C.P.H.A COMMITTEE FOR MEDICAL AND HUMANITARIAN AID IN AFGHANISTAN

Project Website CPHA Committee for Medical and Humanitarian Aid in Afghanistan
Story Telling is important to NGOs as it allows donors to empathize. The task was to create a tool of communication for the CPHA to share with their potential donors and stakeholders.

Afghanistan, Chak-e-Wardak Hospital: Project Case Study
Karla Schefter’s summary in collaboration with Dyria Aloussi

1. Development Aid in Afghanistan:

The Chak-e-Wardak hospital stands for humanity, dignity and altruism; Karla Schefter, the persistent backbone of the project, build a showcase for bravery and will power. She establishes the hospital in the Afghan province despite tremendous challenges and sustains it for over 26 years: it is a light in the darkness of the suffering people living on the brink of despair in the Afghan provinces. The project is exemplary of how development aid can work in such desperate and hopeless conditions. Empathy, long-term thinking, persistence and selfless readiness to help form the key to development aid. Only trust, respect and education lead to peace and economic progress. If you want to teach how to build a ship, you must inspire the desire to conquer the ocean.

2. Afghanistan, a country in despair:

Afghanistan is not only physically destroyed but also erodes in its rich traditions and morals. Outside proxies impose war for years and undermine structures in society and government. A civil war rages for almost 40 years; today, Afghanistan is one of the poorest countries in the world. The unemployment rate is up to 40% (Worldbank, 2015) and the economy still suffers the longterm effect of the wars. Since most of its educated and qualified workforce flees abroad, Afghanistan has one of the lowest literacy rate in the world. The public administration and government remains unreliable whilst traffic and communication services such as telephone landlines and postal services are dysfunctional. However, mobile phone services are available throughout the country.
Public Health services are only limited functioning and skilled medical personnel is scarce. Public Health is one of the biggest social challenges in Afghanistan. The Chak-e-Wardak hospital’s priority is to work within local structures and use local workforce from the community in Chak. This improves the acceptance of foreign development aid even amongst conservative blocks in Afghan society. Hospitals and health related projects promote education, well-being and peace within society and therefore form an important stepping stone for development in Afghanistan’s provinces.


3. Background: 

After the soviet troops leave Afghanistan in 1989, the German Afghan Committee (DAK) with the financial support of the EU, decides to establish a hospital in Wardak province, approximately 65km southwest of Kabul. The committee had already gained experience during the years of soviet occupation, with its medical missions in the region.
The Committee chooses the location of the hospital in the immediate proximity to the Siemens hydroelectric power station in Chak for security reasons. In years of conflict and war, the power station was never attacked. Moreover, the Chak River and the Highlands climate -2400m above sea level- are obvious and important advantages of the location.
Karla Schefter is a former head-nurse of the municipality hospitals in Dortmund. At the time she is working for the German Afghan Committee in Afghan Refugee Camps near Sadda and Khost. She travels to Wardak province with two other doctors to work in the hospital as a head nurse and trainer. In the early beginnings there are two provisional rooms set up inside the power station as an emergency ambulance and very primitive equipment is used for surgeries and treatments. In summer 1989, the local Shura approved the construction site for the hospital.
When the EU confirms the grant, the construction of the hospitals starts: despite organizational challenges and corruption, the project is finalized and functions until today as the only hospital for half a million people in the region.
In January 1992, Karla Schefter returns to Wardak province, appointed by DAK as project leader for the Chak-e-Wardak hospital project. In December 1992, the EU grant expires and shortly after the hospital closes down due to insufficient funds. Afterwards, the DAK dissolves. Only loyal hospital staff remains in Chak and continues working non-paid to protect and guard the hospital from theft and abuse. Karla Schefter uses her time in Germany to convince a group of medical doctors she knew to establish a charity and to keep the hospital in Chak operating. This led to the formation of the C.P.H.A Committee for medical and humanitarian aid in Afghanistan.

4. History:

In 1993, Karla Schefter returns to Chak with a humble amount of 30.000 Deutsche Mark: with minimal staff, she managed in her persistent and undeterred manner to keep the hospital running for a year.

