Working as a nurse in Afghanistan is a daunting task, but Cork woman Aoife Ní Muruchú is taking it in stride.
The Waterfall native works with Médecins Sans Frontiéres (Doctors Without Borders) and is currently stationed in the Khost province of the war-torn country.
She primarily works on MSF's Sexual and Sender Based Violence project.
“It is a positively unique experience to be an Irish woman working so far from home, in a country as interesting as Afghanistan,” said Aoife.
“While life is confined to compounds, I have daily contact with my Afghan counterparts, with MSF national staff and patients. The warmth and hospitality of the Afghan people, who suffer from decades of war, displacement, and loss of family and friends, is remarkable. Although the impact of decades of war is very visible even in daily life sometimes, I have experienced the Afghan people to be extremely warm and kind, friendly, funny, hospitable and respectful.”
Aoife, from Waterfall, explains that she greatly enjoys the company of her Afghan colleagues and patients.
“There is a strong and friendly rivalry between the Afghan and Irish cricket teams and we discuss and laugh about this often. Afghanistan happen to be hosting the Irish cricket team in a series of matches this month, commencing on March 8th!” she laughs.
In terms of her specific role, Aoife works with women who have experienced forms of violence.
“My role as Gender Based Violence program implementer involves visiting the various project sites to implement a strategy which creates access to care and preparing a response to GBV - including physical and psychological care,” she explains.
“Currently I am located in Khost, a mountainous area in eastern Afghanistan, close to the Pakistan border. Here, MSF is running a maternal health project providing safe delivery care and emergency obstetrics for women.
“My work takes me to a number of other MSF projects across the country. We have on average 80 deliveries a day and last year more than 21,000 babies were delivered.”
Aoife also provides different levels of direct and indirect training to different groups of staff and is “preparing key national medical staff” to be focal points to identify survivors of GBV and offer medical and psychological care to them.
“GBV has been exacerbated by long and ongoing conflict in the country, a reality which can also be found in many other insecure contexts that experience a co-relation between heightened conflict, insecurity and violence against women. In our projects, we see many women who have experienced GBV, including domestic violence and sexual violence,” said Aoife.
“Some of the consequences of GBV that we commonly experience include unintended pregnancies, miscarriage, low birth weight, prematurity and gynaecological problems. Addressing GBV is a much needed intervention for MSF as we need to be sensitive to GBV amongst our patients and our staff.”
Aoife first got involved in this area of expertise when she was working in Papua New Guinea.
“While working as the Nursing Activity Manager of an emergency surgical project on my last mission in Papua New Guinea, I witnessed a high prevalence of family and sexual violence and was in contact with these patients and survivors every day,” she said.
“When Médecins Sans Frontières launched a report which highlighted the cycle of abuse for survivors of family and sexual violence in PNG, I was involved in the launch as the field representative. This advocacy experience cemented my interest in this area of work and this is how I came to be in Afghanistan in October 2016.”
Though the job has been tough, Aoife said she truly believes in what she does, especially because Afghan women face so many barriers to health care right now.
“Seeking health care is difficult for all Afghans living in the rural areas but it is even more the case for the women because of cultural barriers,” she explained.
“Insecurity, bad roads, prohibitive costs, distance from functioning health facilities – are all realities for women to access healthcare.
“Some women also remain hidden and isolated in the home and can only leave if they are fully covered and accompanied by a male relative. Women’s restricted mobility can also create a barrier to their ability to seek healthcare. They are restricted again when health treatment is subject to male approval and treatment of women by male doctors is largely unaccepted.”
She said many women also have a lack of formal education and are illiterate and, therefore, there is a lack of female professionals.
“This also has a negative impact on the GBV response in health care. The modes of transport for women to reach health facilities are limited, and a lack of decision making power regarding their health highlights the gender based barriers which affect the health outcomes of women and their families in Afghanistan.”
In addition, Gender Based Violence is an extremely sensitive subject in Afghanistan.
“Gender based violence is as sensitive issue in most countries and so it is in Afghanistan – MSF is a medical organisation and so we try to assess which health care can be given to victims of GBV and provide it when possible. Of course in Afghanistan like in many other countries gender based violence carries along a huge stigma for the victims so all the support has to be delivered with an extra care for confidentiality,” said Aoife.
“The subject is very sensitive in Afghanistan, like in most of other countries, and it’s really important to try to understand better the impact of this on Afghan women.”
She said GBV is viewed as dishonourable, sexual violence in particular, and can result in the survivor being blamed and perceived as not being marriageable.
“Sometimes victims can be forced to marry the perpetrator to avoid stigma and shame for the entire family,” said Aoife.
“In the worst cases, a survivor of sexual violence can be killed to restore honour to the family. GBV remains silent and underreported.”
Making a difference in this area, however, is extremely rewarding.
“The most rewarding part of my job is building on the capacity of health care professionals to enable them to provide quality care to survivors of GBV in Afghanistan. When the overall culture of GBV is silent and hidden, and exposure can mean a matter of life or death for the survivor, staff training is a very important aspect of my work. Health care professionals are often the first points of contact survivors of GBV speak to making it essential for them to be able to recognise the signs and respond safely and appropriately,” said Aoife.
“It has been reported by MSF national staff that the trainings have already resulted in a positively changed work environment and in how survivors of GBV are being supported. This made me feel very happy.”
While Aoife is happy with her job and her work, she said she does occasionally get homesick for Cork. She said she misses her “fantastic and supportive family and friends”, her mother's dog Cormac, doing yoga in Bikram Yoga Cork, and running with her friends from Marathon Club Ireland.
Médecins Sans Frontières/Doctors Without Borders (MSF) is an independent international medical humanitarian organisation that delivers emergency aid in nearly 70 countries worldwide. MSF provides emergency medical care to people caught up in war, disasters and epidemics. For more information, or to donate, go to www.msf.ie.