Open heart: The French hospital of Kabul.
“Time flies by, at the French Medical Institute for Children, in Kabul (IMFE),” explains Agnès Simon, medical coordinator and project director of the Mother and Child program of the French association La Chaîne de l’Espoir. The institute is located in a country devastated by war for more than twenty years. The last attack on a hospital took place in May 2020, when an armed commando broke into the maternity ward of the hospital in Dasht-e-Barshi, a district of the capital, and killed around thirty people, including several women. who were giving birth and some babies.
The FMIC was inaugurated in 2006 by La Chaîne de l’Espoir and provides 160 beds, including 61 in paediatrics, 16 in intensive care, 52 beds in the gynaecology-obstetrics unit, 14 beds in neonatal intensive care, as well as 6 operating theatres, a medical imaging unit, a laboratory and a pharmacy. In total, more than 500 people work there, the majority of them are Afghan doctors. Since its opening, missions by French and international specialists (surgeons, doctors, nurses, pharmacists, biomedical engineers, etc.), involving an average of 150 expatriates per year, have been carried out to support the local teams. As part of our partnership with La Chaîne de l’Espoir, Prodie Santé has sent several obstetrician gynaecologists (OB-GYN) to the maternity ward of the French medical institute of Kabul. Here are the portraits of three courageous women that have collaborated in this project:
Agnès Simon, medical coordinator and project manager of the Mother and Child programme of the association La Chaîne de l’Espoir from 2016 to 2020: A woman of action
At Prodie Santé, Agnès is our contact with La Chaîne de l’Espoir. In spring 2019, part of our Canadian team organized a meeting with her in Paris. Since then, the bond has never been broken. Agnès has a contagious energy. She instantly draws you into the projects that are close to her heart. Her functions at the FMIC in Kabul are multidisciplinary: project coordinator and midwife, she seems to handle her many roles smoothly. Besides, Afghanistan is not her only mission. She travels several times a year to explore other countries where La Chaîne de l’Espoir runs projects. Despite the pandemic, she never stopped working. In fact, she decided to return to Pitié-Salpêtrière University Hospital, in Paris, while remaining available to volunteer in Afghanistan during her holidays but there were fewer flights, and her last mission in Kabul took place in January 2020. In Kaboul, the institute is run by local medical teams. The hospital is very proud of the head of the obstetrics department. She is a very experienced Afghan woman with an excellent professional reputation. To meet the needs, the team of anaesthetists has also been strengthened. However, Agnès explains that there is still a shortage of obstetricians and gynaecologists who agree to stay for longer periods. Long-term missions are needed; they facilitate the doctor’s integration in the hospital, promote trust in doctor-patient relationship, and represent an opportunity to share knowledge about surgical techniques that the local team does not necessarily master. Therefore, La Chaîne de l’Espoir gives an organizational and training impulse to the FMIC. Still, it does not have a direct impact on the day-to-day running of the hospital. The patients come from all social backgrounds in Afghanistan. Some have to travel across the country to receive medical treatment. This was the case of a father who walked from the province of Sar-e Pol to the capital with his child on his shoulders, for several nights, to avoid bad encounters in this war-torn country. When he finally arrived at the institute, the man had the traces of his son’s arms around his neck. He had clung fiercely to his father’s body all the way to the city and left an ephemeral trace on his skin. When people come from far away, they are often redirected to the Women and Children’s Pavilion [Pavillon des Femmes et des Enfants]_a project of La Chaîne de l’Espoir where patients who have to undergo an operation can wait. These women and children suffer from illnesses that are often at a very late stage and need to be treated quickly. Once the operations have been performed, these patients, who need to rest, are monitored until they are discharged. The Pavilion provides basic health services, but most of the healthcare is delivered within the hospital. Nevertheless, many people staying at the Pavilion come from distant provinces, with no infrastructure, and have been sent there by partner NGOs of La Chaîne de l’Espoir such as the Red Cross or Terre des Hommes. Upon arrival, they stay at the Pavilion for additional examinations. Agnès has anecdotes for each day spent at the FMIC. Her role as a midwife is really part of who she is. What is most striking about her is that she still plans to return to Kabul despite the pandemic and the signs indicating that violent escalation is imminent after the departure of American and OTAN troops from the country and the Afghan security forces from certain checkpoints, exhausted by the constant Taliban attacks. Agnès has chosen to devote her days to helping others. In Paris or Kabul, she builds bonds with people who are lucky enough to cross her path. Those are bonds that set you free.
