Australian doctor Katherine Franklin changing and saving lives in Medecins Sans Frontieres’ Kabul clinic
Long before Dr Katherine Franklin studied medicine in Melbourne, she dreamed of humanitarian work.
She even chose her speciality, paediatrics, in the hope it would be useful in impoverished communities overseas.
But it still came as a shock when Medecins Sans Frontieres (MSF) emailed her and cheerfully informed her she had been selected to work in Afghanistan.
Seven months later, at MSF’s Kabul maternity clinic in one of the city’s poorest neighbourhoods, the 31-year-old smiles as she recalls her family’s campaign to convince her to not go.
“My father in particular was not thrilled about it,” she said.
And neither were her colleagues at Melbourne’s Royal Children’s Hospital, who would often pull her aside to advise her against the move.
Before she left Australia, Dr Franklin’s father gave her a St Christopher medal, the patron saint of travellers. She had to “promise I will take it with me everywhere … I think it’s the only way he felt he could protect me”.
Her family’s fears were intensified by the US military airstrike on MSF’s hospital in Kunduz, northern Afghanistan, in October last year, which killed 42 staff, patients and caregivers.
An Australian doctor, Kathleen Thomas, narrowly escaped.
PHOTO: Dr Katherine Franklin and other staff examine a baby suffering from seizures related to a complicated birth. (Mariam Alimi)
But Dr Franklin said any fears she had were immediately allayed on her first day at the bustling MSF clinic, one of Kabul’s leading facilities in the fight to remedy a little-known tragedy.
While Afghanistan’s war commands headlines, more than double the number of Afghans die from birth-related complications than from the conflict, according to a 2012 WHO survey.
In that year, a staggering 31,100 women and infants died due to birth complications, trauma and newborn infections.
While shocking, Afghanistan has in fact made remarkable progress in maternal and newborn health since the Taliban’s rule, when only a few female doctors remained in Afghanistan and women were confined to their homes.
In 2002, 1,600 mothers died out of every 100,000 live births and 91 out of every 1,000 infants would die before their first birthday.
Today, with improved health services, including more female doctors, nurses and midwives, those rates have been slashed to 400 mothers and 65 babies, respectively.
But there is still a long way to go. By comparison, in Australia only eight mothers die out of 100,000 live births and four out of every 1,000 infants before their first birthday.
Afghanistan’s conflict, poverty and low education still puts it’s mothers and babies at high risk.
Culture is another factor.
“Many families believe it is shameful for a woman to give birth outside the home, in a hospital,” said Aqila Asifi, an Afghan midwife at the clinic.
She added, many are too poor “to pay medical costs, even to pay for a taxi to a hospital”.
Unlike the numerous private clinics in Kabul, MSF’s services are free.
When the maternity clinic opened in October, 2014, MSF planned for 600 babies a month. In 2015, they welcomed more than 11,000, that is over 900 babies each month.
This year, MSF expect to deliver more than 15,000 babies.
With resources stretched thin, women at the hospital receive professional care but with few frills, a far cry from births involving pools, relaxing music and massage that has become almost the norm in Australia.
“It’s very different here,” Dr Franklin said, laughing.
It’s not unusual for up to four women to give birth in the same room at the one time and without pain relief, unless medically necessary.
“If you don’t have access to [pain relief], you just get on with it,” she said.
MSF sees a high number of complicated cases. Although there have been significant improvements, many Afghan women still do not seek pre-natal care and attempt home-births without a professional, often coming to MSF as a last resort.
“It’s not uncommon for mothers to come in fully dilated,” Dr Franklin said.
“It can be really frustrating and it’s certainly not something you’d see in Australia.”
Still, with MSF’s clinic, many babies now have the chance to fully recover. Pre-term babies born underweight, some as low as 1 kilogram, are now surviving and flourishing.
A key factor has been MSF’s introduction of effective techniques such as Kangaroo Mother Care (KMC), where the mother constantly holds the baby against her chest, keeping the infant warm.
KMC is used globally, but in Afghanistan where incubators are in short supply, it has been lifesaving.
For Dr Franklin, that has been a key lesson.
“I am genuinely amazed at what we can do with what we have,” she said.
