May 2004

AFGHANISTAN :: "Without medicine, you can’t have medical care"
Din Mohammed on the importance of medicines

No doctor or nurse can work without medicines. Din Mohammed has been working for Médecins Sans Frontières since '92. He coordinates the pharmacies in Médecins Sans Frontières' clinics in northern Afghanistan. A conversation with a man thanks to whose resourcefulness programmes were able to keep operating in times of crisis.

Wednesday 5 February 1998. The ground shakes in Rustaq. A shock of 6.1 on the Richter scale claims 5,000 lives and wipes out 27 villages. Bad weather makes it difficult for help to arrive. Snow and thick fog prevent helicopters from landing. The stricken population needs medical help, tents, blankets, and food. News of the disaster arrives at the Médecins Sans Frontières base in Mazar. "How can I help?", wonders Din Mohammed. "How can I get the medicines to where they are needed?" The disaster contingency plan goes into action: a well-oiled machine starts up. In great haste, relief supplies and medicines are sent from the nearest Médecins Sans Frontières clinic – they will be the first to arrive at the scene of the disaster.

Later that same year, on 30 May, an even more severe earthquake (7.1) struck 81 villages in Rustaq and Cha-Ab, claiming a further 4,000 lives. For three days in March 2002, earthquakes reduced the district capital, Nahrin to rubble and left 2000 of its people dead. Afghanistan is frequently struck by natural disasters and each time the stocks of medicines that Médecins Sans Frontières has built up in its clinics has turned out to be worth their weight in gold. To a great extent, the credit belongs to Din Mohammed, who coordinates the network of pharmacies in Médecins Sans Frontières' clinics.

© Carl De Keyzer/Magnum Photos Din Mohammed in Mazar-i-Sharif.

Nursing and pharmacy
Din Mohammed is 35; he grew up in Kabul in a large family with eight children. From an early age he was interested in medical matters, and when he finished his secondary schooling he decided to study nursing. After nursing training he went on to the pharmacy faculty in order to become a pharmacist. But that dream came to a sudden end when, in 1992, the city came under heavy fire from rival factions competing for power. His family joined the massive flood of refugees fleeing Kabul and the young Din Mohammed found himself forced to interrupt his studies while he and his entire family found shelter with a cousin in the northern city of Mazar-i-Sharif which he now calls home.

Plans for the future fallen apart, flight, violence...these are ingredients in many Afghan lives. Including Din Mohammed's. He smiles a somewhat melancholy smile as he tells of what he has been through, but that soon passes. Din Mohammed likes laughing: his broad, open face, with its dark brown eyes, lights up frequently in the course of our conversation, particularly when he talks about his work. "Via a cousin who worked for the Red Cross I heard that Médecins Sans Frontières was looking for people with medical training and I decided to try my luck. In '92 I started work in the displaced people's camps around Mazar, where Tajik refugees had gathered. At first I worked in the nutritional programmes, but after just one year Médecins Sans Frontières asked me to work as a pharmacist," he recalls, beaming. He now coordinates the work of all the pharmacies run by Médecins Sans Frontières in northern Afghanistan. So his boyhood dream has come true, after all.

Medical supplies for twenty pharmacies
In northern Afghanistan Médecins Sans Frontières runs twenty clinics that concentrate on basic health care. As the population is very poor, all medicines are provided free of charge. Patients only pay a symbolic amount for a doctor's consultation. The waiting rooms are almost constantly crowded for the six days a week the centres are open, and of course, this requires efficient planning of pharmaceutical supplies. Organising the pharmacies in so many clinics is no sinecure.

"The main base in Mazar has a huge stock of medicines, enough at any given time to tide us over for a period of four months," says Din Mohammed. "For each particular medicine, I keep a close eye on whether our stock is adequate and on when orders need to be placed. From the main base supplies are regularly distributed to our local offices in Maimana and Pul-i-Kumrhi, each of which in turn serves the clinics in its region. Clinics such as those in the Charkent mountains, which are sometimes snowed in for months on end in the winter, need extra stocks." Where medicines are approaching their expiry date, he checks whether other clinics or even other aid organisations might have an immediate requirement for them, so that supplies can be put to maximum use and no medication goes unused unnecessarily. All of this keeps Din Mohammed extremely busy. And the medicines are not all he has to deal with. The people in charge of each of the Médecins Sans Frontières pharmacies in the region can turn to him with all their questions.

"The widespread location of so many clinics in the northern provinces did not happen by chance," explains Din Mohammed. "They are part of Médecins Sans Frontières' emergency intervention plan. Afghanistan is a country that is frequently struck by earthquakes, famines, and refugee movements. This network of pharmacies makes rapid local intervention possible. Each pharmacy has at its disposal not just ordinary medical supplies, but also has emergency stocks with the specific items that are needed to provide initial assistance to victims of earthquakes, cholera epidemics, and famines. When a disaster occurs, the nearest pharmacy is already in a position to guarantee medical follow-up while extra supplies are being forwarded from other clinics and from the main base in Mazar."

Evacuation
Over the years Médecins Sans Frontières' international personnel have had to leave the country several times for security reasons. Showing considerable resourcefulness and courage, the Afghan staff has always succeeded in keeping most programmes going during their absence even though they have had to deal with the offices being repeatedly plundered. In 1997, for example, two political groups, the Hezb-i-Wahdat and Junbisch-i-Islami factions, came to blows in Mazar-i-Sharif. To prevent the medical supplies – always much sought-after spoils in times of conflict – from being robbed, Din Mohammed took preventive measures and divided the entire stock among a number of clinics. "Even if one or two clinics were to be attacked, that way we would still have had sufficient supplies in hand in order to continue our work," he says with a laugh. "When the fighting died down, all the pharmacists dutifully returned the stocks they had been assigned."

It's a stratagem he has employed several times. Each time he was too smart for the thieves and the medicines were dispersed and hidden in different locations. "I remember as if it was yesterday how more than once in mid-1998, under the Taliban regime, armed men forced their way into our offices. We had guns held against our heads while they searched the buildings and took away things they thought were worth something," he recalls. "At that time the senior staff took turns staying with the watchmen at night, in order to help with negotiations in case of an emergency. On one of those nights, all the local staff members who were present were locked up in one room. 'We're going to execute you later, because you're working for unbelievers,' said the attackers. Luckily, nothing came of it.”

The future
The commitment of Din Mohammed and many other local staff members to Médecins Sans Frontières continues to amaze. The news that Médecins Sans Frontières will soon hand over the clinics to other organisations was greeted by Din Mohammed with a mixture of comprehension and regret. “I wonder whether the grandiose plans that the international donors and the authorities have for health care in this country will work out in practice. On paper it looks good, but we'll wait and see. The work that Médecins Sans Frontières did, for its part, was very well thought out. The clinics kept operating and medicines were available, which is more than you can say of many pharmacies in this country. The new plans by the health ministry provide for more widespread clinics and health centres, but medicines will no longer be free. Where do you stand then, when half of your population cannot afford your medicines? Without medicine, you can't have medical care. But now that Médecins Sans Frontières is considering setting up new programmes in Afghanistan, I'm hopeful again. That opens up new prospects!”

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