The patient, a 25-year-old Afghan woman named Mariam, has a long list of complaints. She says her heart is pounding. She has trouble breathing. She's nauseated. Her limbs ache.
A nurse at a Kabul drug treatment center for women assures Mariam that her symptoms are normal. She tells Mariam that her body is waging a fierce war now that she has stopped smoking heroin.
It's a battle the five other women who have come to see the nurse this day are also fighting.
The nurse, Farida Ludeen, gives all of the women iron tablets for their anemia and ibuprofen for the pain. She says there is little else she can do, and she glumly predicts that all the women will relapse and soon begin using drugs again.
Heroin, Opium Plentiful And Cheap
"Our one-month program is too short. We don't get good results. We need more funding so we can treat them intensively for three months. That's the only way to make sure they give it up for good," Ludeen says.
Health care workers say they are waging a losing battle in the drug fight. Afghanistan is experiencing an alarming increase in drug abuse among men, women and children. Heroin and opium are affordable and plentiful.
Few Aid Dollars For Treatment
But relatively little Western aid is forthcoming for drug treatment centers across Afghanistan.
Officials say that is, in part, because of economic hardships plaguing donors at home. But the lack of money is just one problem. Experts say there are cultural obstacles, too.
Many Afghans take opiates as medicine. Sometimes, they are the only drugs available.
An Addict At Age 9
Nine-year-old Imamdad says his mother first started giving him heroin when he was 7.
"If I got sick, she'd say, 'Here, take this; it'll make your headache or sickness go away,' so I did. That's how I became an addict and started smoking it three times a day," he says.
Imamdad, his two younger sisters and their mother, Gol Jan, have spent the past two months getting over their heroin addiction at the Sanga Amaj center in Kabul — one of only two women's drug treatment hospitals in the country.
A robust coalition of international partners spends billions of dollars each year on strengthening Afghanistan's government, security forces and public works. Many Western officials feel that money designated for the drug fight is better spent on counternarcotics enforcement programs to reduce the supply of drugs.
U.S. Aid Helps
Only a single donor stepped forward this year with money earmarked for drug treatment — the United States. But what it spends averages less than $3 per addict per year.
Landry Carr, narcotics affairs officer at the U.S. Embassy in Kabul, says too little attention to prevention and treatment will undermine Western efforts in the long run.
The effort to build up Afghanistan's police force is a good example. Carr says that since officials began requiring drug tests of police officers and recruits in training, about 17 percent have tested positive for illegal drugs.
"That really puts a dent in what we can do and the amount and quality of training we can provide, especially since we have to segregate some of these people before we can start training with them so they can have a detox period so they'll be fit for training," Carr said.
Most female addicts in Afghanistan are not allowed by their husbands, fathers and brothers to leave the family home to seek hospital care. They must rely on weekly mobile clinics like the one that visits Mariam and her neighbors.
More Treatment For Men
Afghan men have more drug treatment options. Some three dozen clinics and hospitals across the country cater to them.
The largest is a rudimentary detoxification program started by U.N. agencies a few months ago at the former Russian Cultural Center in Kabul.
The program draws its patients from the 1,500 addicts who hang out in this bombed out complex. They spend most of their time shooting up or smoking heroin — or suffering the effects of withdrawal.
One patient named Taqih says he and other recovering addicts in the U.N. program rub each others' limbs to help ease the intense pain caused by withdrawal.
But at least the pain means they are still alive.
The U.N. decided to start the program after as many as three addicts per day died during the winter months owing to harsh conditions and malnutrition.