Health Care
HEALTH EMERGENCY, FROM THE EYES OF IBN SINA
The task of providing Afghanistan with public health and a medical system is huge. After 40 years of warfare, in combination with geopolitical manipulation from outside forces, the nation has been left without a health system.
With peace now established in Afghanistan, now is the time for all nations of good will to work together to facilitate the building of hospitals and public health infrastructure, and educating the staff so that all in need can be cared for. The healthcare facilities must become part of an integrated infrastructure system which supports the well-being of the people, by providing for all necessitiesclean water, safe food, housing, electricity and all essential services.
Afghanistan and the region have a rich history in medical science, which had a high point in the works of the universal genius Ibn Sina. In the revival of Afghanistan, his work and that of the Islamic Golden Age can be a reference point to build a bright future.
IBN SINA TO GUIDE US
“There are no incurable diseases — only the lack of will.
There are no worthless herbs — only the lack of knowledge.” (Ibn Sina)
What would Ibn Sina (980-1037, also known as Avicenna), one of the greatest physicians in universal history, be doing today, were he to be among us and see the suffering of his fatherland? Ibn Sina would bring his great work, the Canon of Medicine (Al-Qanun fi’t-Tibb) up to date, which was the guiding star for medical practice in the Islamic world and Europe for 600 years.He would create new chapters for fields not yet discovered in his time, to incorporate all new knowledge and inventions which followed him in the last 1000 years.
Paid by the Emir, Ibn Sina himself never demanded money from his poor patients and considered curing them of disease enough of a reward. He would today most likely think that health care is the responsibility of the state, with the goal of universal health coverage for all people, no matter if rich or poor.
He developed the method of quarantine, to stop the spread of infectious diseases, and, centuries before Pasteur and microbiology, Ibn Sina understood the need for facilities for personal hygiene, and for disinfection to prevent the spread of germs.He worked on different antiseptic and antiinflammatory medicines.
His universal scientific capability was also honored by the greatest thinkers of the European Renaissance, for example by Nicolaus of Cusa, Dante Aligieri and Johannes Kepler. Afghanistan can revive this great scientific tradition of the Golden Islamic Age and reach the goal to create a modern health system. Its reconstruction will be a rallying point around which many more skills can be developed.
To be able to construct a hospital network in Afghanistan, it will be necessary to coordinate providing the supply and treatment of water, the supply of electricity and the education of advanced technicians to support all the functions in the clinics. Further, in the near future, there must be new industries for other vital supplies, foremost, a pharmaceutical industry to supply medical drugs inside of Afghanistan.
EMERGENCY ACTION
The World Food Program Afghanistan Situation Report No. 31 October 2022 estimates that humanitarian aid—food, medicine, fuel, shelter, safe water, “livelihood” assistance—is necessary for 25 million people in Afghanistan, more than half of the population of 40 million. Of this total, 18.9 million are acutely “food insecure,” and of those some 6 million are in emergency need.
The UN requested $4.4 billion in March 2022 for the supply of humanitarian and medical aid to Afghanistan for the year, and as of August, only $1.8 billion had been received so far. There must be a scale up of the volume of medical and health care material supplied, ideally with bilateral agreements to provide medicines, vaccines, water decontamination equipment, nutritious food, fuel of all sorts, and a scheme for knowledge sharing with other doctors worldwide.
This situation demands emergency action on the part of the world community. There is no future health improvement possible without meeting all life-and-death needs on an emergency basis.
Before summarizing what interventions are necessary, it must be stated that this crisis situation was not only foreseeable, but deliberately furthered, when the U.S. and NATO exited the nation, then took measures to subvert the functioning of the country, by seizing $9 million of the nation’s assets needed for running the banking system. Sanctions and other hostilities were perpetrated.
Over the coming months, every aspect of the existing provision of emergency medical, health care, food and humanitarian aid generally must be continued, and expanded, to fully meet the emergency needs. The United States should immediately stop its sanctioning policy and release the funds it seized, which assets are owned by Afghanistan. For food, the World Food Program’s deployment throughout the country must have the resources needed for supplies in the winter months, and agriculture support for spring planting. The food distribution network is described in the agriculture section of this program.
