Kabul field work visit 2016

In the coming updates, we will give you a personal look into our journey to Kabul, Afghanistan.
Each time one of the group members will tell his or her story about one of the aspects of our trip.
We will tell you about all the activities we undertook and give a glimpse of each person’s personal view.

Part 1. Arrival and first impressions

From rain to dust

After a transfer in Istanbul we arrived early in the morning in the capital of Afghanistan, Kabul.
In my memory it was a warm and dry place, but that image went quickly down the drain.
It was raining in Kabul and it was chill.
Of course we’re used to rain in the Netherlands, but this was unexpected.

At the airport we were welcomed by our families. After reclaiming our luggages we separated and had the day off.
The next impression was that of the chaotic traffic in Kabul. The roads are not only crowded with cars, motorcycles, bicycles and pedestrians crossing the street wherever they like; the rain created water pools on the streets! Some daredevils didn’t let the water stop them, others were more careful.

It was obvious, traffic and rain didn’t go well together. Thankfully the weather improved over the next days.
After a few days of sun, all the water had evaporated. Now the dust rose from the earth. This was the Afghanistan I remembered.

The next day we met at the entrance of the Kabul Medical University (KMU). The gate was guarded by men with machine guns, who were controlling all students and their IDs. As I learned, many buildings like this and also fancy restaurants, were guarded.
This was a reminder of all the wars and turmoil Afghanistan has been through. Although it was peaceful, there was a faint sense of a palpable threat.

About me
– name: Siamak Zahmat
– occupation: general practitioner in training
– joined MCAN in 2012
– board member PR
– why Afghanistan: for me this journey was extra special! Not only because I could help with the UpToDate project and represent MCAN; but also because I returned after more than 20 years! The long wait was over!

Part 2. Presentation UpToDate project

Sharing up-to-date knowledge!

On Sunday the 3rd of April, we got to attend the ceremony of the opening of the Academic Year of the KMU.The dean of the faculty, professor Shirin Agha Zarif, took the stage and welcomed the staff, the invited students, and the media.
The Deputy Minister of Higher education, mister Baburi, addressed the current state of health and the challenges Afghanistan will face in the coming years. He was happy to see diaspora returning to Afghanistan with projects like UpToDate.

Safir Zewari, our chairman, introduced MCAN to everyone. Why was MCAN founded? What are our goals? And how do we want to achieve them? His passionate words were inspiring and moved us all.

To elaborate more about our current UpToDate project, Zahir Zomra, MCAN board member and general practitioner, introduced himself. He has studied and practiced medicine both in Afghanistan and in the Netherlands, and thus he acts as the perfect bridge between the two countries.
He explained thoroughly what the project entails and about the benefits of using the online medical database. UpToDate is an online tool: readily accessible, evidence-based and as the name implies up-to-date! There is no longer any need for big, expensive, outdated medical books!

To wrap up our presentation, I gave a few clinical examples of how to use UpToDate. Unfortunately the internet connection of the KMU was troublesome and we couldn’t show the whole product. Nevertheless the reactions were positive and everyone was enthusiastic and eager to use the product.

Presenting and teaching UpToDate in Dari, my native language, proved to be quite difficult, but at the same time also very exciting. I’d expected to use more English or Dutch words, but with a little help from my MCAN friends and a good preparation, I succeeded. As I repeated the presentation more and more during the workshops the next days, it felt more natural.

About me:
– name: Khoshal Khorami
– occupation: assistant Neurology
– general board member of MCAN
– why Afghanistan: not only because I’m an Afghan myself, but also because I realize that after decades of war, Afghanistan as a country is in dire need of (international) attention and support

Part 3. UpToDate training sessions

After the general presentation about UpToDate and introduction of MCAN on the first day of the academic year at Kabul Medical University (KMU), we had planned training sessions for the following days.

During these sessions, we showed medical and dental students how to use of UpToDate. Each class had one hour to practice with UpToDate. Our colleague, Khoshal Kharami, started with a presentation about the use and features of UpToDate. What’s the best way to approach a clinical question? And how is each topic constructed?
UpToDate has a separate product for Drug Interactions, called Lexicomp. This is a somewhat unknown feature which could be very useful in patients with multiple medications.
Hereafter, the students got the opportunity to practice with UpToDate by answering clinical questions that we had come up with. Our team was present and coaching the students whenever they needed some help. At the end, some clinical questions were shown as examples and were discussed in more detail.

Even though KMU does not have the optimal facilities, we are used here in Europe; I found the students very enthusiastic and motivated to learn about a new tool such as UpToDate. The response was great; we had classes of more than 80 students per session and sometimes up to eight students had to share one computer!

