Afghanistan in the 1970’s mirrored the styles and attitudes in the United States. Female lawmakers spoke out in Afghanistan’s Parliament; Journalists wrote freely of events around the country; Universities flourished with student life. Girls wore miniskirts. Tourists, enchanted by the beautiful scenery, gardens, bazaars, and cosmopolitan feel of Kabul, the capital, called it the “Paris of Central Asia.” 

Present day Kabul looks nothing like the city of a half century ago. Estimated to have over 4.6 million residents prior to the fall of the Government to the Taliban this past August 2021, some estimate there are more than two hundred thousand people hiding in Kabul with relatives, friends, and in abandoned buildings. Taliban forces patrol the twenty-two districts and have checkpoints looking for journalists, teachers, and anyone who showed loyalty to the American Forces and the previous government. Once identified through facial recognition programs and biometrics, systems created and implemented by the United States, many are executed on the spot. Frequently the bodies are hung from cranes in public places. Previous men and women who served in the Afghan military are particularly at risk.

Essential emergency response programs such as fire, police, and emergency rescue cease to exist. Many diabetics can no longer afford insulin, or it poses too high a risk to try and buy it; many in renal failure can no longer afford dialysis or it poses too high a risk to go to a hospital; and many women ceased prenatal care when the country collapsed. Chronic medical conditions, left untreated, become acute over time.

The U Medical Corps, the dream of a writer/ex flight medic in the United States, and a Doctor of Internal Medicine in hiding in Afghanistan, emerged in September 2021 as an underground movement to connect Afghan patients in peril with in-country Afghan doctors and hospitals. It has grown to over 270 doctors in a variety of specialties and relationships with six hospitals.

In November 2021 several days after Thanksgiving, the U Medical Corps, supported by the Upperwood Foundation, received a request for assistance. Fair warning: the following content is disturbing…

A young couple, married barely a year, hides in the basement of a partially destroyed home. The windows have been blown out and the roof partially collapsed. At night, the temperatures drop into the thirties. The 28-year-old husband served with the Afghanistan National Army Special Forces, and his 26-year-old wife had worked as a journalist for one of the television stations. Afraid to be seen in public, the young couple never leave the basement in daylight, and rely on food and supplies provided by friends. A cell phone solar charger keeps their communication link intact. 

The young wife, pregnant for the first time, ceased her prenatal care at six months because she could no longer see her obstetrics doctor. For several weeks, friends brought her prenatal vitamins, but they became hard to find due to shortages and stopped all together mid-September. In October, two of the husband’s family members disappeared, and recent reports of female journalists and activists killed by the Taliban further cemented the decision of the young couple to remain in the basement and deliver the baby themselves.

The husband researched delivery methods on the internet for several days. He prepared with blankets from friends and medical supplies stolen from a local pharmacy. When his wife’s water broke and she started contractions, he felt ready.

Eighteen hours later, at 12:30am Kabul time, the husband called a friend to say the baby wasn’t coming, and he didn’t know what to do. The friend told them to go to the local government hospital, but the husband said if they encountered the Taliban, biometric scanning would reveal his identity and his wife’s face was easily recognizable from television. They would be killed. The friend called another friend who called another who called another. The fourth person into the link said he knew of an organization who might know someone who could help. Eventually, the sixth person in the chain reached the U Medical Corps.

Within an hour of the husband reaching out, a primary physician in Kabul called the husband and referred a female OB/GYN who followed up with both husband and wife. Afraid to go out in the dark, the U Medical Corps arranged for transport of the female doctor in a truck delivering supplies to a nearby community. Hiding under a metal frame obscured by hundreds of pounds of firewood, the female OB/GYN made it through three Taliban checkpoints undetected. Early evening in the States, the U Medical Corps also had an OB/GYN on standby in the U.S. Midwest, should the Afghan OB/GYN have to cease communication for security purposes. 

Arriving at the partially destroyed home, an exchange of code words, first via text, then via phone, led the doctor to the young couple in hiding. The two doctors, one in Afghanistan and one in the United States discussed the delivery conditions and the mother’s status via an encrypted phone app. Without electricity, flashlights from two cell phones provided the only light.

When the baby finally came several hours later, all the husband could convey through the screams was, “I can see my wife’s breath, I can see my own breath, but I cannot see my baby’s breath. I cannot see my baby’s breath.”

Despite the best efforts of the local OB/GYN and supportive input from the American physician, resuscitation was not effective. The baby was set aside on the hardened ground as the Doctor talked the father and mother through the delivery of her placenta.

Shortly before the sun came up in Kabul, the young parents and doctor buried the baby just outside the house under a pile of rocks. They named him Abdullah Yusuf.

The female Afghan doctor instructed the mother to wrap her milk laden breasts tightly with a cloth and to place cool compresses on them. She also said to take Ibuprofen. The female Afghan OB Doctor, transported from the location back in a food truck, wore a disguise and took photographs of a medicine in a local pharmacy known as Bromocryptine.

The U Medical Corps arranged for medicine to be delivered to the basement entrance within hours. One will ease the inflammation, one will dry up the mother’s milk, but nothing will ease the pain.

