The Disease of War

"War can be thought of as a complex disease process that attacks the group organism of mankind” –Salim Yusef

            Afghanistan, compared to other lower-income countries has the unfortunate disadvantage of being war-torn for decades. Because of this, it has never had the chance to develop and maintain a strong and independent political system. Our group was interested in the impact of war and living in a war-torn country on mentally ill citizens and on women and children.  

Usually popular press articles about mental health and war are from the perspective of the soldiers or the actual war – leaving behind the perspective of actual people that call the region of war their home. This article however took into account the importance of daily stressors (stress apart from that of war) and its interrelationship with stress from war.  The 2008 empirical study was done in Kabul, Afghanistan and set out to measure daily stressors with that of war experiences (PTSD) and other general mental health measurements (depression, distress, etc.).  One finding was that trauma therapy should be available to help deal with the stressors from daily life, as well as with stress directly related to the war. The reasoning from the study was that when material and other social conditions were met to ease the daily stressor, instead of therapy, one has a greater vulnerability to the impacts of war (violence and loss).  I thought this way of thinking about trauma counseling in less developed nations was extremely interesting because it made me think back to Maslow’s hierarchy of needs – in which the needs of survival must be met first before dealing with more complex mental health matters.  This article also made me think back to discussions in class about dealing with trans-cultural mental health. This article does a good job of addressing any limitations from the study due to cultural norms/misunderstanding getting in the way. For example, the trickiness of asking an Afghan woman about abuse and the fact that sensitive matters are not discussed easily by Afghan men. It made me think about how complicated it is to actually carry out research studies outside of one’s culture due to so many variables. Overall this article did a great job of making me realize just how tricky something like stress can be, and how different stresses can piggyback on each other because of how closely they can interact with each other.  Their needs to be more focus on indirect stress as well as direct stress during war.

Essentially, the war has exposed various threats to children’s survival, development, and well being in Afghanistan through economic, social, and emotional influences. Firstly, due to the adjustment of national economy system, children are forced to be very independent and are increasingly dependent on money. Because parents tend to leave their own lands and settle in towns/cities, children have adapted their new responsibilities in response to the change of economic structure. Having a duty to contribute to the family’s financial ability limits the opportunity for children to attend in school and get a primary education. Shown here, even though the country has the highest proportion of school age children (7-12) comparing to any other country, the effort to promote education is extremely low and half of all children in this age group do not go to school, resulting in illiteracy of 80% of Afghans. Without any receipt about necessary knowledge, young generation will be less likely to able to protect themselves from illness, diagnose simple ailments, and get appropriate treatments for diseases through engaging in good health practices. Secondly, living in a society where violence is a common phenomenon, children in Afghanistan today have been killed and tortured in many cruel ways. Those brutal behaviors go against the human rights of physical integrity and freedom from torture based on the Declaration of Human Rights. Also, violent behaviors not only bring negative influences toward children’s physical development in a short-term but also shape a wrong notion in dealing with conflict in their adulthood. One remarkable example about children actively involved in violence is boys under 18 are mandated to serve as armed forces in the war. Studies have shown that war causes detrimental consequences not only to children’s physical health but also to children’s emotional health. The emotional results put on children are heavy, including depression, weariness, and exhaustion. The most common reason that leads children to suffer this grief is the loss of family members during the war. Since they are not mature enough to overcome the pain, some children have faced with special hardship. Besides, due to the lack of resources, medical care and community support, those children have to struggle for their own survivals in the midst of the devastating war.

In the Afghan culture, families and children are traditionally the heart of the community, however family planning and prenatal care are considerably poor and underdeveloped. In 2003, Afghanistan’s maternal mortality rate was the second highest in the world. The Bureau of Democracy discusses many of the serious impacts toward women including high mortality ratio, prohibition on education, and poor mental health.  First, it is estimated that maternal mortality ratio in Afghanistan is higher than any other country, about 1600-2200 per 100,000 live births. In Badakhshan province 7% of all women die during childbirth. One reason for this is the cultural norm of marrying women at a young age. 52 % girls in Afghanistan get married before they turn 16. Giving birth with a small pelvis, either because it has not had time to fully develop or due to malnourishment, greatly increases a mother’s risk for reproductive health illness, pregnancy-related complications, and even death. Another contributor to such a high maternal mortality rate is the lack of adequate OBGYN care. 87% of birth are delivered at home and without proper care or a knowledgeable midwife present, these deliveries often result in compilations. Under the Taliban, male doctors were not allowed to treat women under any condition but girls were not allowed to attend school, making female doctors virtually absent. This made women’s access to healthcare extremely difficult resulting in maternal mortality rates in Afghanistan one of the highest in the world. Though the Taliban has since been dismantled, according to the NYtimes in 2009 80% of women in Afghanistan were still giving birth without the aid of a skilled birth attendant.

To address this, the Afghan Midwifery Project was began by female U.S. soldiers stationed in Afghanistan. This program financially supports the advancement of Afghan women to become midwives. Since the end of the Taliban era (within the last ten years) over 3,000 midwives have graduated from accredited institutions, more than 17,000 healthcare facility employees have been cultivated, and community health workers have educated more than 10,000 women in isolated, rural areas on the use of prenatal care and drugs used in pregnancy related complications. One example of these is Misoprostal, a drug used in prevention of postpartum hemorrhage that is taken when a woman is unable to reach a healthcare facility. These interventions were in part of several organizations that are in support of the Afghan Midwifery Project, renamed the  International Midwife Assistance Program. The Afghanistan relief organization (ARO) and American Midwives have partnered together to focus on training women about childbirth and prenatal care while Jhpiego, the USAID’s Rural Expansion of Afghanistan’s Community-based Healthcare (REACH) organization, is also responsible for resurrecting midwifery programs that have been neglected for years. These programs are determined to achieve four main goals: the ability to control and deal with emergency situations during childbirth, respect the culture and incorporate traditional midwifery traditions within modern medical practices, save the lives of women and children, and continue to develop apprenticeship-type programs.