Besides enquiring about UpToDate, students showed a great interest in MCAN as well; they wanted to know more about our activities and our possibilities to help them with their needs as students. I found these conversations very enlightening as it gives insight into what students cope with and what their needs are.

In order to motivate the students for attending the sessions and working with UpToDate, we provided them with certificates.

Furthermore, to continue the training sessions after our return to the Netherlands, we trained a group of young students (Jawanan-e-Fahal), who are now able to train the upcoming students. This is a great way to pay it forward.

About me:
– name: Razma Paykardjoe
– occupation: medical student
– function at MCAN: secretary
– why Afghanistan: Working far away on a project is interesting, but initiating a project in Afghanistan is exciting and at the same time challenging. I revisited Kabul after eight years and was excited to experience and actually get to know about KMU and its students. I think these experiences make you understand the situation in Afghanistan better which may result in better collaboration.

Part 4. The future of UpToDate

‘A winner is a dreamer that never gives up’ – Nelson Mandela.

In the previous parts you can read how we started the journey and what we have experienced during our stay in Kabul till day 3. Looking back, many thought it was impossible to achieve this project. Fortunately, after years of hard work with many struggles we achieved what seemed impossible. We proved that dedication and a never give up mentality of a strong team is the key to success. The implementation of UpToDate at KMU was a fact in April 2016. Our project got a lot of attention from the (inter)national Afghan media and this project became a signal of hope for the medical education in Afghanistan. This inspired us more and although we had very little time, we didn’t want the project to fail because of organizational issues.

By day 3 we had a good impression of what needed our attention the most. Although a lot of progress is made at KMU, the facilities are still far from optimal. Nevertheless, it was inspiring to see people doing their utmost to make the best out of the situation. Some shortcomings needed to be addressed in order to ensure the sustainability of a project like UpToDate. That is why we had several meetings.

This was an additional task for our team, so the group split in two. Safir Zewari, Zahir Zomra and I were going up and down to the meetings. While the rest of the group gave lecture and practical workgroups, for the groups of more than 80 people each. But we had to do it, so we managed.
First, in order to ensure that students and teachers use UpToDate optimally we came to an agreement with Prof. dr. Zarif (dean of KMU) to include a few questions related to UpToDate in their exams at the end of the year. Second, there were issues with connectivity and speed of the internet at KMU. The head of technical division pointed out that KMU had certain amount of Internet speed appointed from the Ministry of Higher Education. By giving everyone access to the KMU network, the speed would significantly slow down to a not preferable level.

In order to issue these problems and also discuss the future of UpToDate, the three of us together with the dean of KMU had a short meeting with the MoHE, Ms. Dr. Farida Momand. I found it personally very inspiring to see a woman as minister in a nation that is still terrorized by extremists. She knows that by doing her work she is a direct target, and still she stands for what she believes in.
In this short meeting we discussed the future of UpToDate. She agreed for a more close collaboration with KMU. The minister also promised to look at the internet connectivity problem at KMU. Unfortunately, we did not get a clear answer about the future financing of UpToDate. We find it important that such projects will be financed from internal resources in the future.

So, it began as a dream and now its implementation is a reality at the KMU. Implementation is underscored because we still need all the help we can get. We need to finance the coming years and give medical students at KMU access to the same level of knowledge that we have in the Netherlands.

We won’t give up dreaming! Feel free to join our dream!

About me:
– name: Hogaei Oriakheil
– occupation: resident internal medicine at the University Medical Centre of Utrecht and master in health economics
– function at MCAN: vice-chairman
– why Afghanistan: as a doctor, I believe that everybody should have access to proper medical care. The latest research has shown that Afghans spend billions of dollars for medical care in neighboring countries. I would like to see that Afghans get the best possible care in their own country. To achieve this, I believe that contributing to sustainable medical education is essential.

Part 5. Project Eyewear

In the eye of the beholder

Alongside the UpToDate project, there were some other smaller projects. One of these projects was project Eyewear, aimed at providing the destitute and underprivileged people of Afghanistan with eye glasses. Around 1200 second-hand eyes glasses were collected as donations from opticians. Together with 3 devices for measuring the eye glasses, the glasses were sealed in cases and stored in big boxes for transport. Shipping these boxes to Kabul independently proved to be too expensive. That’s why we decided to wait for the opportunity to bring them to Kabul ourselves, as part of our luggage that is.