The husband’s last communication was “Tonight she is near to me. She cries a lot.”

“Afghanistan remains one of the most dangerous places in the world to be a baby, a child or a mother, and access to a hospital or health facility is beyond the reach of most. The country has one of the highest infant mortality rates in the world and thousands of Afghan women die every year from pregnancy-related causes, a majority of which can be easily preventable.” (UNICEF)

A prominent U.S. Board certified OB/GYN Physician with over twenty-five years’ experience delivering babies and Department Chair at her hospital offered up the following, “The already concerning maternal and perinatal morbidity & mortality in Afghanistan is now escalating rapidly with no known data points. It’s primitive. This is due to pregnant mothers no longer seeking prenatal care because of fear of the Taliban repercussions but also the lack of physicians & midwives to care for them in a clean safe hospital with necessary supplies. This is causing parents to choose home births due to the dire consequences of seeking obstetrical care. Babies and mothers are dying needlessly. The emotional impact from this will take a severe toll on these mothers and their families. I beg the World Health Organization to address this women’s health issue immediately to the Taliban. Afghanis MUST be free to not only seek care without fear but have adequate medical care available- especially emergency care.”

In December 2021, the U Medical Corps, supported solely by the Upperwood Foundation, instituted the “Safe Delivery Program” providing pre-natal care and exams, safe deliveries in a hospital setting, and postpartum care – all with no questions asked, no identification required, and no charge to the patient. To date, over three hundred babies have been born safely under the auspices of this program. ∎

Christmas in the States is a time for family. We have a great routine that starts the day after Thanksgiving when we bring out our Christmas decorations. We have bins and bins that are marked Christmas #1 or Christmas #2 and then further labels detailing what’s inside. Our bins are a mish mash of colors and shapes because each year we seem to “acquire” more decorations which are now stored in a closet under the steps and in the garage because we need additional room. Christmas #1 are outside decorations and inside decorations, including Advent calendar houses for the kids to hold daily chocolates, and Christmas # 2 are more tree related things and tend to take up more space because of bubble wrap and boxes to protect fragile ornaments. We have a routine; Christmas # 1 decorations are completed by the end of weekend after Thanksgiving, and Christmas # 2 decorations are completed by the end of the first week in December.

This past Christmas was a little different. We had COVID and Afghanistan in our lives, and things were… well… focused in another direction. The U Medical Corps had launched its “Safe Delivery” program a month earlier. Supported by the Upperwood Foundation, the “Safe Delivery” program provides prenatal care and exams, safe deliveries, and post-partum care to mothers free of charge. With Afghanistan having one of the highest infant and maternal mortality rates in the world even before the Taliban took over, the Upperwood Foundation’s program is critical for pregnant women and facilitates more than thirty deliveries a week in a superb maternity hospital that rivals Western facilities.

This is the story of twins who came into the orbit of the U Medical Corps on December 20, 2021. The inquiry came from a US Army Captain in Virginia who said he had his Afghan interpreter, Samim, with him at his home. Samim’s wife, in Afghanistan, was pregnant and had problems walking because of pain. Like many women in Afghanistan, she had ceased prenatal care when the country collapsed August 15, 2021 and had not seen a doctor in months. Her husband, having worked with the American forces for more than a decade, was wanted by the Taliban.

“My wife and I went to the gates together in August hoping to get on a plane and get out of the country. Our US advisors called us several times over several days, and we went each time but could not get close to the gates. The fourth time I told my wife to stay home, and I would check it out to see if it was the same conditions. The weather was hot, no water, and chaos. She was around five months pregnant, and I didn’t want her to risk another day for nothing. So, I went to see if the crowds were any lighter. There was gunfire constantly, and people falling and running and pushing. It was insane. At one point I managed to get near the front, I explained to the US Marine that my wife was pregnant and could he hold a spot for both of us. He reached out and pulled me in. He promised me we would get my wife out. Three days later I was forced to leave. They would not let me exit the airport. They would not send someone for her. We said our good-byes over the phone.”

Samim, in Virginia, advised the U Medical Corps that his wife, in Afghanistan, needed to see a doctor for her pregnancy, but she had no money and was a pregnant woman without a husband - which is the equivalent of a death sentence under the Taliban. Her brother could act as her escort, or Mahram, but if questioned it could be problematic. The U Medical Corps, with support from the Upperwood Foundation, arranged for Samim’s wife to enter the “Safe Delivery” program and be seen for an intake exam at a maternity hospital the next day in Afghanistan. The appointment went well and to everyone’s surprise two heartbeats were heard – twins - and the OB/GYN said she should come back in 48 hours for another exam. That was the plan… but things don’t always go as planned.

It was 11:00 at night on December 22nd in Afghanistan when Samim’s wife’s water broke. Emblematic of the craziness, the wife, in Afghanistan, called her husband in Virginia, who called the U Medical Corps in New Jersey, who called the doctor in Afghanistan. The hospital had a team waiting because twins can be a challenging delivery. Samim expressed great concern, “It’s late. Taliban will stop my wife and her brother for sure. They will want to know where I am. Even if she says I am dead, they will try and look me up in biometrics.”

