Mina, 25, has brought her young children to get vaccinated at Médecins Sans Frontières (MSF) new mobile clinic in the outskirts of the city of Kabul, Afghanistan. The mother of six walked an hour from her village to get to the site in Buthkhak where the MSF team provides preventive health services each week for the neighbouring communities. “We only have private doctors in our village and it costs quite a lot of money for us to go to see them,” she says.
Kabul has an estimated population of more than five million, having tripled over the last ten years. These new residents are a varied mix of internally displaced persons fleeing conflict in more insecure regions of the country, economic migrants seeking better opportunities in the city, returnees from refugee camps in Pakistan, families without land, and members of long marginalised minority groups who struggle to find a place within mainstream Afghan society. Many of them live in the outskirts of the city and are confronted with very poor access to healthcare services.
Reaching out to isolated communities
Since April this year, MSF has been conducting preventive mobile clinics in ten locations in the suburban areas of Kabul, in order to reach out to these isolated communities. The clinic focuses on women and children under the age of two; almost 2900 patients have been seen since the start of the activities. The team provides pre- and postnatal care and family planning for women, as well as vaccination and malnutrition screening for children. Since there is a high incidence of tuberculosis in the country, patients with the disease are also encouraged to bring their family members to the clinic for screening.
“The feeling is quite strange,” says Lajos Jecs, MSF nurse who leads the mobile clinic team. “Even though we are in Kabul, in the capital, it looks like we are really very far from the city. The preventive care approach is important as there are a lot of Afghan women who don’t know about the need for antenatal checkup. “There is no health education for them at all. A lot of mothers don’t know how to breastfeed their babies and so we see a lot of malnourished children.”
Patients who need a follow up examination or treatment are referred to the Ahmad Shah Baba District Hospital, located in eastern Kabul, where MSF has been working with the Afghan Ministry of Public Health since 2009.
Going beyond hospital walls
“While we are treating an increasing number of patients in Ahmad Shah Baba and our other hospitals in Helmand, Kunduz and Khost, we know that many more people cannot even make it to the hospitals or other health structures because of distance, insecurity or the cost of transport,” says Benoit De Gryse, country representative for MSF in Afghanistan. “That’s why we want to go beyond our hospital walls and reach out to some of these isolated communities.”
The mobile clinics in Kabul are the first step, but De Gryse acknowledges that this was not a simple undertaking. “The negotiation process for launching the mobile clinics took quite some time. We had to talk to different community and religious leaders and explain the preventive mobile clinic concept to them. Since then however, we have gained a lot of trust from them. They help us promote and explain the mobile clinics to their communities and we even use their houses to see patients.
“Another challenge is to ensure the security of our staff as well as our patients when we reach out to these areas. That is why the acceptance from the community is critical.”