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Giving birth in Afghanistan: inside MSF’s ‘baby factory’

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By AFP
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The mother was admitted at 9.30am, the birth recorded at 9.35. Women often arrive In extremis at the Doctors Without Borders (MSF) maternity hospital in southeastern Afghanistan, one of the most active in the world, with more than 60 babies born daily.

The early hours of the morning are the most feverish for the hospital — affectionately known by the NGO as “the baby factory” — just a stone’s throw from Pakistan’s tribal areas, in Khost province.

The Taliban are active in the region and roads are often dangerous after dark, so when 25-year-old Asmad Fahri felt her contractions begin at night she knew she would have to wait until daybreak to begin the three-hour journey to the hospital.

In this photo taken on August 8, 2018, Afghan

In this photo taken on August 8, 2018, Afghan women are assisted during labour at the Doctors Without Borders (MSF) maternity hospital in Khost. PHOTO | ANNE CHAON | AFP)

Finally she is resting, her infant tightly swaddled and asleep between her knees.

On average new mothers are kept in the ward for six hours, but she has asked to leave after just three, to ensure she reaches home before darkness falls again.

Sometimes the mothers have to travel for days, in pain and bleeding, over unpaved, insecure roads in carts or by whatever mode of transportation they can find.

In an opposite wing, the delivery tables continuously welcome newcomers.

Most only have time to lift the long layers of clothing hiding their bodies and wedge their coloured veils between their teeth, too rushed even to change into MSF’s standard red pyjamas.

The Khost Maternity Hospital (KMH) opened at the end of 2012 in a medical desert in the conflict-riven country with one of the highest infant and maternal mortality rates in the world.

It was an overnight success, with nearly 12,000 deliveries in its first full year in 2013.

By 2017 that figure had nearly doubled, to 23,000.

This year the hospital is on track to deliver 24,000 babies, says Dr Rasha Khoury, a Palestinian gynecologist who is medical officer at the site.

afghan mother and newborn

In this photo taken on August 7, 2018, an Afghan woman rests next to her newly born baby at the Doctors Without Borders (MSF) maternity hospital in Khost. (PHOTO | ANNE CHAON | AFP

If so that puts it within crying distance of the busiest maternity wards in the United States, where the Northside Hospital in Atlanta delivered 27,000 babies in 2016, the highest number in the country that year.

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“Here we are saving lives for free,” smiles Safia Khan, 24, the assistant manager of the midwifery team.

Behind her, a young mother of twins searches her skirts and hands her a folded banknote. It is a traditional gesture of gratitude after delivery, at times required in some hospitals but politely declined here. “It’s forbidden,” insists Khan.

The UN and the World Bank put maternal mortality at around 396 deaths per 100,000 live births in Afghanistan.

But the figure is disputed, with experts pointing out it is an improbable fall from the 1,600 per 100,000 recorded in 2002.

Such a decline would mean Afghanistan would have reached its Millennium Development Goal set by the UN some five years early, a study published in the medical journal the Lancet noted in 2017.

The authors of that study say more credible figures released by the Afghan government in partnership with USAID suggest maternal mortality could still be as high as 1,291 per 100,000 — meaning that giving birth is around five times more deadly for Afghan women than the conflict itself.

If so, it is a staggering figure 17 years after the fall of the Taliban regime, despite billions of dollars in international aid, in a country with one of the youngest, fastest-growing populations in the world.

afghan woman swaddling a newborn

In this photo taken on August 7, 2018, an Afghan woman swaddles a newborn baby at the Doctors Without Borders (MSF) maternity hospital in Khost province. PHOTO | ANNE CHAON | AFP

Dr Khoury says that MSF facilitates around 40 percent of the births in Khost, which has an estimated 1.5 million inhabitants.

But to make a real dent in the mortality rates in the face of these challenges they would need “three hospitals like MSF”, she says.

On top of war, poverty, and a galloping population, the medical staff face a further obstacle: the Pashtunwali, the patriarchal social code of honour that dictates life in the conservative Pashtun tribal region where Khost lies.

Under the Pashtunwali the genders must be segregated, and a woman must never show her face to a stranger.

As such, medical staff at the hospital are exclusively female, with the exception of some anaesthetists and the director of the neonatology department.

Even so, a little persuasion has at times been necessary, says Salamat Khan Mandozai, a respected local figure who deals with security for the hospital and has also acted as a community liaison.

“In this rural environment, some women still prefer to give birth at home,” he notes.

Going to hospital embarrasses them, agrees Safia Khan — birth is a private matter.

Dr Khoury says the hospital is aware that many women are not coming to them, but adds that the families who do come do so “without hesitation”.

For many, she adds, obstacles are not about culture, but finances — namely, paying for transportation — or safety and security, especially at night.

Women must also wait until a man of the family is available to accompany them, she says.

