A new study shows that after more than 30 years of war and years of oppression under the Taleban, people in Afghanistan are suffering from high rates of depression, anxiety, and stress. But this is far from the worst public health problem in a country that faces some of the world's worst medical conditions. In an effort to improve them, the United States is sending thousands of copies of talking books it hopes will teach Afghans basic health concepts.
Afghanistan rates low on every health indicator. It has one of the world's highest birth rates and maternal and infant death rates. Life expectancy is only 35 years. Just one-fourth of the population has access to safe drinking water and only one-eighth to sanitation.
Afghanistan's ambassador to the United States, Said Tayed Jawad, tells of widespread malaria, tuberculosis and measles and deplorable hospital conditions, despite aid from donor nations, international organizations, and non-government groups.
"Today, even in Kabul hospitals, you still see two or three kids sharing one bed," the ambassador said. "Patients are bringing in their own medication and syringes. Those who cannot afford to buy medication are dying in the hospitals. Many clinics and hospitals do not have trained doctors and medical equipment for basic surgeries."
In addition to the physical health issues, a study in the Journal of the American Medical Association shows that a majority of Afghans are suffering from depression and anxiety, and almost half from post-traumatic stress disorder. The findings are based on a survey of nearly 800 Afghan households conducted by Dr. Barbara Lopes Cardozo of the U.S. Centers for Disease Control.
"The people in Afghanistan are much worse off in terms of their mental health, even compared to other populations that have been affected by war," she said. "Women were more affected than men in terms of their mental health, and the disabled were more affected than the non-disabled people."
But the researchers were surprised to learn that violence of war was not the most important factor in the deteriorating mental health of Afghans. Instead, they found that the people were bothered more by the daily stress of dealing with shortages of food, water, shelter, and lack of medical care.
"The socio-economic factors in Afghanistan also play a major role and not just the traumatic events, just the chronic stresses, day to day life, the poverty that may be as important in this situation as the specific traumatic events," Dr. Lopes Cardozo said.
In an effort to improve Afghanistan's poor health situation, U.S. health authorities are distributing 20,000 copies of a talking book that conveys basic health care information in Pashto and Dari as well as English. The Voice of America provided the translations into the Afghan languages.
The battery-powered books deliver details on topics like diet, childhood immunization, pregnancy, breastfeeding, sanitation, and disease prevention through colorfully illustrated stories. A narrator and the characters in the stories speak when the user touches certain parts of pictures.
U.S. Health Secretary Tommy Thompson says he expects the interactive health books to have an enormous impact on the people of Afghanistan.
He adds that other areas of the world could benefit from the same approach.
"This talking book model, I believe, is an excellent example that could be expanded to other places where public health is held back by illiteracy and language barriers, " Mr. Thompson said. "For example, we certainly could consider using such technology in sub-Saharan Africa as part of our fight against HIV-AIDS."
The U.S. government is hiring a non-governmental organization to distribute the talking books throughout Afghanistan, beginning with clinics, hospitals and libraries.