How she reached the hospital: A story of a girl with a deadly infectious disease living

Author: Shohra Qaderi, Shahid Beheshti University

Editors：Akihiko Ozaki, Yudai Kaneda

In Afghanistan, a country plagued by decades of instability and a dearth of resources, women's health has always been marginalized. I would like to share a story of a girl living in a remote area with a deadly infectious disease who could not receive timely care and almost lost her life.

In 2017, the World Health Organization declared that the number of confirmed cases of Crimean Congo Hemorrhagic Fever (CCHF) had risen dramatically in Afghanistan. Consequently, my professor in Afghanistan asked me to investigate the characteristics of the patients with this disease in the country. Thus, I conducted a study to evaluate the root and causes of the increased diagnoses of the CCHF at that time. Following the proposal defense and its ethical approval, I started recruiting the patients with the CCHF and collecting their data at a hospital in Kabul, Afghanistan.

One day, while I was collecting the patients' data at the hospital, suddenly I heard the cry of one lady. When I tried to take steps toward her to ask whether she needed any assistance, my colleagues came in front of me and explained a critical situation of a 23-year-old girl at the CCHF ward. Consequently, I rushed to the CCHF ward and thus could not eventually talk with her. At the ward, the young girl was in a severe condition experiencing hemorrhage in multiple body parts, including the vagina, which is a rare and unusual site of hemorrhage in this disease. Our team decided to cover this girl as a case report article due to its rare presentation to disseminate a criticalness of the condition, and I was requested to take the lead. Following her stability and ethical clearance, I contacted her mother to take a history of the patient, and I, for the first time, learned that her mother was the woman crying in the yard. She accepted my request for an interview and explained about multiple difficulties they faced before her daughter could finally receive reasonable care for the CCHF at the hospital.

Indeed, the girl originally had only mild symptoms like low-grade fever and fatigue and did not have bleeding at all. However, she could not make a timely medical consultation since the girl's father did not gain permission to do so because he assumed that she would get well without consultation with the doctor. Then, as her symptoms got worse, they seriously sought medical attention, but there were no reliable medical institutions around their neighbors because they resided in mountainous regions of Badakhshan, and owing to heavy snow, no paths were open to seeking help.

After encountering all these difficulties, they reached the center of the urban areas with a secondary health care provider, but there were no doctors to diagnose her disease properly. Consequently, they decided to take her to Kabul, the country's capital and a better treatment place, and it was fortunate that she got well.

Of note, she was illiterate and had never been allowed to attend school. Eventually, these are the main reasons she did not know enough about her disease. Further, her father did not allow her to seek care at the beginning of the symptoms. Moreover, when they reached a care centre, there was insufficient equipment to diagnose and treat her condition.

This case suggests that women in Afghanistan have struggled to live and have been invisible in public life. They have been discouraged from having education opportunities, and their life is in danger because of their gender, low access to facilities, and poor knowledge.