"They keep calm and do their work."

Dr. Najafizada speaking at last year's UWHAW fundraiser

Maisam Najafizada is working on a thesis about primary health care in the remote communities of Afghanistan.

As the guest speaker at our UWHAW meeting last Thursday, he gave an example of an Afghan Community Health Supervisor, “Shamsia”––not her real name. As a 2nd wife with ten children she had an education up to 9th grade and is the only breadwinner in her family. She first worked as a home-school volunteer for her neighbours, became a vaccinator and identified the sick children in her community, has also been an unpaid mental health counsellor. She trained as a Community Health Worker (CHW) under the BRAC scheme and dispensed medical drugs. She now supervises and trains 16 CHWs at 8 separate posts. Her husband hasn’t allowed her to become a midwife because that would mean her having to leave home for 18 months.

Community Health Workers and their supervisors are a “front line army” of volunteers, approved by the Afghan communities they serve. There are about 10,000 of them (whereas there are only about 2500 doctors in Afghanistan). CHWs educate people about hygiene, treat the prevalent diseases, dispense drugs and contraceptives (they call contraceptive pills “the happiness drug”), visit pregnant women and help prepare for the delivery of their babies. They offer maternal and child healthcare. Men volunteer to be CHWs as well, but only provide services for men.

CHWs are knowledgeable and mobile; they are highly respected locally, but do not receive much recognition from the national authorities (although this may be changing), and they get no pay. Often they serve as vets and / or teachers as well. They tend not to be aware of their own value and lack in self-confidence. In school they were taught to be silent and obedient. Many are illiterate, although their mentors––nurses, midwives and doctors––have to be able to read. Dr Najafizada told us of a CHW who is known as “the illiterate doctor” in Bamyan. She won an award for her services and then insisted on a school being built in her village.

In some ways it is to the advantage of these volunteers to keep a low profile (because prominent women are vulnerable to attack––the Taliban sees them as a threat and so threatens them). CHWs “keep calm and do their work.” They operate with a certain amount of freedom; women in the Afghan cities, with a “higher bride price,” are generally more oppressed than country women.

Volunteering is a new concept in Afghanistan, although the “birth attendant” (the dai) was a traditional figure in village life. There is little privacy or confidentiality in these communities of 100-400 souls. Nowadays, though, they nearly all have cellphones.

A photo I took at last Thursday's meeting