Training Nurses Bolsters Health Care in Rural Afghanistan

GHOR PROVINCE, Afghanistan (GP) — Axon, dendrites, myelin — strange words squeak across a whiteboard as Heather Edwards* labels a crude drawing that resembles a Medusa-headed alien from Star Trek. But this apparent work of science fiction is actually much more down to earth. Edwards, a registered nurse from the United States, is teaching a class on the human nervous system. Her cryptic words are parts of a neuron, the nervous system’s basic building block.

Through a project supported by Global Partners (GP), Edwards’ students are on track to become part of Afghanistan’s next wave of health care professionals, some of the first formally educated nurses serving in Ghor province.

“What are the names of some neurotransmitters?” Edwards asks the room of about 20 young Afghan students. One cautiously slips up his hand and answers correctly. “Very good!” she replies with a reassuring smile. Though health care in Afghanistan is steadily improving, Edwards knows that many people are still in desperate need, particularly in rural, isolated areas. That is why she has come to Ghor. When GP officially launched the nurses’ training program two years ago, Edwards says there were only about 35 nurses for the entire province of more than 600,000 people. None were formally trained.

“This is the only [government] hospital in the entire province, so when people come here they are usually very, very sick,” Edwards says. “But if you have a nurse who doesn’t know what they are doing, many times they do more harm than good. And because of the lack of doctors in the hospital, nurses run emergency rooms and the hospital at night if a doctor isn’t available.

“I’m hoping these classes will give them more knowledge to make good decisions. It’s a start, but we have a long way to go.”

Edwards’ class is unique. Not only will this be Ghor’s first group of home-grown, licensed nurses, but the training program features the first two female nursing students in the history of the province. Nadia,* 20, wants to work in pediatric nursing when she completes her training. She’s already spent nine months in the emergency room and says she wanted to become a nurse to help her people.

Funded by GP, the training program is based at Ghor Provincial Hospital, where most of Edwards’ students, like Nadia, already work as nurses.

“It’s very similar to a two-year nursing program in the U.S.,” Edwards explains, though not as strenuous. “They’re starting from a lower level. Their high school education is so poor that they’re having to learn a lot of things that we take for granted, like basic math skills to figure out dosages of medications.”


There are other challenges, too. Edwards developed all of her own lectures because the nursing school has no textbooks. Even if they did, Edwards isn’t sure her students would use them. Rather than absorbing knowledge by reading, she says most of her students are oral learners.

But the biggest obstacle, Edwards adds, is simply getting the students to come to class. Ghor’s nursing shortage means that Edwards’ students may be scheduled to work a shift at the hospital during class time. Students’ responsibilities at home also hurt attendance.

“If they have company at their house, they don’t come to class. If they need to go home to their village and harvest wheat, they go home,” Edwards says. “We’re still living in an agrarian society where everything else comes before any kind of schooling.”

“They have to choose to come to class. My challenge is trying to keep coursework relevant enough to what they’re doing at the hospital that they want to come to class.”

Despite those hardships, Edwards doesn’t let her students slide. “I think they’d tell you I was hard. They don’t like my tests, but they’re proud of themselves when they pass them,” she says.


Edwards’ high standards combined with her students’ hard work, is paying off.

“I’ve seen changes in every single one of them,” Edwards says. “They’re seeing there’s more reason to be in this class than just to better themselves. There’s a purpose for it. They want to help the Afghan people.”

The hospital’s doctors are seeing the changes, as well. The level of nursing care is improving. Students are asking more intelligent questions while on rounds. Some students, like Abdul,* seemed destined to fail Edwards’ nursing course before he even began, but have experienced amazing growth.

“When he walked in the class last semester, I thought there is no way he’s going to make it,” Edwards says. “He’d come straight in from the village. … He was so proud. He didn’t think he could learn anything because he knew everything. But he stayed with it, and he’s done very well. His grades got better and better. Now he’s probably fourth or fifth in the class.”


And it is seeing those kinds of transformations, Edwards says, that makes her job so rewarding.

“They’re like my sons and daughters now,” she says of her students. “I know them so well. I love every one of them. I get frustrated with them, but I also have so much hope for the difference they can make in the health care in this province. They know I’m fair, and they know I care about them.”

Edwards personally funded the nursing school the first year, spending more than $12,000 to get it off the ground. GP adopted the program after seeing its potential and the need for steady financial support.


Edwards dreams of a permanent nursing school in Ghor that’s not only attended, but taught by Afghans. The demand is there. Right now the school can only accept 25 new students each year. There are more than 100 on a waiting list. That’s why Edwards is training a few of her brightest second-year students to begin teaching a new class of first-year students.

“It’s important for them to be able to continue this without me here, so they can build their own school and be proud of what they’re building,” Edwards says. “They understand their culture, they understand the equipment they have, they understand the problems, and I think they can do it better than I can.”

*Name changed

Jim Durham is a freelance writer based in the United States