Upon arrival at the airport in Kabul, the Afghan customs were not cooperative. We had the paperwork ready, but the head of the department was not present since it was a holiday. Gladly, the next day we managed to get the boxes back from customs and we could continue our project.
A few days later we had a meeting with dr. Said Nazir Miri and other members of the AEDS (Afghanistan Eye Doctors Society). They welcomed us happily and appreciated our efforts. Furthermore they told us about their situation and their lack of proper diagnostic equipment. Of course, we introduced ourselves as well, and told about our goals and projects. We hope to work together more often in the future, and look for demand-driven projects. But for now, this was a one-off project.

I would also like to share with you my personal perspective on the MCAN UpToDate trip.
In the past I’ve travelled occasionally to Afghanistan, bringing medicine and helping local people by myself.

Going together with five other MCAN members was special, for several reasons.
The UpToDate project is a large scale project, which can help many students and teachers. They may, in turn, use their acquired knowledge to help their patients.
A team of six members raises attention and makes a lasting impression. Besides that, it was also remarkable to see my younger team members, who have been raised and educated in the Netherlands, return to their roots. The Afghan students were surprised and uplifted by seeing people from their own generation reaching out. Their response was enthusiastic and exceeded my expectations.

Finally, seeing the Afghans students up close, being able to compare their situation with ours, hearing about their trials and tribulations; showed us the true meaning of our project. Working in the field can truly be an eye-opener!

About me:
– name: Zahir Zomra
– occupation: general practitioner, general practice in Spijkenisse, Netherlands
– general board member MCAN
– why Afghanistan: I’ve studied medicine in Kabul myself and therefore I feel a strong connection and obligation to help the poor people of Afghanistan. It’s my call of duty.

Part 6.
Final days and initiation of a new project: E-learning Surgery

As the days passed in Kabul and project UpToDate seemed to have a great impact, we also discussed a new project with our colleagues at KMU. A workgroup within MCAN had thoroughly investigated the
possibilities and prepared a proposal for this new project. As all our projects require to be demand driven, we had the task to discuss this proposal with the staff of KMU (especially the staff at Department of Surgery). In order to introduce this project, we were given the opportunity to present this idea to the surgeons of Aliabad hospital (affiliated teaching hospital of KMU).

I had the honor to introduce the idea of learning surgical procedures through a step-by-step (video) guide with 3D glasses. For this project we cooperate with Incision Academy. They have developed a web based tool which learns surgical skills to surgeons and surgeons in training. We received many enthusiastic reactions from the staff after the presentation. There is certainly a need for such an instrument to improve surgical skills. At the same time some concerns were addressed, mainly technical issues such as the internet connection. The internet speed at the site of the hospital seemed to be insufficient to stream 3D videos. This problem was discussed with the authorities at KMU and arrangements were underway to boost the internet speed in the near future. We also agreed to discuss this issue with Incision Academy in order to find a solution.

The next day we had a meeting with dr. Samad Omar, surgeon and teacher at KMU, who became our contact for this project in Kabul. During this meeting we discussed the project in more detail. Together with dr. Samad Omar we deciced on the top 10 of most useful surgical procedures from the available training guides. Agreements were made concerning a trial period, to evaluate whether this tool is beneficial in training surgeons at KMU. Currently, MCAN is preparing the arrangements for the start of this project. Keep following our website and Facebook page for the latest updates.

As we returned to the Netherlands I felt very proud to be part of a team which works with such a dedication and commitment to achieve projects like UpToDate. All members had a very positive and unique role in the implementation of UpToDate. I would like to thank all members of MCAN and hope that this is the first step to a lot more!

About me:
– name: Safir Zewari
– occupation: PhD candidate, MD at department of Pulmonology, Rijnstate hospital Arnhem
– Chairman of MCAN
– why Afghanistan: In my opinion, all physicians around the globe deserve to have the same access to medical knowledge and all patients deserve to get the most updated care no matter where they live. Unfortunately Afghanistan has suffered a lot in the past decades. I feel it as a responsibility and honor to contribute in the rebuilding of my native country. Sharing knowledge is one of the most powerful tools to help rebuild a nation and that is why I enjoy being a part of MCAN.

‘Education is the most powerful weapon which you can use to change the world.’’
Nelson Mandela

A strong team of five doctors and one medical student are in Kabul (Afghanistan) for the implementation of UpToDate, an online medical knowledge source; at the Kabul Medical University (KMU). It will be used by more than 2.500 medical students and medical teachers at the KMU.

MCAN works demand driven and we hope to provide them with the resources to provide the best care for their patient.

TOLO news, at 17 min, about the importance of the UpToDate project for the KMU:

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