‘Dealing with Antibiotic Resistance Every Day,’ MSF Raises Awareness About AMR in Afghanistan
For the last two weeks, Said Dawood has been stuck alone in an isolation room in the Médecins Sans Frontières (MSF) Kunduz Trauma Center, still trying to recover from an injury sustained eight months ago.
Working as a skilled laborer in the northern Afghan province of Kunduz, Dawood fell from the fourth floor of a building and suffered open fractures to both of his legs. He was discharged from the trauma center in March, but twice now has had to be readmitted due to infection. Recent results from the microbiology laboratory confirmed the suspicions of his doctors – the bacteria that caused the infection is resistant to commonly used antibiotics and requires targeted treatment.
The news shocked Dawood, who didn’t know anything about antimicrobial resistance (AMR). But it comes as no surprise for Dr. Letizia Ottino, an MSF infectious disease specialist, who has spent the last year working on AMR in Afghanistan.
These very serious infections increase the risk of death, particularly for vulnerable people such as newborns, pregnant women, children with severe acute malnutrition, and those with trauma-related injuries.
New mothers at MSF’s Khost Maternity Hospital face that fear every day as they put on medical gowns to visit their preterm babies lying in neonatal intensive care beds.
At the first sign of infection, MSF staff send a blood sample to the newly installed mini-lab –an easily transportable small-scale standalone bacteriology lab that MSF has rolled out in low-resource settings – so they can identify the infection-causing bacteria and tailor antibiotic treatment.
Across MSF projects in Afghanistan, we are implementing a package of services to address AMR, including strengthened infection, prevention, and control (IPC) measures and the creation of antimicrobial stewardship committees, with staff responsible for ensuring the appropriate choice and correct use of antibiotics for patients.
MSF has also opened two bacteriology labs, in Kunduz and Khost, to help identify bacteria and select the right antibiotic to treat the infection.
Patient and Prescriber Practices Are Key to Addressing AMR
These activities are a good start toward addressing AMR in MSF projects, but far more is needed to tackle this public health problem, Ottino says.
Although data on antibiotic resistance in Afghanistan is limited, Ottino notes that available scientific literature shows high levels of AMR in the country.
A new MSF report on AMR in humanitarian contexts highlights broad structural challenges—such as poor access to quality healthcare, water, sanitation and hygiene services, IPC measures, vaccines, and medical and laboratory supply chains—as key drivers of AMR in low-resource settings like Afghanistan.
But patient and prescriber practices also play a significant role, says Dr. Zabihullah Fazalzoi, a pediatrician in the MSF-supported pediatric department at Herat Regional Hospital.
“Over-prescription, overuse, misuse, and the widespread availability of antibiotics over the counter all contribute to the growing problem of AMR,” he says.
This has been a long-standing issue, according to an MSF mixed-methods study that looked into perceptions of antibiotics and their use among patients, prescribers, and pharmacists at a district hospital in Kabul in 2015.
The study found that patients often had limited knowledge about antibiotics and frequently overused or misused them—for a wide range of conditions, including common colds, infertility, and general body pain. It also revealed that antibiotics were widely available for over-the-counter purchase in private pharmacies.
Raising Awareness about AMR
Health promoters in MSF projects are trying to increase public education about AMR and encourage better practices in the community.
Haji Abdul Rehman Niamatullah gathers a group of patients in the MSF-supported Boost Provincial Hospital in Lashkar Gah, Helmand. With a flip chart in hand, he explains that antibiotics fight infections caused by bacteria but have no effect on common viruses responsible for coughs, colds, or the flu.
“Antibiotic resistance occurs when bacteria, after exposure to antibiotics, stop responding to these medications over time. This natural process is triggered and accelerated by the misuse of antibiotics—such as skipping doses or not completing the full course of treatment”, Niamatullah explains. “When antibiotics fail to kill the bacteria, treating the infection becomes much more difficult”, he adds.
Back at the Kunduz Trauma Center, Dawood has learned firsthand how challenging it can be to treat infections caused by a multidrug-resistant organism. His infection was caused by a highly resistant organism that is called methicillin-resistant Staphylococcus aureus.
After more than two weeks in the trauma center’s isolation ward, Dawood says he can tell his infection is starting to heal. While grateful for the treatment from MSF staff, Dawood looks forward to going home soon.