Let's start by asking, what exactly does "built" mean? (I also live-blogged it):
8:36 - -He says he built a women's hospital in Afghanistan He did?And regardless of good intentions, what was the outcome of the project?
A quick Internet search finds, as to "built" - -
* A State Department news release about the project, which says Thompson's Health and Human Services Department and the Department of Defense were rebuilding and refurbishing sections of an existing facility:
Secretary Tommy G. Thompson met with Afghan President Hamid Karzai today and renewed the department's commitment to promote health in Afghanistan -- including training, staffing and working with the Department of Defense to rebuild a women's hospital in Kabul.* A release from Thompson's department that said "the improved and refurbished Rabia Balkhi Women's Hospital in Kabul" would be, in Thompson's words, "top-notch."
Secretary Thompson and Defense Secretary Donald Rumsfeld agreed in November to begin the rehabilitation of the maternal and child health section of Kabul's Rabia Balkhi hospital, with plans to expand to four maternal-child clinics in rural communities, as part of the administration's commitment to assisting the people of Afghanistan.
The Department of Defense (DoD) is refurbishing the facility, while HHS is designing a training course in obstetrics and gynecology for the physicians at Rabia Balkhi to begin in mid-April 2003.
"Today is a new day in Afghanistan, where we now have a new hospital for women to receive topnotch health care and a new training program that will provide the best of medical instruction to Afghanistan's health care providers."So, as to outcomes - -
* A report in the Atlanta Journal-Constitution newspaper (AJC) photo gallery shows that what was completed fell short of "top-notch."
'Top-notch' care eludes Afghan hospital
At the grand re-opening of Rabia Balkhi Hospital in April 2003, then U.S. Secretary of Health and Human Services Tommy Thompson announced: "Today is a new day in Afghanistan, where we now have a new hospital for women to receive top-notch health care..." Dr. Pamela Hyde was the first ob/gyn assigned by HHS to train at the hospital. She took this photo. She and others found the reality inside the hospital starkly different...
Instruments are sterilized in buckets in the delivery room at Rabia Balkhi Hospital in February 2005. Donna Harris, a nursing consultant from the University of Wisconsin-Milwaukee who took the photo, said she was troubled that during her visit the hospital still lacked good infection control, there was no soap and water in the delivery room and staff often failed to take basic vital signs...
Dr. Jean Amoura, an ob/gyn, was part of a University of Nebraska Medical Center team that visited Rabia Balkhi for four days in December 2004 to provide continuing education separate from the U.S. government training program. Amoura said she was disturbed by the physical condition of the hospital and questioned how it would be possible for its Afghan attending physicians to serve as trainers for young resident doctors, a key element of the U.S. program.* There is a report of a subsequent House investigation into the project:
Rep. Henry Waxman (D-Calif.), chair of the House Committee on Oversight and Government Reform, on Thursday opened an investigation into possible mismanagement of the Rabia Balkhi Women's Hospital in Kabul, Afghanistan, the Atlanta Journal-Constitution reports (Young, Atlanta Journal-Constitution, 12/7)...
Former HHS Secretary Tommy Thompson and officials from the U.S. Department of Defense and Afghanistan's Ministry of Public Health in April 2003 opened the renovated Balkhi Hospital. About $23 million has been spent on the project.
After a 67% increase in infant mortality at the hospital, officials at CDC and the Afghan health ministry began questioning an HHS training program that encouraged physicians to perform caesarean sections without proper training or basic medical supplies. The c-section rate and postoperative infection rate at the hospital increased by 45% and 66%, respectively, according to CDC data. In addition, infants delivered by c-section at the hospital are nearly four times more likely to die than those delivered vaginally.
A contractor's assessment of the hospital found that Afghan physicians at the hospital often did not have basic knowledge of anatomy and physiology and lacked skills needed to resuscitate women and infants. In addition, the hospital routinely lacked basic supplies, including surgical gloves and antibiotics. Officials also have cited problems associated with the hospital's training program (Daily Women's Health Policy Report, 11/20)...
Waxman said that a Nov. 18 Journal-Constitution article about the hospital "raises serious questions about how the Bush administration responded to concerns raised about dismal conditions at the hospital," adding, "Millions of dollars have been spent on this initiative, and those funds should have been spent in ways that most effectively improve the quality of care for Afghan mothers and their babies."* Among Waxman's findings and conclusions in his online letter referenced above:
Waxman's letter is available online (.pdf)...
In the meantime, HHS used $ I .3 million, more than 25%o of its fiscal year 2004 funds for Rabia Balkhi, to purchase "Afghan Family Health Books."l5 The books, actually sophisticated electronic tools from the LeapFrog company, displayed health information for Afghan women in audio and pictures, because the majority of Afghan woman are illiterate. However, it does not appear that the decision to purchase this costly technology was based on any research into whether the devices would be acceptable or understandable for Afghan women...
* Other reports found continuing poor care there:However, it appears that early claims of progress at the hospital were not based in fact. Furthermore, it appears that HHS missed multiple opportunities to take steps that would have facilitated and expedited the work of these committed professionals. The concerns conveyed by CDC staff and other experts who worked in the hospital appear to have been minimized or dismissed entirely, and HHS touted the hospital's rebirth as a prime example of the agency's accomplishments in global health at a time when the picture on the ground was not consistent with these claims.
When reached for this article, Thompson said he believes the hospital “is a hell of a lot better than it was when we started.” The AJC also reports that Thompson “said he doesn’t remember hearing concerns from officials at CDC or others.”
“I thought the program was well-received by everybody,” Thompson said. “All I wanted to do was make sure women were taken care of.”
Oh. My. God.
The AJC, which deserves many kudos for this reporting, has posted emails between doctors and U.S. officials (PDF) (here’s another) that describe the hospital conditions, along with a letter from Thompson to then-Defense Secretary Donald Rumsfeld in which Thompson outlines the hospital’s “successes.”
