Lal Aqa Sherin
KABUL, Aug 5 2009 (IPS) – Thirty five-year-old Habibulah Khan walks out of a private clinic in the Afghan capital, covered in dust and looking dog-tired.
Doctors and administrators at private hospitals defend their billing practices Credit: Najibullah Musafer/Killid Media
The doctors, he says, told me to buy medicine from a nearby drug-store and bring the bottle back to him. He says his prescription cannot be found at other pharmacies.
Critics say that doctors at private clinics require patients to visit certain pharmacies and that the doctors somehow profit from this scheme.
Dr. Muhammad Tahir Kaseen, who works at Shah Mahmood Market, denies these allegations. He says that he asks his patients to bring the bottles back to him so that he can be certain that the medicine is not expired and of good quality.
The drugstore I recommend is obligated to stock the medicine I prescribe, he says. This is the reason I send my patients there. I have no connection with them.
The head of Shenuzada Hospital, Dr. Aminullah Khan, insists that he would never let any doctor with a link to a drug-store work in his hospital, though he admits that the practice is widespread throughout other private clinics.
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The Directorate of Health Regulations job is to block and punish drugstores that are linked to doctors and accept prescriptions for which they provide a kickback.
Dr. Ibrahim Kamel, the director of the agency, says that some doctors give these kinds of prescriptions, and we try our best to stop these drugstores from the practice.
Twenty two-year-old Subhanullah has a look of deep worry on his face as he hurries from Malalai, a government-run maternity hospital in Kabul.
My wife is pregnant, he says, and I have to take her to Nangarhar. The doctors at Bust Hospital won t accept her as a patient and the doctors at Shenuzada and Malalai Maternity told me that if my wife does not receive an operation our baby will die.
Luckily, his wife didn t need the operation and gave birth to a healthy baby without one. Still the young family is stuck with the bill.
Allah has granted me a beautiful daughter, said the new father, but the hospital has charged me much for these two nights. People in provinces from Kabul to Nangarhar and Kunar to Laghman have spoken about the high cost and low quality of care that they receive at private hospitals.
Ghulam Muhammad, a Laghman resident told Killid, My wife is pregnant. Bedari Hospital wants to charge me 300 dollars for an operation. Where am I to find such money?
Rafiqulah Zaraswand, who runs Bedari Hospital, defends the costs at the facility. We have modern equipment, he says. The charge for a big operation is 300 dollars.
Muhammad Aziz, of Subrayu District, Khost province, says that when two of his fellow villagers were injured, they were taken to a private hospital in Khost. We spent 100,000 Afghanis [2,033 U.S. dollars on treatment], says Aziz, but the patients did not get better We then took them to Peshawar (Pakistan) and spent 100,000 more.
Again, doctors and administrators at private hospitals defend the billing practices of these businesses.
There is no regulation from the Ministry of Public Health, says Dr. Muhmmad Usman of Khost. The price of everything is rising day-by-day and I realise that patients think treatments are expensive. But for their money they get doctors, medicine and a place to recuperate. It is a fair deal.
A daily wage worker in Khost who was wounded in an explosion not long ago, might disagree. He was taken to a private hospital and told that his wound was not particularly serious. At the end of his treatment, he was handed a bill for 50,000 Afghanis (1,016 dollars) by the hospital s head doctor. I don t have 5,000 Afghanis (101 dollars), let alone 50,000! says the exasperated worker.
There are nine private hospitals operating in Kandahar province, in addition to a government facility. But Kandahar residents complain that these hospitals are inadequate. They say that the doctors are poorly trained and the equipment is sub-standard.
The facilities we need do not exist in these hospitals, says Hajji Lala, a Kandahar resident.
One of my younger relatives ate opium, says Aziz Afghan, another Kandahar native. We took him to four different hospitals but we couldn t find any doctors in the emergency rooms. We ended up bringing him to a drugstore.
Dr. Ismatullah Frhang, a doctor at one of Kandahar s hospitals, denies these claims as absurd. All of our doctors are professionals, he says. If they do not have proper documents and accreditation, they cannot work for us.
Kandahar Public Health official Dr. Ahmadullah Faizi points out that the problem is not just limited to his province. The Ministry of Public Health is working to find solutions to the problems related to private hospitals. It is said that the ministry has drafted a new bill, about a month ago, related to the control of private hospitals. It will be implemented through a special commission after approval by the Ministry of Justice.
But the bottom line is that these private hospitals are designed to make money. As Amina Hashimi, of the Ministry of Public Health says, All private hospitals have been built for business. That is different than helping people.
(This is the second of a two-part investigative series on private health care in Afghanistan by Killid Weekly. IPS and Killid Media, an independent Afghan group, have been partners since 2004.)
