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An eye surgeon battles blindness and ignorance in Afghanistan
An Afghan ophthalmic center survived war and Taliban rule, and now seeks aid for equipment to treat its patients.
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MAZAR-I-SHARIF, Afghanistan — The Mazar Ophthalmic Center is located on a dusty, unmarked street behind high adobe walls in the northern Afghan city of Mazar-i-Sharif. Setting the center apart from every other health care facility and relief agency in the city is the absence of armed guards flanking the entrance. Instead, there is a sign bearing a silhouette of a Kalashnikov automatic rifle with a red “X” painted through it.
I came across the Mazar Ophthalmic Center in late March 2002, while shooting footage for a documentary on Afghanistan after the fall of the Taliban. By this time the U.S. bombing campaign was winding down and the defeat of Al Qaeda and Taliban forces was largely complete, but the task of transforming Afghanistan into the peaceful democracy envisioned by President Bush was in its infancy.
Toyota land cruisers bristling with soldiers toting Kalashnikovs, rocket launchers and heavy caliber machine guns were as omnipresent in Mazar as yellow cabs in Times Square. Reports of the looting of relief agencies and hospitals were commonplace. On the day I spotted the clinic’s “No Kalashnikov” sign I took pause. In the militaristic climate of post-Taliban Mazar, the sign was a statement of both political and personal bravery.
The center’s wizened gatekeeper assumed I was a visiting eye surgeon and hustled me inside the compound to meet the clinic’s director and founder, 41-year-old A. Zia Aamoon, MD. Laughing, Dr. Zia apologized for the misunderstanding and invited me to tour the facility.
The center consists of three modest cinderblock buildings (housing a pharmacy, a diagnostic area and an operating/postop recovery center) that form a horseshoe around a courtyard of flowers and almond trees. In the courtyard, turbaned men and burkha-clad women cooled themselves in the shade and patiently waited for their number to be called to go into the examining area.
Dr. Zia introduced me to his pharmacist, a woman, and I was again taken aback. She was unveiled and dressed in western clothes. After weeks of seeing only men’s faces, the sight of an Afghan woman’s face was startling. Over the next week, I returned to the center several times, filming surgeries, accompanying the surgeons on their postop rounds and conducting long interviews with Dr. Zia. I was curious to learn how Dr. Zia was able to carve out this oasis of health, modernity and peace in a nation wracked by poverty, lawlessness and war. Following are excerpts from our conversations:
Ocular Surgery News: When did this center open?
Dr. Zia: We opened in 1994, 4 years before the Taliban came to power in Mazar. I was given a grant to start this ophthalmic center by the Christoffel Blindenmission, a German nongovernmental organization. There was no eye care facility in all of northern Afghanistan at the time and, to this day, we remain the only eye care facility in the North. Since we have opened we have provided eye care to more than 134,000 patients.
OSN: How big is your facility?
Dr. Zia: We have 35 beds and a staff of 14, including four surgeons, two nurses and two techs. But that is not enough. Most days we examine and diagnose close to 100 patients. We perform surgery twice a week and on each surgery day we average 30 surgeries. Our schedule is overwhelming, but we work every day so we somehow manage.
OSN: What surgeries are most common?
Dr. Zia: Glaucoma surgery is very common. In this region of Afghanistan we have many people from the Turkman and Uzbek ethnic groups. People of this ethnicity have shallow anterior chambers, so they are more prone to glaucoma. We also do approximately 700 IOL implantations a year and many intracapsular and extracapsular surgeries, including extracapsular cataract extraction with lens implantation. Most of the rest of our surgeries are retinal detachments and for trauma injuries from land mines or other combat injuries.
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OSN: What is your yearly budget?
Dr. Zia: Our budget is US$80,000 per year. We get about $40,000 from NGO grants, and we get $40,000 from the patients themselves. Although we have a free fund, we do charge most patients.
OSN: $80,000 seems incredibly low for your annual budget.
Dr. Zia: Yes, but of course our costs are much lower here. Our highest-paid surgeon makes only $160 per month. Additionally, some of our supplies, like our lens implants, are provided by NGOs. This makes for a very low cost per surgery. We charge our patients $4 for trichiasis surgery, Glaucoma surgery is $5 and our most expensive surgery, intracapsular cataract extraction with lens implantation, is only $33.