For medical treatment, supplies and emergency staffing need to be expanded through the ad hoc network of the remaining hospitals in the nation, including the five operated by Doctors without Borders, hospitals funded in western Afghanistan by Turkmenistan, the Indira Ghandi Children’s Hospital in Kabul and other such institutions, including wherever there are still viable facilities from the prior 2300 clinics run under the World Bank-funded Sehatmandi project of for-profit, subcontracted services, which was due to have its funding cancelled June 2022 by the World Bank.
For additional medical facilities, all options must be activated. Military-style, “field” hospitals and clinics can be set up, for example, potentially in conjunction with where the WFP operates its warehouses for the logistics it runs for the UN Humanitarian Air Service. These depots are in Fayzabad, Kabul, Kandahar, Kunduz, Herat, Jalalabad, Mazar-i-Sharif, Bamyan and Maymana.
For saving children, all special measures must be taken. The most affected by today’s crisis are the children, of which 41% are hampered in their growth and development. Too many of them are so malnourished, they are dying, because no help is provided. Hunger lowers the innate immune response and makes its victims susceptible to serious complications and even death in combination with other diseases.
For combating infectious diseases, all means—from vaccines, to temporary safe water and hygiene arrangements, to pesticides, as well as nutrition supplements, etc. —must be taken. The range of expected and infectious and parasitic disease continue their spread, along with COVID19 —malaria, dengue, tuberculosis, measles, and others. For example, measles is in all 34 provinces. A special effort to eradicate polio should be supported by all, Pakistan and Afghanistan being the last countries where the virus is rampant.
The leading causes of sickness among all age groups are ARI (Acute Respiratory Infection,) and ADD (Acute Diarrheal Disease) across the country. Cholera/AWD (Acute Watery Diarrhea) is endemic,. The death toll from this among children is high.
It is the moral duty of the west to unfreeze the sovereign wealth of Afghanistan that would help to finance imports of health care and food supplies. But the likelihood seems small, so there should be an alliance of friendly neighborly states who could provide the funds for such purchases. Where possible, NGOs as middlemen for donors should be avoided and the representative of the people, the government, should organize the delivery and distribution of materials.
Exemplary of this has been the functioning of the Red Cross and the Red Crescent Societies, and also the Organization for Islamic Cooperation, which on Nov. 13, 2022 opened an office building in Kabul, to further humanitarian and economic assistance.
Pledges from six neighboring countries (Iran, Turkmenistan, Uzbekistan, Tajikistan, Pakistan and China) were made at the March 2022 meeting in Tunxi, Anhui Province, China, and “Humanitarian Assistance” was the title of the first category of the total of 72 points listed in the April 1 “Tunxi Initiative of the Neighboring Countries of Afghanistan on Supporting Economic Reconstruction In and Practical Cooperation with Afghanistan.” The first two points of the document state: “China will speed up delivering its commitment of providing Afghanistan with emergency humanitarian assistance such as food, winter supplies, COVID-19 vaccines, and medical equipment, and is ready to provide additional humanitarian assistance through bilateral and multilateral channels… [China] will support the operation of Afghanistan’s medical and health systems….” Specific pledges were also made by Iran, Pakistan, Turkmenistan, Uzbekistan and Tajikistan, and also, through representation, pledges are specified in the Tunxi Initiative from Russia and from the Organization of Islamic Cooperation. For example, the OIC is working with the World Health Organization on getting in vaccine supplies of all kinds to Afghanistan.
Most significantly, in the Tunxi Initiative, the OIC pledges, that the “OIC General Secretariat, together with Islamic Development Bank and the Humanitarian Trust Fund, to devise a roadmap in concert with UN system organizations, for unlocking banking and financial channels.”
IBN SINA BRIGADE
In the midst of today’s hardship and crisis, having the approach of an Ibn Sina Brigade is the way to succeed, especially under makeshift conditions, while the full capacities of nationwide public health and medical treatment systems are being built. The mobilization of the human spirit as well as human action is critical.
A top priority is to start training physicians. Statistically, Afghanistan barely has 0.3 doctors per 1000 people. For reference, contrast this with Uzbekistan at 2.37, or Cuba at over 5 physicians per 1000 residents. This calls for setting up large education centers as Ibn Sina Medical Schools in selected cities, to train over the next decade, the thousands of new medical staff required. The same push for training applies to all other specialties, from nursing to diagnostic equipment technicians, bio-chemistry laboratory experts, and so on.
