Members of Canada's Dental and Medical Corps now known as CF Medical and Dental Services provide mentoring in local hospitals and dental clinic in Afghanistan. They face many cultural problems with the provision of care. The professionalism of both Canadian and US Dentists, Doctors, Nurses and Techs is strained by culture , primarily concerning Afghan women. This story is from Canwest Global.
Canadian hospital workers face cultural challenges in Afghanistan.
Matthew Fisher, Canwest News Service: Tuesday, March 9, 2010
CAMP HERO, Afghanistan - How does a doctor treat a woman when he can only make a diagnosis by asking her husband to tell him what is wrong with her?
What are the challenges for a dentist who only sees a female patient when she is in serious agony because a male relative is required to escort her to a clinic and he won't go unless her situation is dire?
Aside from violent trauma and disease caused by war and extreme poverty, cultural issues were always a major consideration when Canadian military health care workers mentored their Afghan colleagues at the Kandahar Regional Military Hospital.
``There is a gender barrier,' said navy Lt. Kirsten Barnes, a general practitioner who assists Afghan doctors attending to the wives and children of Afghan security forces at a once-a-week clinic at this Afghan army base just outside Kandahar City.
``Traditionally, male doctors are not hand's-on with female patients, especially when it comes to things that are gynecological. There are no other female doctors and I have a feeling more women come to the clinic now because a female is here.'
``Cultural sensitivity is important,' said Maj. Mike Kaiser, a dentist and deputy commander of Canada's health services unit at Kandahar Airfield.
``You may have to ask a male relative to find out what a female's problem is. We must be respectful of the culture.'
Afghan medical workers walked a similar tightrope, too, according to Lt. Abdul Malik, who has learned about anesthesia and new methods to extract teeth from Canadian mentors at KRMH.
``I have women patients who will only show me their mouths while the rest of their faces are covered,' the 26-year old dentist said.
However, there were other issues that had nothing to do with gender.
``Generally speaking, Afghan people do not use a tooth brush and tooth paste, ' Malik said. ``Most people don't even understand this idea.'
To improve dental hygiene, the Canadians have prepared a leaflet in Pushto about brushing teeth and the importance of washing hands.
Religious considerations in the deeply conservative south also had an unexpected impact on dentistry.
``When people have cavities in this part of the country they do not get them filled because they believe that it will interfere with their ablutions before praying,' Malik said. ``And they don't like bridges because they believe they cannot pray properly if they have them.
``Because of this, they usually have their teeth taken out, rather than fixed.'
Another factor that explained the preference for having teeth removed was that it costs 500 Afghanis (about $10) to get a cavity filled whereas having a tooth yanked only costs 100 Afghanis.
``The problems are those that you would see at home but there are more of them here because there is no preventive care,' said Capt. Ryan Sinotte, a dentist whose tour ended Tuesday.
``The swelling, abscesses and advanced tooth decay are all things that I saw when I worked in a clinic for the homeless on Vancouver's Eastside.'
Other areas of concern for the Canadian health-care workers included the over-prescription of top-of-the-line antibiotics that were sometimes not as appropriate as broad spectrum drugs and the fact that most patients thought injections were always more effective than pills. Patients were also so insistent on going home with ``goody bags' of vitamins and medicines after visiting KRMH that they were often given placebos.
For all that, Canada's medical mentors were ecstatic about teaching Afghan colleagues.
``We come here wanting to feel that we have done something for the Afghan people,' said Barnes, whose time is mostly spent caring for Canadian troops. ``This is our chance to go out and impart knowledge and to see women and children getting excellent health care.'
The Canadian mentors were not trying to ``impose western medicine' but ``to help Afghans build capacity to provide the best care within their means,' Kaiser said.
``Our goal is to train the trainer and give him the tools and mechanisms so that the next guy who graduates can go under his wing.'
To help the doctors and dentists at KRMH, Task Force Kandahar has donated a complete set of dental and medical text books. Thanks primarily to funding provided by the U.S., the hospital is reputed to be the most modern in Afghanistan.
``The reason we are the best is simply because the south is a very dangerous area with a lot of wounded,' said KRMH's director, Col. Abdul Baseer, proffering a sheet of statistics which showed that all but 43 of 1,086 patients admitted in the past six months had been treated for war wounds or accidents related to the war.
Thirty years of conflict has had a disastrous impact on health care in Afghanistan, the internal medicine specialist said.
``After the Russians, the mujahedeen and the Taliban came and it was a very bad time,' he said. ``The situation has improved over the past five or six years, but it still is not 100 per cent, especially on the women's side.'
The colonel lauded the mentors from Canada and the U.S., stating, ``Those who help us are our brothers.'
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