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.
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.