Gender and Tuberculosis in Afghanistan

The author analyses the relationships between social and political organisation of the Pashtun of Afghanistan and the spreading of TB disease among the women. The spreading of tuberculosis among women in Afghanistan is correlated to the structural violence that marks social life. Women condition often becomes difficult – the author is arguing - when they enter the “new” family: the descent group of the husband. The responsibility of the choice of the therapeutic itineraries weighs on him, that is the political and economic balance of the constituted family in its relationship with the descent group to which he will always belong. Besides the economic contingencies, and the full medical health awareness, any attempt of therapy that is only based on the responsibility of the ill person is doomed to failure. The unawareness of the disease and of the possible recovery, as well as wrong beliefs, certainly prevent recovery. The DOTS therapy program, led by the WHO, includes an agreement with the WFP to provide food for the patients during the therapy. Although the women interviewed receive every month wheat, oil, beans from the WHO, they do not benefit from it and they remain underfed since there is this belief (sincere or manipulating) that there is no hope to recover from TB without a drastic reduction of food quantity. For instance, as referred by the responsible of the Lepco clinic (NGO that applies DOTS therapy in Mazar e Sharif, hospitalizing the poorest of the TB women patients): in order to force the hospitalized women to eat, it is necessary to threaten them telling them that if they do not finish the food they will be reported to the police, this because of the belief among the patients that food reduction helps the patient to recover from tuberculosis. The necessity to start an educational program for the ill women, in order to increase their awareness toward their disease – the author is arguing - is as necessary as an educational program for the families of the patients in order to increase their sensitivity and inform them about the possibility of recovering from the disease. But the training should also include the medical and paramedical personnel. In fact, the lack of communication between patient and medical personnel undermines the potentiality of recovery. A relationship of reciprocal trust and respect should be reconstructed. Finally, as far as the type of therapy is concerned, it appears necessary that it should be adapted to the context in which it is applied. This means that first of all it should be more flexible: health facilities are scarce and this country has the majority of its population residing in inaccessible areas with scarce and expensive means of transport. Traveling is very difficult. When tuberculosis is cured in an irregular manner and with medicines that are not perfectly specific, it leads to new tuberculosis. It doesn’t seem to be widespread up till now in a significant quantity, above all because the war had prevented the cure of TB. But the country seems to have all the conditions – suggests the author - to develop a considerable increase of cases of multiple-drug-resistant TB if it is not supported by efficient TB programs.