what our wars are really all about. Then maybe we can do the right thing: put an end to this madness.

  4. #4 anne
    November 24, 2007

    thank you revere, for this description.
    I am horrified, I could not imagine a similar thing.
    it’s crazy.

  5. #5 M. Randolph Kruger
    November 24, 2007

    Well lets see Joseph, the crime rate puts Memphis in the top ten, we were the number one for murders. The “illegal immigrants” account for over 2/3rds of the budget now with no compensation back from the federal government so the taxpayers have to foot the bill from the state.I wont even go into the illegals in the school system. It is a huge number and 15,000 bucks per kid with nothing to pay for them except property taxes.

    There isn’t a racist cell in my body Joe. I have helped these people all the way back to Mexico as early as last year. There is a large chance that the local regional medical center will close if things dont change and then the LEGAL residents will have no place to go within 90 miles. So with all due respect unless you live in Canada, you dont know what you are talking about. They have raised taxes seven times in ten years and are talking about another one. Coupled up with the high crime and high taxes all of the businesses are moving out. Not much difference in the problems of Afghanistan, just on a smaller scale. We are bouncing back and forth now as the murder capital of the US. So who do we see about that?

    Revere, so you would pull us out of Afghanistan and leave the Taliban and Al Qaeda to their devices? This hospital thing is part of the nation building crap we have been into for years. It doesnt work, it costs way too much and well honestly your supposition that I make about killing them all might be a lot more cost effective. Otherwise its a slow grind, and then you have the human suffering we hear and see. Its also an Afghan problem in all reality, not ours. We won the war, but we are losing the battle. We are on the slow pullout now. As for the Afghans they dont like it and sooner or later they’ll get the money to pay for the requisite items and begin to turn it around to some level.

    You want us home, but you also want us to do more. I hear you complaining about the fact that there is no UHC. Okay, so lets start cutting aid to these countries and see how fast they turn bad. Its a payoff, just as Indonesia is. They all want the good green dollar and frankly I would just end their suffering. I am not a doctor and if there is shit in the floors of a hospital then is it the problem of the US taxpayer to clean them up!? Is it our responsibility because we took the head off the chicken in Afghanistan? It was a limited war, and because of that and all of the politically correct crap we arent able to decimate villages, or donkey trains and the like. Even though we know they are there. Poor defenseless little Iraqi’s, Iranians and Afghani’s. We just messed up their lives. Not really, if I had been in charge I would have Patton’d them and a lot more than what we did over all. You would have gotten your 1 million casualties. And then? I would have just left with all the things broken, all of the bodies laying about.

    The simple message… Dont screw with us or you’ll pay a huge and terrible price. A Macedonian did the same thing…. You might have heard of him…Alexander. He got killed when he strayed from good military sense.

    We went to Afghanistan on a military mission and then it became a peacekeeping one, then a humanitarian one. I can be a big humanitarian if I think there are going to be results. If there arent I change my tactics and then, if it doesnt work, I take my toys and go home. When they turn bad I would simply warn them once and then do them. Doing them might mean millions next time out but that is the ultimate outcome of a pullout anyway. They get a bomb, we got ours, they lob one, we lob 20 to make a point and then, perhaps, it escalates out of control. Shit on the floors is the least of our problem. The question is, who felt comfy about doing that?

    Afghanistans medical system was a shambles before we got there, it will be after we leave. They have no GNP or GDP except heroin poppies. So once we leave they’ll be squatting in the hospitals and happily doing it. We cant keep doing this nation building stuff. Its actually cheaper if you want to put numbers on it to put them out of their misery.

    So unless you have a suggestion other than to spend more money that you happily pointed out yesterday I cant see what the beef is with this. If we werent there, would there have been or was there shit on the floor six years ago? I’ll bet there was camel shit on the floor then. No, I understand your point and this is part of the far right that took over and that is being expulsed as fast as humanly possible. Those arent Republicans, those are hard and fast assholes who are using their positions for political gains. I have seen them before and will again. From the lefty side, Wes Clark is the one that I have a problem with. He was one of the first to assert that the US was strafing villages and people. Unfortunately there were only 100 total air ops by the USAF during those three months that Obomb-me and Clark asserted we were… pure unadulterated horse shit and its getting deep. You and others might not be aware that all frag orders since Mi Lai that involve civilian targets have to be in writing and retained for a long period of years, for just that reason.

