Afghanistan Peace Campaign
What happens when the medical treatment you need costs more money than you have? For many Afghans, illness comes with an impossible calculation. Paying for healthcare places a heavy burden on households, with patients and their families usually forced to cover costs out of their own pockets. For those faced with medical bills they cannot afford, this can mean delaying treatment or searching out less expensive alternatives. In this instalment of The Daily Hustle, Roxanna Shapour hears from a 40-year-old man who spent months searching for relief from debilitating back pain. He turned to traditional healers, herbal remedies and a shrine famous for healing back problems before worsening pain drove him, finally, to undergo surgery, which cost him nearly all the money he had. His story shows how the high cost of healthcare can push people to seek more affordable alternatives, including from traditional healers, and the lengths they are willing to go to when the medical treatment they need is beyond their means.
It started as a dull pain that I could manage with exercises and painkillers. Then, about a year ago, the pain began to travel down my left leg until, on some days, I could hardly sit in a chair.
I’m 40 years old and live in Kabul with my family. I am the sole breadwinner in my household, supporting my wife, our three children, my father and his new wife, as well as my two brothers and a sister-in-law. I also send money every month to relatives in our village in Paktia. I have an office job that requires long hours sitting behind a desk. I can’t really afford to get sick because the entire family depends on the money I bring home each month. A back pain that kept me from doing my job was something I could ill afford.
Finally, my wife insisted I see a doctor. He examined me and sent me for an MRI, which cost 4,000 afghanis [USD 57], on top of his 2,000 afghani [USD 29] consultation fee. The scan showed that I had a slipped disc in my lower back, which the doctor said was causing my pain. He ordered bed rest and ten days of physiotherapy, which cost 5,000 afghanis [USD 71]. But instead of getting better, the pain got worse. So I went to a second doctor, this time a specialist. He looked at the same scan and told me I needed an operation. This was not what I wanted to hear.
Until my back started hurting, I hadn’t really thought much about what an illness that could affect my work or a major medical expense could mean for me and my family. Because I have a job, my family could manage [healthcare] expenses if we tightened our belts for a month. But the surgeon had told me I needed an operation that would cost 150,000 afghanis [USD 2,150], not including the hospital stay, medicines and other visits. That was more money than I had.
I was already scared of surgery and everyone I knew seemed to have a story about someone who’d had a back operation and hadn’t got better. Before spending that much money, or going into debt to find it, I wanted to exhaust every other possibility. So I started looking for less expensive ways to cure my back.
Everyone knows a hakim
Here in Afghanistan, we have many hakims [traditional healers] and they are very popular. Everyone seems to know a hakim they swear by. One friend will tell you about someone who cured a relative and another will recommend someone who treated a neighbour.
I decided to go to a particular hakim that one of my friends said had a reputation for treating back pain. The hakim told me that the problem was a blockage in my rag-e nasa [the traditional word for sciatica] and that he would have to bleed me to drain the thick, dark blood, which was causing my pain. Several people wholeheartedly endorsed this method and told me they knew someone who had been cured of their back pain this way, so it seemed worth trying. The hakim made a cut with a razor – the kind you use for shaving – and dark blood came pouring out along with some clots. He told me to go home and rest, promising that the pain would disappear after a few days.
It didn’t.
So I went to another hakim who was also recommended by a friend. This one made his own tinctures from herbs and other ingredients that he said came from Pakistan. He gave me drops to take but they didn’t help either.
I kept thinking about the operation and the 150,000 afghanis it would cost. I wasn’t going to spend that kind of money unless I had no other options, especially when people kept telling me about other treatments that might work.
I decided to ask the hakims’ union if they could recommend someone. They told me about a rish sefid [an older, respected man] in Kot-e Sangi, who specialised in treating back pain. This sounded promising. He wasn’t just some person claiming to have cures; other hakims were vouching for him. They said he was very busy, but that they’d try to get me an appointment.
After a few days, I got a call from the union saying I could see the hakim that afternoon. He looked at my MRI and told me I didn’t need surgery. He said he could heal me without an operation. This hakim also bled me, this time along four or five veins. Then he gave me two concoctions he had made himself, from herbs he had gathered in the mountains, which he ground into the powders he gave me. He said he had even cured his own wife with them and that people from all over Afghanistan and even from Pakistan came to see him for a cure.
I had to mix one powder with water and drink it every morning. The other I had to mix with the yolks of three eggs from Afghan chickens to make a paste. The hakim stressed that the eggs had to be watani [local], not imported from Iran or Pakistan. I spread the paste on my back like a plaster and left it there for a full day, every day for ten days. But when nothing changed, I went back.
“You’ve had this pain for a long time,” he told me. “It will take time for it to leave you.”
He gave me more powder to use and this time he also gave me exercises and told me not to eat beef, beans or other foods that caused gas or bloating. What he said made sense to me, so I kept at it for another month. But after a month, the pain had eased only slightly. I had spent 8,000 afghanis [USD 115] on his visits and medicines and while it was still far less than the 150,000 afghanis for surgery, it wasn’t working.
A friend recommended that I see a hakim in Ghazni. This involved a long car journey and by then, even a brief trip was unbearable. Still, I held on to the hope that this hakim might be the one to cure me. When I arrived at his office, he told me to get some raw lamb fat, rub it onto my back, bind it there overnight and return the next day, when he would perform a ‘procedure’ that he said would heal me. He wouldn’t say exactly what he planned to do.