Safia Djellali, specialist in gynaecology and obstetrics: Safia's vocation
“Gynaecology is a priesthood,” explains Dr Djellali with some sense of humour. Even as a child, she remembers her mother talking about her gynaecologist. She thought this man who took care of women so well must be a demigod. That’s when she found her vocation and proudly announced to her family that she wanted to become a gynaecologist. This commitment is her raison d’être. She has a name that fits her like a glove: “Safia”, which means “loyal” in Arabic. Indeed, commitment and sheer tenacity are crucial in this profession. Dr Djellali decided to leave for Afghanistan after a successful career in Tunisia. She started her career in Sousse, then she moved to Tunis, where she chose to work open a private practice to have time left to take care of her sick father. Safia is not only a doctor; when she decided to open her own cabinet, she was also a mother of three young children. She also travelled during her career and participated in congresses in France, the United States, Germany, Italy and India. Because of her family obligations, her visits were always short but also enriching. Safia felt the desire to practise her profession beyond Tunisian borders. She wanted to change her routine and discover new aspects of her beloved profession. During her exchanges with Prodie Santé, she said she was looking for a purposeful mission and not necessarily for paid work. So obviously when Emmanuelle, the director of our offices in Canada, suggested that she should volunteer for La Chaîne de l’Espoir, Dr Djellali did not hesitate for a second and accepted the offer. The next step was to put Agnès Simon and Safia Djellali in touch. Agnès talked about her long experience in Afghanistan and Safia heard about the difficulties she would encounter there but was not worried. She was only concerned about making sure she would cover the FMIC needs. She prepared herself relentlessly before the trip. To do so, she contacted her teacher and friend, the dean of the faculty of Sousse and she participated in the English medical course to brush up on her skills and knowledge. In parallel, she practised in public maternity services for a few months. As a former vice-president of the Gynaecology National Society of Tunisia and ex-Secretary General of the Menopause Society, doctor Djellali has never left the academic world. Still, she felt her practice was not enough to prepare herself for Kabul. Aware that the work pace will not be the same, she wanted to be ready and operational as soon as possible. Safia speaks quickly and apologizes for it. The way she tells her story reveals what made her strong, her respect for others and her generosity, even her doubts. She explains that thanks to her two professional experiences and human encounters in Kabul, she has a precise idea of the work carried out by the French institute. She also expresses her admiration and respect for the projects of La Chaîne de l’Espoir in Afghanistan and its partner Prodie Santé. Dr Djellali’s two missions took place in December 2019 and early March 2020. She recalls the hectic beginning of the pandemic and she remembers the repatriation flights to Istanbul and Dubai that left just before the arrival of former US President Donald Trump in Kabul. What a strange conjunction of events. On her first trip, she quickly understood the hospital’s needs. She was not sure that her areas of expertise, like Assisted Human Reproduction (AHR) and ultrasound, were priority areas for the FMIC. She worked with a specialist in vaginal surgery, but she felt that she did not accurately cover the needs of the hospital. The obstetricians are well trained and while she thought that assistance could be helpful, she did not necessarily considered-it essential. The feeling of not doing enough is common among volunteers working in difficult areas. It translates into a false impression of being useless and not finding one’s place. However, when the end of the mission approaches, it also triggers the paradoxical feeling of abandoning the people involved in the project, whether they are colleagues or patients. Emmanuelle, her contact at Prodie Santé, called her to discuss the situation and became her greatest support. Gynaecology is a very broad speciality. Dr Djellali wrote in her end-of-mission reports that even if it is not a vital priority, there is a local demand for AHR. As fate would have it, she met a woman at the FMIC who was desperately trying to have a child with her husband. Unfortunately, the hospital didn’t have the means to help her, so the couple clung to the hope that the dream will come true one day. To thank Doctor Djellali for her work, the couple gave her a cloth embroidered with the name “SAFIA”. Ever since the establishment has been trying to develop its AHR service. Dr Djellali work has been critical for this sector at the FMIC. As a history and archaeology enthusiast, Safia always keeps in mind the words of Anatole France: “Let’s not lose anything in the past. Only the past completes the future”.