    This rhetoric is cranking up and its designed to do nothing but sway people. You ARE right about that clown. I have heard of him before and I am deeply unimpressed.

  6. #6 Mac
    November 24, 2007

    Calling it an “immigrant problem” does not make one racist. We do, in fact, have a problem with the current immigration system in this country. While there may be more tactful (or “PC”) word choices, it’s not remotely like talking of a “white problem” or a “black problem” or a “jew problem” (a la Borat), which would indeed be undeniably and despicably racist. And I’m not saying that immigrants don’t contribute substantially and beneficially to our economy either. (They do, and I’d rather have them here than not.)

    This is all off-topic, but saying we don’t have a problem with immigration in this country is turning a blind eye. But it’s only part of the problem. We have to acknowledge that a huge number of the abusers of emergency rooms are American citizens, too.

    Drifting back in the direction of the main post, however, I must say that sadly, I’m not surprised an organization as incompetent as the Bush administration could let something like this happen on their watch. (If they can let Walter Reed happen in our own capital, who knows what they’d let happen in some poor, remote developing nation?)

    That being said, the post is an attack on a system that relies primarily on emotional and anecdotal accounts. I’d like to see it accompanied with more objective information–numbers–which would have far more persuasive power.

  7. #7 HatTrick
    November 24, 2007

    Kruger said: “Poor defenseless little Iraqi’s, Iranians and Afghani’s. We just messed up their lives. Not really, if I had been in charge I would have Patton’d them and a lot more than what we did over all. You would have gotten your 1 million casualties. And then? I would have just left with all the things broken, all of the bodies laying about.

    Doing them might mean millions next time out but that is the ultimate outcome of a pullout anyway.
    We cant keep doing this nation building stuff. Its actually cheaper if you want to put numbers on it to put them out of their misery.”

    Revere, once upon a time you told me that MRK was ‘a good man who would be shocked if he thought about the things he said.’ I believe I’d called him a mean-spirited asshole.

    Trusting your judgement on the issue, I apologized. Since then I’ve gagged dozens of times for having done that.

    MRK is a dangerous thinker with (apparently)exceptional typing skills, and a true gift for rhetoric.

    It’s my hope that his influence extends only to the easily impressed, clueless few who pass through this blog occasionally; all others, who regularly read his posts(for the shock and awe quality)or must endure his opinions in person, must surely know a psycho bigot when they encounter one.

  8. #8 M. Randolph Kruger
    November 24, 2007

    Hat-Thank you. I have said before and you are right I can and have gotten just as shitty as a situation dictated. Most here havent seen what happens when those goddman diplomats get something wrong (Revere’s guy from above). Oh and believe me he is right and this “guy” I have seen in various levels of government for both Democrat and Republicans with a bent to who is in the White House for over 40 years. But for them its mostly the power.

    I am appallied that the conditions exist in the hospital in Afghanistan. Who wouldnt be. When presented with the problem this jerk turns around and basically say, “Gee, the sunrise this morning was really nice” and ignores the issue. But, and this is a big but, whose problem is it really? I cant sit back and say that the average American gives one big crap about the crap in the hallways of a hospital 7500 miles away. Oh wow! My life is upside down today because some jerk needed to take a dump and squatted in a hospital. I am sure he was noticed. Dont have to bomb someone back to the stone age when they are already there.

    Is it wrong? Yup. But Revere wants us out, then he wants us fundamentally in, then he doesnt want us to spend any more money, then he wants us to spend more money. I am confused beyond all recognition with the position he takes on this. Is it bad? Is it really bad? YES, but is it our problem? These countries want us out, but like Revere they want us in. They only want the money so they can do what? Same thing that Indonesia has done with it, haul it off to the really nice places in the world and settle in, collect 13% on the interest. They never, ever, have done anything with the money exept steal it. And we keep right on giving it.

