Fiona Gall is our project consultant
in Peshawar. This is her latest report.
GENERAL SITUATION
The general situation in Afghanistan could not have looked bleaker at the end of 2001 with fighting and bombing in many regions of the country and large numbers of refugees leaving the country because of lack of food as well as for safety reasons. The beginning of 2002, however, sees a new government installed, which has been internationally recognized, and there are promises of support from many countries. The question is no longer who will support Afghanistan but how will the money pledged be spent. Currently the international humanitarian community in consultation with the new government is drawing up a plan of reconstruction for the country and assessing the priorities. The new government has a daunting task ahead. At the Tokyo conference at the beginning of January, the Afghan Prime Minster, Hamid Karzai, mentioned that civil servants in Afghanistan had not been paid for the last six months and that government had no money to run the country, the government accounts in the National Bank had been emptied before the Taliban left Kabul.
Despite this it is most encouraging to see the voluntary return of many Afghan refugees to their homes, even though it is still winter. Some of these returnees are urban refugees returning to Kabul and other cities which are now peaceful. Others are from provinces, which are less affected by the drought. In contrast, there are still many internal refugees in the country, around the cities of Herat and Mazar, who are seeking humanitarian assistance because they have nothing left to eat in their villages.
The Afghan Diaspora, headed by the ex-King, Zahir Shah has also declared interest in returning to help with the reconstruction of the country. Many Afghans who have emigrated to the West during the last 20 years have acquired professional and business expertise, which they can now offer their country.
The future of the country is much more promising than four months ago but security is still poor in many areas outside the main cities and this is impeding the flow of aid to those in need.
UPDATE ON SGAA PROGRAMME ACTIVITIES
Jalalabad
SGAA continued its activities in Jalalabad throughout the war and bombardment in the Eastern region which carried on between September and December 2001. The major difficulty for our Afghan staff was crossing the border into Pakistan to visit their families as the border is now closed for all Afghans. In mid-December after the Eid holidays SGAA activities recommenced completely staff moved their families back to their homes in Jalalabad in December when our activities reopened after the EID holiday and with the arrival of the new authorities. More patients have started to visit our outpatient clinics in January as security conditions improved and public transport between the villages and towns recommenced. One major problem for our patients who come from the camps in Pakistan to be treated in Afghanistan is that they cannot cross the border back into Pakistan. The border has been closed by the Pakistan government since the beginning of the war to discourage the flow of refugees and prevent terrorists from the al-Qaeda network entering Pakistan. In fact this has greatly hampered the work of NGOs because their Afghan staff who work in Afghanistan need to come back to Pakistan for official work and no longer have permission to do so. Most therefore have to enter Pakistan illegally by taking smugglers routes.
In mid-January SGAA held entrance examinations for women and men candidates for physiotherapy. 16-20 candidates were selected for a three year training which will start in March in Jalalabad with trainers from SGAA's senior physiotherapist staff and local medical staff. The graduates will be expected to work in different hospitals and centres in the Eastern Region of Afghanistan once the training is completed.
Kabul
SGAA has a physiotherapy programme for women and children in the Kabul region based in the north of the city. This programme started in June 2001 and continued throughout the war despite the dangers. Since the departure of the Taliban restrictions on the separation of men and women have eased. Now our female physiotherapists can discuss their patients with male doctors and other male professionals. They are free to move around in the community and do outreach work. This makes it much easier to follow the progress of patients by visiting them in their homes.
FUTURE PLANS
At the end of February 2002 SGAA will hold a two-day workshop for agencies working for the disabled in Afghanistan in order to assess the needs of the disabled in Afghanistan and to plan training courses for new Afghan physiotherapists and orthopaedic technicians.
PUBLICATIONS
SGAA has published a report on the Probable Causes of Childhood Disabilities in Eastern Afghanistan with funding from UNICEF Afghanistan. This survey highlights the inadequate ante-natal clinics and neo-natal facilities in obstetric wards and the risk of children under five suffering delayed mental and physical development as a result of malnutrition and hypothermia.
The survey is available from: SGAA, PO Box 145, Tonbridge, TN11 8SA, Kent, UK.
A BRIEF HISTORY OF THE CHARITY
INTRODUCTION
Working inside Afghanistan has made SGAA more aware that the needs of the disabled Afghan population have increased - not declined - over the past decade. Initially the majority of patients were war-related casualties including mine-blast injuries and children suffering post-polio paralysis from the refugee camps. Today SGAA helps a wide variety of patients including children suffering from the effects of polio, cerebral palsy and congenital defects such as club foot, defects of the hip and spine and tuberculosis of the spine. Women patients suffer from orthopaedic problems such as osteo-arthritis, rheumatoid arthritis, fractures and soft tissue injuries and neurological complaints.