But once inside the hospital power returns to the mothers-in-law who escort the patients until they reach the doors of the delivery room.

“We are really reaching people at the margin of the society in Afghanistan,” says Dr Khoury.



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Sordid tale of the bank ‘that would bribe God’

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Bank of Credit and Commerce International. August 1991. [File, Standard]

“This bank would bribe God.” These words of a former employee of the disgraced Bank of Credit and Commerce International (BCCI) sum up one of the most rotten global financial institutions.
BCCI pitched itself as a top bank for the Third World, but its spectacular collapse would reveal a web of transnational corruption and a playground for dictators, drug lords and terrorists.
It was one of the largest banks cutting across 69 countries and its aftermath would cause despair to innocent depositors, including Kenyans.
BCCI, which had $20 billion (Sh2.1 trillion in today’s exchange rate) assets globally, was revealed to have lost more than its entire capital.
The bank was founded in 1972 by the crafty Pakistani banker Agha Hasan Abedi.
He was loved in his homeland for his charitable acts but would go on to break every rule known to God and man.
In 1991, the Bank of England (BoE) froze its assets, citing large-scale fraud running for several years. This would see the bank cease operations in multiple countries. The Luxembourg-based BCCI was 77 per cent owned by the Gulf Emirate of Abu Dhabi.  
BoE investigations had unearthed laundering of drugs money, terrorism financing and the bank boasted of having high-profile customers such as Panama’s former strongman Manual Noriega as customers.
The Standard, quoting “highly placed” sources reported that Abu Dhabi ruler Sheikh Zayed Sultan would act as guarantor to protect the savings of Kenyan depositors.
The bank had five branches countrywide and panic had gripped depositors on the state of their money.
Central Bank of Kenya (CBK) would then move to appoint a manager to oversee the operations of the BCCI operations in Kenya.
It sent statements assuring depositors that their money was safe.
The Standard reported that the Sheikh would be approaching the Kenyan and other regional subsidiaries of the bank to urge them to maintain operations and assure them of his personal support.
It was said that contact between CBK and Abu Dhabi was “likely.”
This came as the British Ambassador to the UAE Graham Burton implored the gulf state to help compensate Britons, and the Indian government also took similar steps.
The collapse of BCCI was, however, not expect to badly hit the Kenyan banking system. This was during the sleazy 1990s when Kenya’s banking system was badly tested. It was the era of high graft and “political banks,” where the institutions fraudulently lent to firms belonging or connected to politicians, who were sometimes also shareholders.
And even though the impact was expected to be minimal, it was projected that a significant number of depositors would transfer funds from Asian and Arab banks to other local institutions.
“Confidence in Arab banking has taken a serious knock,” the “highly placed” source told The Standard.
BCCI didn’t go down without a fight. It accused the British government of a conspiracy to bring down the Pakistani-run bank.  The Sheikh was said to be furious and would later engage in a protracted legal battle with the British.
“It looks to us like a Western plot to eliminate a successful Muslim-run Third World Bank. We know that it often acted unethically. But that is no excuse for putting it out of business, especially as the Sultan of Abu Dhabi had agreed to a restructuring plan,” said a spokesperson for British Asians.
A CBK statement signed by then-Deputy Governor Wanjohi Murithi said it was keenly monitoring affairs of the mother bank and would go to lengths to protect Kenyan depositors.
“In this respect, the CBK has sought and obtained the assurance of the branch’s management that the interests of depositors are not put at risk by the difficulties facing the parent company and that the bank will meet any withdrawal instructions by depositors in the normal course of business,” said Mr Murithi.
CBK added that it had maintained surveillance of the local branch and was satisfied with its solvency and liquidity.
This was meant to stop Kenyans from making panic withdrawals.
For instance, armed policemen would be deployed at the bank’s Nairobi branch on Koinange Street after the bank had announced it would shut its Kenyan operations.
In Britain, thousands of businesses owned by British Asians were on the verge of financial ruin following the closure of BCCI.
Their firms held almost half of the 120,000 bank accounts registered with BCCI in Britain. 
The African Development Bank was also not spared from this mess, with the bulk of its funds deposited and BCCI and stood to lose every coin.
Criminal culture
In Britain, local authorities from Scotland to the Channel Islands are said to have lost over £100 million (Sh15.2 billion in today’s exchange rate).
The biggest puzzle remained how BCCI was allowed by BoE and other monetary regulation authorities globally to reach such levels of fraudulence.
This was despite the bank being under tight watch owing to the conviction of some of its executives on narcotics laundering charges in the US.
Coast politician, the late Shariff Nassir, would claim that five primary schools in Mombasa lost nearly Sh1 million and appealed to then Education Minister George Saitoti to help recover the savings. Then BoE Governor Robin Leigh-Pemberton condemned it as so deeply immersed in fraud that rescue or recovery – at least in Britain – was out of the question.
“The culture of the bank is criminal,” he said. The bank was revealed to have targeted the Third World and had created several “institutional devices” to promote its operations in developing countries.
These included the Third World Foundation for Social and Economic Studies, a British-registered charity.
“It allowed it to cultivate high-level contacts among international statesmen,” reported The Observer, a British newspaper.
BCCI also arranged an annual Third World lecture and a Third World prize endowment fund of about $10 million (Sh1 billion in today’s exchange rate).
Winners of the annual prize had included Nelson Mandela (1985), sir Bob Geldof (1986) and Archbishop Desmond Tutu (1989).
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Monitor water pumps remotely via your phone

