Tackling NCDs in Afghanistan: building resilience amidst uncertainty

Dr Sarah Montgomery and Dr Peter Le Feuvre, PCI’s clinical team directors, recently went to Afghanistan to train key medical staff there in the use of WHO Emergency Kits medicines and equipment for the management of key NCDs. The Kits will be deployed to primary health care centres run by the Afghan Red Crescent Society (ARCS) in four provinces of Afghanistan.

Today in Afghanistan, non-communicable chronic diseases (NCDs) such as cardiac diseases, cancer, respiratory diseases and diabetes are responsible for almost 33.3% of all deaths in the country, similar or exceeding the number of deaths caused by war-related trauma injuries. (WHO, 2018)

Read more on Dr Sarah Montgomery’s experience below:

Nothing quite prepared us for the experience of arriving in Kabul. After flying over bleak mountains scarred by river beds with just a glint of water remaining to irrigate the occasional patches of populated land around remote villages, the plane skimmed the final rocky summit and descended into a bowl of yellow smog that smothers the city.

Our purpose in coming to Kabul was to deliver training for Afghan health workers in the use of the WHO’s Emergency Kits. These Kits contain the basic medicines and equipment needed to treat NCDs like diabetes, cardiovascular disease, hypertension and chronic lung disease, in primary health care settings. 26 Afghan health professionals attended the training: both doctors working in hospitals in Kabul, and also doctors and nurses from primary health care clinics in places all too familiar to us from news bulletins.

It turned out that our four-day training course was the first course on managing NCDs that has ever been held in Afghanistan. Although more Afghan people die from complications of NCDs (stroke, heart attack, kidney failure, asthma attacks and end stage chronic lung disease) than from infectious diseases or trauma, no care for NCDs is currently provided by public health facilities. The only options for patients with these diseases are to pay for private treatment, or to travel across the border into Pakistan or Iran.

Our training covered hypertension, Type 2 diabetes and chronic respiratory disease and included sessions on communication and consultation skills with a focus on motivational interviewing techniques to support behaviour change. We also looked at cardiovascular disease and secondary prevention, including the problems and rehabilitation needs for a patient that has suffered a stroke. The level of active engagement and participation was high, especially during the practical sessions on examination of the diabetic foot and communication skills role-play such as helping a patient to stop smoking.

Following the training we did, WHO staff in Afghanistan are arranging follow-on training to ensure health staff are fully ready to receive the Emergency Kits. We will continue to support those doing this next round of training as well as developing tools to monitor how the kits are being used .

Afghanistan has known nothing but war for 40 years. As if the fighting were not enough for this country to have to bear, Afghanistan is hurting from drought and food insecurity. No rain has fallen here since March. Rivers are dry, the harvest is poor, ground water in Kabul is becoming lower and lower. Improving health care in a situation like this may seem almost impossible but the WHO are doing what they can, working with others in this country to address what is an increasing burden for the people living there. And, as is often the case in the most difficult and abnormal of situations, we found people of courtesy, calm courage, skill and wisdom who remain determined to do what they can to make their country a better place.

Read more on the toolkit and project here from WHO.


Photo: Dr Supriya Warusavithana/WHO Afghanistan