In 1994, The EU renews their grant for two years. In the meantime a French NGO, running a hospital in Hyatabad, shows interest in the Chak-e-Wardak hospital. In the end, the grant was syndicated between both, the French NGO and the EU. The newly formed CPHA, led by Karla Schefter, executes the project.

In summer 1995, the hospital expands to add a seperated tract with 20 beds for women and children. The GIZ (former GTZ, Gesellschaft für International Zusammenarbeit) funds the new women and children hospital complex. After two years construction work, the new tract finishes and doubles the projects capacity from 20 to 40.

From 1998 until 2000, the EU in cooperation with the German foreign Office and USAid continuously finances Chak-e-Wardak hospital.

The hospital capacity continuously expands: the German embassy in Islamabad funds a new bigger kitchen, bakery and incineration plant for medical waste. The city of Dortmund sponsors several storages for the hospital. The electrical system is renewed and a drinking fountain build with a water reservoir attached to it. The hospital constructs two guesthouses, new staff housing facilities and walls around the compound for security reasons. The simple fleet includes currently four vehicles.

In 2005 until 2006 the entire hospital is renovated: today the Chak-e-Wardak has 60 beds, X-ray, Ultrasound, and cardiogram devices.

In 2011, the hospital purchases a new X-Ray device and updates the office furnitures and fixtures with PCs, printers and a new satellite telephone.

Statistical summary: 
The number of patients in the year of 1994 was 14.500. In 2013 the patients increase to 84.500 patients per year.
From 1994 until 2014 more than one million patients are treated in the Chak-e-Wardak hospital. Around 10% of which are inpatients and 74% women and children. Through vaccination campaigns by the hospital around 8000 people are vaccinated a year.

The project outcome is unique for Afghanistan in its efficient and long-term character.

5. Code of Ethics

Donations:
The Chak-e-Wardak project undergoes a tightly controlled accounting by Karla Schefter personally and the managing board of the Committee. Since the early beginnings, the project has been administered with the least amount of costs. The project is 100% financed by donations. A loyal support base of donors from Germany donate 75% of the contributions to Chak-e-Wardak. Schools, service clubs, church institutions and trusts finance the remaining 25%. The staff costs are kept low; the project mainly employs multifunctional local staff and volunteers.
General Principles: 
Financing complies with the principles of non-profit-rule, non retroactivity rule and non-accumulation rule. All costs are identifiable, tightly controlled and accounted for as well as accounted for according sound financial management principles and full transparency requirements.

Karla Schefter’s International Awards and Official Honors: 

1993 Federal Cross of Merit on Ribbon

2001 Human Rights Nursing Awards

2001 Charity Bambi

2001 Iron Reinoldus Dortmund

2004 Federal Cross of Merit First Class

2006 Malalai Medal

2007 Badge of Honor city of Dortmund

2009 German Nursing Association

Committee for the Promotion of Medical and Humanitarian Aid to Afghanistan C.P.H.A

Contact for donations: 
www.chak-hospital.org

C.P.H.A Donations Account: 
Sparkasse Dortmund
IBAN: DE7044051990181000090
BIC: DORTDE33
KtoNr: 181000090
BLZ: 44050199