Note that the number of women trainees as physicians has increased over the past year in Afghanistan, to abide by strict sharia law, requiring that female, not male, doctors treat female patients.
Community health workers also need recruited and trained, under the banner of Ibn Sina. They can be organized to compensate for the lack of medical staff, which will continue a while longer. The goal is to integrate as many youth as possible in productive and beneficial occupations, to both get educated, and to serve the public through their work in the health sector. They can work for the government in various health services functions, while at the same time, continuing their own training. These health care worker teams are very suitable for serving and training as part of “clinic to clinic” partnerships and hospital exchange programs, formed between Afghanistan and healthcare centers all over the world. There are precedents for this from Boston, USA, to New Delhi, India. There should be regular nationwide radio broadcasts of sections from the Autobiography of Ibn Sina or other relevant works by him, to remind the population of their great heritage in the science of medicine, and to spark curiosity to learn more. This could be combined with relevant health information from the health ministry.
One can create a TV personality, speaking as Ibn Sina, who will educate the population about the basic facts of hygiene, and elaborating how he discovered many of them. He could explain how to recognize symptoms of common diseases, and what to do about it and which measures would help to prevent diseases and elaborate the benefits of healthy life. This all could be presented in an appealing story-telling way, to grab the attention of all age groups.
This Ibn Sina Brigade is especially needed to help to perform various jobs connected with water filtration and decontamination to do everything possible to reduce water-borne diseases like typhoid fever, cholera, giardia, dysentery, Escherichia coli and salmonella.
It is reported that more than 67 per cent of Afghans have clean drinking water through “improved drinking water sources” that are protected from outside contamination – a marked progress from a decade ago when drinking water reached only 20 per cent of people. However, although a little more than 80 per cent of families have toilets or latrines, only about 43 per cent are improved and safe – meaning capable of hygienically separating human waste from human contact. So the problem remains.
Open defecation continues to be a dangerous challenge in Afghanistan because human waste near waterways and living environments spreads diseases quickly and puts children and their families at risk.
A war-like effort to mobilize all necessary resources to create a safe water supply for all people through water pumping, diversion and treatment, e.g. (gravity) filtration combined with water chlorination, is a benefit for society and develops skills of the younger generation at the same time. The construction materials for this effort could hopefully be obtained from donor countries. Youth teams can also be trained to do monitoring, and find potential sources of fresh water contamination. Community health workers can also help with contact tracing in situations of infectious disease outbreaks.
One big concern is the treatment of heroin addicted people, caused by the despair of conditions imposed on the nation for decades, and presence of drugs. Up to 10 percent of the population is addicted to opium and increasingly to methamphetamine. All of them must be safely freed from addiction and reintegrated into society. Ways can be found to make them part of the labor force as fast as possible, so they can overcome addiction, and gain a long term perspective with good prospects.
The complete eradication of opium poppy production and drug use in Afghanistan is in the immediate, direct interest of all nations in the region.
LAUNCH INFRASTRUCTURE FOR MODERN HEALTH CARE
The long term goal is a medical system of hospital-centered networks of doctors, clinics, and diagnostic and treatment capabilities of all kinds, as well as full-scale public health capacities— water treatment, sanitation, pest control, food safety and the like.
The basic metric is the number of modern-care hospital beds per thousand residents. In a region with decent infrastructure of all kinds, the recommended ratio of beds per thousand may be in the range of 2 to 5 (depending on transportation time to the facilities) for a desirable level of health care security. However, with today’s microbial threats until the economic breakdown is reversed, a ratio of 3 to 6 beds per thousand is better. The concept is to plan for the peak, of any disease outbreak or disaster. The World Health Organization at present, recommends 3 beds per thousand.
Afghanistan is way under half a bed per thousand. In 2017, the statistical estimate was the nation had 0.39 beds per thousand. For reference, Uzbekistan has 4.4 beds per thousand residents. This means that a building program needs to provide in the range of 25,000 modern-care hospital beds per thousand, to be achieved over the coming years, way up from the range of fewer than 16,000 in 2020.
