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Monday, July 2, 2012

Rebuilding smiles

By LIM WEY WEN
star2@thestar.com.my

On the barren mountains of Bamyan, Afghanistan, Malaysian troops employ creative approaches to help the community improve their health and quality of life.

WINTER was approaching at the central Afghanistan province of Bamyan when the third Malaysian Contingent for International Security Assistance Forces (Malcon 3 ISAF) arrived at the Kiwi Base in October.

However, the harsh weather conditions and subzero temperatures were only the first of a long list of challenges the teams faced in the poorest province in the war-torn country.
Oral help: Besides providing dental services, the Malaysian team in Afghanistan also offered a course to train Afghan students in basic dental techniques. In this photo, Malcon 3 ISAF dental officer Kapten Dr Naili Hayati Abd Mukti (centre) supervises two of her students while they treat a local in Bamyan. — Photos by Malcon 3 ISAF

The mountainous terrain, isolated villages scattered across them at more than 2,400m above sea level, and barren soil with no trees in sight were also daily obstacles to grapple with.

“We felt very sad because although we are living (in the 21st century), there are still people living in caves,” says Lt Kolonel Nordin Mohd Yusof, head of the Malcon 3 ISAF team who had returned from the mission in April. He and his team members shared their experiences with us recently in Kuala Lumpur.

“There is no electricity or water. People have to get water from the rivers or wells, some electricity comes from solar panels (supplied by international missions like Malaysia’s), and light from lamps using kerosene or whatever oil they make locally,” Nordin says.

Nordin led a team of 40 staff members to continue Malcon-ISAF missions in several districts of the Bamyan province, including the capital, Bamiyan, and rural districts such as Yakawlang, Wasar, and Panjab.

His team, which was the third deployment on a six-month rotation from Malaysia, comprised officers and enlisted personnel from the Royal Medical and Dental Corp, as well as administrative and security personnel from the Malaysian Armed Forces.

“Our mission is to provide humanitarian assistance to the people of Bamyan so that they will be able to reconstruct the province,” explains Nordin, adding that “we are focusing more on capacity building.”
With female officers in its ranks, the Malcon 3 ISAF team managed to promote family spacing among Afghans who are generally very resistant to family planning. Soon, people began approaching Kapten Dr Nor Azima h Zakaria (in uniform, above) for advice as well as listening to her speak on national radio (left) in the country’s national language, Dari.

While the previous Malcon-ISAF teams focused on providing medical assistance, Nordin’s team has expanded Malaysia’s assistance to helping the community achieve some form of clinical governance, where systematic programmes are devised to help healthcare professionals in the province better care for their own people.

Together with dental surgeon Kolonel Dr Kamal Abdullah, senior medical officer Mejar Dr Mohd Zaki Mokhtar, and Kapten Dr Nor Azimah Zakaria, who led the dental, medical and health promotion teams respectively, Nordin worked with the Afghanistan Ministry of Public Health (MOPH) to come up with innovative programmes to help the people of Bamyan gain access to clean water, an uninterrupted power supply, better oral care, and access to information on family planning.

“We do not want to implement just any programme that we bring from Malaysia. We want it to be led by the (Afghan) people for the people,” says Dr Zaki.

Clean water
By distributing toothbrushes and toothpaste to schools and orphanages, the team hopes to start young Afghans on the road to better oral health.

One of the first programmes the Malcon-ISAF team discussed with the MOPH was to introduce a water filtration system that is made locally from materials that can be found in the region.

Although there are NGOs helping to dig wells and provide containers to collect water, Dr Zaki says the need for the people to have a sustainable way of accessing clean and safe drinking water still remains.

“We are not the first to introduce a water filtration system there – organisations like the WHO (World Health Organisation), Unicef (UN Children’s Fund) and the World Food Programme have introduced some – but we were thinking of something that the Afghan people could claim ownership of,” says Dr Zaki.

“That is why we came up with the polycarbonate water filter, which you can build by using gravel, pebbles, big stones, and sand available from the river bed,” he explains.

However, during the long winter months, these filters tend to be abandoned as the water inside freezes. The Malcon 3 ISAF team overcame this by building an insulation box around the filter.

“(The water filtration system) is now available in the bazaar, and every time they go to hardware shops, they can see their own filters,” says Dr Zaki.

Healthy smiles

Another one of the team’s programmes was to work with the MOPH to come up with a system to provide dental care for the people of Bamyan.

“When we went there, we found out that there were no organisations in the MOPH that deals with oral health,” says Dr Kamal, who heads the dental team.