Development Aid in Afghanistan

6. The beginning

Together the Afghan people and the Committee are building the hospital over 25 years by using the potential of the Afghan province Wardak.  Chak-e-Wardak develops step by step into a fully functioning hospital. However, it is still entirely financially dependent on donations from Germany. Karla Schefter lives the life of the Afghans in the province and leads the project from Chak: she suffers with the Afghans and lives with them through wars and regime changes.
The nearby Siemens hydroelectric power station generates just enough electricity to keep the lights on in wintertime, with only one functioning turbine; due to attacks from the Taliban and a lack of funding, it is not possible to revive the power station and reactivate the second turbine. A generator provides electricity for the Chak-e-Wardak hospital. As long as the security situation allows it, Karla Schefter spends nine months a year in Chak. At first, she has no adequate accommodation or office facilities. For decades she is the only European coming and living in the provincial Chak district. Against the odds, she finds herself sharing her living space with men as the only woman: 1989 she shares a room with three men in an ailing Muhajideen clay hut. At the time the hospital is still made of make shift first-aid treatment rooms located inside the Siemens power station. After a while, Karla Schefter lives in a small back room with a washing area and a toilet outside, no showers and only cold running water. In 1996 Karla Schefter moves into a small clay house with warm running water but still only limited electricity. In the darkness lanterns and torches give light.
During conflict, the injured come in on vans and lay on the cold floor of the power station. The station’s turbines separate men from women. After the main hospital tract is built in 1994, the hospital has 20 beds, an operation room, x-ray department and a generator to provide electricity.
On the weekends, Karla Schefter spends her time in traditional homes and lives the Afghan daily routine. She gets to know the traditions and religious celebrations. Accompanied by her Afghan friends, she travels all across Afghanistan through every province and city. She is impressed by the country’s versatile magnificence and wild beauty. Karla Schefter, with her selfless nature and strong commitment, builds a strong network of relations in Afghanistan over the years supported by trust and loyalty.

7. Political Context 1989 to 2001

The main frontline is only 35km away, between Chak and Kabul; when the Soviets surrender in February 1989, a full-blown civil war breaks out.
In 1989 until 1992 the Mujahideen fight against the former president Najibullah, a communist installed by the Soviets. After Najibullah is overthrown in 1992, the Mujahideen start to fight for power against each other. Only an elderly man from Chak risks his life bringing construction materials such as glass, cement etc from Kabul to Chak.
After six months of clashes, Hekmatiar, a Pashtoon Islamic extremist, takes power in Kabul. During his reign, 80% of Kabul is destroyed.
Thereafter Masud, who belongs to the Tajik minority, overturns Hekmatiar. Both leaders are unable to control and stabilize the country. End of 1994 the Taliban, an extremist Islamic movement made of Pashtoons from Kandahar, are on its way to power: they attack Chak in 1995 the Taliban and move towards Kabul.  A year later, Kabul is taken. The Taliban make several attempts to take over Afghanistan but are not able to gain a foothold in the north of the country, such as Kunduz and Herat. However, they rule Afghanistan out of Kabul from 1996 until 2001. During the Taliban, women are not allowed to work or study. Basic education for girls is forbidden and they are taken out of school; only in the refugee camps in Pakistan and Iran, elementary and secondary education for girls is provided. The medical field is an exception, where women are still allowed to work in Afghanistan. The Taliban regime is a fascist regime where listening to music is illegal and men have to wear long beards. During the Soviet time, women in the main cities, Kabul and Herat, dont even wear the Hijab and are part of the public life in an open and modern society. The Taliban subjugate Afghan women, introduces the burka dress code and exclude them from public life.
Every regime change in Afghanistan triggers a new wave of refugees and displaces Afghans internally. Qualified and educated Afghans are fleeing the country to find opportunities elsewhere. Only a handful Academics and technicians remain. Slowly Afghanistan bleeds dry and is left with a majority of illiterate Afghans, more violence and extremism. Due to the state of war, regular education at schools and universities disrupts. There are rarely vocational training seminars to qualify workers. In 2001 Karzai replaces the Taliban.

8. Development and supply

Afghanistan is a difficult and complex environment. The country has lived through years of military conflict, which resulted in a deep economic crisis. This is why the project is 95% dependent on donations from Germany. Despite the challenges, Chak-e-Wardak hospital is built with local manpower and resources. Electricity is unstable and there are no cranes in the province to lift heavy construction material. 40 men carry heavy parts from the truck. Until 2002 it is not possible to get prefabricated building parts such as doors or window frames. Everything is hand made from scratch. Karla Schefter and her staff also participate in the construction work; the medical director hangs the curtains, the baker assembles the traditional Tandoor bred oven and the laboratory technician solders spirals to distill water. The couple responsible for the hospital’s laundry sews the covers for the sitting areas as well as traditional dujaks and cushions. Chak-e-Wardak hospital buys steel beds and side tables for the patient rooms from a training centre in Ghazni. Step by step the hospital developed and improved year on year.

