“Now I can finally start working as a midwife and help to further reduce maternal mortality in the villages of southern Afghanistan”, says Shahnaz (30). She is one of 1000 young Afghan graduates the Kandahar Institute of Health Sciences has trained in the past 13 years with support of Cordaid.
(June 18, Kandahar. Graduation ceremony for nurses, midwives, pharmacists and lab technicians at the KIHS)
Going against the grain of conservatism and extremism
Cordaid’s support of the Kandahar Institute of Health Sciences – which started in 2007 – showcases the importance and the success of long term donor commitment. Against the odds of war, insecurity and strong conservatism the institute expanded its degree programme over the years. It also enrolled and trained hundreds of young Afghan women. In a part of the world where conservatism and violent extremism join forces in denying women even the most basic of rights. Where women in rural areas are often not allowed to be treated by male healthcare providers.
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KIHS and Cordaid thus managed to partly fill some of the appalling health staff gaps in southern Afghanistan. This week’s graduation ceremony had a golden lining: with a batch of 119 graduating students – nurses, midwives, pharmacists and lab technicians – the institute passed the cape of 1000 graduates since the collaboration with Cordaid started.
Finding female students even harder than teaching them
Today’s celebrations and achievements stand in stark contrast to the years when Dr Nasreen Barakzai, KIHS director, started working with the institute in 2004. “During the Taliban rule, from 1996 to 2001, the institute was mostly closed. In 2000 they managed to reopen the nursing school. But even years after Taliban rule, in 2004 when I joined the institute, it was still extremely difficult to enroll girls and women for the midwifery program. Finding them was an even harder task than teaching them. They weren’t allowed to educate themselves, to leave their houses, to live and study in the big city of Kandahar. To conquer conservatism and change mindsets, we collaborated with women’s organisations, with the department of women’s affairs and others. Making sure that in every village girls and the families were informed of our health degree programmes. Making sure they knew their rights.”
I consider the steady increase of female students over the last 15 years as one of our main triumphs.
Dr Nasreen Barakzai
This campaign – which took and still takes place in the high risk and volatile areas of Southern Afghanistan – worked out well. “In 2004 23 female nurses graduated in de mid-level nursing program. This year 41 young women obtained their degrees, either as midwife or a nurse. They are far outnumbered by our male students, 78 of which graduated this week, as nurse, pharmacist or lab technician. Still, I consider the steady increase of female students over the last 15 years as one of our main triumphs”, Dr Nasreen continues.
Graduates are posted in all parts of Southern Afghanistan
The KIHS is a key provider of health professionals in all parts of the southern provinces of Urozgan, Kandahar, Helmand, Zabul and Nimroz. In fact, it is the second biggest health training center of the country, after the one in Kabul. “This is one of our assets”, says Dr Nasreen, “our students come from all parts of the country. After graduation they are posted in public and private clinics and hospitals all over the country. I can proudly say that by helping us educate and train more than 1000 Afghan health professionals, Cordaid is contributing to health care for millions of people who live in extremely difficult conditions, often in hard to reach places.”
Shahnaz (30) is one of this year’s graduates. Personal circumstances caused her to pick up studies later in life. “But I am proud and happy to be a midwife!”, she says. “I am from Kandahar and I had heard of KIHS’ good reputation. The KIHS standards are higher than elsewhere, allowing us to work in bigger hospitals as well. That’s why I chose to study here.”
I took the oath that as a health professional I will serve the people without any form of discrimination whatsoever. That is what I will do.
Shahnaz, KIHS Midwifery graduate
First I thought ‘how on earth will I manage!'”, Shahnaz goes on. “But then, by combining theoretical and practical classes, and doing internships in health facilities, I got the hang of it. I have assisted quite a few births so far and am more than ready and very eager to work as a midwife. Especially in the rural parts of Kandahar, where women live in harsh conditions and where maternal mortality rates are very high. I took the oath here at the institute, that as a health professional I will serve the people without any form of discrimination whatsoever. And that is what I will do from now on until the end of my career. It will come with a lot of difficulties because just like all afghans health staff faces a lot of problems of insecurity, instability and poverty. But we will not be stopped by this.”
After reopening the nursing department in 2000, and opening the midwifery department in 2004, the KIHS made a big leap in 2014. “That year we added two new educational departments, for pharmacists and lab technicians”, says Dr Nasreen. “It was a big step, allowing us to cover more health needs and fill more gaps.”
Women’s access to all departments, a long journey
Unfortunately, so far only the nursing school enrolls both women and men. And so far, women are not admitted to the pharmacy and lab departments, just as men cannot enrol as midwife students. “Nursing is the only department that has the means to offer separate classes and separate dorms for men and women – because in Afghanistan education for men and women is segregated”, Dr Nasreen explains. “It will take more means, more gender campaigning and more cultural changes to open up all sections for women”, dr Nasreen maintains.
‘We have battles here, but I will do all I can to provide services’
Noor Ahmad is a young man of 20 from Urozgan, brimming over with energy and pride. “I am so happy I obtained the pharmacy degree I obtained this week at the KIHS”, he says. “I graduated from high school in 2017. Then for 2 years, I moved to Kandahar, lived and studied at the institute, and now I can go back to Urozgan as a pharmacist.”
Noor knows he will face a lot of challenges. But he can’t wait to go back to his province and work as a pharmacist. “We have battles and wars there, like in so many places in my country. On top of that we lack essential drugs, we lack facilities and means. But still, I will do everything I can to provide my services. To educate villagers on how to use which medicines, to provide the right drugs, to make them myself if I have the right tools and substances. The situation can only improve, as most people in rural areas have only got limited access to care, medicines and information. As for the security risks, we have to live with that. Luckily, as far as I know, health professionals were not yet targeted deliberately in the areas where I come from.”
According to Dr Nasreen, security is not the prime risk the Kandahar Institute of Health Sciences is currently running. “Financial dependency on external donors like Cordaid is my main concern”, she says. “In fact, the KIHS is a government institute. But so far the government has not shown a long term vision or strategy for health institutes like ours”, she says. “I thank Cordaid and their donors from the bottom of my heart for what they have done for us the past 13 years. But at the same time I know it is a big risk. I can only wish the Afghan government is going to prioritise health, also in terms of budget allocations. Because, once foreign aid stops, up to 80% of our activities are at risk.”
Withdrawal of international support catastrophic for Afghan healthcare
Cordaid’s Health Expert Albert van Hal in the Global Office in The Hague, has been working closely with KIHS ever since he visited Kandahar 11 years ago. He confirms Dr Nasreen’s concern. “The international donor community is decreasing it’s funds for Afghan healthcare. Understandably, after decades of support, it wants the Afghans themselves to step up their efforts”, van Hal says. “But it would be utterly wrong to withdraw now. Without first ascertaining more Afghan money for health, it would simply mean the collapse of healthcare in Afghanistan. And the collapse of all the achievements of the past two decades, like the rise of the KIHS to the position it has today. It is this resource shift Cordaid has been campaigning for in the last few years”, van Hal concludes.