By Thomas Abraham
If it hadn't been for his training,
Afghan refugee Mullah Mohammed might have seen nothing wrong with the rural
tradition of confining a new mother and her baby in the cowshed. Nor with
the infant's diet of clarified butter and honey, instead of the mother's
own milk.
But some years before Mohammed visited his village in Afghanistan, the Afghan refugee had become a Community Health Worker with Church World Service's Mansehra Health Program, which provided basic health care to refugees along the Karakorum Highway in northern Pakistan. During training and on his rounds, Mohammed saw the link between infant diarrhea and the indigestible food that babies were fed. This was only one of the traditional practices he had discarded to make way for new ideas of health care.
So while congratulating his old friend on the birth of a son, he also shared what he had learned as a health worker. To his surprise and delight, the mother and child were brought out of the cowshed. The baby was encouraged to nurse, instead of choking down the butter and honey that is a recipe for diarrhea in infants.
Mullah's experience illustrates the changes that the Mansehra Health Program is bringing to many Afghan refugees. Begun by CWS when Afghan refugees fled the Soviet occupation of their country in 1979, the program is now supporting Afghans repatriating after more than 20 years of war.
More than 1.5 million Afghan refugees returned from Pakistan by the end of 2002. They return to a land devastated by death, destruction and displacement. But those from the Mansehra camp return with proven health skills and knowledge that their compatriots desperately need.
Church World Service's Immigration and Refugee Program (IRP) has taken over the management and administration of the Mansehra health program as it accompanies refugees in camps in Pakistan to communities being rebuilt in Afghanistan. The program is one of several new initiatives on which IRP has embarked last year for uprooted peoples for whom resettlement is not an option.
Further east in Asia, IRP is in the process of taking over management of a program that supports Burmese refugees along the Thai border. In Africa, IRP partnered with FilmAid International to screen educational and entertainment films in refugee camps in western Tanzania and Kenya. Other initiatives in East Africa will help maintain schools, provide incentives for teachers, feed refugee schoolchildren and support vocational training schools.
"Health related services are new for IRP," said associate director Erol Kekic who visited Pakistan and Afghanistan last October. He sees the provision of these services as a legitimate extension of priorities in IRP's portfolio. "We're very interested in building on a foundation of local staff in both places."
That foundation was laid and reinforced by Church World Service's Emergency Response and Social and Economic Development Programs (ERP & SED).
"We want to recognize the vision and response of ERP and SED in putting the program together and administering it for so many years," said Erol. A new cross-programmatic approach is underway between IRP and the other two CWS units to address the issues of displacement, resettlement and local integration in a comprehensive manner.
In Pakistan, Erol saw long lines of women and children standing in the cold, waiting to see doctors, trying to get some kind of health care.
Problems with the water supply, long distances and poor roads make access to health care even more difficult in Afghanistan. Continuing lack of security is another obstacle in Afghanistan. Nearly every Afghan has a gun, said Erol, and the government has little control outside Kabul. "Coalition military operations are still underway," he added. "I saw a lot of helicopters returning from the hills."
Humanitarian efforts are hampered by daily attacks on anyone perceived to be working with Allied forces, including NGO staff. After the killing of Gettina Goislard of the United Nations High Commissioner for Refugees last year, the UN agency pulled all staff back to Kabul and halted repatriation of Afghan refugees from Pakistan.
Twenty years of conflict has left the country a thicket of landmines. Erol was disturbed to see children playing around a clearly marked land mine site in a settlement of returnees, displaced persons and refugees.
On both sides, the program is rooted deep in the community. Health workers like Mullah Mohammed have helped break down traditional barriers and alleviate suspicion of modern medicine. The participation of women, as Female Health Workers, has been even more crucial to eradicating harmful birthing practices. Through the program, women have found new standing in the community.
Even more amazing, according to Erol, is that reproductive health is being incorporated in the program with classes on child spacing, and workshops on sexually transmitted diseases. HIV/AIDS is being addressed in Mansehra. If it's successful there, it will be expanded to Afghanistan.
"It's the communities' program as much as ours," says Erol. "We're there with their blessing. This enables us to be present in some of the most dangerous and volatile places of the world and continue to do our work. We're able to reach people who have little or no access to health care at any point in their lives."
In Afghanistan, where there are four units serving 155,000 in the Nangarhar province and a sub-unit in Torabora, the program is run by dedicated, hardworking local staff under the capable leadership of regional program officer Dr. Muhammad Ashraf in Jalalabad. He is credited with starting up the program in 1997 after negotiating with Afghanistan's Taliban rulers and keeping it afloat during their regime. Dennis Joseph coordinates the Afghan program from Mansehra.
Accompanying the Afghan returnees is a vital objective for CWS. "We have an absolute mandate to do our best for the Afghan people who have been plagued by conflict so long," says Erol. "By contributing to health care we will be improving living conditions."
In 1996 the Mansehra program recognized that it needed to look forward to the day its clients would return to Afghanistan. One of its goals was to prepare the refugees for their return and give them as much knowledge as possible on matters that affect their health.
Female Health Worker Rooh Afza hopes to continue her efforts toward safe motherhood and against ancient superstitious beliefs and practices when she returns to Afghanistan.
"What I have learnt from the Program will go to Afghanistan with me," Afza says.