Reporter December 2002 Home

113th AAMC Annual Meeting: Leadership Forum Examines Trends, Future Opportunities

Plenary Speakers Address Challenges, From Bioterrorism to Health Disparities

Roundup from San Francisco: AAMC's 113th Annual Meeting Notes Trends, Concerns, Solutions

2002 AOA Winners

Medical School Applications May Be On the Rise

For the Love of Country: Afghan-American Physicians Rebuild Medical Education in Their Homeland

Caring for Community: Loma Linda Medical Students Organize Health, Mentoring Programs

Viewpoint: The State of the VHA Is Strong

A Word From the President

Reporter Archive

AAMC Newsroom

Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

For the Love of Country: Afghan-American Physicians Rebuild Medical Education in Their Homeland

Heart for the Homeland: Ghulam Dastgeer, M.D., founder of the Afghan Physicians Association in America.

There's a janitor working in Boston whom Ghulam Dastgeer, M.D., founder and president of the Afghan Physicians Association in America, wants to perform orthopedic surgery in Afghanistan. The janitor, formerly a professor of surgery at Mazar-i-Sharif Medical School in Afghanistan, fled his native country when the Taliban invaded his workplace, killing the school's dean and several teachers. Like many other Afghan physicians, he came to America seeking political asylum, but was unable to navigate the complex processes that would allow him to practice medicine in his new country.

"Can you understand that loss?" questions Dr. Dastgeer. "To be a surgeon at home and then come to work as a janitor here? It's devastating."

Dr. Dastgeer, who graduated from Kabul Medical Institute (KMI) and did residency training in surgery in the United Kingdom, now practices primary care at the North Hampton VA Medical Center in Springfield, Mass. When he fled his native country's Communist regime in 1979, he landed in America knowing nothing about how to earn the credentials he needed to practice medicine in the United States.

"There was no one to help me or tell me what to do," recalls the surgeon. But Dr. Dastgeer overcame the odds, and by 1980 he was practicing medicine and teaching at the University of Massachusetts Medical School. He wanted to give other physician asylum-seekers from Afghanistan the same opportunity.

"I knew a lot of doctors were coming, and some type of organization was needed to help them," explains Dr. Dastgeer. "They needed information about what is involved in getting into a residency program, what you need to do to pass the qualifying examinations."

An association formed

In 1989 Dr. Dastgeer founded the Afghan Physicians Association in America (APAA) to respond to that need. Dr. Dastgeer's organization continues its original mission, but now that the Taliban have been driven out of his native country, he also wants to help exiled physicians like the janitor in Boston brush up their medical skills and return to a country whose healthcare and medical education infrastructure is in ruins.

"I am told that there are over 700 Afghan physicians in the United States doing restaurant work, driving taxis, even attending parking lots!" says Dr. Dastgeer. "These are the people we are trying to encourage to go back and help train physicians in Afghanistan."

But Dr. Dastgeer readily acknowledges that his solution is not as simplistic as it sounds. "A person who was in medical school 20 years ago and has since been driving a taxi cannot just pick up and begin practicing medicine," he says. So his organization is seeking such people out to retrain them in the medical sciences so they may take their knowledge back to their home country.

Decades of war and domestic chaos have left Afghanistan's once-solid medical education system in tatters. According to Dr. Dastgeer and others who have assessed Afghanistan's medical needs in the wake of America's "war on terror," major cities like Kabul are populated with "pseudo-physicians" whose qualifications are dubious at best.

"In Kabul, you will find many self-proclaimed 'specialists' in gynecology, surgery, radiology," says Dr. Dastgeer. "This is what bothers me. During the Russian invasion, if you were working in medicine for three to four years, they told you that you were now a doctor, and to go out and practice. There is no system to find out who really are physicians and who are untrained individuals practicing medicine. It's difficult to know where to start."

The U.S. Department of Health and Human Services (HHS) is attempting to reform Afghanistan's healthcare and medical education infrastructure by implementing a program in partnership with the APAA and the Afghan Medical Association of America (AMAA). HHS Secretary Tommy Thompson recently accompanied two physicians from each organization to assess where assistance is most needed. The trip, completed in October, is meant to lay the foundation for a program allowing Afghan-American physicians the opportunity to provide healthcare services and medical training in their homeland.

Coming home

When Habib Baha, M.D., recently returned to his native Afghanistan and visited KMI's Department of Anatomy, in which he had taught for over 14 years, he was crestfallen at what he found. One skeleton model, a few bones, a torn chart. Not only were traditional anatomical teaching tools gone, but also were all amenities needed to operate any lab: running water, electricity. Four professors still there were exhausted and overloaded, unable to see to the educational needs of the 4,000 students enrolled in KMI.

Teaching methods, says Dr. Baha, have been reduced to conversations, occasional lectures, drawing on a board. But the persistence of Kabul's medical students to pursue their education under these conditions in buildings that are literally falling down around them gave hope to the former anatomy professor.

"The students are so enthusiastic to learn after so many years of the Taliban not allowing them to run the school," says Dr. Baha, who was part of the HHS delegation sent to assess the state of medical education in Afghanistan. "It brought tears to my eyes to see people with nothing have expectations and hope for a brighter future."

Dr. Baha himself is a graduate of KMI. Completing his studies in 1965, he taught there until 1979, when the Soviet Union invaded Afghanistan. The anatomy professor was vocal about his opposition to Communist rule, and he soon found himself a prisoner in squalid conditions along with other university professors and government officers. He remained imprisoned for six months before the new government told him to return to work.

