'No doctors, no hospitals, nothing'

For Afghans, India is the nearest thing to home another country can be. They grow up watching Indian films and soaps and singing Hindi songs. They know all the Bollywood stars. Indian engineers are helping to rebuild their country's shattered infrastructure. There is even a story that cabinet meetings in Kabul are sometimes delayed as a certain minister finishes watching his favourite Indian serial.

When someone falls sick, therefore, for many Afghans their first thought is to travel to India. Apart from the emotional affinity, they know India offers world class treatment and the latest medical techniques at its private hospitals. When the patient and accompanying relatives arrive at Delhi airport, tense and anxious, it helps that there is not too much of a culture shock, despite India's swirling chaos.

And yet, it is not a happy trip. Afghans are not coming to India on a whim, but rather because most have no chance at adequate healthcare in their home country. ''Who would not want to walk into a hospital in their own country? But we have no doctors, no hospitals, no technology, nothing,'' says Rahima Amini, 48, who is recovering from surgery for breast cancer.

Amini came to the Apollo Hospital with her 19-year-old son Mohammed Arif, leaving behind a husband and eight other children in Heart province. She must have been anxious about leaving her children? Amini's eyes suddenly fill with tears and she pulls the headscarf around her chest up to her eyes to wipe them away.

''If I say I miss them, what difference will it make? What good will it do?''

Amini is one of hundreds of thousands of Afghans who have been coming to the Indian capital for medical treatment because decades of war, the repressive Taliban regime, American bombing and the past few years of instability have left them with pitiable healthcare.

Sick Afghans, if they are rich, go to London or New York. The middle class could go to Pakistan, a neighbour and closer than India, but the violence and instability there put them off. India is the obvious choice because they know that foreigners come from all over the world for treatment that is a fraction of the cost in developed countries.

The World Health Organisation says that Afghanistan's health status is one of the worst in the world. Health indicators are three to fivefold higher than in neighbouring countries.

Dr Vivek Gupta, senior cardiologist at Apollo, has seen the collapse of the healthcare system with his own eyes, having visited Kabul several times. ''There are no trained doctors, no facilities, not even an angiography lab in Kabul. Heart attack patients just die because there is nowhere to take them. The Indian government is helping a lot but Indian doctors won't go because it means risking their lives,'' he says.

After three American doctors were shot dead at Cure International Hospital in Kabul on April 24 - the latest in a series of attacks on foreign civilians - even fewer foreign doctors will be prepared to work in the country.

While some reports coming out of Afghanistan have suggested that healthcare is being restored, Medecins Sans Frontieres (Doctors Without Borders ) contradicted these claims in a report published in February which showed that one in five Afghans had lost a close relative in the past year owing to lack of treatment.

The moment they think an illness could be problematic, those Afghans who can, book a flight to Delhi. At Apollo hospital, Afghans account for the third highest number of foreign patients, after Nigerians and Iraqis. Max hospital in Saket, in south Delhi, admits about 6000 Afghans a year.

Many have sold land or borrowed from friends to finance the trip. The patients range from children to pensioners and from judges to butchers. Speaking of meat, since the Afghan diet is rich in meat, coronary heart disease is a common ailment.

''If you add to the meat diet, the high levels of stress they have suffered for so many decades, you can see why heart disease would be a big problem,'' says Dr Navin Saraf, cardiac surgeon at Fortis Escorts.

Many come for plastic surgery having been maimed by bomb blasts and landmines or caught in crossfire. The number of patients with mental illnesses is also high. The MSF report estimated that as much as 60 per cent of the population suffers from mental health disorders.

''The only treatment Afghans can get in our own country is for trauma. Thanks to our history, we specialise in that. But nothing else, not even medicines. The local pharmacy often doesn't have what the doctor has prescribed,'' said an Afghan interpreter at Apollo who did not wish to be identified.

For Kabul-based businessman Sayeed Kamalluddin, 55, chronic back pain brought him to Fortis Escorts. The diagnosis was a cyst on his kidney. A few days ago, Dr Ashish Sabharwal, consultant urologist, removed the cyst.

On his morning round, Dr Sabharwal tells Kamalluddin, an exporter of the pistachios, walnuts and almonds for which his country is famous, that he will be discharged in a few days. His wife Homira (who refuses to be photographed - ''It's not in our culture for women to be photographed outside the family'') and sons Jawid and little Hilaluddin, smile with relief.

''Our friends told us to come to India because it has the latest medical techniques. It was quite easy. We got our visa and booked our flight. I am comfortable in the guest house that the hospital told us about but language is a bit of a problem, even though I know a few words of Hindi,'' says Homira.

''We are all crazy about Indian films so we pick up Hindi,'' she says.

The private hospitals in Delhi, realising the psychological stress of families coping with a different culture while also worrying about the illness, help with variety of services. A car picks up the family from the airport, the hospital helps the family find accommodation nearby, and Afghan interpreters are on hand.

There is no dearth of interpreters. Periodic waves of Afghan refugees escaping war, the Taliban or the endemic violence that is a feature of Afghan life, have brought an estimated 18,000 Afghans to India. Over the years, little Afghan enclaves have emerged in the Indian capital where medical tourists can feel at home.