I had been willing to be cut with a razor twice, to take drops, drink powders and wear an egg yolk concoction on my back for days, but whatever this man was planning to do to my back felt dangerous and a step too far. This time, I didn’t go back.
By then, the costs were also mounting. I had paid for an MRI and physiotherapy, the bleedings, the drops, the powders, the eggs and the journey to Ghazni. Each expense was small compared with 150,000 afghanis, but together I had spent a little over 30,000 afghanis [USD 430] and I was still in pain. Every time I tried a new treatment, I told myself that if this one didn’t work, it would be the last.
The Shrine of the Lame
Then one of my relatives mentioned a ziarat [saints’ shrine] near our village in Paktia – the Shrine of the Lame [da godano ziarat]. This shrine is well known in our area for healing back pain.
In our area, it’s very common to go to ziarats for a cure. There are many shrines, each known for curing a specific ailment. For example, there’s a shrine where a stream flows from beneath a grave. People bathe in its water because they believe it cures skin conditions. Another shrine is said to cure toothaches by pressing a nail against the aching tooth, while women who have trouble getting pregnant go to yet another shrine.
This is something we grow up with. From the time a child is born, families may take the baby to a ziarat and ask the mullah for a tawiz [an amulet containing religious writings, worn for protection or healing] to keep the child safe from illness, harm or the evil eye. The mullahs who write tawiz have learned from their fathers, who learned from their fathers before them. The shrines themselves also have longstanding reputations and many of them have been there for generations.
So when my relative suggested the Shrine of the Lame, I went. After all, it was a shrine people specifically visited for back pain. At the shrine, the mullah wrote me a tawiz and tied it to my left arm – the same side as the pain. He also told me not to eat beef and to walk slowly. On the way back to Kabul, however, the pain became worse than it had been in weeks. I kept asking my brother to pull over so I could get out and lie beside the road until it eased, then climb back into the car, only to ask him to stop again a little further on.
We had to stop several times because I couldn’t sit in the car for long. Finally, we stopped at a meadow we knew well because my family sometimes picnicked there. It was a hot day and I was sweating from both the pain and the heat. I sat down, took off my shoes and socks and dipped my feet into the stream that ran through the meadow. I let my feet dangle in the cold water for a few minutes before we left. As we drove towards Kabul, the pain in my back started to ease and, by the time we reached home, I felt much better.
A cure, or so I thought
The next morning, I woke up without pain. I went back to the doctor and told him about the tawiz and the stream. I told him I was cured. He sent me for another MRI and said the slipped disc was still there. Whatever had happened to the pain, he told me, the underlying problem hadn’t disappeared. He insisted that I should still have the surgery.
But that day, I didn’t want to hear it. It had been months since I’d had a pain-free day. I felt as if I had been given my life back and I wasn’t going to let him ruin the moment.
For six months, I had no pain. As time passed, I became increasingly convinced that the doctor had been wrong and that I had escaped the operation after all.
Then, one day in April, I was working in the garden. I bent down to pick something up and, when I tried to straighten up, a sharp pain shot through my back. Suddenly, I could hardly stand. The pain was back, as bad as it had ever been.
I went back to the doctor. This time, he told me that if I continued to delay the operation, things would keep getting worse and that eventually they might have to put a rod in my back.
I knew then that I’d reached the end of the road. I’d tried everything I was willing to try, but the pain was back and I couldn’t go on living like this. I had to stop looking for cures and give in to the operation.
Paying for the operation
But accepting that I needed surgery was one thing; finding the money to pay for it was another.
Most of what I earn goes towards my family’s expenses and helping relatives in our village. Friends and relatives sometimes ask me for loans too, especially since the economy took a bad turn and many people lost their jobs or don’t earn enough to support their families. If you have a steady income, people come to you for help and, when you can, you help them.
Several people owed me money, but I wasn’t going to ask them to repay it because I needed an operation. I knew they had their own problems and asking someone who was struggling to repay a loan would have been shameful. I decided to borrow the money for the operation from one of my relatives who was in a good financial position. He knows I have a job and that I will eventually pay him back.
Then, out of the blue, one of the friends I’d lent money to paid me back. I hadn’t asked him for it. I hadn’t even mentioned that I needed money for an operation. He just stopped by the house one day and gave me the 200,000 afghanis [USD 2,900] that he owed me. This was enough to cover the operation itself and the other costs, including the hospital stay, medication, the post-op MRI and the doctor’s visits.
Two weeks later, I was in hospital having the surgery. Fourteen days after the operation, the surgeon removed my stitches. He told me to come back in a month and said I should have physiotherapy to help with my recovery. But I really didn’t have enough money left to pay for it. So a friend who lives abroad sent me some exercises for people recovering from back surgery. I do them by myself at home every day.
I still have pain, although it is much less than before the operation and every day I feel a little stronger. The surgeon says it will take time for me to recover. Sometimes I think about all the things I tried to avoid the operation. In the end, it cost almost everything I had and I was only able to pay for it because a friend happened to pay me back just when I needed the money. I try not to think about what would’ve happened if he hadn’t.
Edited by Jelena Bjelica