    I learned at about 25 what can happen when you PC a war. I was in when Carter was Prez. As the country fell down around his ears, he did nothing. Our sovereignty was attacked and rather than ordering up the air strikes he did nothing. I watched a huge army form to our south and IAW a Russian battle plan start north just as the fall of Russia began. Reagan came in and the last fleeting chance for the Russians to take us on ended on Jan 20. A few years later the Russians fell and we enjoyed a pretty good run thru there. Clinton wasnt bad as a Prez, just he impugned the honor of the Presidency. When it came time to pay the bills he just cut the balls out of the military.

    Some would say Bush 2 has impugned it by going to war without the approval of the world. That world wouldnt exist without us. I read that for what we have spent on social programs we could have fought WWI, WWII, Korea, The Cold War, Vietnam, and this gig in Asia 175 times over… I am sure that the numbers are arguable but I guess anything past 100 times is kind of redundant. But what have the American people gotten for their money? Nothing but active participation of certain countries to try to kill us. We cant keep trying to Americanize the populations of the world and we cant keep going quid pro quo. There are 6 plus billion on this planet. How can things keep going the way they are without something fundamentally changing?

    Psycho bigot? Far from it Hat… I do draw the line on that. Do try to refrain from that kind of language because I never call any inciteful names here. I served in the military with blacks, whites, mex, Canadians, Jews, Wops, Heinies, Chinks and anyone else that had American first on their name with all of these descriptives afterwards. The were and are Americans of those descent and not those descriptives first. I went into combat with each and every one of them and they would have died if necessary for me and me them. Bigot? Only against any nation that would do us harm….

    “It’s my hope that his influence extends only to the easily impressed, clueless few who pass through this blog occasionally.” I really liked that one Hat…. Its the clueless of the US that dont get it and its the reason we went so far to the right in the last two presidentials. Those clueless and easily impressed are the backbone of the country but most of the time they get it right. We have them because there were two terms of a extremely leftist President held in check by a Republican Congress. Now we have had to move back more to the center and thats very good. But those easily impressed clueless are religious and they are balanced off by a huge group of elitists on the left that think that we should all just sit down and go socialist/communist on everything. So those easily impressed are being dictated to. Even your statement above is part of that.

    I still reiterate the problem with what I have above. We get into these deals every 15 years or so now, but afterwards we always come in to help these people who have done us harm. Why should we? The flat answer is that if we start doing what Revere wants it ensures a major knuckle to knuckle war. He will disagree of course, but its the logical outcome of cutting and running. They will still be there and we will still have to eventually wheel the military out, albeit a very poorly equipped one as we will spend the money on social programs and aid for foreign countries. Can someone PLEASE tell me why we are sending food to Iran and Korea? Change occurs from within and not without and without the food aid these situations would simply melt away. Their people would take care of business on their own.

    We can argue the above to days end but the outcomes are never in question. We have standards that we try to apply to the rest of the world and quite frankly its a goddamn big world. The US is for the better part the policeman of the world. We can do Revere’s ideas and then we will have all sorts of cool little programs to feed the poor, redux the healthcare in America and it will last right up to the second that there is a blinding flash on US soil. Then all of that goes out the window.

    So without further ado, whats next? A bill to fund Afghan bathroom ethics? Halliburton to the rescue. A contract to fund toilets, toilet paper, oh and lets not forget the lighting is poor, urps, no electricity for the light, got to spend 20 million on a generator, urps, no fuel for the generator, got to spend 100 million on the fuel. Then one day when we leave and they have no infrastructure to support the above, a camel shits in the hallway of the now defunct hospital. A never ending cycle.

  9. #9 oca sapiens
    November 25, 2007

    that war was waged in retaliation – whether deserved or not, isn’t the point – and to establish democracy and human rights later, from what I remember. It seemed an unusual task for soldiers at the time, still does, and might explain some of the present problems and Mr. Kruger’s comments. But his arguments sound like the “anthropological fallacy”, e.g. where newborn’s have a high mortality rate, parents think it is the normal human condition, don’t mourn etc. But several ONGs had trained Afghani women to run their women’s hospitals under the Taleban, apparently even they would rather improve their own children’s survival rate.
    Tks Revere, your post reminded me – a journalist – to check the conditions of civilian hospitals under our European governments’ supervision in war zones.

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