Frontline healthcare workers are integral to the success of the global response to COVID-19. While citizens of wealthier countries have been requested to stay at home, the consequences of prolonged quarantines on low-medium income countries like Afghanistan have proven to be profound and meant that adherence to restrictions has been limited.
Healthcare workers themselves are taking on significant personal risk, and too often working without adequate equipment, supplies or training, to fight the coronavirus. In Afghanistan, frontline health workers are bearing the brunt of rampant transmission with 10 per cent (3,647 cases) of all confirmed cases among healthcare staff according to the Ministry of Public Health. Fifty-three health workers have lost their lives.
Two such courageous individuals dedicating themselves to answering Afghanistan’s significant healthcare needs are IOM’s Dr. Khalid Ahmad Esmathy and Fatima Gholami, a psychosocial counsellor.
Dr. Esmathy is part of IOM’s Mobile Health Team (MHT) in southern Kandahar province. Since the COVID-19 pandemic began to unfold in the country, he has been working long hours to ensure that suspected cases are screened and referred to hospitals for testing and treatment. Dr. Esmathy and his colleagues not only have to fight the misinformation circulating about the disease among community members, but also face the potential consequences of falling ill on the job.
Dr. Esmathy says: “Initially, there were a lot of rumours and misinformation regarding the virus. People weren’t receptive to the information we were providing them. Continuous efforts on the part of the government, UN agencies and different organisations have created public awareness around the disease. However, a majority of people who come to seek health services often don’t take precautions such as maintaining physical distancing or wearing masks, and that puts health workers at risk of becoming infected and taking the disease home to loved ones.”
In rural areas and IDP camps where access to health services is limited, IOM’s MHTs provide lifesaving healthcare services to vulnerable populations. Seven MHTs are in operation and additional staff have been seconded to government health facilities with over 200 health staff deployed in Nimroz, Herat, Kandahar and Nangarhar provinces.
IOM is assisting the Ministry of Public Health in sample collection, surveillance, screening, and carrying out awareness and hygiene sessions. Since January, the MHTs have served 203,772 patients across the country. In Kandahar, two MHTs with 16 health workers, consisting of doctors, nurses and midwives, navigate security risks and limited community awareness in response to COVID-19.
“We provide COVID-19 related health services in areas that are prone to fighting between government forces and non-state armed groups. Therefore, there is a constant security risk as we continue to respond to and educate communities about the virus. Moreover, the lack of roads in some areas prohibits access to vulnerable populations in rural areas which is further slowing down our efforts to contain the transmission of the virus,” says Dr. Esmathy.
Dr. Esmathy’s concerns are not limited to his everyday routine but extend to the disastrous economic impact of the coronavirus on poor Afghans. The biggest threat to most Afghan people is the grinding poverty they live under, which in turn creates hurdles to accessing proper healthcare. Moreover, with the majority of Afghans relying on informal and unskilled work, they have no financial resilience to weather prolonged periods of lockdown. As a result, Dr. Esmathy often finds patients hiding their symptoms because they can’t afford to pay for the treatment. Furthermore, stigma attached to the disease also means many families are reluctant to seek medical services.
Doctors, nurses and paramedics are not only working in stressful environments but also inadvertently placing their families at risk. Afghanistan has reported high infection rates among health workers. Even within Dr. Esmathy’s own social circle, many health workers have tested positive for the disease.
“There is an enormous concern that we might get ill and transmit the virus to our families. My family members are constantly worried and insist that I stop working in the COVID 19 response. But that is not the solution. We need qualified health workers to defeat this virus,” says Dr. Esmathy.
Globally, 70 per cent of health workers are women. Fatema Gholami works as a psychosocial counsellor at an IOM-run health centre In Herat. She has been at the forefront of raising awareness around COVID-19, working simultaneously with patients and community members, dispelling misinformation and common misunderstandings about the disease.
“During the first weeks of the pandemic, a number of myths grew about the disease. People didn’t listen to or follow the recommended preventative measures against COVID-19. It was mentally draining, especially when I had to stay away from my parents and relatives,” says Gholami.
Gholami’s hometown, Herat, is the epicentre of COVID-19 in Afghanistan and where the first cases of the virus were reported in February. The mass return of over 400,000 Afghan migrants from Iran, which is also experiencing a sizeable outbreak has created fear in Afghanistan over the potential impact of infections in returnees, which led to increasing levels of stigmatisation in their communities. Gholami is working with teachers, religious leaders, community elders and family members to reinforce their understanding of the disease, carefully explaining to them how they should treat coronavirus patients without prejudice and with compassion.
“I conduct individual counselling sessions with COVID-19 patients focusing on positive attitude, diet, and maintaining isolation. In addition, I organise group sessions for community and family members, so that the coronavirus patients aren’t stigmatised. I also do follow up sessions over the phone to make sure that the patients have the support they need,” says Gholami.
COVID-19 affects women and men differently and exacerbates gender inequalities in provision of healthcare. Gholami believes that a significant section of Afghan women aren’t able to access health facilities and testing due to the cultural practices, and manifest themselves where sick women and girls are not granted leave to go to hospitals especially where no female health staff are present. This is borne out in statistics where for every three men only one woman is tested for the disease.
“I have seen women being brought to the clinic only when they are extremely sick. In a majority of the cases, women aren’t allowed to see a male doctor. That is why such a comparatively low number of women are being tested for coronavirus,” laments Gholami.
Gholami believes female health workers are facing a double burden: longer shifts at work followed by additional responsibilities at home. Balancing work and family during a pandemic remains a major challenge. However, she is grateful for having a supportive husband who shares her responsibilities at home.
“My husband is a doctor and he understands the emotional and mental pressure I am under. We share tips to stay healthy and safe. But staying away from our parents for many months has been very difficult,” exclaims Gholami.
Both Dr. Esmathy and Ms. Gholami are taking on enormous personal risks to help combat the coronavirus, which continues to take a devastating toll on global health, national economies, trade, and tourism. Equally, Afghanistan’s economy is suffering through COVID-19 with a significant rise in the price of staple goods. World Bank has projected increase in the number of Afghans living below the poverty line to more than 70 per cent of the population. It is the selfless and sustained provision of health services by medical professionals like Dr. Esmathy and Ms. Gholami that offers a glimpse of hope in these difficult times.
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