Fardin Khan, 48, owns Kabul restaurant in one such enclave in Jangpura Extension. ''About 60 per cent of my customers are the relatives who are accompanying patients here for medical treatment,'' he says.

Near his restaurant is a pharmacy with neon lights in Dari (the language spoken in Afghanistan, along with Pashto), and a bakery selling the large thick Afghan flatbread, prettily dimpled and dotted, fresh out of the big tandoor (clay oven).

Two kilometres away is Khrishna Market, a little corner of Afghanistan in the overcrowded and dirty quarter of Lajpat Nagar. Afghan men in their distinctive baggy tunics and loose pyjama-style trousers stand around chatting outside The Afghan restaurant.

The food and culture may not be too alien but what Afghans do struggle with is the insane heat. Summer temperatures in India can reach 44 degrees centigrade. In Kabul, the highest temperature is 23 degrees .

Just as the visiting patients have stories of loss and melancholy, so the Afghan interpreters have their own stories about what tragedy or fear prompted them to leave their homeland to come to a foreign country.

Some, like Jafar Hashmi who works at Fortis Escorts, are political refugees because of the Taliban. They have left behind their homes and wider family. Hashmi says he cannot return.

One interpreter refused to give his name. Looking distraught and intensely anxious, he has yet to master the skill of interpreting. He has only been in India a few months. He fled in panic because he had to whisk his beautiful daughter away from the clutches of a neighbour, a man with contacts in high places, who was bent on forcibly marrying her.

Muzghan Aslami is 24 and works as an interpreter at Apollo. Apart from English and Dari, she speaks fluent Hindi because she was only 16 when she arrived in Delhi and picked it up quickly.

Her striking looks make her stand out in the vast hospital concourse where people of numerous nationalities mill around. ''There was no security in Kabul. There was no education and we had no money. My parents had no choice but to come to India. We have never been back so I miss my cousins and aunts,'' says Aslami.

Some Afghan refugees hope that a new government may improve the situation sufficiently to allow them to return. If successful, the just concluded elections will mark Afghanistan's first truly democratic transfer of power.

No candidate won an outright majority in the initial results of the April 5 presidential election. This will require a second round. But once a new government has been sworn in, Aslami says she hopes to be able to visit her homeland.

Many patients voted before coming to India. Kandluddin says he voted for Abdullah Abdullah, who was the frontrunner in the campaign and is a member of the anti-Taliban Northern Alliance. ''I pray to God he will give us good facilities in Afghanistan that all human beings need. He gives us hope,'' he said.

But for Muhebullah Esma, a former principal of Mirhamza, a co-educational school in Kabul that had 3000 pupils and 72 teachers, a new government cannot give him back the years he has lost at his beloved school. When the Taliban took over, they ordered Esma, principal for 20 years, to close it down.

Later, the US bombing that followed 9/11 destroyed the school. German aid workers have partially rebuilt the facilities but it is too late for Esma who is now 68 and at Fortis Escorts for heart bypass surgery.

At times, when Dr Gupta hears about the conditions that drove Afghans into his hospital, he feels almost tempted to go Kabul to help. Some years ago, an Afghan NGO asked him to establish a hospital and train doctors. But his wife will not even discuss the possibility.

''There is just so much to be done. Of course there are medical training colleges but their courses are not good enough. So the very basics need attention. And then labs, medical equipment, hospitals.''

Dr Gupta knows the goodwill that Afghans feel for Indians. The links are historical. Babur, who laid the foundations of the Mughal empire in India, is buried in Kabul. But the goodwill is also based on the help - partly altruistic, partly strategic - that the Indian government has given to the country.

In 2005, the Indian government began offering a special medical visa. It is free and applicants do not have to furnish any proof of financial status.

After the ousting of the Taliban regime in 2001, India was one of the first countries to reopen its embassy in Kabul. Since then, it has given over $2 billion in aid, sent its engineers to help rebuild schools, roads, power stations, transmission lines and bridges, and helped to train Afghan diplomats, policemen and judges.

''We come with a positive attitude towards India,'' says Mustafa Gul, 26, who has left his studies in the Logar province to bring his 58-year-old father, butcher Shireen Gul, to Apollo for prostate surgery. ''We feel we are in our own country where people will be friendly and caring.''

Shireen Gul says that he had no faith in the Afghan doctors he met. ''Even if they get the diagnosis right, where do we go then for treatment? The nearest hospital was a day's journey away and travelling wasn't safe so you are trapped,'' he says.

Gul understands some Hindi. He is the kind of patient that Aslami has to be careful with. Sometimes, if a doctor is standing by a patient's bedside and telling Aslami, in Hindi, that the disease is incurable and nothing can be done, the patient may understand the grim message. ''I try to see how much Hindi they know so that I can tell the doctor in advance not to say anything heart-breaking in front of the patient. They are so far away from home, it would be too much to bear.''

The story 'No doctors, no hospitals, nothing' first appeared on The Sydney Morning Herald.

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