Dr. Randall Williams: Why doctors go to Afghanistan

April 28, 2014 

Regarding your April 26 editorial “ Deadly duty,” I always appreciate your attention to the efforts of so many North Carolinians and others who serve in conflict zones. North Carolina has the fourth-largest number of active duty soldiers of the 50 states, and there are others such as your own Jay Price who have spent much time in Afghanistan. Your coverage is especially appreciated at times of great loss as when physicians and nurses were targeted at Cure International Hospital in Kabul. I tell people that it really does help patients if they think other people care, and your reporting is an appreciated expression of caring.

Your editorial raises a legitimate question as to whether volunteer physicians should leave Afghanistan, but the question deserves further context. Afghanistan has one of the highest maternal and infant mortality rates in the world. When I was at Cure, they were trying to teach local Afghan physicians skills to decrease the suffering those numbers represent. They were also teaching rectovaginal fistula repair, a condition some women develop when they have unattended deliveries in the Hindu Kush mountains. If the condition isn’t corrected, these women are ostracized for life, which is incredibly sad for a young teenage mother with a baby. These problems are fixable, but there is a catch – their physicians can’t come here to learn to operate because of licensing issues. We need to go there so we can teach a large group at once with their patients. It is also not lost on our friends that we are willing to experience some hardship as volunteers to go to their home, which is very important to them as a sign of respect and friendship.

On a broader level, the great problem we confront in countries like Libya, Iraq and Afghanistan is replacing brutal authoritative regimes with a functional civil society. Those who oppose a civil society have a saying in Afghanistan: “You have the watches, but we have the time,” which reflects their strategy to wait until we leave. Our friends in these countries who are trying to build a civil society prefer that colleagues, and not the military, help them establish civic institutions. It is difficult work. So we stay, understanding the risks, because they need and want our help, and that is what physicians do.

Conflict and suffering are two sides of the same coin. The military helps on one side, we help on the other, and journalists at even more peril keep the world informed. The Committee to Protect Journalists reports that 74 journalists were killed around the world in 2012. Meanwhile, we spend about a third of our dollars on security and undergo regular security briefings, practice situational awareness and leave if the U.S. State Department says to leave. But otherwise we stay to teach sustainable skill sets to local physicians, to establish infrastructure and to treat patients who otherwise would suffer greatly.

Our hope is that in doing so, we prevent the conditions we encounter from escalating into a source for worse violence.

Randall Williams, M.D., Raleigh

The length limit was waived to permit a fuller response to the editorial.

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