Decades of war and internal conflict have had negative affects on almost every aspect of the life in the Afghan community. The major infrastructures, including healthcare, have been severely affected. The country of Afghanistan has one of the worst health situations in the world, as well as a devastated economy. There are many factors affecting the population's health, making it a very complex scenario. Proper education is limited; most of the population is illiterate. In order to find underlying and root causes of the Afghanistan health problems there is a need for expertise and skills.
The crises experienced during more than two decades of war in Afghanistan, including acts and threats of war, terrorism, drought and other natural disasters and epidemics, as well as the chronic problems of poverty, hunger and disease, have made the general public more aware of and responsive to the on-going need for effective public health services. While many efforts are underway to address these problems, each of these activities currently relies primarily on expatriate experts; there are only a handful of Afghan public health specialists. Consequently, there is a grave need for the Afghan experts to monitor and evaluate these activities and also, manage public health programs.
We four students traveled from Afghanistan to St. Louis , Missouri to acquire the skills and knowledge needed to improve the health status of our home country and also with a greater goal of working to serve humanity. We have been inspired by our expatriate colleagues who came to Afghanistan and worked to manage public health projects and programs. One second year MPH student, Shafiq Mirzazada, worked as a clinician for Afghan Red Crescent Society after graduating from medical school, with the aim to serve the poor. Lack of equipment and pharmaceuticals tied their hands and limited their services. People couldn't afford medicine. Afghanistan is among the list of countries with high infant and maternal mortality rates. For every 1000 infants born, 165 of them die, and 1,700 mothers die of delivery complications for every 100,000 childbirths (UNICEF, 2005).
Shafiq decided to move forward to find ways to help more people receive the health services they needed. He joined an international health organization to establish comprehensive health programs. In five years, these program served a total population of 340,000. Dr. Mirzazada notes, “I am proud of what we achieved. But we have always relied on knowledge and experience from outside in order to manage programs of that magnitude. Lack of local competence in managing public health programs was obvious. No university [in Afghanistan ] offers a degree in public health.”
We came to the United States seeking knowledge to help us to look at each situation analytically, to find the gaps, to conduct research and gather evidence that will support policy making and lead to the development of policies and programs that address the root causes of health problems in Afghanistan . Khalid Rahim, an MPH Health Policy student, believes, “that health policy and health care management are interdependent...my research and education will assist in the effort to reform, more effectively manage the healthcare system, and will play a significant role in improving the health system in Afghanistan, especially identifying new policies as well as strengthening existing public health policies in the Ministry of Public Health.”
Each of these men was awarded a Fulbright scholarship; the application processes were mediated and supported by the International Institute of Education (IIE) and submitted through SOPHAS. Abdul Alim Atarud stated, “Fulbright through Saint Louis University enables me to fulfill my career development goal and bring positive changes and improvements in the healthcare system of my country, Afghanistan .” In addition, Alim believes that his newly acquired knowledge in public health would enable him to contribute in efforts of reducing morbidity and mortality rates in his home country Afghanistan .
Khalil Ahmad Mohmand, another MPH Health Policy student, wrote that after beginning his study program he “realized that the curriculum is designed in a comprehensive way that covers required fields essential for public health professionals. My current study will enable me to contribute in reduction of high maternal and child morbidity and mortality in Afghanistan .” The mothers of Afghanistan should be proud and thankful for their native sons. Through the educated efforts of Khalid, Khalil, Alim, and Shafiq, as well as other public health students like ourselves, we hope and expect to see significant improvement in the health status of the country of Afghanistan .
Abdul Alim Atarud, Mohammad Shafiq Mirzazada, Khalil Ahmad Mohmand and Khalid Rahim, Saint Louis University School of Public Health MPH Students
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