Tracking and monitoring motor vehicles is not new to Kenyans. Competition to install affordable tracking devices is fierce but essential for fleet managers who receive reports online and track vehicles from the comfort of their desk.

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Agricultural Development Corporation Chief Accountant Gerald Karuga on the Spot Over Fraud –

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Gerald Karuga, the acting chief accountant at the Agricultural Development Corporation (ADC), is on the spot over fraud in land dealings.

ADC was established in 1965 through an Act of Parliament Cap 346 to facilitate the land transfer programme from European settlers to locals after Kenya gained independence.

Karuga is under fire for allegedly aiding a former powerful permanent secretary in the KANU era Benjamin Kipkulei to deprive ADC beneficiaries of their land in Naivasha.

Kahawa Tungu understands that the aggrieved parties continue to protest the injustice and are now asking the Ethics and Anti-corruption Commission (EACC) and the Directorate of Criminal Investigations (DCI) to probe Karuga.

A source who spoke to Weekly Citizen publication revealed that Managing Director Mohammed Dulle is also involved in the mess at ADC.

Read: Ministry of Agriculture Apologizes After Sending Out Tweets Portraying the President in bad light

Dulle is accused of sidelining a section of staffers in the parastatal.

The sources at ADC intimated that Karuga has been placed strategically at ADC to safeguard interests of many people who acquired the corporations’ land as “donations” from former President Daniel Arap Moi.

Despite working at ADC for many years Karuga has never been transferred, a trend that has raised eyebrows.

“Karuga has worked here for more than 30 years and unlike other senior officers in other parastatals who are transferred after promotion or moved to different ministries, for him, he has stuck here for all these years and we highly suspect that he is aiding people who were dished out with big chunks of land belonging to the corporation in different parts of the country,” said the source.

In the case of Karuga safeguarding Kipkulei’s interests, workers at the parastatals and the victims who claim to have lost their land in Naivasha revealed that during the Moi regime some senior officials used dubious means to register people as beneficiaries of land without their knowledge and later on colluded with rogue land officials at the Ministry of Lands to acquire title deeds in their names instead of those of the benefactors.

Read Also: Galana Kulalu Irrigation Scheme To Undergo Viability Test Before Being Privatised

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“We have information that Karuga has benefitted much from Kipkulei through helping him and this can be proved by the fact that since the matter of the Naivasha land began, he has been seen changing and buying high-end vehicles that many people of his rank in government can’t afford to buy or maintain,” the source added.

“He is even building a big apartment for rent in Ruiru town.”

The wealthy officer is valued at over Sh1.5 billion in prime properties and real estate.

Last month, more than 100 squatters caused scenes in Naivasha after raiding a private firm owned by Kipkulei.

The squatters, who claimed to have lived on the land for more than 40 years, were protesting take over of the land by a private developer who had allegedly bought the land from the former PS.

They pulled down a three-kilometre fence that the private developed had erected.

The squatters claimed that the former PS had not informed them that he had sold the land and that the developer was spraying harmful chemicals on the grass affecting their livestock and homes built on a section of the land.

Read Also: DP Ruto Wants NCPB And Other Agricultural Bodies Merged For Efficiency

Naivasha Deputy County Commissioner Kisilu Mutua later issued a statement warning the squatters against encroaching on Kipkuleir’s land.

“They are illegally invading private land. We shall not allow the rule of the jungle to take root,” warned Mutua.

Meanwhile, a parliamentary committee recently demanded to know identities of 10 faceless people who grabbed 30,350 acres of land belonging to the parastatal, exposing the rot at the corporation.

ADC Chairman Nick Salat, who doubles up as the KANU party Secretary-General, denied knowledge of the individuals and has asked DCI to probe the matter.

Email your news TIPS to [email protected] or WhatsApp +254708677607. You can also find us on Telegram through www.t.me/kahawatungu

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William Ruto eyes Raila Odinga Nyanza backyard

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Deputy President William Ruto will next month take his ‘hustler nation’ campaigns to his main rival, ODM leader Raila Odinga’s Nyanza backyard, in an escalation of the 2022 General Election competition.

Acrimonious fall-out

Development agenda

Won’t bear fruit

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