Seeking to bring healing and continuing medical education to a war-torn land, a team of five physicians from Loma Linda University Medical Center and the Loma Linda University Children’s Hospital traveled to Kabul, Afghanistan to conduct medical education workshops for local physicians.

Working in conjunction with Kabul Medical Institute, the physicians held five continuing education classes over three days in early May. Medical topics presented included treating adult and pediatric patients in the emergency room.

This is the second team that has traveled to Afghanistan this year to present continuing education workshops. It is planned that similar workshops will be presented approximately every two months.

An earlier delegation, headed by Loma Linda University chancellor Richard H. Hart, MD, DrPH, traveled to Afghanistan during the week of March 15 in response to a request made by the ministry of health of the Islamic Republic of Afghanistan to operate a major hospital located in Kabul, the capital city of 3.5 million inhabitants.

Accompanying Dr. Hart on the trip to evaluate the Wazir Akbar Khan Hospital were Jerry E. Daly, MSLS, Loma Linda director for the Afghanistan project and director of the Del E. Webb Memorial Library; Larry A. Feenstra, director of clinical engineering, Loma Linda University Medical Center; Roy V. Jutzy, MD, professor of medicine, Loma Linda University School of Medicine; and Jan Zumwalt, MS, MBA, RN, executive director for case management, Loma Linda University Medical Center. Each member of the team evaluated specific aspects of the hospital facilities and staff.

The Wazir Akbar Kahn Hospital, operated by the Afghanistan ministry of health, was built approximately 35 years ago. Today the hospital is located among a cluster of medical facilities including the Indira Gandhi Children’s Hospital, a physical therapy clinic operated by the International Committee of the Red Cross, and an allied health educational complex. Located on an adjacent piece of property is a military hospital operated by the Afghan ministry of defense.

Currently, the hospital is undergoing a complete renovation, according to Dr. Hart. All patients have been referred to other medical facilities in Kabul.

“The Norwegian Red Cross, operating under the auspices of the International Committee of the Red Cross, is completely rehabilitating the hospital,” Dr. Hart says. “When completed later this year, what was a 248-bed hospital will be downsized to approximately 200 beds.”

During a recent visit to Loma Linda University, Afghan deputy minister of health Abdullah Sherzai, MD, asked Dr. Hart if Loma Linda would consider running the Wazir Akbar Khan Hospital and upgrading the facility to the equivalent of an American community hospital.

“If Loma Linda University is able and willing to take on this task, this collaborative effort could play a significant role in changing the way the Islamic world sees the United States,” Dr. Sherzai says. “What better way to change the world view and the world direction than to give life to a country that has nothing but its will?”

Prior to the closing of the hospital for renovation, Wazir Akbar Khan Hospital could only accept the most needy patients. “Only those in immediate need could be helped,” says Mahammed Njib Haleem, MD, vice president of the hospital and an internist. Saleem Tawana, MD, chief of surgery, noted they could only schedule elective surgeries one or two days a week because of a lack of medicines.

Hospitals in Afghanistan have limited resources, according to Dr. Sherzai. Many of the hospitals in regions outside Kabul do not have electricity or running water in the facility.

Although Wazir Akbar Khan Hospital has those amenities, the facility lacks basic medical equipment such as stethoscopes, modern medications and blood pressure cuffs.

“We estimate that it will take approximately $2 million worth of equipment and supplies to raise the level of the hospital,” Dr. Hart states. “We will need an additional $3 or $4 million for staffing, construction of an outpatient clinic, and housing for expatriate medical staff.”

The University administration is currently exploring ways of obtaining external funding of this project. A positive answer is expected in a few months.

“This will be an opportune time for Loma Linda University to collaborate with the ministry of health in operating the hospital,” says Dr. Jutzy, who with Ms. Zumwalt, evaluated the current medical staff needs for the hospital. “We have been assured by the ministry of health that Loma Linda will be able to retain only those physicians, nurses, and other medical staff who have been and will continue to make a positive impact on the hospital.” Currently, physicians who work only part time staff most hospitals throughout Kabul and in the rest of Afghanistan.

“The pay for an Afghan physician is approximately $100 a month,” Dr. Jutzy notes. “Consequently physicians will work in the hospital for a few hours in the morning and then operate their own private practice in the afternoon to supplement the hospital income.” The additional income increases a physicians pay to approximately $400 monthly.

“We know that we will have to pay more to retain a qualified medical staff,” Dr. Jutzy says. “We expect to be able to increase the pay of hospital physicians to equal what they would make in private and public practice.” With the pay increase, the Loma Linda group, with the concurrence of the ministry of health, expects that finding a qualified staff will not be difficult.

“We will still need from seven to 10 overseas personnel to play key administrative and medical roles in the foreseeable future,” Dr. Hart says.

“Tentatively, we are looking at supplying a hospital administration, business manager, three or four physicians, one or two nurse managers, and a physical plant operations manager.”

Wazir Akbar Khan Hospital is situated in an ideal location, according to Dr. Hart. The facility is located in the center of extensive grounds that can be transformed into a park-like setting for patients and visitors. In addition, there is enough vacant land surrounding the hospital to build housing for the expatriate staff. 

“We are very interested in helping Afghanistan with this facility,” Dr.  Hart says. “We have been working with Kabul Medical Institute, Afghanistan’s primary medical education facility, on upgrading medical education and recognize the additional value of establishing a solid teaching hospital.

“We expect to have local medical students and residents, as well as nursing students and other students in the allied health professions working and learning in the facility.  Currently, many patients who can afford medical care are seeking treatment in nearby countries such as India and Pakistan.

“We hope that many of these patients will choose to remain in Afghanistan and seek treatment at the new facility when it is opened,” Dr. Hart says. “This will be good for the patient and good for the country.”

Loma Linda began its involvement with Afghanistan in 1962. Primarily anchored by G. Gordon Hadley, MD, dean emeritus of the School of Medicine, his involvement has included World Health Organization support and has provided faculty and consultation resources to Kabul Medical Institute and similar facilities in Afghanistan.  Loma Linda’s involvement in Afghanistan ceased during the time that the Soviet Union invaded Afghanistan in the late 1970s and early 1980s.

After armed forces of the then-Soviet Union withdrew from the country, Afghanistan was taken over by the Taliban.

“Approximately six years ago, we were contacted by the Taliban government to see if we would once again come to Kabul to help strengthen the medical school. We responded to this request,” Dr. Hart says.

After September 11, 2001, and the fall of the Taliban government, the new government of Afghanistan once again asked Loma Linda University to return and assist in the redevelopment of medical education in Afghanistan.

As part of Loma Linda’s renewed interest in Afghanistan, a new Loma Linda University Center was constructed at Kabul Medical Institute. The center consists of teaching laboratories, a medical library, and a computer facility for students and faculty.

Recently, 45 computers from Loma Linda have been installed in the computer laboratory that is networked by a system donated by Cisco Computer Systems, Inc., of San Jose.

Currently, two Afghan teaching faculty are studying at Loma Linda learning current teaching methods, according to Dr. Hart. Three additional Afghan faculty members will arrive in Loma Linda in the next few months after the two current teachers return to Kabul.

“Tremendous challenges lie ahead,” Dr. Hart says. “We are pleased that Loma Linda can be a part of this effort to rebuild the health-care and medical education systems of Afghanistan.”