Afghanistan Peace CampaignI’m 38 years old and live with my four children in a small house in Kabul’s Deh Sabz district. My daughters are ten and five, my older son is eight and my youngest is just over a year old. My husband used to be the head teacher at a private high school during the Islamic Republic, but he lost his job when the Taliban came to power. He spent several months looking for another job in Kabul, but when nothing turned up, he decided to go to Iran for work. There, he found a job on a farm. He didn’t earn much, but it was enough for him to live on and send money home every month.
The last time my husband came to Kabul, I was already pregnant with my youngest son. He told me he was planning to go into business with an Iranian he’d met at the farm and that they wanted to start a vegetable trading business in Dubai. He promised me he’d keep coming home every three months and would be there when it was time for me to deliver the baby.
But after he got to Dubai, he lost his passport and his tazkira (Afghan ID card). His visa later expired and, without a passport, he hasn’t been able to renew it or come home. Getting new documents is taking a long time. In the meantime, he’s been picking up odd jobs, mostly night shifts at Dubai’s vegetable market. He also lost money trying to get the vegetable business started and ended up in debt. Most of what he earns now goes towards his own living expenses and paying those debts, so there isn’t much left to send us.
Making ends meet
When I got married, I was 20 and was just about to finish the tenth grade. I hadn’t been able to go to school during the first Emirate, so I’d been trying to catch up and really didn’t want to stop. But my husband was against my going to school. He said that, since he was a teacher himself, he would teach me at home instead. I agreed, and he kept his word. After we married, we would sit together at home and he would teach me different school subjects.
I didn’t know it at the time, but those lessons later gave me a way to earn some money. When what my husband sent home was no longer enough to support us, I used what I’d learned from him to start a small school in our house. I mostly teach girls from the neighbourhood, teaching the Holy Quran and some school subjects.
I have about 40 students and ask each of them for 100 afghanis (USD 1.55) a month. But people around here don’t have much money, so they can’t always pay. I don’t pressure them. I just ask them to pay when they can. I know which families are struggling and, if they really can’t afford it, I don’t take anything from them. The little I earn helps cover some of our household expenses.
When I started to feel unwell
I was happy to be having another baby and, at first, everything seemed fine, so I didn’t go to a doctor. But as the weeks went by, I started to feel unwell. I was teaching in the mornings and spending the rest of the day doing housework and looking after the children. I was tired and thirsty all the time and sometimes I felt dizzy.
By the time I was in the third month of my pregnancy, I knew that I had to go to the clinic. There used to be a midwife at the clinic near our home in Deh Sabz, but when I went there, they said they didn’t have one anymore. I’d have to go to the government hospital or a private clinic in the city centre to see a gynaecologist. That made things much more difficult. Since the Taliban came to power, I can’t go out without a mahram (close male relative) and in any case, I’ve never gone into the city alone in the all the years I’ve been married. My husband told me to stop teaching for a while, rest and look after myself. He said he’d call his brother, who lives next door, and ask him to take me to the doctor.
So my brother-in-law took the day off work to take me to a private hospital in the city centre about half an hour’s drive from our house. The doctor there was a very nice woman. She did an ultrasound, listened to the baby’s heartbeat and ordered blood tests. She said I was very weak and anaemic and that the amount of water, which she called the amniotic fluid, around the baby was low. She gave me some medicine, told me to eat better and asked me to come back every month so she could keep an eye on the baby and me.
When care is hard to reach
But going to the doctor every month was easier said than done. First, I had to find the money to pay for transport and the doctor’s fee. Then I had to find someone to look after the children and a mahram who could go with me. Our home is far from the city centre and I have to walk part of the way to the main road and then take a taxi the rest of the way. I was afraid the Taliban might stop me and ask where I was going and why I didn’t have a mahram with me. Also, in our culture, a woman doesn’t usually go to the hospital, the market or into the city alone. So if I needed to see a doctor, I had to find a male relative who could go with me. The only person nearby who could take me was my brother-in-law, but he has his own family and responsibilities, and I didn’t feel comfortable asking him to take me to the doctor every month. So even though the doctor had told me to come back every month, I didn’t manage to see her again until I was seven months along.
By then, I’d become very weak. I was sick to my stomach all the time and couldn’t manage the housework anymore. My parents live in Kapisa, so they weren’t nearby to look after me or help with the children. It was obvious that I needed to go back to the doctor. Finally, I asked my husband to speak to his brother and ask him to take me. I felt embarrassed having to ask my brother-in-law for help, but by then I was so weak that I didn’t really have a choice.
I could tell something was wrong as soon as I saw the look on the doctor’s face. She scolded me: “I told you that you needed to come every month. You’re severely anaemic and dehydrated, and the amniotic fluid around the baby is very low.” She said that if I hadn’t come when I had, I might have lost the baby. Her words really shook me. All sorts of thoughts were running through my mind. What if things had gone badly wrong and I’d lost the baby or even my own life? Would my husband ever forgive me for losing the baby?
