Survey: Maternity Waiting Homes

Mahbouba and I just completed a survey in three provinces that examines the feasibility of what is called a "maternity waiting home" (MHW) for mothers who are 'at risk" of dying in childbirth. Medical care for women is still developing here. But the issue of infant/mother mortality is that the families have so little access to the care. The MWH's would be essentially birthing centers next to a hospital where women could stay for a period of time leading up to birth for care by midwives as well as post natal care as well. We did this survey for the arm of John Hopkins University here in Kabul (JHPIEGO). With that explanation given if you have a professional interest in the outcome of the survey please e-mail me. On these pages I am going to describe my experience of the work we did.

Our three provinces to visit were Badakshan, which has one of the highest mortality rates in the world, Bamiyan and Jawzjan. Mahbouba and I are a consulting and training team, and we love working in the provinces. We specialize in women's programming. We "subcontract" with agencies so we are not bound to the often cumbersome security regulations other agencies have and we are old enough as women to earn respect among Afghan men. That said, I have only participated in one other survey in Afghanistan, one that my anthropologist husband organized so this was my first time to direct a survey. Dr. Patricia Omidian, also anthropologist, designed and supervised which was great. But we the actuality of conducting a survey in Afghanistan was one of my most challenging experiences here as well a humbling learning experience. Learning experiences here tend to humble me.

Attached to our team was 26 year old Afghan physician, Dr. Sami Wardak, who would survey groups of men giving Mahbouba and I the opportunity to focus on the women.

We made all of our own arrangements for Badakshan securing the services of young Myroweis, a driver that both of us had used before in Badakshan. Mahbouba, Sami and I arrived in Faizabad on October 22 with an ambitious agenda for interviews. It also happened to be and the 3rd week of Ramazan where Afghans fast all day. Mahbouba, an Afghan American is recently returned to Afghanistan and she was fasting for the first time in a long time. Dr. Sami is a good Pushtun boy, and Myroweis a good Tajik boy have always fasted during Ramazan. The Koran was consulted and Mahbouba determined that it was ok for traveler's to break fast during Ramazan, but not ok to carry on the fast to the point one might be un-Islamic, mean or irritable. This was a daily point of discussion and contention throughout our travel in Badakshan.

Our young men were not used to fending for themselves food-wise and would often wait until 4:45 to figure out what the food would be which would initate a series of heated discussions, and un-Islamic behavior-and a scattered and unproductive effort to find edible food. I learned, in self-defence, to make organizing the meal to break the fast at 5:15 pm, my highest priority.

To add to our survey dynamic, a local warlord set up a rocket launcher on top of a hill overlooking Faizabad, and sent nightly rockets into the area of town where we were staying. After eight days-the stress of managing the survey-trying to figure out where to spend the night-the lack of bathing facilities-and the ongoing unproductive and contentious discussion my Afghan companions conducted in Dari, convinced me to abandon my "collaborate and empower" management style that I perfected in the States and adopt a non-benevolent-in fact -malevolent dictatorship management approach.