Amélie Grouin, specialist in gynaecology and obstetrics: The encounter
The Kite Runner, Khaled Hosseini’s novel published in 2003, tells the contemporary history of Afghanistan since the 1970s through the story of a broken friendship. It is one of the novels that Dr Amélie Grouin read before going on her first mission to the FMIC. In Afghanistan, from November to March, the capital’s sky is filled with kites. Once made of silk, the strings of these funny paper birds are now made of nylon, soaked in rice glue and coated with mini glass shards to cut off competitors. When they were in power from 1996 to 2001, the Taliban banned kite competitions. Amélie has learned about the country through her readings, whether purely literary or more actual. She knows about the country’s geopolitical situation and probably knows that 0-14 years old represent more than 40% of the local population. A few months before her first assignment, the practitioner was looking for a replacement in Canada. At that time, she wanted to take advantage of a month and a half between two work periods to put her professional skills at work outside the Schengen area. Our Canadian team warned her of the difficulties for a French doctor to temporarily work in this country, and suggested putting her in contact with Agnès Simon, the medical coordinator of La Chaîne de l’Espoir for their programme at the FMIC. The doctor already knew the association through an earlier work experience in Cambodia when she was still a student. During her studies, she did an internship of almost two months at the cardiology hospital in Phnom Penh, one of the first centres opened by the founder of La Chaîne de l’Espoir, Professor Alain Deloche. Agnès’ story and her experience at the FMIC ended up convincing Amélie to go to Afghanistan and Dr Grouin decided to prepare herself for several trips to Kabul. She needed to give continuity to the commitment and increase the professional benefits for her and the local teams. Agnès, who already had a long experience at the FMIC, talked to the doctor about her work and mission with honesty. Upon arrival, Amélie got picked up at the airport and was taken directly to the FMIC guest house where the foreign medical staff stays. The doctors work in secure conditions, and Amélie immediately felt at ease. Agnès, who arrived the same day from France, introduced her to the gynaecology team composed of five or six female doctors. Every day, the teams benefited from her support during their visits to the wards and the delivery rooms. The aim was to ensure the best possible management of pain and assisted birth. In the afternoon, to help the staff reinforce their technical knowledge, theoretical courses were provided and/or surgery was performed. Dr Grouin helped support during night shifts. Everything went well during this first mission in Kabul, so without any hesitation, Dr Grouin prepared herself for a second visit to the land of lapis lazuli and flaming carpets. The second mission took place in January 2020. This time, Amélie focused on surgical care. In early 2020, operations were not frequent. Therefore, it was an opportunity to help the local doctors to improve their training. This educational component is the main purpose of these missions since it combines theory with practice. The mornings are dedicated to caring, and doctors like Amélie are in the delivery room or surgery, but in the afternoons, when the medical staff has some free time, they can attend lectures. Communication is very fluid, and the relationship with the team on site is excellent. All the women in the medical and nursing staff are keen to take these courses and are very responsive. They also do not hesitate to discuss with the foreign doctors to inform them of any disagreement and share their experiences and the protocols they follow as well as their medical readings. “These are vibrant discussions,” insists Dr Grouin. She explains that “their comments are very relevant”. And she adds that “there is no one way to take care of patients.” Places are made of stories. Tales became the walls of the French hospital in Kabul. They are sad, touching, sometimes difficult to hear. Afghanistan is a country that has suffered a lot, and its civilian population is the victim of endemic violence fuelled by years of war. Dr Grouin recalls with deep emotions her encounter with her patients and their openness. Amélie remembers those fathers whose faith was about to change forever, filled with a universal emotion waiting in the entrance of the delivery room. Some seemed worried, others were thrilled, but they did not hesitate to approach Dr Grouin to politely ask about their partner. This trust, tinged with great respect for the work of foreign doctors who do not speak their language and who come from far away, surprised her a little. “They should be less trustful, but they are not,” she says. On the contrary Amélie “saw this respect in their eyes “and it moved her. In Kabul, the French hospital welcomed these three women, passionate about their work, absorbed by their important missions, their minds remembering the faces of the patients who shared a part of their personal history with the medical staff. Together, they are walking towards the future. Volunteering for an association such as La Chaîne de l’Espoir is enriching on many levels. The doctors discover a new culture that allows them to broaden their professional and personal horizons. But above all, what lies at the very heart of these doctors’ missions and reinforces their commitment is the encounter with people. The deepest meaning of this awork is to invite us to stay open to difference and the singularity of consciousness. Beyond the art of healing lies humanity. This is what gives this profession its full meaning.