A father of five, Dr. Baha watched as the political climate in his country grew more and more oppressive. His oldest children, aged 13 and 14, were to be taken away for military training. So the physician found someone to smuggle himself, his wife, their children, and his brother out of the country. After staying in Europe for a few years, the family finally reached the United States in 1982. Today Dr. Baha trains medical assistants and lab technicians in San Diego. He has not practiced medicine since fleeing his country.

But medical education remains the former anatomy professor's passion. Dr. Baha is the secretary of the AMAA, founded 10 years ago to send humanitarian aid to Afghanistan and to maintain the country's medical education system.

"Our main objective is to work with the universities there and focus on medical training," explains Dr. Baha. "If you don't have well-trained doctors, the entire healthcare system is weakened and physicians cannot help in the way they should. So the AMAA tries to bring the knowledge level of Afghan medical students and doctors up to that of physicians in the U.S. We do this by sending them textbooks, giving them fellowships to train in the U.S., and establishing new medical facilities like the Children's Hospital in Jalalabad."

When Dr. Baha joined Secretary Thompson to assess the state of his alma mater, he found it gutted and pillaged. "There is no sign of the Kabul Medical Institute I graduated from," he says ruefully. "During the Russian siege, civil wars, and the reign of the Taliban, the school's buildings were used as fighting grounds. Soldiers broke into the school and took everything, even the water pipes and electrical wiring, materials they sold to support the war."

Afghanistan's women and children

Westerners who have visited Afghan-istan in the wake of the expulsion of the Taliban agree that the country's most pressing healthcare problems involve maternal and child health. Secretary Thompson made the health of women and children the focus of his recent trip to the country. Homaira Behsudi, M.D., M.P.H., a family physician in Vienna, Va., who also graduated from KMI, made the trip with Secretary Thompson to evaluate the few maternal and child health clinics in operation in Afghan-istan's capital city.

"A lack of basic health services for women coupled with extremely high rates of fertility result in Afghan women being at very high risk for dying in childbirth," Dr. Behsudi says. "Their children also die at alarming rates due to maternal health complications."

Emphasizing that it is important not to get "overwhelmed" in the face of such need, Dr. Behsudi, who represented the APAA during her most recent trip to Kabul, says that effective programs need good physicians to be sustainable. She believes that countries like the United States should retrain Afghan physicians who in turn will pass their knowledge on to their students. In the meantime, she says, the APAA has developed a few health projects that can be implemented in Afghanistan immediately. They include a model maternal and child health project for rural Afghanistan that Dr. Behsudi says can be duplicated in many parts of the country isolated from urban areas.

Dr. Dastgeer emphasizes that these projects, consisting of small clinics equipped to provide pre- and post-natal care, OB/GYN services, preventive medicine, immunizations, and vaccinations, are the country's best hope to quickly respond to the healthcare needs of its women and children.

"The easiest way to help right now, and anyone can do it, is to establish well-equipped clinics with two to three doctors and two to three nurses," says Dr. Dastgeer. "These clinics can be built in a matter of weeks." Dr. Dastgeer estimates that about three to four thousand of these clinics are needed across the country to care for women and children living in large, devastated cities as well as women and children in hard-to-reach, isolated villages.

Change through academic affiliation

While in Afghanistan, Sec. Thompson promised to build a large teaching hospital in Kabul that would double as a place to obtain quality health care and a training ground for new physicians. The new hospital will specialize in providing health services to women and children. "That was exciting news for all of us," says Dr. Baha. "But it takes time to rebuild. And we all had headaches after examining the state of things."

Dr. Dastgeer emphasizes that people who want to elevate the state of medical education in Afghanistan should not wait until the promised teaching hospital is built. He advocates affiliations between American and Afghan medical schools that he says can be beneficial to both. These affiliations, says Dr. Dastgeer, can be put into place immediately.

"There is a two-way benefit to such affiliations," he explains. "Our students learn from American professors, and American professors benefit from the tremendous opportunity for scientific and clinical research in Afghanistan. This country is an open book for them."

The president of the APAA also emphasizes that such affiliations should ensure that the medical education they provide in Afghanistan stays within the country's borders. "These affiliations should be approached with one condition: that Afghan medical students and doctors stay in Afghanistan," Dr. Dastgeer says. "When they come here for training, they must agree to go back again to Afghanistan. There should be no exception. We don't want medical schools to go there and train doctors for America. We want them to be trained for the benefit of the people of Afghanistan."

One such affiliation that may serve as a model for future agreements is the one forged between Loma Linda University School of Medicine in California and KMI and other Afghan medical schools, an affiliation that has resulted in numerous professional exchanges among the universities.

Dr. Dastgeer adds that U.S. medical schools seeking alliances with their Afghan counterparts should be aware that improvement will come in measured steps. Afghan President Hamid Karzai recently lowered the passing score for medical school exams in his country to 35 percent, a move that outrages Dr. Dastgeer. "This means that almost anyone, with even no training, can pass," he says. U.S. partners should also be aware of the severe overcrowding in Afghanistan's medical schools. Due in part to poor admissions standards, thousands of students are enrolled in schools meant to accommodate hundreds.

But even these hurdles do not dampen the determination of members of the APAA and AMAA who want to see Afghan medical schools returned to their former glory. "There are ways to achieve our goals soon," affirms Dr. Dastgeer. "When I recently talked to people in Japan who are interested in helping Afghanistan, I told them that our situation is similar to theirs after World War II. I said to them, 'You have built yourself up, and look at where you are now. This is what I want for my country.'"

By Barbara A. Gabriel

Contact Us    © 1995-2008 AAMC    Terms and Conditions    Privacy Statement