The doctor told me I needed to follow the treatment she was giving me exactly and eat better so that both the baby and I would be stronger. She prescribed a lot of medicine, as well as injections and IV fluids. She warned me that if I stayed this weak and anaemic, I could have serious problems when it came time to give birth. She told me that my body wasn’t strong enough for a normal delivery and that I’d probably need a Caesarean section. This time I took her seriously. I started the treatment and I’d walk to the nearby clinic every day with my son to get the injections and IV fluids, but by then I was so weak that even that short walk was hard for me.
As my due date drew closer, I got more and more tired. Walking became increasingly difficult and I started having pains in my stomach and lower back. I’d already decided that I’d go to a government hospital to deliver because I couldn’t afford to go private. I’d delivered my other children at a private hospital because my husband’s job at the school came with health insurance. But that isn’t an option anymore. A Caesarean section at a private hospital could cost between 20,000 and 30,000 afghanis [USD 310-466] and I didn’t have that kind of money. Even the two times I’d gone to the doctor during my pregnancy, I had to borrow the money from my brother-in-law.
My husband was still away and I couldn’t go to the hospital alone. I also needed some help with the children and housework after I delivered, so I asked my mother to come from Kapisa and stay with me.
The night I went into labour
It was early in the evening when I went into labour. At first, I didn’t think much of the pain, but as the night went on, the pain got stronger and stronger. I woke my mother and son and told them what was happening. They ran to the neighbour’s house to ask them to look after the children while we were gone and called my brother-in-law, who went to the main road to find us a car.
Meanwhile, my labour pains were getting stronger and my mother kept telling me everything would be alright, but I kept thinking about my husband and if only he were there to hold my hand and take me to the hospital. He’d been there for the birth of all our children; this was the first time he wasn’t, and in that moment, I felt his absence more than ever. Eventually, my brother-in-law found a car, and we set off for the government hospital in the city with his wife and my mother. By the time we reached the hospital, the pain was unbearable. A midwife examined me and said I was already in active labour. I was terrified. This pain was nothing like I’d experienced in my earlier pregnancies.
Waiting to be seen
The hours that followed were very difficult. We waited for a long time and no one seemed to be paying much attention to us. I could see people who’d arrived hours after us being taken inside while we were still waiting. My brother-in-law went from one doctor to another trying to get someone to attend to me. Finally, a doctor came and told me time was running out and I needed an operation. I didn’t want a Caesarean and kept hoping I’d be able to have a natural delivery. But the pain was unbearable and the doctor told me the labour had gone on too long and that unless I had a Caesarean section, the baby would die.
I was exhausted and in pain, worried about the baby and thinking about my three children at home and my husband being away. Everything was going through my mind at once. The way the doctors behaved made it even harder. They started yelling at me and using harsh words. One doctor told me that if I wasn’t going to have the operation, I should go somewhere else and stop wasting their time. How could a woman say something like that to another woman in distress?
In the end, I agreed to the operation. Then there was a lot of paperwork, with many forms to fill out and sign. I had to sign a paper saying that I consented to the Caesarean section and that, if anything happened to me during the operation, the doctors would not be held responsible. I was in so much pain, and the paperwork took a long time. The doctor told my brother-in-law to go out and buy the supplies they needed for the surgery. Once he came back with them and the paperwork was complete, they took me to the operating theatre.
When I came round afterwards, I was still very weak and had some bleeding, so the doctors kept me in the ward for two days and two nights. Once I started to feel a little better, they told me I could go home and gave me some medicine to keep taking at home.
I remember holding my baby and feeling relieved that he was safe. After everything that had happened, that was what mattered most to me.
Looking back
I’ll never forget the way I was treated in the government hospital. These problems aren’t new. They existed during the Republic too, but they’ve got worse since the Taliban took over because more people are using government hospitals now that families have less money. At the government hospital, patients aren’t treated with respect. They make you feel like you have no value. If something happens to a patient, there’s no one to answer for it. To get better treatment, you need money or connections. If you have neither, no one will speak for you.
Getting medical care has also become more difficult where I live. There used to be a midwife at the clinic near our home in Deh Sabz and because the clinic is close by, I could have gone there on my own for my monthly check-ups. But there isn’t a midwife there anymore. That meant that whenever I needed to see a midwife or gynaecologist, I had to travel into the city centre, and for that I needed both a mahram to go with me and money for the taxi.
People go to government hospitals because they can’t afford private care, but once you’re there, almost everything except seeing the doctor costs money. You have to buy your own medicine and if you need tests or other examinations, you often have to pay for those too. During the Republic, some of these things were free in government hospitals. You still had to buy medicine outside, but now patients have to pay for much more. At the same time, people have less money than they did during the Republic, so even small costs are difficult for many families to manage.
Sometimes I still wonder whether things might have been different if it had been easier for me to get care. At every stage, there was something else to arrange, someone else I had to depend on or another expense we had to find the money for. Somehow, we managed each time. But I often think about how easily things could have gone the other way.
Edited by Roxanna Shapour and Kate Clark