Teaching Neonatal Resuscitation in Afghanistan
What’s an African American neonatal intensive care nurse doing in the middle of Kandahar City, Afghanistan? Teaching neonatal resuscitation protocols (NRP), what else!
During my deployment to Afghanistan in 2005 in support of Operation Enduring Freedom VI, I had the opportunity to teach NRP to local nurse-midwives in Kandahar. I had been assigned to the 249th General Hospital Alpha Detachment as an adult intensive care nurse. After months of caring for a variety of sick patients, I jumped at the chance to teach a class. I was excited about getting the opportunity to meet Afghan nurses and learn about their practice.
I had been invited to teach the class by Dr. Holland, a pediatrician assigned to the 173rd Army Battalion out of Italy. He had taught a previous NRP course in Kandahar and felt that having a female nurse assist with the teaching would be beneficial to the students.
The class I taught was coordinated by a Canadian physician who worked with both the coalition forces and local nationals. The goal of the course was to familiarize Afghan nurses and doctors with basic NRP in an effort to address the high rate of infant mortality in the region. There was also hope that after Dr. Holland and I taught the course to local nurse-midwives and pediatricians, they in turn would be able to teach NRP basics in their hospital and at the local midwifery school.
Dr. Holland and I donned our protective military equipment and traveled about 30 minutes from our base in Kandahar Airfield to an enclosed Canadian military base in the heart of Kandahar City. The base was surrounded by an eight-foot-high concrete fence topped with threatening barbed wire. Soldiers with weapons guarded the gates and kept watch from towers high above the ground.
While we felt safe inside the base, our students did not. The class was some two hours late getting started because of an early morning suicide bombing in the city. Because of the nurses’ security concerns, we were forced to condense two days of eight-hour-long classes into two blocks of instruction two hours each in length.
The Afghan nurses were concerned about being seen working with coalition forces. They felt unsafe traveling to the Canadian facility because the route was dangerously laden with improvised explosive devices. Due to an increase in suicide bombings and Taliban activities around the country, many husbands had restricted the movement of their wives and children. The nurses’ frustrations were compounded by several other factors, such as the refusal of a local male pediatrician to attend the course. He had been scheduled to take the class but refused to attend because he did not want to be seen traveling with a group of women.
But in spite of their fears and concerns, the eight nurses and one female pediatrician were full of energy. They arrived huddled together dressed in sky blue burkas that concealed their faces and bodies. Once the women were inside the classroom, the burkas came off and the course began like any other NRP class. We used an interpreter to translate each slide and followed up the instruction with lots of hands-on practice. The students were excited and eager to learn. They were desperate to improve their clinical knowledge and skills.
Most Afghan midwives are trained by experienced nurses. They have very little classroom education. They also continue to do a fair number of deliveries in patients’ homes rather than in mater-nity wards. This is because their local hospitals lack many vital newborn supplies, such as bulb suctions and ambu bags. The typical Women and Pediatrics Ward has minimal oxygen and a small foot-pump suction machine. The local city hospital had two donated newborn warmers but they were kept in storage because no one knew how to use them and the hospital lacked the proper power supply.
Teaching this class in a country where medical technology was primitive, women lacked freedom and potential danger was everywhere made me feel as though I was teaching NRP to black nurse-midwives in rural America at the turn of the 20th century. I found myself wondering about the lives and working conditions of these African American nurse-midwives from an earlier era. Like the Afghan nurses, did they worry about their safety as they traveled around the countryside? Did they cluck their tongues at the dangers of 14-year-old girls giving birth in dusty village houses? Did they shake their heads at doctors who refused to be seen in the company of a nurse-midwife?
Perhaps they too trained younger nurses in back kitchens with little equipment in the hope that some young woman wouldn’t have to travel miles on unsafe roads just to give birth. I also wondered if black midwives from the past century were as vocal as the Afghan nurses of today about the lack of basic prenatal care available to women.
The students in our NRP course were excited to have a female nurse teaching the class. They were fascinated by my skin color and hair texture. “Is she from Africa?” they whispered amongst each other.
They were shocked that I would leave my children at home in America in the care of my husband to go work in a foreign country—something that would be unthinkable in their culture. “Why would any mother do this?” they wondered. They were disappointed that I had traveled to their country without my husband or brother but they were pleased that I was a married woman, a nurse with children who was educated and able to earn her own money.
At the end of the course, each nurse-midwife was provided with a copy of the NRP book, in English. They hoped that perhaps a doctor or local interpreters would translate the important pages we earmarked for them. As the women donned their burkas, they voiced excitement at the thought of practicing and sharing their new clinical skills. (And yes, they now know that there are black female nurses in America!)
I learned a great deal about bravery from the Afghan nurses. Today, as I travel back and forth across the world to do my job, I am grateful that I don’t have to be overly concerned about my personal safety. Above all, I am gratified that the classes Dr. Holland and I taught added a small amount of useful knowledge to midwifery clinical practice in Kandahar, Afghanistan. I believe this knowledge will help make a difference in improving the lives of women and children in this war-torn city.
CAPT Colleen Reid, BSN, RN, is a military nurse who currently works at the Landstuhl Army Regional Medical Center in Germany.