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In their own words

Dr. Nadera Hayat Borhani

Afghanistan: Starting from scratch in a war-ravaged country

In Afghanistan Dr Nadera Hayat Borhani worked during the former Taliban rule. She was one of the few doctors able to treat women. Dr Borhani travelled by special car to the houses of female patients forbidden to leave their homes. Today she is the Afghan Deputy Minister of Public Health.

“Nobody in Afghanistan has access to health facilities for cancer. It’s the same situation for the children, the men, the women, the elderly -- nobody has access. Thirty years ago we had a centre for radiotherapy and a centre for diagnosis. But unfortunately during the war everything was destroyed and the infrastructure, the equipment, everything, was destroyed. So nearly we are starting at zero again.

“When the doctor sees some sign or symptom that a patient has cancer – the option is to send the patient to Iran, or to go to Pakistan, or to India, as their economic situation allows. But Afghanistan has a low economic situation, and most of the people are very poor, so most of them don’t go.

“I also worked in a provincial hospital for 15 years, so I met many patients with cancer but unfortunately we cannot help them. In my heart I want to work with my people -- especially for the women and children. All over the world they are the most vulnerable, but especially in Afghanistan. As you know we were suffering during the war from bad culture, it’s not religious culture, but it’s a bad culture of war. Always women are under pressure: they don’t have the right to go to a health facility in rural areas without permission of the mother-in-law or father-in-law or husband. It’s changing day-by-day but unfortunately if the families don’t accept it, it’s difficult, so we need time to change our people. We want to educate them, to teach them that this is a women’s right, a child’s right, a human right. For this change, it will take years and years.

“In 2002 the coverage of health services was 9% in Afghanistan. But fortunately this access now reached 82% but only for basic health services. For an essential package of hospital services it’s about 28%-30% coverage. But there is no radiotherapy for cancer.

“A big problem we face in Afghanistan is lack of skilled female health staff. Literacy is low among women, about 15%. Afghanistan is a mountain country and mostly the people who are living in very rural areas don’t access water, electricity, transportation, roads so it’s hard to access schools and hospitals. Doctors don’t want to go to rural areas and women from rural areas can not go to the city for training unless their whole family agrees and moves with them. So far we are finding it very difficult to recruit women specialists for training.

“We need a cancer registry in Afghanistan to see the numbers and different types of cancers in the country. Sadly in Afghanistan we do not know this. We need this information to make our policy. We have some data from the paediatric hospital in Kabul. They now have about 75 children with leukaemia. But the real number I think is much greater, because the doctors send cancer patients to the foreign countries for treatment, or home to die. Even in my family I have a history of cancer. My uncle and aunt had cancer of the brain. We need a cancer treatment centre in Afghanistan, and to have radiotherapy treatment.”