It was a twenty-minute drive across districts in Kabul that time of night to get Samim’s wife to the maternity hospital partnering with the U Medical Corps. Samim’s wife and her brother didn’t make it five before stopped at a Taliban checkpoint. Four men, with AK 47’s approached the car and ordered them out of the car. Samim’s brother-in-law protested and said his sister was in labor, and they needed to get to the hospital. The Taliban made him step out the car as he continued to protest and then beat him with rifle butts. Two other Taliban dragged Samim’s wife from the car and threw her to the ground.

“I didn’t know what happened to my wife. I was expecting a phone call when she got to the hospital, but I knew better than to call her, so I waited…. A little after 7:30am Afghanistan time, my brother-in-law finally called. He said the Taliban had separated them for questioning and made my wife stand while having contractions. They laughed at her whenever she tried to sit and yanked her to her feet. They beat my brother law repeatedly with a cable whenever he tried to interfere. Finally, when it appeared my babies where ready to fall out they let my wife go to a clinic, a horrible place, to deliver. When they find out we don’t have any money, they sent my wife and babies home.”

We immediately involved an OB/GYN doctor from the maternity hospital in Afghanistan to take charge of the situation. He called and asked Samim’s wife what the APGAR scores were, a scoring system at birth, and she didn’t know. It was suggested they come immediately to the maternity hospital recommended by the U Medical Corps because twins are usually problematic, come early, and require additional support. Samim’s wife explained she hurt too much to move, and her brother was unable to stand from the beating he had received. She asked if she could wait a day or two.

Christmas Eve in the States is a time of tradition. A family dinner is served, and many homes hold an open house for friends and family to visit. Depending on one’s beliefs and religion, cookies and milk are left out for Santa, maybe a carrot for the reindeer, and families read “The Night Before Christmas” to younger ones. It is a time of joyous anticipation and excitement when, “… the stockings were hung by the chimney with care, in hopes St. Nicholas soon would be there.”

Christmas Eve came at us with a sense of dread regarding the twins. They had not eaten in the thirty plus hours since their birth, and Samim’s wife had developed a fever and explained she had torn during delivery and did not receive stitches. The U Medical Corps, with support of the Upperwood Foundation, had a phone conference with an OB/GYN at the maternity hospital in country and with an OB GYN in the States. Samim expressed he didn’t like how his wife was sounding, and she said the newborns weren’t moving much. It was agreed she would go at first light to the maternity hospital – around 11:00pm EST in the States, December 24, 2021.

A little after midnight, now the early hours of Christmas Day, Samim’s wife and the twins still had not left for the hospital, her brother could no longer walk, and a neighbor who came to check on the family said a new Taliban checkpoint had been set up two hundred meters from the house. With the brother unable to walk, Samim’s wife was an unaccompanied female, and could not travel. At 1:00am on Christmas Day, while young children in the United States were “…nestled all snug in their beds while visions of sugar plums danced in their heads” the U Medical Corps crafted a plan for a food delivery truck to come to Samim’s wife’s house and pick her, the twins, and the brother up and transport them to the hospital. It was risky and had to be done under the eyes of watching Taliban. It required a distraction at the checkpoint and several men in the truck to carry to adult patients and the twins. At 2:55am on Christmas Day, the food truck notified us all patients had been picked up and were en route to the hospital. The twins were unresponsive, barely breathing, and the mother passed in and out of unconsciousness. They arrived an hour later.

A little before sunrise Christmas Day in the US, the Medical Director of the hospital texted, “For your confirmation, both babies admitted in NICU for treatment of jaundice, low weight, birth asphyxia, malnutrition, etc. Both are very critical and on ventilators. Also, the mother has been checked by OB and GYN specialist. She has vaginal discharge, a high fever, high blood pressure due to postpartum eclampsia, and bordering on sepsis. She will also receive reconstructive treatment for a tear in her perineum during birthing process. We have sent the brother to a nearby medical complex for treatment of his injuries.”

An hour later, as our children were waking to Christmas morning and coffee was making the gurgling sound in our Cuisinart, the Medical Director sent this text, “Greetings on your Christmas Day sir. First, I have to say thank you and U Medical Corps for doing a great job to connect us with premature twins. Surely you people have done a great job. You save the life of these twins. If they had not come to the hospital, we would have lost them tonight. Thank you for loving Afghan people and your caring. As you know, most births of single babies happen at 39-40 weeks. But the average length of a twin pregnancy is 34-37 weeks. As per information, mother made her delivery at 35 weeks at a substandard hospital in Kabul, and after delivery discharged without proper postpartum care and neonatal care. The twins are premature and low birth weight with each weighing less than five pounds. When we received them last night, it was close to the end. Again, thanks to U Medical Corps. You worked hard to save their lives and get them to a hospital on time. Now they are in a NICU and receiving what will hopefully be lifesaving treatment.”

Twenty-four days later, Samim’s twins were released from the hospital. His brother, wearing a cast on one leg, and a cast on one arm, accompanied his sister. They remain trapped in Afghanistan. Samim, in Virginia, hopes to see them again someday. ∎