Medical Supply: In 1994 it is possible to obtain medical devices such as x-ray machines, anesthetic machines and electricity generators from Pakistan. Transport is time consuming and undertaken under the most difficult circumstances. Since 2003 medical devices are procured in Kabul. This presents a major progress for the hospital supply chain. It eases inductions, maintenance, repair work and secures the availability of necessary spare parts.
Electricity Supply: In 2013 solar panels are installed which lights the hospital and the attached building. The solar panels generate enough electricity for hot water in the kitchen, delivery room as well as in the operation and emergency room. In the laboratory it provides the cool chain for vaccines and test materials.
Food Supply: From 1989 until 1992 food for the hospital is cooked on open fire. A functioning kitchen replaces a makeshift kitchen in 1998, where daily food portions are cooked for 300 to 500 patients and staff. Food consumption is monitored and accounted for on a monthly basis. The data establishes a stocking list for six months of non-perishable items for the hospital.

9. Contracting

During the Taliban regime, the German embassy in Pakistan is also responsible for Afghanistan. Due to the difficult working conditions and hostility from the Taliban, all major international institutions, such as the UN and EU, move to Peshawar and Islamabad: only a handful of international aid organizations work out of Kabul.

When the construction of the hospital starts, Karla Schefter is responsible for contracting developers. She finds them in Kabul. At the time, there are only three developers working in Afghanistan.European institutions organize vocational training and qualifications courses for Afghans in Pakistan: training courses and qualifications for laboratory assistants, nurses and x-ray technicians are conducted to train staff for the hospital in Chak. A German technical centre for engineering and construction, set-up for Afghans in Peshawar, provides workers to set up electricity and sanitary facilities in the hospital. Workers from the Chak district complete the remaining building works.
For the women and children tract, Karla Schefter approaches the GIZ (former GTZ) in Frankfurt, Eschborn. Beforehand, Karla Schefter provides an Afghan architect with offices in Wiesbaden, a hand drawn plan of necessary rooms, the Chak canal and existing buildings by the site. He revises the drawings and Karla submits them for funding. The GIZ approves financing the building of an additional women and children tract for Chak-e-Wardak. An Afghan partner NGO of the GIZ supervises and follows progress of the constructions in Chak.
Until 2002 contractors in Afghanistan are desperate and vigilant; after the fall of the Taliban, huge amounts of aid money flood the country for ambitious construction projects. Suddenly there are not enough qualified technicians and architects for constructions in the country and the prices for building work skyrocket. The developers no longer care for small projects. They send unqualified personnel such as medical doctors as supervisors to oversee the construction. Under most difficult conditions and with much delay the construction of the women and children’s tract is finished.

10. Capacity Building

In 1997 the NGO ‘Save the Children’ approaches Karla Schefter and suggests to build an educational center for women in Chak: the NGO provides teachers and trainers. Initially, instructors are accommodated in the Women and Children tract, where the seminars take place. After a successful beginning, Chak-e-Wardak provides special accommodation and guesthouses for the teachers and their immediate family. In Afghanistan it is a tradition and necessary to provide for immediate family of staff and workers.

With time, Chak-e-Wardak hospital develops into a medical education center for women, located around an old mulberry tree. Under the watch of their fathers, children are playing and running around in the garden. Their mothers educate and train midwives and physiotherapists inside the classrooms. Women from all over Afghanistan attend the seminars.
Chak-e-Wardak hospital keeps good relation with hospitals from the neighboring provinces Ghazni and Logar. Ghazni is about five hours driving distance from Chak. A surgical center was developed at the ICRC (international red crescent) hospital. Logar is about four hours driving distance from Chak. The EU funded a hospital in Logar with a similar amount it provided for Chak-e-Wardak hospital. Karla Schefter keeps in regular contact with both hospitals and organizes monthly exchange seminars and workshops between them. A member of the Chak-e-Wardak medical team personally delivers handwritten invitations for the partner hospitals. Until today the postal service is not functioning in Afghanistan. Meanwhile, good mobile telephone service is provided.
Participants of workshops and seminars enjoy their time in Chak. It is located within green landscape flanked by fruit trees and natural beauty. There is a regular training schedule in anatomy, physiology and pathology. The Chak-e-Wardak team also successfully organizes vaccination campaigns. Karla Schefter personally trains staff in surgical materials, medical devices, hygiene, disinfection and sterilization. Women from other districts come to attend the training. The hospital staff recruits women in their extended family and friends circle in nearby villages to become mother and child health workers, nurses and midwives.
Education at Chak-e-Wardak hospital creates a reverse women’s role in the Afghan society; women become the bred-winner of the family.
(At the moment, as a result of the security situation, knowledge exchange and education activities are very limited.)

