By BARBARA SHERMAN
Of the Times
TIGARD - A crowd of about 100
people would be waiting each morning outside a makeshift clinic in a refugee
camp outside Mazar-e-Sharif in Afghanistan, as Nanette Laufik, a physician's
assistant and nurse, arrived to treat as many patients as possible in the
time allowed.
"We knew we couldn't see them all," Laufik said, recalling her recent three-week trip to the war-torn country with Northwest Medical Teams. "We tried to do triage and explain to the guards to let the sickest people in. Our priority was children under 5 and women who were pregnant or lactating. We tried to focus on them."
Laufik, who works for Southwest Family Physicians in Tigard, just returned Saturday from the war-torn country with the husband-and-wife team of Dr. Tom Hoggard and Dr. Mary Burry. Although they treated patients, their primary purpose was to assess the situation and set up the infrastructure for future teams who will visit over the next 10 months or so.
Because the team spent so much time in meetings, hiring translators and doctors to be paid by the Ministry of Public Health and renting places for clinics and future teams to live, they were only able to treat patients two to four hours per day.
"The hardest part was seeing everyone who needed help," Laufik said.
The team also had to work around local traditions, such as the expectation that a medical exam is not complete without the doctor using a stethoscope on one part of the body.
"It didn't matter if they came in with a sore foot, we had to use a stethoscope," Laufik said.
Tradition calls for babies to be tightly swaddled, and mothers would come to the clinic saying their baby had a fever, when in reality the child just needed its garments loosened.
Laufik, 48, recalled one mother whose baby had a cold but didn't need any medication. An hour later, the grandmother came back with the baby, thinking no one would notice that it was the same child.
Because the team had not been able to acquire enough pediatric medications before leaving, they had to explain to parents how to divide and crush pills and add water, hoping the instructions would be followed.
The team took four 66-pound bags filled with medical supplies but was appalled by the lack of supplies and equipment in Afghanistan.
At a hospital they visited in Mazar-e-Sharif, there was no ultrasound or radiology equipment and no pathologist on staff.
"If they took a tumor out, they couldn't do a biopsy," Laufik said. "They couldn't do cultures. The treatment was mostly clinical - they would just treat symptoms."
Afghanistan has two medical schools, and there are plenty of doctors, according to Laufik.
"They are dying for more training and equipment," she said. "Northwest Medical Teams will be sending over specialists to do more training instead of just sending doctors to treat people and then leaving."
Hospitals do not pay their doctors and nurses, so they volunteer their services in the mornings and then work in private practice in the afternoon to make money.
Patients' families must provide all the equipment and medicine needed, Laufik said. She recalled one infant who was dying and the parents had to purchase an intravenous set-up.
"The hospital was terrible," she said. "The tiny pediatric ward had 10 beds and two kids to a bed, some with different infectious diseases."
According to Laufik, there are very few children in Afghanistan under the age of 2 because they don't survive the harsh winters and disease is so prevalent. About 85 percent of the women get no prenatal care.
"The maternal death rate is the second highest in the world, after Sierra Leone," she said. "That is partly why Northwest Medical Teams is so eager to go."
Laufik recalled a woman about 27 years old with several children who said she wished that Laufik could give her something to keep from having more children.
Many people are illiterate, and mothers don't know their babies' birth dates, so many people use round numbers for their age - 20, 30 or 40. The life expectancy in Afghanistan is 47.
The team encountered a lot of people with respiratory problems as well as diarrhea. "The water is so bad there," Laufik said.
Although the team did see some malnutrition, it was not the norm.
"There is food in the cities and camps," Laufik said. "But the people are so poor. You see a woman wearing a tattered burqa and carrying a baby and begging. It just breaks your heart. Beggars would come into the restaurants when we ate, and we were not supposed to give them money, but we gave them bread."
Arriving in Mazar-e-Sharif, the team learned that there are 20 camps around the city for internally displaced persons, as refugees are called. The team chose two camps, one with about 1,800 people and one with about 32,000 people, to set up clinics.
"People lived in tents, and when it rained, the mud just wanted to grab your feet and suck you in," Laufik said.
For security reasons, they were warned to stay at the clinics, which were set up on the periphery, and not wander into the camps. However, while they were a curiosity, the local people treated them with respect and did not seem resentful because of the American bombing.
Laufik said that once she got used to the presence of big guns everywhere, she did not feel afraid. However, she kept all her documents and passport on her at all times and had someone write "Take me to the airport" in the local language on a piece of paper, so she would be able to escape quickly if necessary.
"We were careful in crowds," she said. "We were told not to go off the roads because of land mines. We saw so many guys with one missing, usually above the knee. That really limits their ability to make a living."
One frustration for the team members was that their days were made artificially short by a curfew. They could not go out on the streets until 8:30 a.m., and while nationals could stay out until 9 p.m., foreigners had to be inside by 5 p.m., when the power was turned off for the night.
The Afghans were appreciative of what the Americans were doing for them, according to Laufik.
"They have a lot of problems," she said. "They have had 20 years of war and three years of drought. The camps have been there a long time. They are glad to see us help to turn their country around.
"An experience like this puts your life into perspective. I'm probably hooked and will keep doing this."
Laufik works part time as a physician's assistant and part time as a flight attendant for American Airlines, where her husband is a pilot. She traveled with NWMT to Albania in 1999 and later to Honduras with another organization.
She stressed that Northwest Medical Teams continually needs contributions to keep sending teams and supplies to countries like Afghanistan. For more information on Northwest Medical Teams, call 503-624-1000.
Copyright =A9 2002
Northwest Medical Teams
P.O. Box 10
Portland, OR. 97207-0010
