Refugee life inspired Dr. Shams Rahman

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Shams Rahman lived in an Afghan refugee camp in Pakistan for 18 years, starting with the Soviet Union’s invasion of Afghanistan when he was a toddler.

“My family fled. My father was a judge, and my grandfather was the chief justice of Afghanistan, so we were a very highly targeted family,” Rahman said. “My uncle was a prominent lawyer in the country, and the Soviets detained him and killed him. We had to leave everything and flee.”

Shams Rahman, MD,  MPH

Shams Rahman, MD, MPH

A child of nobility from Nangarhar Province, he would live without electricity or running water from the age of 1 until he qualified for medical school nearly two decades later. He would walk 40 minutes to school and another 40 back home. Few could afford shoes to navigate the dirt path.

“It was a huge camp,” he said. “Maybe 30-40 thousand households were living there. It was on deserted land. The local people were not using it. There was no water or agriculture. It was a barren land.”

Over the years, news of Rahman’s homeland was rarely good, certainly never good enough to signal a return. The Soviet invaders gave way to a Soviet-backed regime that lasted until it was run off by the Taliban. Refugees had a long wait for any dream of seeing their homeland again. Few could afford to escape the refugee camps, most available work was day labor that paid next to nothing, and no land under Taliban rule was going to appeal to many people.

One escape available to youth before Taliban rule was joining the anti-Soviet freedom fighters. Another, ironically, was higher education. The process was stringently competitive, but well worth it to the few who were accepted. All 12-graders were required to take an entry exam for higher education. Rahman’s high score won him admission to the university and a scholarship to study medicine, something he had first dreamed about in high school.

With his family’s avid encouragement, he was off to the university for refugees in Pakistan. There would be no undergraduate degree first, he explained. Rather, it was the beginning of eight years of study and training that led directly to an MD. Later, finally able to return to his native land after the fall of the Taliban, he transferred to Kabul Medical University and finished his degree there.

Shams Rahman (27)

After getting his MD, Rahman worked in a clinic as a general practitioner, but the widespread poverty of his homeland and the stark reality that most of his people couldn’t afford basic medical treatment pushed Rahman toward a decision to enter the public health realm.

“I realized that sitting in a clinic and treating one patient is just a tip of the iceberg,” he said, “because this patient was different from those patients who couldn’t make it to the clinic. What about those people who are sitting in the village, who are suffering from the same conditions but can’t make it here? So then I realized that helping one person is not what I want in my life.”

The public health direction became clearer when he applied personal experience to his medical knowledge, an equation that spelled prevention.

“Living in the refugee camp – it’s a very harsh and tough environment,” he said. “You don’t have clean drinking water, you don’t have running water in your house, you don’t have proper latrine facilities. Most of the time, you live in a tent house. The luxury there would be a mud house. A whole family might live in one room.

“So, different diseases, particularly preventable infectious diseases – the prevalence is very high in those kinds of conditions. For 100 or 150 households, there was only one well. There was no hand pump on the well, so you would have to get a bucket, and with the help of a rope, to pull water from the well, and it was 40 to 50 feet deep.

“If that much intense labor is involved only to pull out drinking water, imagine how water would be scarce if you take a bath. That’s why it affects your whole hygiene and also your whole health. And not having proper latrine facilities for defecation, you create a cycle of open defecation and transfer of oro-fecal micro-organisms. That’s why a majority of the kids there were suffering from diarrhea, worms, dysentery or other diseases.

“I grew up in that environment. I would see all these kids. They would go outside near the trash and garbage and do open defecation. But at that time, I didn’t understand what was going on. Most of these things I realized when I started medical school: ‘Oh, that kid was suffering from dysentery; that kid was suffering from diarrhea. Oh, man – it is so easy to prevent these things!’

“Another thing is, in that kind of environment, even if you have the knowledge, you don’t have the resources. Even if soap is only one cent, but a family has to use that one cent to buy bread, they’re not going to buy soap. It’s not an environment where you think about luxury. You think about survival.”

Medical school quickly shed light on the mysteries of the refugee camp, where he had wondered as a teenager why he saw so many behaviors that made no sense to him, like pica – quite simply, eating dirt. Were they that hungry? What was going on?

“I would see all these kids eating the soil, and I couldn’t figure out why. But then, I studied blood diseases, and I realized, ‘Oh, they were suffering from anemia!’ That’s one of the signs of iron deficiency, anemia, and soil can be a source of iron. I started connecting the dots. As I progressed through my courses, I started connecting them and relating them to my personal experiences. I realized I was living in a live public health lab.”

Realizing the potential of public health was a natural next revelation.

“Instead of treating one person, I would be able to prevent a community from getting sick. How easily we could have prevented all those kids sitting in their refugee camps, young kids eating dirt, by giving them iron pills! For a dollar, you can get hundreds of them. How easily we could have prevented all those cases of diarrhea by giving soap to those households! That’s why I started working with the Johns Hopkins Bloomberg School of Public Health in Afghanistan.”

That project, a collaborative effort with World Bank, was aimed at assessing the country’s primary health care services.

Rahman remained in the nonprofit humanitarian sector for the next few years with the United Nations Food and Agricultural organization, for which he directed fundraising and grants, and the Swedish Committee for Afghanistan as senior manager of the monitoring and evaluation unit.

A Fulbright Scholarship awarded in 2010 signaled Rahman’s journey to USF’s College of Public Health. By now convinced that public health was his highway to fulfillment, it was time for more study.

Shams Rahman (35)

He earned a dual-concentration MPH in epidemiology and global health to complement an MBA in health management he had earned while working in the nonprofit sector in Afghanistan. Now a year into studies for a PhD in epidemiology, Rahman said he plans to return to his native land for a public health career dedicated to helping the people of Afghanistan.

Drawing loosely from the saying about teaching someone to fish rather than giving him a fish, Rahman said the greatest gift anyone can give to Afghanistan is self-reliance, and that has shaped his long-term career goal.

“I would like to establish a research collaboration between institutions here and back home,” he said. “If you want to see Afghanistan stand on its own feet and provide for its own community, peace and stability and a prosperous life, research and development should go hand-in-hand. The research cannot produce meaningful results if the local community and the local stakeholders are not engaged. So I believe that, if you work over there and build the capacity of local people, that would be long-term and sustainable.

“Because I am a health professional, I look at it from a health perspective, but it can be viewed from economics, from education. From any other lens, it can be viewed in a similar context. Empower those local people so they carry out their own research, and based on those findings, guide their own development processes.”

Rahman’s latest endeavor to that end is serving as editor-in-chief of the only peer-reviewed scientific journal in the country, the Afghanistan Journal of Public Health.

Story by David Brothers and photos by Natalie D. Preston, USF College of Public Health