Like a lot of things here, I am trying to understand the differences in situations as well as the why behind those differences. I definitely don’t have it all figured out so as always, feel free to comment with your thoughts, especially for my friends who grew up outside the U.S. medical establishment.

I first became aware that the medical profession here is very different from what I’m used to about a month after I arrived in Afghanistan. I was talking with the office IT guy about why I only see him in the afternoons. I learned that he is, in fact, a doctor. Actually, make that the department head of a major division of a hospital. (Wow, really!?) For the past 5 years, he works half the day at the hospital and the other half of the day as the “IT guy” in our government office. It seems like an odd combination to me, but he responded that the IT work pays for him to do the doctoring work. Of course, we all know that IT pays well, but…pays that much more than being the head of a hospital dept??

After this, I started noticing how many of the guys (there are only a few Afghan women that I interact with) I know who are called “Dr.” Afghans are very big on titles and formality so I assumed that these people have a PhD. I later learned that almost all of them actually graduated from a medical program (faculty). They could practice medicine. But instead, they work elsewhere.

In the U.S., you will often find people, from other countries working as taxi drivers, in retail, or in other service industries, who were doctors or other advanced professionals in their home country. That situation is usually the result of the bureaucracy to prove their foreign credentials in the U.S. However, that doesn’t explain why Afghans, who graduated from medical programs here, are working in completely different professions.

I asked one “Dr” I know who works as an assistant to a Deputy Minister. (Note: all of these guys have very good English skills both as a requirement to get into the medical program as well as because of their use of it in the program.) He told me that out of his graduating class, 10% work as doctors. When he was applying for hospital jobs, he was offered a position in one of the provinces  for around $10/month.

Obviously, this is a pittance for a professional job, especially a doctor. But what makes it completely unbearable is the fact that there are so many development organizations in Afghanistan who need translators and professionals to work for them. There is a HUGE discrepency in pay scales because of the amount of money good, well spoken Afghans can make if they work for an NGO, an embassy, the UN, ISAF, etc.

I actually found out that the donor community recognized this was a problem and made an effort to ensure that professions (such as doctors) could get reasonable salaries in their chosen profession. Doctor salaries were increased 3-fold (I don’t know the details of how this was paid for). However, based on the estimates I got for potential salaries, if those doctors instead become translators, compared to the propped up medical salary, they will still make 4 times as much. (I should probably note here that this is for a basic translator position, a job which is generally looked down upon in this culture as not very skilled or resourceful.)

Of course, all of this crazy information about salaries means that very few people will work as doctors; most will instead do various office jobs for donors. It also means that there are very few doctors left to actually practice medicine here (and those few are potentially rather unqualified). So it should come as no surprise that Afghanistan and other countries in this region rival the world for their poor health care and maternal mortality rates. (See this article.)

The pay scale discrepancy that our development dollars has created has huge implications for the quality of care Afghans receive as well as changing the cultural attitudes to even getting this kind of education in the future. These are the things I think about when I pass this: