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KABUL, Afghanistan – Despite the United States spending nearly $600,000 in taxpayer dollars on Salang Hospital in Afghanistan’s Parwan province, the facility must still resort to medieval medical practices such as pulling teeth out with pliers.
Salang Hospital – the only medical facility servicing the mountainous community of approximately 50,000 – lacks essentials such as basic medical equipment, clean water, electricity and a working sewage system.
"We are working with just three light bulbs here"
A comprehensive report released Wednesday by the Special Inspector for Afghanistan Reconstruction (SIGAR), a federal government watchdog, details the good intentions of the U.S. contract that was commissioned in 2009 to build the hospital, and tries to get to the bottom of what went wrong.
Teeth pulled with pliersOn a recent visit to the facility, NBC News observed the hospital’s desperate staff trying to administer care to patients like 12-year-old Khorshid, who goes by only one name. She came in with a toothache and left traumatized.
“We have a total of six pieces of dental equipment,” said Dr. Said Maqsoud Sarwy, as he laid the rusty tools down on a table. He pushed a chair up against the wall, sat Khorshid down and poked around her top row of teeth with a pair of unsterilized scissors to determine which one hurt the most.
“We don’t have what we need to check the teeth for cavities,” he frowned. “We don’t even have the equipment to help us determine whether we should extract a tooth or not.” That said, he decided to pull one of hers out.
The girl was shivering with fear, and began crying after the doctor gave her a shot in her gums. Another man held her still as Sarwy swiftly tilted her head back, opened her mouth and yanked out one of her teeth with a pair of pliers.
Her tooth – along with some bloody gauze – were thrown in a filthy bucket and she was sent home. Compared to the other two patients NBC observed in the hospital on the day of our visit, she appeared to fare the best.
Best intentionsAccording to the SIGAR report, the USFOR-A (U.S. Forces-Afghanistan) commissioned a local Afghan contractor, Shafi Hakimi Construction Company, to do the job in 2009 through a program designed to give Afghans jobs.
A 20-bed hospital with surgery and X-ray rooms, a lab, a pharmacy, dental, pediatric and mental wards was supposed to be built.
Instead, the resulting structure is a mostly unused, understaffed, inadequately supplied, structurally deficient building at risk of collapse in the second most seismic zone in an earthquake-prone country.
“They should have had a team of observers here, making sure the work was done properly and that they were using the right materials,” the hospital’s administrator, Arsala, who only goes by one name, told NBC News.
“Promises that were made to us here were broken,” said one of the nurses, Arzoo Mohammadi. She is part of a small staff that comprises less than 17 percent of the proposed staff that was supposed to be hired to provide care to the rugged mountain community.
Mohammadi worries that the hospital has no ability to perform surgeries. Besides having no surgeons on staff, the “operating room” lacks even the most basic equipment. The hospital actually has to use its ambulance to send critical patients away from their facility to get care elsewhere, she said.
Salang Hospital is also in desperate need of an OB-GYN specialist to help mothers giving birth. The day NBC visited the facility, the “delivery room” consisted of one dirty, rusty bed standing in a puddle of flood water next to a moldy, wet wall. The water was leaking from the shoddy roof, where snow was melting. When babies are born here, the staff told NBC News, they are washed in untreated river water.
SIGAR’s report commends the small staff for “making the best of a limited facility.” They simply do what they have to, the staff said, in order to get by. That includes jerry-rigging wires to a neighbor’s property to keep the hospital running at night.
“We are working with just three light bulbs here,” the hospital’s supervisor, Dr. Khan Mohammad, told NBC News. SIGAR reports that when its inspectors visited the facility, the hospital staff told them they were "paying the equivalent of about $18 a month of their own money” in order to keep those three lights on.
Military aware of problemsUSFOR-A has been aware of the many issues plaguing the hospital since it conducted an inspection of the property in mid-2012, said the report, which was sent to top U.S. military commanders, including Marine Corps Gen. Joseph Dunford, who commands all international forces in Afghanistan.
Despite documenting its problems and requesting additional funds to rectify the problems it identified, it issued a final payment to the builder before handing control of the beleaguered hospital over to Afghan officials.
In documents obtained by NBC News, USFOR-A said that due to “reduced combat forces, threats in the area, and reduced technical engineering assets… it could not conduct a re-inspection.”
On Tuesday, the day before SIGAR’s inspection report was publicly released, USFOR-A’s public affairs office issued a press release praising the facility, titled, “U.S.-funded, historic Salang Hospital providing critical care to mountain villagers.”
In it, USFOR-A said the hospital “represents a significant step forward in medical services for local Afghans who previously had access to minimal medical care.”
The statement acknowledges the SIGAR inspection report citing incomplete construction and safety issues, but asserts that according to the province’s director for the Ministry of Public Health, the hospital’s capabilities include “internal medicine, pediatric, maternity, dentistry, nursing care, immunization, pharmaceutical and overnight hospitalization services.”
John Sopko, the Special Inspector General for Afghanistan Reconstruction, told NBC News, “either no one from USFOR-A has actually visited this facility recently or USFOR-A is living in an alternate reality. SIGAR inspectors went there and what we saw was a decrepit facility, riddled with problems and underserving the community.”
NBC’s Ahmad Bukhari and Fazul Rahim contributed to this report.