An Afghan doctors restless sense of mission

The following story about Interburns’ colleague and faculty member, Dr Habib Rahman, was printed in the San Antonio Express News in December 2016, and is re printed with acknowledgements to the author, Martin Kuz. (Picture) Habib Rahman, a pediatric burn surgeon at the Indira Gandhi Institute of Child Health in Kabul, checks on a 6-month-old boy who was brought to the hospital after he was scalded by hot water. Rahman’s patients, most of whom are injured in household accidents, come to the hospital from across AfghanistanPhoto

KABUL — The young boy shivered beneath a brown blanket as Dr. Habib Rahman placed a hand on his shaved head. After a moment, Rahman, talking in a murmur to reassure him, peeled back the blanket, exposing a stick-figure torso wrapped in white gauze.

The boy, Asadullah Mustafa, had suffered severe burns when he stumbled into a cooking fire, and to describe him as fortunate makes sense only in the context of time.

If his injuries had occurred a year or two earlier, his parents, instead of sitting next to his hospital bed as he recovered, would have stood beside his casket as it disappeared into the ground.

The family owed the change of fate to Rahman, Afghanistan’s lone pediatric burn surgeon. He runs the pediatric burn ward at the Indira Gandhi Institute of Child Health in Kabul, drawing parents from across the country who bring him the broken bodies of their young.

A San Antonio Express-News reporter met Rahman this fall at the institute. In recent years, aided by international medical groups, he has defied steep odds to save and improve the lives of thousands of children. He performs as many as two dozen surgeries a month, backed by a staff of nine nurses, two pediatric specialists and a relentless sense of mission.

“When I’m leaving the ward at night, sometimes I think, ‘I’m not coming back,’” said Rahman, 43, who works seven days a week, dividing his time between the institute and a nearby private hospital. “But I know the needs of the families. I know I must go back.”

Zarmina Mustafa, the mother of 6-year-old Asadullah, feared that her son would die by the time she and her husband arrived at the institute in late summer from Mazar-i-Sharif, a seven-hour drive from Kabul. Weeks later, as the boy gained strength and his smile reappeared, she felt that Rahman had performed not surgery but a miracle.

“I was afraid I would lose him,” she said, stroking her son’s cheek. “What Dr. Rahman has done for us, we cannot repay him. Our family is whole because of him.”

Three years ago, when treating children with severe burns over 35 percent of their bodies, Rahman knew their chances of survival were small owing to the ward’s outdated equipment. Now he saves children with burns across twice as much of their bodies.

His patients benefit as much from Rahman’s surgical skills — refined through training at hospitals in Switzerland and the U.S. — as his prowess for soliciting equipment and supplies from Western nations.

Rahman met Dr. Clemens Schiestl, director of the pediatric burn center at University Children’s Hospital in Zurich, when he traveled there for training in 2012. Schiestl has worked to obtain equipment for the Gandhi institute, and Rahman consults him by email and Skype on his most difficult cases.

“In Switzerland, we have excellent facilities, a lot of resources and highly educated, well-trained surgical teams,” Schiestl said. “Habib has none of that in Afghanistan. To stay there and do your best to treat the children when a war is going on is a credit to him. He is one of the most dedicated burn surgeons I know around the globe.”

First burn ward

Rahman, a Kabul native, grew up and learned to speak English in Pakistan, where his family fled after the Soviet Union invaded Afghanistan in 1979. His country remains fractured by war almost four decades later, and across its tattered health care system, access to adequate pediatric treatment ranks as perhaps the deepest deficiency.

A pediatric surgeon by training, Rahman began treating child burn victims six years ago, and recognizing the overwhelming need, he decided to devote his career to them. At the time, the country lacked a public hospital with a children’s burn ward, with young and old alike sent to the same doctors.

He persuaded administrators to establish the institute’s ward in 2012, and since then, the number of beds has grown from 24 to 60, enabling him to double his caseload to 800 patients a year. Over the same period, he has more than halved the number of patients who die, lowering the toll to two or three a month.

Most of the children brought to the ward are injured in household accidents, burned by a kettle of hot water or cooking fires. In Rahman’s view, their plight reflects that of the entire nation.

“The parents of the children have very little education, and many of the families live in poor conditions,” he said. “This is because of war. We have a bad economy and we don’t have enough schools. Children are unsupervised, and the parents sometimes are too young to know how to raise them. This is how accidents can happen.”

Rahman sat down beside the bed of a 6-month-old boy and held a water bottle to his mouth. Zainab Amarkhil, the child’s mother, explained that a teapot had tumbled from a stove and scalded his legs with boiling water.

“I feel very lucky that he is healing,” said Amarkhil, who has three children and lives in Kabul. “I was so worried. I don’t know what we could have done if the doctor wasn’t here.”

Hope amid despair

Rahman’s work has earned him a nomination for the 2017 Zora Janžekovič Prize, awarded by the European Club for Pediatric Burns to a physician who contributes to the field while surmounting extreme adversity. Despite his rising profile, he has struggled to recruit colleagues to his specialty, their initial interest dissolving after they realize that patients face an agonizing, uncertain recovery.

“When the doctors see the suffering, when they hear the crying and the screaming and don’t see good results right away, they don’t want to be in this ward,” he said. “A friend told me when I was thinking about doing this, ‘You will need to have a strong heart.’ He was very much right.”

The consistency of care in the ward lags behind Western hospitals as Rahman confronts faulty equipment, depleted supplies, unsanitary conditions and the limits of his stamina. There are days when the father of eight children feels his spirit rupture.

In those moments, he lies down on the sofa in his office with the door closed, waiting for the despair to recede.

After 15 or 20 minutes, he opens his eyes and stands up. He walks back to the ward, returning to the pain of the children and the anxiety of the parents, returning to provide a whisper of hope.

“I want to serve the families, and I want to serve my country,” he said. “It is my duty as a doctor.”