“They have a very simple dental clinic, which was not managed by people with licenses or degrees to practise,” he says
To help peripheral clinics in Afghanistan gain access to continuous power, Malcon 3 ISAF have embarked on a solar panel installation programme in the province of Bamyan. In this photo, Dr Zaki (second from right) and his team are helping one of the clinics install a new solar panel.

Those who provided dental services there were somewhat like the “dental carpenters” Malaya had in the 1950s, he says.

What’s more, as most people live in isolated villages spread across the mountains, many had to walk as long as three hours to get even that basic level of dental care.

“Generally, the incidence of periodontal problems (like gum problems and loose teeth) among adults is very high there,” says Dr Kamal.

“There is also a lack of dentures ... so when they have extractions done they do not know where to get (their teeth) replaced,” he adds.

The team started out by putting seven locals through a basic clinical dental training course, a 10-week programme that teaches basic dentistry techniques.

After that, the team started offering dental services at its base and later at mobile clinics it set up at hospitals in the capital Bamiyan and the Yakawlang district.

“Dental equipment was lacking there, so we also innovated the multi-purpose dental chair,” says Dr Kamal with justifiable pride, adding that the team eventually built three dental chairs with the help of local metallurgists.

At the same time, the team also worked with the Afghanistan Education Ministry on school dental health programmes and distributed close to 4,000 pairs of toothpaste and toothbrushes at schools in Bamiyan and Yakawlang.

“The team’s aim is to set up a model oral health service in one district, Yakawlang,” says Dr Kamal, adding, “If we can achieve that, the other districts can follow on their own.”

Giving gifts of life

With female officers among its ranks, the Malcon 3 ISAF team have also achieved something that was previously difficult even for local healthcare professionals: promoting blood donation and family planning.

Although family planning facilities are available in hospitals around the province, it is not well accepted.
With education and promotion, the Malcon 3 ISAF team managed to hold two blood donation drives that gained the participation of the Afghanistan national police and army.

“From what we understand, some think that they might not be able to have children after that, and that it is a way of making the Afghan population smaller,” Dr Zaki explains.

What the Malcon 3 ISAF team did instead was to introduce the concept of “family spacing” – ie, that families should wait for a few years before having another child.

“Our advantage is that we have female Muslim doctors who can talk about it,” says Dr Zaki, adding that Dr Azimah also spoke regularly on radio programmes to provide information about family spacing in the Dari language (Afghanistan’s national language) to local women.

“We have also approached the Mullah, their religious leader, to convince him that this is necessary,” says Dr Zaki.

Soon, the concept of family planning began to be more accepted by the locals and women even started approaching Dr Azimah for advice.

“With blood donation, the locals think that if they donate blood to another patient, it will take all of their blood away and they will die,” says Dr Azimah, explaining, “That was why in the past, only close relatives or family members were willing to donate blood.”

To correct these misconceptions, the team gave out flyers, put up posters in the Dari language, and educated the local community about blood donation and common diseases such as Brucellosis (an infectious disease that can pass to humans from stock animals or their products) and typhoid.

“We have even managed to conduct two blood donation drives, first with the Afghan national police and then with the Afghan national army as well,” says Dr Zaki.

“We have also called on the local press to raise public awareness about the benefits of blood donation.

“Hopefully, there will be more people who are willing to come forward to donate in the future.”

As the Malcon-ISAF teams are committed to maintaining their presence in Afghanistan until 2014, team members intend to make their programmes as sustainable as possible.

After training healthcare workers and more than 800 police, army and special forces personnel in providing basic life support, the Malcon 3 ISAF and Malcon 4 ISAF (currently in Afghanistan) started “training trainers” so that the Afghan people can eventually run the training programmes themselves.

Other efforts the teams are involved in include ensuring that peripheral clinics have access to continuous power; this involves helping those clinics install solar panels.

Worth the sacrifice

“Our message to the Afghanistan people is that the ball is at their feet, so they must take advantage of our suggestions and start doing something concrete with them,” says Dr Kamal.

While the physical demands of running these projects amidst harsh weather and environmental conditions could be overcome, Dr Zaki says that it is the emotional longing for the comforts of home that is most trying.

His fourth son was born when he was over 4,000km away from home, and Nordin welcomed his first grandson at the time.

“We could communicate with them through Skype (over the Internet) but we also wanted very much to be there for our families,” says Dr Zaki.

So is all the hardship and time away from loved ones worth it, we wonder?

It will be, say the team members, if the programmes they started continue to be practised in Afghanistan.

That would be the best reward, they conclude.

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