11. Mobility, Infrastructure and Security

Moving around in Afghanistan is dangerous and difficult. Afghanistan lacks adequate infrastructure and security. Like in the old caravan days, people ask others about the current state of security on the roads.
It takes about two and a half days to drive from Peshawar to Chak. For safety, Karla Schefter travels with an armed security guard. In the early beginnings of Chak-e-Wardak, Karla Schefter drives from Peshawar six hours south to the refugee camp in Sadda, located in Pakistan’s tribal area. Karla Schefter needs a special permit to pass the checkpoints on the road. From Sadda, they drive another 13 to 17 hours through North Waziristan over the mountains to the Afghan border. Until the Afghan border, a Pakistani police guard with a special permissions escorts Karla Schefter along the Khyberpass. On the Afghan side, the road takes them north passing Ghazni, Angurata, Sadran, Sormat and Bande Sarde towards Chak.  In 1991, when the Mujahideen conquered the city of Khost, they opened the historic passage Tera Mangal from Sadda to Afghanistan. From 1992 onwards, a road leads to Logar and Chak through Gardez. Driving by car from Pakistan to Afghanistan, Karla Schefter familiarizes with the provincial life. She has seen places and spent time in areas, which are today totally closed off and too dangerous to pass. Nowadays, Karla Schefter takes flights from Düsseldorf via Dubai to Kabul. Karla Schefter then drives from Kabul to Chak. In 2002, Chak-e-Wardak hospital project closes its office facilities in Peshawar and relocates to Kabul. The staff resettles with their families in Kabul.
After years of bombardment and destruction, the road from Kabul to Chak is in such bad conditions that it is only possible to drive 20km per hour. With the danger of landmines lurking and unsafe bridges, it takes three and a half hours to drive 65km. In 2001 the main road from Kabul to Ghazni finally gets paved and it is possible to reach Chak from Kabul in less than two hours. However the loaded trucks passing with containers and diesel are a constant target for the Taliban. The main road from Kabul to Ghazni is also Nato’s main supply line and therefore remains a dangerous target. Apart from the aid money for Afghanistan’s infrastructure that is going missing, ambitious plans to revive the country’s roads are undermined by the security situation. After some unfortunate instances in Chak, it is no longer possible to receive foreign visitors in Chak. Across the country, foreigners and international aid workers are nearly absent in Afghanistan’s provinces.

12. Conclusion:

Chak-e-Wardak hospital stands for effective and sustainable development aid: Karla Schefter and the Committee are determined to continue their support for the suffering people of Afghanistan.

Chak-e-Wardak hospital serves as a showcase for long-term thinking in Afghanistan. The entire project is realized with the help and engagement of local Afghans. The Committee and its volunteers manage press and communication efforts out of Germany. The project’s finances are tightly controlled by the committee’s board; administration costs are kept at the lowest and every cent is spent directly on the project. Since formation, the Chak-e-Wardak hospital is an indispensable regional healthcare facility in the Wardak province. It is the only fully functioning hospital in the Wardak province for a population of half a million people. Patients from neighboring provinces come for treatment to Chak. The hospital is also a health education centre for women, which is rare, especially in Afghanistan’s provinces. Chak-e-Wardak enjoys an excellent reputation as one of the best and continuously operating hospitals in the country. The government of  Afghanistan, international NGOs as well as UN organizations highly respect its achievements and efforts.

Despite the current challenging security situation, the hospital is working with tireless commitment. Due to its neutrality vis-a-vis all political and religious parties, Chak-e-Wardak hospital is an island of peace.