This is obviously dependent on the industrialization and infrastructure build-up of the whole nation. Even if some would say that anything like this is unthinkable for the short term, it must be seen nonetheless as the goalpost for the future development of the nation.
The way the hospital-centered system functions, is that the initial contact of a person is with a local doctor or nurse who is a general practitioner. If necessary, a referral is made to send the patient to a specialist person or treatment office. Then, and at any time in an emergency, there are emergency departments for immediate diagnosis and treatment. The hospital itself in the community will directly, or indirectly, be connected with research and training centers, to bring about the maximum clinical experience and front-edge analysis. Hospitals should be built in all provinces and districts to cover the whole nation, to avoid too long a travel time for treatment.
University clinics can be used as the connecting link of learning, teaching and practice, where the best doctors and scientists and their students are engaged in research and its application in treatment. Each of these universities can have fields of specialization, which can set new standards for the whole nation. The experience of local doctors and patients will be included in the research.
The long term target across the network of hospitals, clinics and access to physicians is a ratio of 4.5 doctors per 1000 inhabitants. Thus, the national training program under the banner of Ibn Sina must be launched and expanded as rapidly as possible.
This health care training can be combined with a universal science education. Afghanistan’s future hospitals will use magnetic resonance technology, X-Rays, ultrasound scanning and nuclear medicine. These diagnostics and treatments need well-educated professionals. Support from foreign countries for training and emergency treatment should be mobilized. Space Age Health Care.
Besides new treatments in medicine, there are exciting new breakthroughs in logistics, which can help bridge the gap to providing full service treatment before the build-out of health care infrastructure in completed. First, there is “teleconsultation.” Space programs were devised to answer the question, how do you take care of astronauts thousands of miles away from their doctor? Developing technologies to solve that problem have had immediate positive benefits for people staying on Earth.
Today, in several nations, where doctors are rare in the countryside, medical vans can be deployed to remote areas. On board are key medical instruments, especially basic imaging equipment, and internet technology to connect to specialists who are in medical centers in large urban areas?
Consulting a doctor that way will of course always be insufficient, but enough to identify emergencies that otherwise went unnoticed and undiagnosed until it was too late.
Another space spin-off is the use of drones for medical purposes. Six years ago in Rwanda, a country where hospitals are rare, and there are many accidents on the winding, bumpy roads, authorities signed a contract with Zipline, a San Francisco-based drone startup, to streamline blood deliveries. Zipline’s autonomous drones fly the blood from a distribution hub to the health care facility. The blood, contained within an IV bag, parachutes down in an insulated cardboard box, and the drone zips back to base.
Today, Zipline has two hubs in Rwanda; each can make up to 500 deliveries per day! Writing in the April 2022 issue of Lancet Global Health, a Rwandan doctor analyzed nearly 13,000 drone orders between 2017 and 2019 and found that half of the orders took 41 minutes or less to deliver by drone. On the road, that median time would be at least two hours. Reports of wasted blood donations dropped. The study was the first to analyze medical delivery in Africa by unmanned aerial vehicles. (Drone programs are more common in higher-income countries, where they are used to deliver medicine and defibrillators.) With Africa showing the way, Afghanistan certainly will find out how to make it work.
HEALTH AND ENERGY FLUX DENSITY
The foregoing review of what is needed to meet both the emergency and long-term health care needs of a nation, shows that a core requirement is having public infrastructure projects to defeat pathogens through safe water and sanitation for all people. This, in turn, necessitates the mobilization of all the productive resources of the nation, which are discussed in the other parts of this report.
The American economist Lyndon H. LaRouche, Jr. developed the concept of relative potential population density as a measurement of the productivity of an economy. There is a direct correlation between the amount, quality and organization of energy consumed by a given population and its life expectancy. It is through the increase in energy flux density, per capita and per square kilometer of national territory, through which the potential relative population density increases. This refers to the increase in the number of people which can be sustained on a given area of land.
To climb up the ladder of life expectancy requires the society to be accomplishing more physical work, as in the energy used in many ways to provide clean air, ample and safe food and water, and the means in the economy to produce many specific goods, such as pharmaceuticals, medical instruments, and many other results, including the joy of knowledge itself.
This is the way to health, seen through the eyes of Ibn Sina.