In the Children’s Ward

MAZAR-E-SHARIF

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By the time the government-run Mazar Civil Hospital finally accepted Nadia four days ago, the 22-month-old girl had been unable to hold down any food for eight months. She couldn’t walk. She couldn’t stand.

Now she lies motionless, sweating on top of a cruddy synthetic blanket in 90-degree heat, with an IV catheter sticking out of her limp right foot. The catheter is hooked up to nothing.

The diagnosis on the handwritten chart Nadia’s grandmother has tucked behind some clothes tied into a filthy checkered scarf reads: Diarrhea. Dehydration. Malnutrition. Pneumonia.

The same diagnosis is scribbled on the chart of the 22-day-old Khurzadeh, who passes in and out of conscience next to a plastic bag holding two cucumbers, his mother’s beggarly dinner.

And on the chart of the three-month-old Naqibullah, he of the thumb-thin legs and the horrid, scratching cough; he whose moonfaced mother spends her days rocking him in her arms — because what else can she do? Her breasts are barren from too many children and too little food.

She cannot afford to buy most of the medicine the doctors here have prescribed. Love and oscillation is all she can offer.

The hospital is foul-smelling and grimy. The floor has not been washed for days. A piece of old gauze hard with black dried blood lies in the hallway. But the children who are here are the lucky ones. In most of rural Afghanistan, sick children just die. Oxfam, the British relief agency, reports that the mortality rate for Afghan children under five is 257 out of 1,000.

In a country where less than a third of adults can read and policemen adorn their stations with ram’s horns to block jinxes, taking a sick child to the hospital is usually the last resort. Government hospitals and clinics are free, but travel is too expensive, or too distant. Few parents recognize the symptoms of disease. The mothers who squat over their children at the pediatric ward had waited for weeks, even months, before they decided to come here. Abdul Rauf Furukh, the chief doctor of the pediatric ward, says two out of every 100 children arrive in his care too late to be saved. That number seems low, given the circumstances.

With a piece of coal, Sharifa has drawn a black vertical line on the forehead of her five-month-old son, Hasan, to ward off the evil eye. She also has stitched a special prayer — written for her on a piece of paper by a mullah at her mosque — into a square of brown cloth, pinned that cloth and some beads to a white cotton sheet, and wound the sheet tightly around Hasan. Hasan was born prematurely; his twin brother died at birth, before Sharifa had a chance to name him.

Sharifa says Hasan has always been sick.

“Even with the doctors and the mullah, he is not well,” Sharifa sighs.

The same four words — diarrhea, pneumonia, dehydration, and malnutrition — are written in Hasan’s chart. But who is to say for sure that the diagnosis is correct?

“Our diagnostic system is antiquated,” says Dr. Furukh. “It has not been updated in 50 years.”

Across the aisle from Hasan, two emaciated toddlers share a rusty metal cot by the window, next to the cardboard box inscribed with the word BIOHAZARD; three used syringes stick out of the top of the box. There are not enough cots in the 120-bed pediatric ward for each patient to have one to himself. The boys’ mothers sleep in this cot, too: The ward has only 15 nurses, and relatives have to stay by their children at all times.

I ask the women how the four of them fit on the same bed at night. They don’t seem to understand the question. Their children got admitted to the hospital. Maybe they will get better. Who are these mothers to complain?

At one point during the winter, when the annual pneumonia epidemic spread through northern Afghanistan, the ward had three, even four children — and their mothers — to a cot.

As the desert air outside the hospital windows pulsates in the heat, Dr. Furukh prepares for another annual epidemic: dysentery. Children will ingest infection with river water (only a third of Afghans has access to clean drinking water) and lick it off their fingers at family meals; they will pass bacteria to each other at night, on the sweaty mattresses they share with their siblings.

Sick children at the hospital will have to double and triple up on beds again. Doctors will have to stop admitting new patients.

It was winter, pneumonia time, when the hospital turned Nadia away.

“They said there was no room, no medicine,” says Nadia’s grandmother, Safia. “Eight days ago, they finally accepted us.”

But there is still no medicine for Nadia. Her treatment at the hospital consists of some IV fluid and milk formula, which she still does not hold down. Safia has wrapped the doctors’ prescriptions for antibiotics and anti-diarrheal drugs into the same filthy checkered kerchief in which she keeps a change of clothes. The prescriptions add up to almost $150 worth of medicine to fill at the bazaar. Nadia’s mother is recovering from giving birth to another baby, her fifth. Nadia’s father, a day laborer in a western suburb of Mazar-e-Sharif, earns enough for the family to eat dinners of stale bread soaked in hot water.

Flies land on Nadia’s face. Her eyes are open, unfocused, unseeing.

Safia will not buy the medicine.