27 year old Zarlasht Sherzai merely had some abdominal discomfort. Seeing the attractive advertisement for Wahhaj Hospital boasting of its international doctors, she decided to go for a check-up, says her mother, Sharifa.
27 year old Zarlasht Sherzai merely had some abdominal discomfort. Seeing the attractive advertisement for Wahhaj Hospital boasting of its international doctors, she decided to go for a check-up, says her mother, Sharifa. But Sharifa’s daughter never came home, dying on the operating table on March 19, under the care of a team of which included two Indian doctors who claimed to be surgeons. What happened is not clear since investigations are underway but the Sherzai family is convinced that there was medical malpractice.“When we went to Wahhaj hospital she got a check-up. The doctors told her that she had to be operated on. After a long wait, they called for her presence in the operation theatre. It was 11:00 am when Zarlasht went in. At 11:10 am Dr. Wahhaj came out of the operation room very nervously and told me ‘your patient went into shock before the operation was carried out on her’.” It was from the nurse present at the operation that Sharifa had to learn that her daughter was no longer alive.
The Sherzai family says an autopsy showed that the medical procedures followed were not correct. But officials in Wahhaj Hospital reject this claim. Dr. Mohammad Hashim Wahhaj, Director of the hospital says “Surgery, which took ten minutes, was successfully conducted. During surgery the patient was conscious as she was not given general anesthesia. When the doctors were moving her to the recovery room, she had a sudden heart-attack.” Doctor Wahhaj said Zarlasht was being treated for infertility.
Saying that Zarlasht had received the best medical care, Dr Wahhaj said two Indian doctors Dr Kapil Kochhar and Dr Tara, both master surgeons, had been part of the operating team. He said their medical qualifications had been verified by the Ministries of Foreign Affairs, Higher Education and Public Health prior to their arrival in Afghanistan.
In case of disputes over medical practices, the initial investigation is done by the Ministry of Public Health. Dr. Sayeed Ibrahim Kamil, Head of Health Laws and Inspection in the Ministry of Public Health confirms that the Ministry has verified the case details and forwarded it to the office of the Attorney General. Prosecutor Mohammad Rahim Rasuli, Head of prosecution for the Northern zone in the Attorney General’s Office says: “Initial investigation of the case has come to an end and we summoned Dr. Wahhaj and some other doctors. Now, we would like to summon two doctors who are allegedly Indian nationals who conducted the surgical operation. We intend to catch them through Interpol police”.
Unregulated licensing
Though the investigations are proceeding, will the office of the Attorney General be able to get the two doctors back on Afghan soil? The question also raises related critical issues including that of the criterion on the basis of which foreign doctors are issued operating licenses.
Analysts are of the view that most of the foreign doctors working in Afghan hospitals are not qualified to carry out the procedures they undertake and also do not have the necessary experience. They are brought to Afghanistan merely to fool people with the tag of ‘foreign specialists’. Pointing out that really good doctors are unlikely to come to Afghanistan for salaries lower than what they get in their own country, a doctor in Kabul city who asked for anonymity says: “Foreign specialists earn monthly incomes of between $15,000 and $27,000 in their own country. They don’t come to Afghanistan to work for $16,000 or $17,000”. According to him, doctors who come to Afghanistan are those who are not well-qualified and cannot find jobs in their own countries.
His opinion is shared by Dr. Tukhi, Head of the Association of Afghan Private Hospitals, who says: “Doctors who come to Afghanistan are not qualified specialists. Those who bring them to Afghanistan, use their connections to obtain the necessary documents from the Ministries of Higher Education and Public Health.” Dr. Kamil confirms this saying: “Most of the doctors who have come to Afghanistan in the past are not specialists”.
So what is the criterion for recruitment of foreign doctors? Ghulam Sakhi Kargar, Spokesman of Ministry of Public Health (MoPH) claims that there has been no criterion in the past for recruitment of foreign doctors. “In the past the foreign doctors were allowed to practice in Afghanistan merely at the request of private hospitals and following processing of their documents in collaboration with the Ministries of Foreign Affairs, Labor and Social Work, Higher Education and the permission letter issued by the Ministry of Public Health. However by a decree of the President, employment of doctors who are not specialists has been banned in Afghanistan. After this decree, we did not extend their license and we officially notified them of the Presidential decree. Hospitals made a commitment that they would stop activities of the foreign nationals that they had brought in the past”.
