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Seema Jilani

Seema Jilani

Posted: September 2, 2010 04:01 PM

When I first arrived in Afghanistan, I spent much of my time swatting away flies that lived on my pediatric patients. Now I let them sit, unless they are on a baby's face. Soon I think I will just ignore them, knowing that they are drooling multitudes of filthy bacteria on my patients. Shrug. I have even learned to shrug off bottles of roach-killing spray that line the hospital rooms and mouse tails that wave at me in the wards. Each room packs six children, sometimes more. This is far better than most government-run hospitals, where three children are sardined into one bed, exchanging both the flies' and the cockroaches' germs. Shug, and shrug again.

Every morning at CURE International Hospital in Kabul, the Afghan doctors-in-training present an interesting case they encountered while on call overnight. During the meeting, we are forced to raise our voices to overcome the chilling noise of low-flying helicopters overhead. So low-flying, in fact, that my colleague once saw these helicopters take down a child's kite. We ignore the cacophony during our morning report and move on, as the people of Afghanistan have learned to do with every other disturbing situation they have been subjected to over the years.

Here, in this room, it is about medicine and learning. They do not comment on my hair, on whether I am fasting or not, or on the hem of my skirt. They do not even worry about my American passport. Here, I am a colleague -- a mentor even -- and it is in this room that I have found the most solace during my time in Afghanistan. In no other room could I possibly discuss testicular cancer with Afghan men. In no other venue would I be able to explain female anatomy in such depth.

From where then, amongst this incredible thirst for academic medical training, does the sense of fatalism arise? Because here, it is true: fatalism is a way of life. Another dead baby. Mother's already buried two. Another heroin addict with flesh-eating bacteria and maggots feasting on his wounds. Just like his brother. Another child who suddenly convulses, with no known diagnosis; therein begins the slow and painful regression rendering him neurologically devastated and mentally retarded. Another malnourished baby with sunken eyes. She probably has tuberculosis, too.

I recently admitted a ten-year-old boy from the province of Ghazni. He likely has an infection that is devouring both his hips -- so much so that he may never walk again. After explaining this to the boy's mother, she said that she could not afford the hospitalization, even if it meant her son would never walk again. She has already lost two children and her husband to war. She is sure that her spirit will survive anything else that comes her way. I gave her a few hours to ponder this decision. When I returned, I was informed that the fellow patients in the ward each decided to contribute money to help pay for this boy's treatment.

This is the essence of the Afghan spirit. This is the saving grace of Afghan fatalism: a commitment to humanity and the spirit of community. They are cognizant that while their life story is tragic, their neighbor's might be worse. Of course, the hospital will help with her financial situation and will not take the money of other, equally poor, patients in the hospital who truly have nothing more to give.

But can I really blame the Afghan people for their stoicism? Would I retain any glimmer of hope if I lost my parents and two sisters to war and invaders left me limbless? What if I had lost ten children, like one of my patients has? How does one crawl out of that misery and not walk through the rest of life completely shattered? Several doses of fatalism, please. Doctor's orders.

Afghanistan has the third highest under-five mortality rate in the world, with only Angola and Sierra Leone surpassing its abysmal numbers. One in five Afghan children do not reach their fifth birthday. This data is exceedingly hard to gather, and even more difficult to interpret, given cultural boundaries and rural limitations of reporting. A recent WHO Bulletin suggests that baby girls' deaths are being under-reported or not reported at all. Since a family is held in higher esteem if they have sons, some families in rural areas lie to the community, saying their newborn child is a boy, rather than a girl. Hence, when the child dies, she is counted as a male for statistical purposes, thereby introducing error and skewing gender statistics on the under-five mortality rate of Afghanistan. Essentially, dead baby girls are being overlooked, even in WHO statistics.

With these dismal facts racing through my mind, I understand why resignation to fate is a necessary evil in Afghanistan. I make my rounds in the Neonatal ICU ward, feeling the stoicism singeing my heart. We code another premature baby boy; this one has a twin sister with a pink diaper on. As I watch his cold, dead body turn shades of indigo and stiffen, I, too, endorse the sting of fatalism. It feels better than the sting of reality.