Medicating in Afghanistan

Working with Dr. H has really opened my eyes to the reality of life here for the ordinary Afghan. Usually, the sequence of events for a patient is as follows:

1) Symptoms arise. Patient goes to a cheap local doctor.
2) Doctor gives at least ten prescriptions to patient.
3) Patient fills prescriptions and problems persist.
4) Patient goes to a mullah.
5) Mullah does a somewhat mystical ritual.
6) Problem persists.
7) Patient goes to a more expensive foreign doctor.
8) Doctor is horrified at previous diagnoses and prescriptions and has to try to convince uneducated patient that he is correct in diagnosing the real problem.

The picture above is of medication given to one of Dr. H's patients. This woman went to a local doctor for infertility. The doctor, without taking a history, prescribed four drugs contraintdicated for pregnant women, two antibiotics, iron, a cream for vaginal irritation, an antifungal, ibuprofen, naproxen, and told her to rub Dettol on her stomach (which is a surface disinfectant). One drug was also prescribed to increase the number of eggs released during ovulation.

However, after coming to our house, Dr. H found that this girl's real problem was her educated husband. He didn't want a child, and was refusing intercourse during her fertile period. Although there could be other problems, it may have been as simple as that. We also recently saw a woman who has been to many doctors over the years for chronic backpain, but after a simple five-minute examination, it became obvious to Dr. H that this woman had scoliosis. None of the other doctors ever checked for that. It is the frequency of such malpractice that is really disturbing here. People are rarely ever correctly diagnosed and treated by local doctors, some of whom have simply read a medical book from Pakistan and opened a stall in the bazaar.