Since early 1998 a Community Outreach Programme has been established in Ghani Khel, 40 kilometres from Jalalabad, with the help of HealthNet International and UNICEF. This programme provides physiotherapy services to the local hospital and outlying clinics as well as health education and disability training to local health workers and Traditional Birth Attendants (TBAs). This much needed Outreach Programme has since been extended to eight districts in eastern Nangarhar and it is hoped to start a new clinics in Kunar Province in 2002. An SGAA physiotherapy unit is now serving the hospital run by Aide Medicale Internationale in Mehtarlam in the province of Laghman.
MANAGEMENT STRUCTURE
SGAA is run by a Committee of Trustees based in the UK who meet every six weeks to make decisions on policy matters and review reports from the field. The Trustees have considerable knowledge and experience of Afghanistan and/or of disabilty and three of them regularly travel as consultants to upgrade the standards of treatment at the orthopaedic centre, while the Chairman and UK Director go once or twice a year to meet donors and ensure that the work of the Afghan staff is maintained to internationally acceptable standards - no easy task given the difficulties in Afghanistan, but which we believe we have been able to achieve. The charity is run on a voluntary basis from the Chairman's home, so costs are kept to a minimum. The Chairman, Director and Trustees give their services gratis. In the UK, only Mrs Christine Anderson, part-time secretary and Mrs Jackie Wray, charity accountant, receive payment.
The Trustees and Members of our Committee are:
Mrs Paddie Chanmugam, Senior Physiotherapist
Mr Winston Churchill, ex-MP
Mrs Eleanor Gall, UK Director
Mr Sandy Gall, CBE, Chairman
Mr John Fixsen, FRCS, Paediatric Orthopaedic Surgeon
Mr John Lamb MBE, Principal Orthotist of Perth Royal Infirmary
Mr Mark Scrase-Dickins, CMG, former diplomat
Mrs Diane Steer, Midwife
Mr Peter Stiles, FRCS, Orthopaedic Surgeon
Total Afghan staff now number 75, with 2 Pakistanis manning the office in Peshawar and one British expatriate part-time consultant supervising operations from Peshawar.
FUNDING
SGAA would like to express their gratitude to the following organisations which have made generous grants in the past: Independent TV companies in the UK, the ODA (now DFID), DFID, the Karim Rida Said Foundation, WHO, UNHCR, Toyota, Rotary and the Inner Wheel, the States of Jersey Overseas Aid Committee, the Headley Trust, the Dulverton Trust, the Bernard Sunley Trust, B.A.T., the Clover Trust, the Clothworkers' Foundation, the Newby Trust, the European Union, Norwegian Church Aid, UNICEF, the Telegraph Diana Memorial Fund, the Eagle Charity Trust and to many private individuals.
Most of all SGAA is grateful to The Diana, Princess of Wales Memorial Fund for their current generous funding which will continue until the autumn of 2003.
PROGRAMME ACTIVITIES
Prosthetics: we continue to make and repair artificial legs for victims of mine-blasts and other war injuries. The legs are made of polypropylene plastic and wood and the feet are made of rubber - each one is cast and manufactured by our Afghan technicians.
Orthotics: we make appliances for patients suffering from post-polio paralysis, cerebral palsy, peripheral nerve injuries, burns, paraplegia, strokes and spinal and hip deformities. Some of them require calipers and leg braces, some need corsets and spinal jackets, and some mobility aids such as walking frames, seating chairs and wheelchairs. There is no comparable service elsewhere in eastern Afghanistan, and patients come from the refugee camps in Pakistan as well.
Physiotherapy: we treat a wide variety of patients - from those with lifelong disabilities to those temporarily incapacitated after an accident or an illness. All new patients are initially assessed at the physiotherapy department and then referred on, to the local hospital for corrective surgery if necessary and to our orthopaedic workshop. The outreach programme enables the physiotherapists to work in basic health clinics in rural areas and identify patients who can benefit from physiotherapy treatment.
Disability Awareness: our health educators teach patients, their families and other health staff including traditional birth attendants (TBAs) about disability awareness. In this way disabilities can be prevented through understanding of hygiene in the home and the importance of vaccination. Children with disabilities can also be identified earlier. A good example is the problem of club foot, which TBAs can easily identify and refer to SGAA for plaster casts when the baby is only a few weeks old. If this deformity is not treated then, corrective surgery is necessary.
Training Programmes: Traditionally Afghanistan has had little knowledge of the importance of physiotherapy services and physiotherapists have been confined to a few hospitals in the major cities. Since 1988 SGAA has trained more than 70 physiotherapists and physiotherapist assistants who now work in community-based rehabilitation centres all over Afghanistan and in the refugee villages in Pakistan. Apart from our own technical consultants, international experts such as Brian Edwards from Australia visit the project regularly and organise seminars and workshops for the staff. Three senior SGAA technicians are currently taking a part-time BSc in orthopaedic technology at Peshawar University in Pakistan. Lastly, SGAA has started a child-to-child programme of health education in three schools in Jalalabad - to the delight of both mothers and their young.