However Huma Khalid, deputy director of the department for appraisal of qualifying documents in the Ministry of Higher Education says “by the end of year 1389(the year ended on March 21, 2011) we appraised and verified documents of 7 doctors from Pakistan, India and Germany.” The MoPH however says that only one foreign doctor has been granted permission for activities in the last one year. Kargar admits that in some cases some irregularities have taken place. Non-specialist doctors have been brought in, declared as specialists. Or in some cases, their documents have not been verified seriously.
“Operating license has been issued only to 16 foreign nationals from Iran and India during the last ten years” says Dr Kamil. However evidence collected by Killid Group shows that currently more than 16 foreign surgeons are there. “According to the news which I had heard in the past, more than 100 foreign doctors had activities in Afghanistan. But I don’t know the current position” says Kargar.
Administrative corruption
Some health analysts and doctors say that there are some officials in the MoPH who issue licenses in lieu of bribes. Eng. Misbahuddin, Head and owner of Kesha Private Hospitals says: “I wanted to open an agency in one of the provinces, but I was asked for money. I came to the Minister and provided the information. Eight months have passed and still my problem has not been solved”.
Dr. Najibullah, Head of Bast private hospital accuses the Ministry of bribery and indifference and says: “When we want to invest $100,000 or $200,000 and apply for a license, they try to take money from us on one pretext or another.”
Kargar rejects the widespread charges of bribery and administrative corruption in this ministry saying they are only allegations and that they need to be reported to the ministry leadership. However he does not deny there could be some cases. “We cannot say that our ministry is absolutely clean.”
Obsolete and substandard regulation
While the rules and regulations are flouted, the rules themselves don’t stand up to scrutiny. The regulations relating to private hospitals were created 15 years ago, in 1996, when the Taliban were in power, and have not been updated.
“The reason for substandard hospitals is the outdated regulations” says Tukhi. “They were prepared during the Taliban regime and are very basic”. He argues that it is difficult for hospitals to maintain standards when the standards themselves are not proper. Acknowledging this Kargar says “On the one hand there is no comprehensive regulation and on the other hand, the ministry focuses on the quantity of hospitals rather than their quality”.
Even the outdated regulation is not enforced says Dr. Mohammad Naem Popal, a surgeon in the government-run Jamhooriat hospital in Kabul. “Though the regulation for private hospitals has shortcomings and deficiencies, even this regulation approved 15 years ago is not properly enforced. For example, it’s written in the regulation that private hospitals should not operate in residential houses, but we see that between 900 and 950 private hospitals are operating in residential houses”. So why has the Ministry not revised these regulations ten years and three different ministers later? The Ministry of Public Health says that it’s working on a new regulation for private hospitals which would be completed soon. According to Kargar, this is expected to be sent to Ministry of Justice and cabinet for their approval.
Brisk business of health
Currently, there are 170 private hospitals in Afghanistan. 81 private hospitals and clinics are in Kabul most of which lack the required standards. For example, one regulation stipulates that private hospitals should be located away from crowded areas. But Killid’s investigations show that private hospitals in Kabul have violated this law. They are located in crowded areas and their buildings violate the necessary engineering standards. Right now, there are many private hospitals that run activities in buildings in which hotels, beverage shops, internet clubs and some other businesses are also there. They all have one entryway, making it a potential hazard.
Until now, no hospital has presented itself to AISA with information on their activities after receiving a license. AISA, which claims that it monitors businesses, says it is the responsibility of the hospitals to provide proper information.
The cumulative impact of the outdated regulations, the lack of implementation and monitoring, the corruption and the greed of private hospitals run like commercial businesses is taking its toll of Afghans. On a daily basis most Afghans who can afford to, go outside Afghanistan to get trustworthy and qualified medical care. It’s important that the Ministry of Public Health take urgent actions for removing problems and improving health services, to prevent the risks to the lives of Afghan patients and to increase trust in the health services in the country.