OSN: Still, you see more than 20,000 patients a year!
Dr. Zia: Yes, and we do more then 2,500 surgeries per year. We also have a mobile team, publish a newsletter, produce a radio show…
OSN: Let’s start with the newsletter and the radio show.
Dr. Zia: We try to educate the public on ways to prevent blindness. Afghanistan has a very high incidence of blindness. At a recent U.N. health conference I heard a speaker say we have an incidence of blindness of 3.1% of the population over 40 years old. Our newsletter gives advice about everything from hygiene to diet to how to spot a mine in an effort to bring this rate down. Our radio show also discusses these matters. Additionally, we are trying to establish Afghanistan’s first association of ophthalmic health care providers. We hope to hold conferences and establish a national blindness prevention program.
OSN: Now tell me about your mobile team.
Dr. Zia: We created a mobile team that we try to send out at least five times a year. Each team comes with a doctor, nurse, administration officer and a technician. We travel to rural parts of Afghanistan where people are too poor to come to the city for treatment. The mobile team is responsible for approximately 1,000 surgeries every year and nearly all these surgeries we do for free. Unfortunately, we have not sent a team out for a while because we lost our vehicles to the Taliban. This spring will be our first mobile team in 2 years.
OSN: Did your hospital remain open under the rule of the Taliban?
Dr. Zia: Yes, but things were very difficult for us. A mullah was assigned to our hospital by the Taliban. This man was supposed to provide us with governmental support but instead he just used our center to line his pocket. On a given day I would arrive to find he had taken our computers or plundered our safe. This man stole $8,000 from our safe and said it was a “tax.” He even stole medical supplies.
OSN: And your vehicles…
Dr. Zia: We had three vehicles and he took them all. We would see one of our jeeps being driven around by his friend. Then, after the defeat of the Taliban, this same vehicle was taken as war booty by General Dostum (a commander in the Northern Alliance) and is now in the possession of his security chief.
OSN: The vehicle is still in Mazar?
Dr. Zia: Yes, I see it nearly every day. But it is in the possession of the soldiers so there is nothing we can do. But we should be able to purchase a new vehicle soon and I am hopeful we will have a mobile team going out to the rural provinces by late spring.
OSN: Did the Taliban ever harm your staff?
Dr. Zia: Yes. We suffered in many ways. When the Taliban first took power they arrested nearly every young man in the city and many of us on the staff lost loved ones. The religious police would harass us because we were partially funded by a Christian NGO. They even once beat a female surgeon for doing her rounds in the men’s ward. Two of our techs were arrested and thrown in jail for days because their beards were too short. These atrocities occurred on a daily basis. It was a very sad time for our entire city. Things are not perfect now, but much better since the Taliban have been defeated.
OSN: Is there anything you would like me to try to get for your hospital when I return to the United States?
Dr. Zia: Yes, we need a laser for photocoagulation — an argon or YAG laser. Unfortunately, there is no laser like this in all of Afghanistan. Many people have diabetic retinopathy and they need this laser treatment to prevent blindness. Right now we can only suggest eye hospitals in Pakistan, and most of our patients are unable to make such a far journey. I think with this laser we could save hundreds of people’s sight per year. These lasers are not terribly expensive, $30,000 to $50,000, but our budget is so small a purchase like this would bankrupt us.
OSN: What are your hopes for the future?
Dr. Zia: I hope the government of President Karzai will succeed in bringing peace and democracy to Afghanistan. I hope this very much. And I hope we will soon have a laser.
A note from the editors:
If you are interested in making a tax-deductible donation to the Mazar Ophthalmic Center’s laser fund, please contact Knightsbridge International (a tax-exempt nonprofit corporation). Knightsbridge director Sir Edward Artis has established a special fund specifically for the purchase and personal delivery of an argon laser to Dr. Zia. For more information, or if you are an ophthalmologist and wish to visit the Mazar Ophthalmic Center, please contact the author at ethanmci@aol.com or at (310) 383-6955, or go to the Knightsbridge Web site at www.kbi.org.
For Your Information:
- Dr. A. Zia Aamoon, of Balkh University, Mazar-i-Sharif, Afghanistan, can be reached by writing Doctor Zia, MOC, C/O IAM Office, PO Box 1167, Peshawar, Pakistan.